Researchers said the findings underscore the close link between poverty and tuberculosis, which sickens more than 10 million people per year.
A government programme to give cash to low-income people in Brazil significantly reduced their risk of tuberculosis (TB), the world’s deadliest infectious disease, a major new study has found.
Brazil launched the Bolsa Família Programme in 2004 to provide financial support to the country’s poorest families as long as they meet certain education and medical requirements.
Eligible families – those earning up to €34 per person per month – receive at least €93 in monthly cash benefits, with higher payments for families with young children, adolescents, and pregnant women.
The Bolsa Família Programme – which reached 21.1 million families in 2023 – is one of the world’s largest conditional cash transfer initiatives, and is credited with reducing child mortality, cardiovascular diseases, suicide, and other health conditions.
Now, a new study in the journal Nature Medicine tested the link between the programme and TB, an infectious disease that attacks the lungs and is closely linked to poverty and malnutrition.
The study found that between 2004 and 2015, the cash transfer programme curbed TB incidence and deaths for people living in extreme poverty – and that the effects were even stronger for Indigenous, Black, and Pardo Brazilians.
“In extremely poor, extremely marginalised [communities], the impact of an anti-poverty programme is not very different in magnitude from a drug or diagnostic or any biomedical approach,” Davide Rasella, the study’s senior author and head of the health impact assessment and evaluation group at the Barcelona Institute for Global Health, told Euronews Health.
Worldwide in 2023, about 10.8 million people got TB. The sometimes debilitating illness can take months to recover from, and roughly half of patients face a catastrophic financial burden as a result, according to the World Health Organization (WHO).
How did the study work?
The new analysis included 54.5 million low-income Brazilians who had similar demographic and socioeconomic features regardless of whether they got cash transfers or not.
During the 12-year study period, there were nearly 160,000 new TB diagnoses and about 8,000 deaths among the cohort.
Over that time, TB incidence and mortality were lower among people who received cash transfers. For example, incidence was 49.44 per 100,000 among beneficiaries, compared with 81.37 per 100,000 among those who didn't get the cash.
Meanwhile, TB mortality was more than twice as high among people who did not receive the money, at 4.68 per 100,000 compared with 2.08 per 100,000 among those who got the transfers.
These effects were even stronger in Brazil’s north and northeast regions, which are less developed than the rest of the country, as well as people in extreme poverty, Indigenous people, and Black and Pardo Brazilians.
Notably, the programme’s “protective effects” against TB were weaker in areas with local prisons, the study found, possibly because prisons can serve as “reservoirs” of TB, with higher rates in both the facilities and the neighbouring communities.
The role of extreme poverty in health outcomes
Experts have long warned that extreme poverty is a risk factor for TB as people may be less likely to seek healthcare due to medical expenses, transportation barriers, or the inability to miss work, which could delay TB diagnosis or treatment.
The researchers said the cash could help curb TB risks by ensuring people have more access to food, better housing conditions – such as less crowded living spaces and better ventilation – and the ability to cook with cleaner fuels that reduce indoor air pollution, another risk factor.
“When you have more economical margins, you can easily access health care [and] maybe be diagnosed on time,” Rasella said.
“And once you have the disease, the fact that you still have better food security and you're better nourished, your response to the treatment is better”.
Brazil’s cash transfer programme also comes with a few strings attached that could help ensure people are screened and treated for TB.
For example, pregnant women must seek prenatal care, while children must get the required vaccines, keep up with nutritional requirements, and attend school.
The researchers said the findings have implications for policymakers across the world, given the Brazilian cash transfer programme is now 20 years old. While the study period ended in 2015 – predating a period of economic and political turmoil as well as the COVID-19 pandemic – Rasella said its impacts have likely held up.
Similar projects have also been trialled on a smaller scale in India and Uganda, with promising results – though the Ugandan study indicates that cash transfers may need to be longer term to maximise their impact.
Ultimately, the findings show that “poverty reduction, and if possible, poverty eradication, will be able to massively reduce the burden of poverty-related diseases, especially among the most vulnerable, and especially in the Global South,” Rasella said.