Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study

Detalhes bibliográficos
Autor(a) principal: Rasella, Davide
Data de Publicação: 2018
Outros Autores: Basu, Sanjay, Hone, Thomas, Sousa, Romulo Paes, Reis, Carlos Octávio Ocké, Millett, Christopher
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/28495
Resumo: Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brazil / Public Health Policy Evaluation Unit. Department of Primary Care and Public Health. School of Public Health. Imperial College London. London, United Kingdom.
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spelling Rasella, DavideBasu, SanjayHone, ThomasSousa, Romulo PaesReis, Carlos Octávio OckéMillett, Christopher2018-08-31T13:56:01Z2018-08-31T13:56:01Z2018RASELLA, Davide et al. Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study. Plos Medicine, v. 15, n. 5, p. 1-20, 2018.1549-1277https://www.arca.fiocruz.br/handle/icict/2849510.1371/journal.pmed.1002570engPublic Library of Sciencecrise economicaaspectos socioeconomicos na saudesauda da criançadados de mortalidadeEconomic crisesSocioeconomic aspects of healthChild healthDeath ratesChild morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation studyinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, 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, CA, United States of America / Center for Primary Care and Outcomes Research. School of Medicine. Stanford University. Stanford, CA, United States of America / Department of Health Research and Policy. School of Medicine. Stanford University. Stanford, CA, United States of America/ Center for Primary Care. Harvard Medical School. Boston, MA, USA.Department of Primary Care and Public Health. School of Public Health. Imperial College London. London, United Kingdom.Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brasil.Instituto Econômico de Pesquisa Aplicada. Rio de Janeiro, RJ, Brazil.Department of Primary Care and Public Health. School of Public Health. Imperial College London. London, United Kingdom / Universidade de São Paulo. Centro Epidemiológico de Estudos da Saúde e Nutrição. São Paulo, SP, Brazil.Background: Since 2015, a major economic crisis in Brazil has led to increasing poverty and the implementation of long-term fiscal austerity measures that will substantially reduce expenditure on social welfare programmes as a percentage of the country’s GDP over the next 20 years. The Bolsa Famı´lia Programme (BFP)—one of the largest conditional cash transfer programmes in the world—and the nationwide primary healthcare strategy (Estrate´gia Sau´de da Famı´lia [ESF]) are affected by fiscal austerity, despite being among the policy interventions with the strongest estimated impact on child mortality in the country. We investigated how reduced coverage of the BFP and ESF—compared to an alternative scenario where the level of social protection under these programmes is maintained—may affect the underfive mortality rate (U5MR) and socioeconomic inequalities in child health in the country until 2030, the end date of the Sustainable Development Goals. Methods: and findings We developed and validated a microsimulation model, creating a synthetic cohort of all 5,507 Brazilian municipalities for the period 2017–2030. This model was based on the longitudinal dataset and effect estimates from a previously published study that evaluated the effects of poverty, the BFP, and the ESF on child health. We forecast the economic crisis and the effect of reductions in BFP and ESF coverage due to current fiscal austerity on the U5MR, and compared this scenario with a scenario where these programmes maintain the levels of social protection by increasing or decreasing with the size of Brazil’s vulnerable populations (policy response scenarios). We used fixed effects multivariate regression models including BFP and ESF coverage and accounting for secular trends, demographic and socioeconomic changes, and programme duration effects. With the maintenance of the levels of social protection provided by the BFP and ESF, in the most likely economic crisis scenario the U5MR is expected to be 8.57% (95% CI: 6.88%–10.24%) lower in 2030 than under fiscal austerity—a cumulative 19,732 (95% CI: 10,207–29,285) averted under-five deaths between 2017 and 2030. U5MRs from diarrhoea, malnutrition, and lower respiratory tract infections are projected to be 39.3% (95% CI: 36.9%–41.8%), 35.8% (95% CI: 31.5%– 39.9%), and 8.5% (95% CI: 4.1%–12.0%) lower, respectively, in 2030 under the maintenance of BFP and ESF coverage, with 123,549 fewer under-five hospitalisations from all causes over the study period. Reduced coverage of the BFP and ESF will also disproportionately affect U5MR in the most vulnerable areas, with the U5MR in the poorest quintile of municipalities expected to be 11.0% (95% CI: 8.0%–13.8%) lower in 2030 under the maintenance of BFP and ESF levels of social protection than under fiscal austerity, compared to no difference in the richest quintile. Declines in health inequalities over the last decade will also stop under a fiscal austerity scenario: the U5MR concentration index is expected to remain stable over the period 2017–2030, compared to a 13.3% (95% CI: 5.6%–21.8%) reduction under the maintenance of BFP and ESF levels of protection. Limitations of our analysis are the ecological nature of the study, uncertainty around future macroeconomic scenarios, and potential changes in other factors affecting child health. A wide range of sensitivity analyses were conducted to minimise these limitations. Conclusions: The implementation of fiscal austerity measures in Brazil can be responsible for substantively higher childhood morbidity and mortality than expected under maintenance of social protection—threatening attainment of Sustainable Development Goals for child health and reducing inequality.info:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-83082https://www.arca.fiocruz.br/bitstream/icict/28495/1/license.txt9193a7c197bc67acd023525e72a03240MD51ORIGINALChild morbidity and mortality associated.pdfChild morbidity and mortality associated.pdfapplication/pdf1983632https://www.arca.fiocruz.br/bitstream/icict/28495/2/Child%20morbidity%20and%20mortality%20associated.pdfe3157544da7b70fc799baa48bb918c8fMD52TEXTChild morbidity and mortality associated.pdf.txtChild morbidity and mortality associated.pdf.txtExtracted 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dc.title.pt_BR.fl_str_mv Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study
title Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study
spellingShingle Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study
Rasella, Davide
crise economica
aspectos socioeconomicos na saude
sauda da criança
dados de mortalidade
Economic crises
Socioeconomic aspects of health
Child health
Death rates
title_short Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study
title_full Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study
title_fullStr Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study
title_full_unstemmed Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study
title_sort Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study
author Rasella, Davide
author_facet Rasella, Davide
Basu, Sanjay
Hone, Thomas
Sousa, Romulo Paes
Reis, Carlos Octávio Ocké
Millett, Christopher
author_role author
author2 Basu, Sanjay
Hone, Thomas
Sousa, Romulo Paes
Reis, Carlos Octávio Ocké
Millett, Christopher
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Rasella, Davide
Basu, Sanjay
Hone, Thomas
Sousa, Romulo Paes
Reis, Carlos Octávio Ocké
Millett, Christopher
dc.subject.other.pt_BR.fl_str_mv crise economica
aspectos socioeconomicos na saude
sauda da criança
dados de mortalidade
topic crise economica
aspectos socioeconomicos na saude
sauda da criança
dados de mortalidade
Economic crises
Socioeconomic aspects of health
Child health
Death rates
dc.subject.en.pt_BR.fl_str_mv Economic crises
Socioeconomic aspects of health
Child health
Death rates
description Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brazil / Public Health Policy Evaluation Unit. Department of Primary Care and Public Health. School of Public Health. Imperial College London. London, United Kingdom.
publishDate 2018
dc.date.accessioned.fl_str_mv 2018-08-31T13:56:01Z
dc.date.available.fl_str_mv 2018-08-31T13:56:01Z
dc.date.issued.fl_str_mv 2018
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.citation.fl_str_mv RASELLA, Davide et al. Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study. Plos Medicine, v. 15, n. 5, p. 1-20, 2018.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/28495
dc.identifier.issn.pt_BR.fl_str_mv 1549-1277
dc.identifier.doi.none.fl_str_mv 10.1371/journal.pmed.1002570
identifier_str_mv RASELLA, Davide et al. Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study. Plos Medicine, v. 15, n. 5, p. 1-20, 2018.
1549-1277
10.1371/journal.pmed.1002570
url https://www.arca.fiocruz.br/handle/icict/28495
dc.language.iso.fl_str_mv eng
language eng
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Public Library of Science
publisher.none.fl_str_mv Public Library of Science
dc.source.none.fl_str_mv reponame:Repositório Institucional da FIOCRUZ (ARCA)
instname:Fundação Oswaldo Cruz (FIOCRUZ)
instacron:FIOCRUZ
instname_str Fundação Oswaldo Cruz (FIOCRUZ)
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