Programa de Transferência Condicionada de Renda e indicadores de doenças crônicas não transmissíveis: uma análise das mulheres adultas beneficiárias do Programa Bolsa Família

Abstract

Introduction: studies show that populations with worse socioeconomic conditions are more susceptible to the development of chronic non-communicable diseases (CNCDs). Another set of evidence points out that social protection policies aimed at improving socioeconomic conditions have positive impacts on health. In the Brazilian context, the Bolsa Família Program (PBF) is the largest Conditional Cash Transfer Program in terms of population coverage in the world, with the granting of this benefit preferably given to women, conforming to the concept of positive discrimination. However, there is an important gap with regard to possible health inequities, that is, whether women beneficiaries of the BFP are more susceptible to CNCDs and their risk factors. Objective: estimate the magnitude of chronic non-communicable diseases (NCDs), their risk factors and their evolution in the population of Brazilian women, according to the receipt of the Bolsa Família Program (BFP) benefit. Methods: this thesis consists of three articles. (Article 1): this is an integrative literature review on the occurrence of CNCD and its risk factors in the beneficiary population of the Bolsa Família Program (BFP), which was searched in national and international databases, with a time cut from 2004 to 2020. (Article 2): cross-sectional study and time series using data from the Surveillance System for Risk and Protection Factors for Chronic Diseases by Telephone Survey, from 26 Brazilian states and the Federal District in the period from 2016 to 2019. The crude and adjusted prevalences and prevalence ratios of the indicators for CNCDs were estimated with the respective confidence intervals using the Poisson regression model. In the analysis of the temporal trend of the period in question, the simple linear regression model was used, with the outcome variable being the CNCD indicators and the explanatory variable the year of the survey. (Article 3): descriptive cross-sectional study carried out with data from the National Health Survey to assess the prevalence of NCD indicators, including laboratory tests, in the population of Brazilian women of reproductive age according to receiving the BF. Indicators were compared among women of reproductive age (18 to 49 years) who said they had or not Bolsa Família, and the prevalence and confidence interval were calculated using Pearson's χ2. Results: (Article 1): 23 articles are part of the analysis corpus of this review. There was a predominance of cross-sectional studies (86.95%), with the majority carried out in the state of Minas Gerais (21.74%) and Brazil (21.74%), 78.26% of the publications were in national journals and 2020 was the year with the most publications (17.39%). The analyzes performed allowed the construction of three categories by thematic similarity: 1. Prevalence of risk factors for CNCDs in women beneficiaries of the BFP; 2. Nutritional status and food insecurity in children, adolescents and families benefiting from the PBF; 3. Food consumption of PBF beneficiaries. (Article 2): this article showed that PBF beneficiaries had higher prevalences of tobacco use, overweight and obesity, lower consumption of fruits and vegetables, less physical activity during leisure time, lower coverage of preventive exams for cancer (Pap and mammography), in addition to evaluating their health status worse. Among the beneficiaries, the trend analysis showed an increase in the prevalence of overweight from 55.9% to 62.6% and screen time without TV (tablet, cell phone and/or computer use) from 13.5% to 27 .8%. (Article 3): it was observed in this article that women of reproductive age who are beneficiaries of the BF have worse health indicators when compared to non-beneficiaries, such as a higher occurrence of overweight (33.5%) and obesity (26.9%) (p<0.001), hypertension 13.4% versus 4.4% (p<0.001), tobacco use (11.2%) versus 8.2% (p = 0.029), in addition to 6.2% realizing their health worse, compared to 2.4% of non-beneficiary women (p<0.001). Conclusion: data analysis showed that CNCD risk factors were higher among Bolsa Família beneficiaries, however, this is not a causal relationship, with BF being a marker of socioeconomic inequality. Furthermore, the results shown here confirm that the resources allocated to the PBF have been directed to the population with the greatest need for health, thus seeking to reduce inequities, and reinforce the importance of the continuity and permanence of affirmative policies for this vulnerable population.