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Projected impact on childhood mortality of austerity versus social protections in Brazil


Compared with fiscal austerity measures currently being implemented in Brazil, the maintenance of social protection could result in a reduction in childhood mortality by 8.6% in 2030, according to simulations published this week in PLOS Medicine by Davide Rasella of the Universidade Federal da Bahia, Brazil, and colleagues.

Since 2015, a major economic crisis in Brazil has led to increasing poverty and the implementation of austerity measures, including proposed cuts to the Bolsa Familia Programme (BFP) and the Estrategia Saude da Familia (ESF), two major programs with an impact on childhood mortality. Rasella and colleagues developed a microsimulation model, projecting the effects of poverty, BFP, and ESF on child health in all 5,507 Brazilian municipalities for the period 2017-2030.

Compared with reducing the coverage provided by BFP and ESF due to fiscal austerity, the maintenance of their levels of social protection would lead to a child mortality rate 8.6% lower [95% confidence interval: 6.9%-10.2%] in 2030, the study estimated. Avoidable childhood deaths would be approximately 20,000 lower and avoidable childhood hospitalisations up to 124,000 lower between 2017 and 2030 under maintenance of social protection. Under various simulations, which varied the length of the economic crisis and the amount of cuts, childhood mortality was still affected. The research also showed that poorer municipalities would be disproportionately impacted.

"Our study suggests that reduced coverage of poverty-alleviation and primary care programmes may result in a substantial number of preventable child deaths and hospitalizations in Brazil," the authors say. "These austerity measures will disproportionately impact child mortality in the poorest municipalities, disrupting previous trends of reducing inequality in child health outcomes."


Research Article


This study received funding from the Wellcome Trust Training Fellowships in Public Health and Tropical Medicine scheme, being DR the recipient Fellow (Grant reference number: 109949/Z/15/Z; CM is funded by a Research Professorship award from the National Institute for Health Research, (Grant reference number: RP_2014-04-03; The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

I have read the journal's policy and the authors of this manuscript have the following competing interests: SB receives a stipend as a specialty consulting editor for PLOS Medicine and serves on the journal's editorial board. The authors have declared that no other competing interests exist.


Rasella D, Basu S, Hone T, Paes-Sousa R, Ocké-Reis CO, Millett C (2018) Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study. PLoS Med 15(5): e1002570.

Author Affiliations:

Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
Center for Population Health Sciences, School of Medicine, Stanford University, Stanford, California, United States of America
Center for Primary Care and Outcomes Research, School of Medicine, Stanford University, Stanford, California, United States of America
Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California, United States of America
Center for Primary Care, Harvard Medical School, Boston, Massachusetts, United States of America
René Rachou Institute, Fiocruz Minas, Belo Horizonte, Minas Gerais, Brasil
Institute for Applied Economic Research, Rio de Janeiro, Brazil
Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil

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