Studies conducted over the past decade by researchers at the Center for Data and Knowledge Integration for Health (CIDACS) of the Oswaldo Cruz Foundation (Fiocruz) in Bahia state have linked participation in the Bolsa Família - a family allowance social welfare program - to reductions in maternal and infant mortality.

Bolsa Família is the Brazilian government’s main direct cash transfer program for low-income families. It provides monthly financial assistance to combat hunger, promote food security, and support the integration of health, education, and social assistance policies.

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A decline in the incidence of infectious diseases and in hospitalizations related to mental health disorders was also observed among program beneficiaries.

One of the pieces of evidence considered most robust by the researchers relates to maternal and child health. Among women who received the benefit, the risk of death from causes related to pregnancy and childbirth was up to 31 percent lower than among those who did not receive the benefit.

According to the researchers, this outcome is linked, among other factors, to greater access to prenatal care and health services promoted by the program’s conditionalities.

The effects are also evident early in life. In a study analyzing more than 4 million births, women who received the benefit during pregnancy were less likely to give birth to low-birth-weight infants. The impact was even more pronounced among black and indigenous mothers.

Other studies found a reduction in the incidence of preterm births and a 16 percent decline in mortality among children under five in families benefiting from the program.

Diseases

The body of studies also revealed significant impacts on diseases associated with poverty. In the case of tuberculosis, for example, Bolsa Família beneficiaries had a 41 percent lower incidence of the disease and a 31 percent lower risk of death after diagnosis. Among indigenous people, the reduction in mortality was even more pronounced.

Similar results were observed for HIV/AIDS. A study tracking more than 22 million Brazilians found lower disease incidence, lower mortality, and better health indicators among Bolsa Família beneficiaries in the poorest segments of the population.

The researchers also identified a reduction in the incidence of leprosy in municipalities with high transmission rates, as well as higher treatment adherence and cure rates among beneficiaries.

Mental health

One of the studies found that the suicide rate was 56 percent lower among Bolsa Família beneficiaries. Other analyses showed reductions in hospitalizations for psychiatric disorders and for problems related to alcohol and other drug use, especially in municipalities with higher poverty rates.

For epidemiologist Mauricio Barreto of Fiocruz Bahia, the findings help explain how economic and social factors directly influence health outcomes.

“Countless health problems are shaped by social and economic factors, especially poverty and inequality. Reducing poverty and encouraging the use of health, education, and social assistance services must be part of efforts to improve the health of the Brazilian population,” said Barreto.

Research

The results were presented this week during a webinar that brought together Brazilian and international scientists. The event focused on the main findings of the so-called Platform for Continuous Studies and Evaluations of the Social Determinants and Health Effects of the Bolsa Família Program and Other Social Protection Programs - Cohort of 100 Million Brazilians.

The studies used data from the Brazilian government’s Single Registry for Social Programs (CadÚnico), cross-referenced with information on births, hospitalizations, disease notifications, and deaths. Using this dataset, the researchers sought to measure the effects of cash transfers on the health of the country’s most vulnerable populations.

According to Mauricio Barreto, the findings reinforce the view that combating poverty is also a strategy for promoting health.

“The existence of Brazil’s public healthcare system, the SUS, is fundamental to protecting and meeting the needs of the population. But when it operates in conjunction with a robust social protection program such as Bolsa Família, it becomes possible to reduce the effects of the main social determinants that negatively affect health,” Barreto stated during the meeting.

The researchers highlight that the studies were conducted using evaluation methodologies considered innovative for public policy, allowing comparisons between population groups with similar characteristics and estimates of the program’s effects over time.

The evidence produced by CIDACS over the past decade reinforces, according to the authors, the importance of integrating social protection policies with the health system.

Pregnant women in the Munduruku indigenous territory, in Pará state, North Brazil, have mercury levels in their bodies 4.5 times higher than the safe limit established by the World Health Organization (WHO). The maximum safe level is two micrograms of the metal per gram of hair (µg/g), but the levels found in these women average 9.1 µg/g.

The data are part of preliminary findings in a study conducted by the Oswaldo Cruz Foundation and were presented Wednesday (Jun. 3) by the research coordinator, Paulo Basta, during Rio Nature & Climate Week, the climate week in Rio de Janeiro.

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Of the 195 women surveyed, 97 percent have mercury levels in their bodies above the safe threshold. In the most extreme case, one woman had 39.9 µg/g of the metal – 20 times the tolerable limit.

Of this total, 134 women have given birth, and their babies are also being monitored. About 90 percent of them are already born with mercury contamination, as the metal passes from mother to child through the placenta. The babies have average concentrations of 5.8 µg/g, three times the limit. In one extreme case, one of them had 30.8 µg/g, 15 times the safe level.

“This baby is monitored at various intervals throughout the first two years of life. We track growth curves, weight-for-age ratios, height, and other metrics. Our hypothesis is that prenatal exposure to mercury causes delays in these neurodevelopmental milestones,” Paulo Basta said.

“Mercury converts into a neurotoxin that primarily affects the tissue of the central nervous system. Damage to the central nervous system is irreversible. People will have to deal with this problem for the rest of their lives,” he added.

The researcher cites an increase in the number of children born with rare neurological disorders, syndromes, congenital anomalies, and conditions for which a definitive diagnosis has not yet been established. All of these are suspected of being linked to mercury contamination. He also noted that the district where the Munduruku indigenous territory is located was the one that requested the most wheelchairs from the Ministry of Health.

“These data must be turned into official statistics, which did not exist in Brazil until very recently. Our system does not yet have a reporting form for specific cases of mercury contamination,” he stated.

“Despite these limitations, we have 751 identified cases of indigenous people contaminated by mercury with laboratory confirmation. Of this total, 318 are from Pará and 378 are from Roraima, home to the Yanomami people,” he added.

Illegal mining

The region where the Munduruku people live has been affected by illegal gold mining for decades, and mercury is used to separate the gold from the soil. This contaminates the rivers and the life forms in them, and the metal enters the human body primarily through the consumption of contaminated fish.

“Our main source of food is fish, and there’s no escaping that. For those who live in the city, it’s easy. They go to the grocery store, buy chicken and meat – they have other options. It breaks my heart to see the plight of these people, because they have no way to leave their territory and go somewhere else,” indigenous leader Alessandra Korap Munduruku said.

“This is our land. Why do we have to give up our land to companies, gold mining, mining, hydroelectric dams, and railroads? Why is indigenous people’s meat cheaper? It’s as if we didn’t exist. What kind of progress is this that kills rivers, forests, and drives people out?” she asked.