Fiocruz Minas e Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs/Fiocruz Bahia)
The growth of unemployment associated with the reduction of public investments in health and social programs increased the mortality rate among adults in Brazil in the period of 2012 to 2017. The finding is a study conducted by Fiocruz, University of London and Fundação Getulio Vargas, which evaluated the effects of the recession on the number of deaths and verified whether social protection programs affected in any way. The research was published in The Lancet Global Health, a renowned scientific journal in the health area.
To reach the results, the scientists were based on data from the Ministry of Health, the Brazilian Institute of Geography and Statistics (IBGE), the Ministry of Social Development and Fight against Hunger and the Information System for the Public Health Budget (Siops). The analysis took into account information related to health and social protection expenditures, in addition to the number of deaths, in each of the 5,565 Brazilian municipalities. It also considered the state unemployment rates, which is the smallest geographic unit for which there are regular data available for all of Brazil.
The results showed that the average mortality rate per county increased 8% in the period analyzed, from 143 deaths for each 100,000 inhabitants, in 2012, to 154 deaths every 100,000 inhabitants, in 2017. This equates to a total of 31,415 deaths in a universe of 7,069,242 deaths occurring during the period. The research showed that the relation between the increase in unemployment and the increase of mortality was evidenced in municipalities that allocated fewer resources for the Bolsa Familia and had lower per capita health expenditures.
“The study points to the effects of a combination of recession – which generates reduced economic activity and unemployment – and austerity measures – which is when the government decreases health investments and social protection programs. It is this combination of losses that caused the increase in mortality”, explains the researcher of Fiocruz Minas, Rômulo Paes, one of the authors of the study. According to him, this happens because it is when the person loses the job, that he/she loses the coverage of the health insurance plan and finds greater difficulty in accessing public services and social programs. “In this way, investments in these areas should be reinforced, and not reduced as it has occurred in several cities”, he says.
In fact, in municipalities where there were health investments and social protection programs, the relation between mortality and unemployment were not identified. “This reinforces the importance of social investments in the formation of a chain of protection around individuals. If this protection network is well built, the chances of lower illnesses and greater survival grow. This is an idea that has been substantiated in the area of health, and this work brings evidence in this direction”, emphasizes the researcher, Maurício Barreto, from the Center for Data and Knowledge Integration for Health (CIDACS/Fiocruz Bahia), who also signs the study. According to him, health is not only a matter of health services, but it is also linked to social and economic policies. “That is, what happens in the social and economic worlds also affects health”, he says.
Afro-descendants suffer more
When analyzing the data, the researchers also stratified the population by age, sex and race, verifying in which population groups there was a greater association between unemployment and mortality. The results showed that men, between the age of 30 and 59 years old, are among the most affected. Among the racial subgroups, the afro-descendants and mixed race are the most affected. Among white persons, the relationship between unemployment and mortality was insignificant.
“The study showed that the effects of reducing investments in social policies are greater in certain social groups, which historically have fewer advantages within society, such as afro-descendants. That is, also in times of crisis, these subgroups suffer more”, Barreto says.
Regarding health issues, cancer and cardiovascular diseases are among the main problems related to increased mortality. For the researchers, the difficulties to have access to health care may be one of the explanations.
“In the case of cancer, late diagnosis may be one of the causes of increased mortality. Cardiovascular diseases, besides the difficulties to seek treatment, are also associated with the psychosocial stress suffered by the persons in moments of crisis”, Paes assesses.
The increase in deaths from cancer and cardiovascular diseases in Brazil goes in the opposite direction to what happens in high-income countries in times of crisis, when mortality rates for these diseases tend to fall. According to the researchers, previous studies show that, in wealthy countries, unemployment leaves people with more free time to practice physical and leisure activities. In Brazil, although they have time, people do not have financial conditions to do so.
According to the researchers, such discoveries may also represent what occurs in other low-and middle-income countries, especially in Latin America, which, like Brazil, have precarious labor relations and less consolidated public systems, making people more vulnerable in times of recession and restricting investments in health and social programs.