The comprehensive health impact of cash transfer, social pensions and primary health care in brazil: An integrated evaluation and forecasting analysis to mitigate the effects of the global economic crisis
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Federal University of Bahia Federal University of Bahia Brazil
Federal University of Bahia, Brazil
Institute of Collective Health (ISC), Federal University of Bahia (UFBA), Brazil
Federal University of Bahia
Swiss Tropical and Public Health Institute, Department of Public Health and Epidemiology Switzerland
Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador Ecuador
Center for Health Economics, University of York, UK
School of Business Administration at the Getulio Vargas Foundation (EAESP/FGV) Brazil
Center for Epidemiological Research in Nutrition and Health. (NUPENS), at the University of São Paulo (USP) Brazil
Fiocruz Brazil
Universidade Estadual de Rio de Janeiro Brazil
Institute of Collective Health, at the Federal University of Bahia (ISC-UFBA) Brazil
University of California, Los Angeles (UCLA) United States
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1803
In the past few years, Brazil has implemented some of the world`s largest Conditional Cash Transfers (Bolsa Familia Program -BFP), Social Pensions (Benefício de Prestação Continuada -BPC), and Primary Health Care (Family Health Strategy –FHS). We evaluated their impact on morbidity and mortality indicators over the last two decades. We then forecasted their mitigation effects on the adverse health impact of the economic crisis due to the COVID-19 pandemic.

In the retrospective impact evaluation, we used fixed-effects negative binomial models with a cohort of Brazilian municipalities from 2004-19 to estimate the impact of BFP, BPC, and FHS coverage on hospitalizations and mortality, adjusted for all relevant demographic, social, and economic factors. Subsequently, we integrated the longitudinal dataset and parameters with validated dynamic microsimulation models, projecting hospitalization and mortality trends up to 2030 according to different intensities and durations of the economic crisis, and alternative policy responses.

Consolidated coverages of BFP, FHS, and BPC were associated with a statistically significant reduction of overall age-standardized mortality rates. Stronger effects were found for under-five mortality, with RR of 0.87 (95%CI:0.85-0.90), 0.90(95%CI:0.88-0.93), and 0.84(95%CI:0.82-0.86), respectively. A significant impact was also found on over-70 mortality and hospitalizations. Considering a scenario of moderate economic crisis, a mitigation strategy that will increase the coverage of BFP, FHS, and BPC proportionally to the increase of poverty will avert 778,845 (95%CI: 665,074-893,674) deaths and 10,780,108 (95%CI: 8,003,123-13,523,359) hospitalizations by 2030, if compared with the current coverage trends, and 1,424,624 (95%CI: 1,264,552–1,587,859) deaths and 15,656,283 (95%CI: 11,963,641-19,358,468) hospitalizations, if compared with scenarios of fiscal austerity.

Cash transfers, social pensions, and primary health care could strongly reduce morbidity and mortality in low and medium income countries, and their expansion should be considered as an effective mitigation strategy for the adverse health impact of the current economic crisis.

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