Austerity measures in Brazil could contribute to an increase in the avoidable infant mortality rate (2018)

Two years ago, the journal of Imperial College of London published an article that warned the Brazilian state of the risks incurred by the decline in funding for medical programmes for monitoring and preventing the risks of children from disadvantaged backgrounds. The economic crisis of 2015 has had a strong impact on Brazilian growth and has wiped out the social achievements of the Lula and Rousseff governments, particularly those of the « bolsa familia ». The fragility of Brazilian society has once again become a reality, reminding us that an emerging country is not yet a « developed » country and that the economic miracle is not always a social miracle. The (illegitimate?) Temer government had made austerity and the contraction of social spending its hobbyhorse. The disengagement of the state from public health sectors and social programmes to help disadvantaged families would, as in other developing countries like Morocco, create a two-tier health (and education) system. Two years later, these choices would weaken the Brazilian State’s capacity to take care of Covid19 pathologies but more generally the most fragile categories of the Brazilian population. The announced disaster would indeed be the result of the imperialism of governments that have favoured the economy over health.

The following text is a translation of the Imperial college article.

Cuts to social programs in Brazil could lead to more preventable hospitalizations and child deaths compared to maintaining current funding.

The findings of the new study, published this week in the journal PLOS Medicine, are the result of research by researchers at Imperial College London and the Universidade Federal da Bahia in Brazil.

Using statistical models to simulate future outcomes, the researchers found that infant mortality rates could be 8.6% lower by 2030 if investments in two major social programmes were protected from the austerity measures currently proposed.

The team also found that these austerity policies disproportionately affect the poorest regions of the country.
Brazil is the eighth largest economy in the world, but since 2015 a deep economic crisis has increased poverty and the government has introduced austerity measures that significantly reduce funding for social programmes .

Among these measures are proposed cuts to two major programmes known to reduce child mortality: the Bolsa Familia Programme (BFP) and the Estrategia Saude da Familia (FSE) – Brazil’s main social assistance programme and primary health care service aimed at reducing poverty.

The BFP was launched in 2003 and, by 2016, is expected to cover 25 percent of Brazilian families, providing funds to poor families, vulnerable people, and pregnant women. The ESF provides families with community-based health care services, including immunization, child health services, treatment of simple ailments, and management of chronic diseases. Existing evidence shows that these programmes have led to significant improvements in health, especially for children.

To date, however, little data have been collected on how the economic crisis, austerity measures and reduced coverage of these social programmes could affect the health of children in middle-income countries such as Brazil.

The cost of reductions
In the last paper, the researchers developed a statistical model to measure the expected effects of the economic crisis, poverty, and the impact of reductions in these two programs on child health in all 5,507 Brazilian municipalities for the period 2017-2030.

Their simulations revealed that maintaining the coverage of social protection programmes led to a decrease in the infant mortality rate to 8.6 per cent in 2030, compared to lower coverage under austerity measures.

In addition, their simulations revealed that maintaining FPB and ESF coverage reduced the number of preventable child deaths by almost 20,000 and that preventable child hospitalizations were up to 124,000 lower between 2017 and 2030, compared to austerity. They also found that the country’s poorest municipalities would be the most affected.

Professor Christopher Millett, from the Imperial School of Public Health and author of the study, said, « It is clear that these programmes are having an extremely beneficial impact on the health of Brazilian children.

« We urge Brazilian policy-makers to protect the health and well-being of children by reversing the proposed austerity measures affecting these important social programmes ».

Davide Rasella of the Universidade Federal da Bahia added: « Our study suggests that reducing the coverage of anti-poverty and primary care programmes could lead to a significant number of preventable child deaths and hospitalizations in Brazil.

« These austerity measures will have a disproportionate impact on child mortality in the poorest municipalities, halting the significant progress made in Brazil in reducing inequalities in child health ».

Unfortunately, Brazilian councillors have not been able to free themselves from the neo-liberal considerations of international donors. The bill is now being paid in tens of thousands of lives…

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