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Social Programmes Save Millions of Lives, Especially in Times of Crisis

A study in Brazil shows that primary health care, social pensions and conditional cash transfers have prevented 1.4 million all-age deaths over the past two decades

Photo: Foto: Leonardo Lara Aldeia

Primary health care, conditional cash transfers and social pensions have prevented 1.4 million deaths of all ages in Brazil over the past two decades, according to a study coordinated by the Barcelona Institute for Global Health (ISGlobal), a centre supported by “la Caixa” Foundation. If expanded, these programmes could avert an additional 1.3 million deaths and 6.6 million hospitalisations by 2030.

The COVID-19 pandemic has exacerbated poverty and social inequalities worldwide, particularly in low- and middle-income countries (LMICs). In addition, the economic consequences of the ongoing war in Ukraine and soaring inflation are expected to push even more people into poverty in the coming years. This is what we call a polycrisis: multiple crises interacting in such a way that their combined impact is greater than the sum of the parts.

In terms of public health, worsening socioeconomic conditions mean higher rates of disease and death, especially among the most vulnerable people in LMICs. But social programmes can mitigate the health consequences of economic crises. Brazil has led one of the largest welfare state expansions over the past two decades, implementing a public universal healthcare system along with conditional cash transfer programmes (Programa Bolsa Familia) for the poorest families and social pensions (Beneficio de Prestacao Continuada) for the elderly and disabled.

Reductions in hospitalisations and deaths

In this study, ISGlobal researcher Davide Rasella and his team evaluated the combined effect of these three programmes (conditional cash transfers, social pensions and primary health care) on hospitalisations and deaths over almost two decades (from 2004 to 2019). “This is the first study to conduct a nationwide combined evaluation of cash transfers, social pensions, and primary health care for a such long period in a LMIC,” says Rasella, who coordinated the study. 

Using data from 2,548 Brazilian municipalities, they show that high coverage of the three programmes led to reductions in overall hospitalisation and mortality rates, particularly among children under five years of age and adults over 70. A total of 1.46 million deaths were averted between 2004 and 2019. The research team then used forecasting methods to show that extending the programmes to the newly poor and vulnerable could avert up to 1.3 million additional deaths by 2030.

“We clearly show that expanding these three programmes is a viable strategy to mitigate the health impact of the current global polycrisis,” says Daniella Cavalcanti, co-first author of the study. “On the contrary, fiscal austerity measures would only result in a large number of preventable deaths.”



Aransiola TJ, Ordoñez JA, Cavalcanti D et al. Current and Projected Mortality and Hospitalization Rates Associated with Conditional Cash Transfer, Social Pension, and Primary Health Care Programs in Brazil, 2000-2030. JAMA Network Open. 2024; 7(4):e247519. doi: 10.1001/jamanetworkopen.2024.7519