Brazilian social program prevents over 8 million hospitalizations and 713,000 deaths in 20 years

An additional 684,000 deaths could be prevented if the Bolsa Família Programme were to extend its coverage to 2030, the target year for the Sustainable Development Goals (SDGs)

Barcelona Institute for Global Health (ISGlobal)

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In 2024, Brazil celebrated the 20th anniversary of the Bolsa Família Programme (BFP), one of the world’s largest conditional cash transfer initiatives. A new study published in The Lancet Public Health shows that the BFP has prevented more than 8.2 million hospitalisations and 713,083 deaths in Brazil between 2004 and 2019. In addition, it is estimated that an additional 683,721 deaths could be prevented if the programme's coverage is expanded by 2030.

These programmes provide cash transfers to low-income families, often with school-age children, provided they meet certain conditions, such as ensuring school attendance and up-to-date vaccinations. The aim is to reduce short-term poverty while breaking the intergenerational cycle of poverty. This is crucial in the current context of polycrisis—multiple crises (armed conflict, rising inflation, climate crisis…) interacting in such a way that their combined impact is greater than the sum of their parts.

The study, coordinated by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the ”la Caixa” Foundation, and in collaboration with the Institute for Collective Health of the Federal University of Bahia (Brazil), combines real-world data with predictive microsimulation models to evaluate the impact of the programme over the last two decades and estimate the potential impact of its expansion until 2030.

A lasting impact on public health

High programme coverage was associated with significant reductions in both mortality and hospitalisation rates across the population. The greatest benefits were seen in child mortality—especially among children under five, with a 33% reduction—and in hospitalisation among people over 70, with a 48% reduction.

The analysis also shows that the benefits of the programme were greatest in communities with a higher burden of disease. “The Bolsa Família Programme has contributed not only to reducing poverty, but also to lowering territorial health inequalities,” explains Davide Rasella, ISGlobal researcher and coordinator of the study. “By highlighting this impact, we underline the importance of integrated public policies that combine social protection with access to essential services,” he adds.

A tool for achieving the Sustainable Development Goals

The study highlights the crucial role that conditional cash transfer programmes can play in advancing the Sustainable Development Goals (SDGs), in particular SDG 3 (good health and well-being), SDG 1 (no poverty), and SDG 10 (reduced inequalities).

Using simulation models, the research team projected three possible scenarios for the BFP to 2030: an expansion scenario, a maintenance scenario, and a third scenario with reductions due to fiscal austerity. In the expansion scenario, more than 8 million additional hospital admissions and 683,000 additional deaths could be avoided compared to the baseline. In contrast, a reduction in coverage would lead to a significant increase in mortality and put greater pressure on the health system.

“In the current context of declining global humanitarian aid and fiscal pressures, it is particularly timely to highlight the positive impact of one of the world’s largest conditional cash transfer programmes,” says Daniella Cavalcanti, first author of the study.

The impact of the Bolsa Família Programme is also in line with the principles of the Global Alliance Against Hunger and Poverty, an initiative endorsed by world leaders at the latest G20 summit in Brazil in 2024. “Brazil’s experience adds value to this global discussion and positions the BFP as a source of inspiration for other countries,” concludes Rasella.

 

Reference

Medeiros Cavalcanti, D., Ordoñez, J. A., Ferreira da Silva, A., Landin Basterra, E., L Moncayo, A., Chivardi, C., Hessel, P., Pietro Sironi, A., Paes de Sousa, R., Campello, T., Eugênio Souza, L., & Rasella, D. (2025). Health effects of the Brazilian Conditional Cash Transfer programme on mortality and hospitalisation rates: a retrospective analysis and modelling study. Lancet Public Health. https://doi.org/10.1016/S2468-2667(25)00091-X

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Journal

The Lancet Public Health

DOI

10.1016/S2468-2667(25)00091-X 

Method of Research

Computational simulation/modeling

Subject of Research

People

COI Statement

DR and AFS declare funding from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (1R01AI152938). All other authors declare no competing interests.

 

Self-employed women may be at significantly lower heart attack risk compared with women employed for salary or wages

University of California - Los Angeles Health Sciences

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New research finds that self-employed women have fewer risk factors for cardiovascular disease (CVD) compared to non-self-employed women, suggesting that the work environment may play a role in the development of risk factors that can lead to heart attacks.

While the findings also showed some positive associations between health outcomes and self-employment among white men, the researchers found women had the most favorable CVD risk profile associated with being self-employed, possibly because they are more likely than men to experience stress and time demands related to balancing responsibilities across work and home.  

Self-employed men of color, by contrast, did not experience the same health benefits.

The study is one of the few to use measures obtained from lab tests and body measures, rather than relying on self-reported measures, to explore the relationship between self-employment and heart disease risk factors, said lead author Dr. Kimberly Narain, assistant professor-in-residence of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. It is also the only study to consider differences across sex and racial/ethnic minority status.

“There is a relationship between self-employment and heart disease risk factors and this relationship seems to be stronger in women relative to men,” said Narain, who is also director of health services and health optimization research at the Iris-Cantor-UCLA Women's Health Center. “It is imperative to increase our understanding of how the work environment gets under our skin so we can come up with ways to ensure that everyone has access to a healthy work environment.”

The study will be published in the peer-reviewed journal BMC Public Health.

Prior studies have shown links between the structure of employment and cardiovascular disease risk. Some have found better health outcomes among people in executive positions compared with those in clerical or administrative positions, which are frequently held by women and people of color. Others have found ties between job control and health benefits. For instance, high strain jobs with higher psychological demands and less autonomy have been linked with hypertension and CVD.

But many of those studies were largely dependent on self-reported measures that are not entirely reliable due to factors such as recall bias.

For this study the researchers used data from 19,400 working adults in the National Health and Nutrition Examination Survey (NHANES). They analyzed the association between self-employment and CVD risk factors that included elevated cholesterol, hypertension, glucose intolerance, obesity, poor diet, physical inactivity, smoking, binge drinking, sub-optimal sleep duration and poor mental health. They explored these questions across sex, race and ethnicity, using biologic and physical measures that are more reliable than self-reported measures, in some contexts.

They found a number of negative associations—that is, lower rates of specific CVD risk factors-- between self-employment and health outcomes. These are among the key findings.

Among white women self-employment was linked to:

•           7.4 percentage point decline in obesity

•           7.0 percentage point decline in physical inactivity

•           9.4 percentage point decline in poor sleep duration

 

Among women of color it was linked to:

•           6.7 percentage point decline in poor diet

•           7.3 percentage point decline in physical inactivity

•           8.1 percentage point decline in poor sleep duration

 

And among white men, self-employment was associated with:

•           6.5 percentage point decline in poor diet

•           5.7 percentage point decline in hypertension

 

The researchers did not find the same benefits among self-employed minority men, possibly because they are generally in businesses with high entry barriers and failure rates, and they may also struggle with lower financial capital and less access to mentorship that could better prepare them to maintain a successful business, the researchers write.

Due to the study’s cross-sectional nature, the researchers can’t make causal claims from their findings. Other study limitations include the possibility that unmeasured characteristics, such as personality traits and coping mechanisms, may affect individuals’ choice to be self-employed and their development of CVD risk factors. The researchers also could not distinguish between individuals who chose self-employment and those who were forced into it due to job loss or other circumstances.

Study co-authors are Daniela Markovic and Dr. Jose Escarce of UCLA.

The research was funded by the Leichtman-Levine-TEM Mentorship in Women’s Health Research at the Iris-Cantor-UCLA Women’s Health Center, and the Tides Foundation (TFR15-00194).

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Journal

BMC Public Health

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

A Cross-sectional Analysis of the Association Between Self-Employment, Racial and Ethnic Minority Status, Sex and Cardiovascular Disease Risk Factors among a Nationally Representative Sample

Article Publication Date

29-May-2025

 

How the International Monetary Fund Underdevelops Africa

Once plundered of both its wealth and people by colonial powers, Africa now faces IMF-imposed austerity, obscene debt, and forced underdevelopment.

By Vijay Prashad

May 28, 2025

Source: Tricontinental: Institute for Social Research

The art in this newsletter was produced by Tricontinental’s art department for its May dossier, Africa’s Faustian Bargain with the International Monetary Fund.

At the start of 2025, Sudan registered an alarming debt-to-GDP (Gross Domestic Product) ratio of 252%. This means that the country’s total public debt is 2.5 times the size of its entire annual economic output. It is not hard to understand why Sudan is in such dire straits: as we outlined in last week’s newsletter, the country has been engulfed in a conflict for decades, which has severely disrupted any possibility of economic growth and financial stability. Yet, in a way, Sudan – one of the richest countries in terms of resources but poorest in terms of household income and wealth – is also representative of what has been happening on the African continent. As of 2022, the average debt-to-GDP ratio in Sub-Saharan countries was 60%, having doubled from 30% in 2013. This rise in indebtedness is shocking.

Africa’s total debt is over $1 trillion, with debt servicing costs of $163 billion per year. Developing countries’ total debt reached $11.4 trillion in 2023, four times the 2004 total of $2.6 trillion. This extraordinary increase has induced a debt crisis in over thirty out of sixty-eight low-income countries. This ballooning debt impacts development in two primary ways:

1. Due to an increased risk of default, further credit becomes very expensive and is often only available through commercial lenders. Africa’s total commercial debt is now 43% of its total external debt – more than twice what it was in 2000.
2. High debt servicing limits fiscal flexibility, forcing many governments to cut spending on education, healthcare, industrial development, and infrastructure. In many African countries, this has led to austerity measures across the board: in 2022, twenty-two countries spent more paying interest on their debt than on healthcare and six of them spent more on debt service than on education. A high debt burden ultimately leads to austerity measures, and therefore to economic contraction.

Only a handful of African countries have been able to immunise themselves from the crisis, largely because they have smaller populations and export high-value goods. One of these countries is Equatorial Guinea, which has a population of 1.8 million, earns $5.13 billion per year (largely from crude oil and natural gas exports), and has a debt-to-GDP ratio of 31.3%. Another is Botswana, which has a population of 2.5 million, earns $5.33 billion per year from diamond exports, and has a debt-to-GDP ratio of 27.4%.

Africa’s Faustian Bargain with the International Monetary Fund (May 2025) is the third in a series dossiers that examines the impact of Africa’s economic crisis (the first was Life or Debt: The Stranglehold of Neocolonialism and Africa’s Search for Alternatives in April 2023, followed by How Neoliberalism Has Wielded ‘Corruption’ to Privatise Life in Africa in November 2024). This three-part series, written by Senior Fellow Grieve Chelwa and me, will be published by Inkani Books later this year in an expanded form and with a substantial introduction.

The series argues that:

1. The colonial era impoverished the African continent of both its wealth and its people, millions of whom were captured, taken to the Americas, and brutally enslaved. By the time African countries won their independence in the 1960s and 1970s, they simply did not have the state resources or accumulated capital in the hands of the private sector necessary for major infrastructure construction and industrialisation.
2. African countries that attempted to amass domestic savings and borrow from the socialist bloc for major infrastructure projects – such as dams and electricity systems that had been neglected wilfully by the colonial rulers – faced assassinations (the Congo’s Patrice Lumumba in January 1961 and Burundi’s Louis Rwagasore in October 1961) and coups (Ghana’s Kwame Nkrumah in February 1966).
3. The neocolonial system structured the world economy in such a way that African countries have been compelled to sell their raw materials for low prices; earn minimal royalties from Western multinational corporations; pay high prices for imported finished products (in many cases for energy sources); borrow money through the International Monetary Fund (IMF) and Western commercial creditors to cover their budgetary shortfall; pay high debt service fees; implement austerity programmes at the behest of the IMF; and then enter into a debt spiral seemingly for eternity.
4. The IMF and its various associated agencies (such as Transparency International) pressure governments in vulnerable African countries to further erode their state capacity by shutting down regulatory departments and reducing their own competence to negotiate agreements with Western creditors and multinational mining companies. A shrunken state means that the people in that country – and the continent as a whole – have less power to negotiate within the neocolonial structure.

In our latest dossier, we show how the IMF’s new policy on the African continent is much like its old policy (as is the case elsewhere in the world, as we discuss in our October 2023 dossier, How the International Monetary Fund Is Squeezing Pakistan). We provide a short summary of the continued attempts to build African financial institutions, such as an African Central Bank, an African Investment Bank, a Pan-African Stock Exchange, and an African Monetary Fund. The target date set to build these has already passed, but the need for them remains on the African Union’s Agenda 2063 (set in 2013). We also make the case for regionalism on the continent using the debate around the African Continental Free Trade Area. There is no easy panacea. At the end of the dossier, we look at the case of Senegal to understand the challenges facing countries that assert their sovereignty. When the country’s new progressive government, led by Diomaye Faye, audited the data reported to the IMF and showed that some of it was erroneous, the IMF responded by suspending Senegal’s $1.8 billion credit facility. Now what is Senegal to do? Faye’s government will go back to the IMF in June. We end the dossier by asking: ‘Will other paths open up for Senegal, or will it be fated to trudge through the IMF debt-austerity agenda that has plagued countries of the Global South for decades?’.

The year before the pandemic, I flew from Uganda’s Entebbe airport to the town of Kisoro, near the border with the Democratic Republic of the Congo (DRC). A guide named Katende and I drove to the border that goes through the town of Bunagana, where the M23 rebel group (the March 23 Movement, backed by Rwanda) had taken up residence on the DRC side of the border. We passed through the beautiful green hills of southwestern Uganda until arriving at the largely deserted town and desolate border post. There had been discussions about upgrading the border post because of the large volume of goods that crossed on both sides. But now, as a result of the ongoing war, all that is visible are a few bicycles, often just waved through by lackadaisical guards and customs officials.

Through Katende, I spoke to a few people who were milling around a small shop called a duuka (from the Hindi dukan, brought to this part of Uganda by Indian traders known in the old days as dukwallas). At this shop, I met an elderly trader who often crossed the border with goods from the DRC. What kind of goods? All kinds, sometimes also diamonds. Her name was Ssuubi and she spoke Luganda. She said something that made Katende laugh. I asked what it was. He took my notebook and wrote down what she had said: Akakonge ak’omu kkubo. Bwe katakukuba magenda, kakukuba amadda. Then he handed me the notebook in which he had written: ‘If the small stump of a tree in the path does not trip you on your way, then it will trip you on your return’. I suspect that Ssuubi was talking about smuggling and customs guards. But perhaps this was just a reflection of life, with fate at the heart of her poverty despite being involved in smuggling diamonds – so inexpensive here yet so expensive by the time they get to the Gulf states and Antwerp and, eventually, high-end jewellery shops around the world.

Ssuubi will remain at the duuka buying a juice, eating a packaged meal, standing in the sun waiting to see if it is safe to cross the border and then deal with the M23 gunmen on the other side, find someone to sell her diamonds and other things, walk back, try not to trip, and, finally, sell the diamonds for almost nothing to a dealer who will take them to the port in Mombasa, Kenya, where they will be shipped out of Africa. None of the people involved – the person who found the diamonds in the ground, the person who sold them to Ssuubi, Ssuubi herself, or the person who buys them from her and takes them to Mombasa – gain the wealth. By the time the ship docks in the Gulf states or Antwerp and finds its way to the person who will polish the diamonds, capital begins to accumulate. Before then, it is poverty that accompanies the jewels from hand to hand as those who do so live a hand-to-mouth existence. This is the reality of African wealth and its theft. This is what lies beneath the debt burden and the IMF austerity agenda.Email

Vijay Prashad

Vijay Prashad is an Indian historian, editor, and journalist. He is a writing fellow and chief correspondent at Globetrotter. He is an editor of LeftWord Books and the director of Tricontinental: Institute for Social Research. He is a senior non-resident fellow at Chongyang Institute for Financial Studies, Renmin University of China. He has written more than 20 books, including The Darker Nations and The Poorer Nations. His latest books are Struggle Makes Us Human: Learning from Movements for Socialism and (with Noam Chomsky) The Withdrawal: Iraq, Libya, Afghanistan, and the Fragility of U.S. Power. Tings Chak is the art director and a researcher at Tricontinental: Institute for Social Research and lead author of the study “Serve the People: The Eradication of Extreme Poverty in China.” She is also a member of Dongsheng, an international collective of researchers interested in Chinese politics and society.

 

The UK Rebukes the UN and Bows to the Israeli Embassy over “Terrorism” Arrests of Journalists

By Craig Murray

May 28, 2025

Source: Craig Murray

Photo from Alisdare Hickson (Flickr, CC BY-SA 2.0)

There is a stunning contrast between the access given by the UK to the Israeli Embassy to influence prosecutions of anti-Genocide journalists and protestors, and the repudiation by the UK of United Nations querying such prosecutions. The UK has rebuked the UN for “outside interference”.

I cannot state enough how unusual it is for the UK to give direct access to the Israeli Embassy to the Police and the Crown Prosecution Service, in order for the Israeli government to influence the prosecution of UK citizens. This is not about extradition, in which case there may be treaty arrangements for direct contact between prosecutors. It is just not normal nor right for an Embassy to be involved with domestic prosecutions in this way.

This is one of a series of heavily redacted emails seen by the Guardian, Middle East Eye and lawyers for Palestine Action. They show the Israeli government being granted direct influence with UK police and prosecutors, to urge the prosecution of UK citizens protesting in the UK, against a genocide for which Israel stands accused at the International Court of Justice, with her leaders indicted before the International Criminal Court.

There is no British precedent for this situation and it is very much against international practice, although comparators may be found in influencing prosecution decisions in Vichy France or the Eastern European communist bloc by Nazi Germany or the Soviet Union – though there were instances of pushback even there. By contrast the UK system is openly influenced by the Israelis.

There is no reticence from the UK government in forwarding Israel influence. Although all released correspondence has been heavily redacted, it is plain that individual cases have been discussed with the Israelis, including those of Palestine Action.

The United Nations has written to the UK on the subject of its treatment both of pro-Palestinian protestors and journalists and the abuse of anti-terrorism legislation. It is almost certain that some of the same cases the UN cites are those the Israeli Embassy has been involved in. The contrast between the UK’s treatment of the Israelis and of the United Nations could scarcely be different. The Israelis are invited in, while the Starmer regime has repudiated the United Nations.

This is stunning hypocrisy. It is characterised as being in the interest of those being persecuted by the UK and Israel, to prevent “interference from international organisations” such as the United Nations. This is beyond the pen of Orwell or Kafka. You can imagine the authors sniggering as they wrote it.

But the truth is the exact opposite of the UK government line. Unlike the Israeli Embassy, the United Nations really does have a right to interfere. The Special Procedures mechanisms by which the United Nations approached the UK are a well-established part of international law, and the UK is a party to them. These are instituted by the Human Rights Council, and it has always been the position of the UK that all nations are subject to them.

In addition the UK is since 1971 a full party to the International Covenant on Civil and Political Rights, which is monitored by the Human Rights Committee and to the provisions of which the UN Special Rapporteurs specifically referred in querying the UK’s actions in this matter.

So the Israel Embassy has no right to interfere, and the United Nations has a direct right to interfere; yet the UK has encouraged the illegitimate while repudiating the legitimate. This is a classic example of the way that Zionism has fundamentally poisoned public institutions in the UK, and also of the profound Zionist capture of New Labour.

Yesterday’s revelation that David Lammy has lied to parliament and the country about suspending trade talks with Israel, while UK “trade envoy” Lord Austin is actually there, should be no surprise.

The hypocrisy does not even end there. The UK has been the most vociferous of countries in weaponising the UN Special Procedures against its own designated enemies, such as Russia and China. For the UK now to repudiate these UN investigations as “interference” is precisely to adopt the position of those states it has long argued against.

I have no doubt that this has been duly noted by any dictatorship the UK may seek to criticise in future.

You will recall that I am among a number of journalists about whose detention under the Terrorism Act and the seizure of whose electronic equipment, and thus correspondence, the United Nations interrogate the UK. You can read the UK government reply in full here.

ukgovtreply

Since the UN wrote, there have been further high-profile arrests of journalists, including Sarah Wilkinson and Asa Winstanley. The basic UK response is that the UN should not interfere, but one point of detail the UK states is particularly worth noting. Detentions and confiscations such as mine under the Terrorism Act specifically do not require the police to have any “reasonable grounds of suspicion”.

What kind of state makes a point of empowering its police to act unreasonably?

But read this further from the UK government reply:

I was detained and my electronics seized under Section 7. That means the UK government is claiming that I was “concerned in the commission, preparation or instigation of acts of terrorism”. Just digest that for a moment.

I might say that nothing in my questioning – which was roughly equally split between the subjects of Wikileaks and Palestine – related in any way to the potential commission of any acts of terrorism. Is the government really pretending that, in travelling home from an Assange campaign meeting in Iceland, they truly suspected I was preparing to commit terrorism? This is ludicrous.

It has often been noticed that despite Sarah Wilkinson, Asa Winstanley, Richard Medhurst, Johanna Ross, John Laughland, Vanessa Beeley, Kit Klarenberg, Ernest Moret, Richard Barnard, Tony Greenstein and Natalie Strecker all being swept up under the Terrorism Act in a campaign against journalists this last two years, there has never been a single mention in UK mainstream media of the UK’s arrest of journalists under the Terrorism Act.

Even following the United Nations intervention to question the UK on the arrest of journalists the UK did not mention it. Even the UK’s tiny number of licensed anti-genocide voices in the mainstream media, such as Owen Jones, have never mentioned it.

Yesterday Asa Winstanley won an important legal victory at the Old Bailey where a senior judge ruled that the police raid on his home and seizure of his equipment was unlawful. That is an important and rare legal victory, and I am tempted to attribute it partly to the turning of the tide of Establishment opinion against sacrificing all principles of law to the interests of Israel.

You may perhaps not be surprised to learn that this victory, too, has not been covered by the mainstream media. This conspiracy of silence over extreme abuse of police power against journalists is deeply troubling.