🪲 Disease control is good for business

Hello! Welcome to another edition of the Brazil Society newsletter! If you have any questions about this newsletter, or topics you’d like to see covered in future issues, you can reach us at [email protected]  

Hello! Welcome to another edition of the Brazil Society newsletter! If you have any questions about this newsletter, or topics you’d like to see covered in future issues, you can reach us at [email protected] 

Fighting a 'disease of the poor' pays dividends in Brazil

A silent epidemic that once threatened millions across Brazil shows how public health interventions can transform not just medical outcomes but economic trajectories as well.

Chagas disease, caused by a protozoan parasite and primarily transmitted by triatomine bugs (known in Brazil as barbeiros, or “barber bugs”), can lead to severe heart conditions that compromise a person’s well-being. 

Disproportionately affecting low-income Brazilians, Chagas has earned its designation as a neglected tropical disease by the World Health Organization, alongside dengue fever and leishmaniasis. “It’s a disease of the poor,” public health expert Tania Araújo-Jorge told The Brazilian Report in 2023.

While Chagas disease remains a silent threat in Brazil — especially in regions experiencing rapid deforestation — the country has made strides in controlling its spread through a decades-long prevention program initiated in the 1980s. The policy significantly curtailed the disease, which in the late 1970s was endemic in 18 states and 2,200 cities.

Now, the long-term economic and social impacts of that program are coming into focus. A recent working paper from the National Bureau of Economic Research (NBER) suggests that controlling Chagas transmission led to a reduction in racial income inequality, eased the long-term burden on Brazil’s public health system and increased GDP per capita in affected municipalities by 11% over two decades. It is important to note that the paper is being submitted to academic journals and has not yet been peer-reviewed.

“Neglected tropical diseases like Chagas have chronic effects that take years to manifest,” said Eduardo Montero, a faculty research fellow at NBER and an assistant professor at the Harris School of Public Policy at the University of Chicago. “When we take a long-term perspective, we see significant benefits.”

A disease rooted in poverty

Chagas disease affects an estimated 6 to 7 million people worldwide, causing approximately 12,000 deaths each year, according to the WHO. It is endemic in several Latin American countries, where roughly 75 million people are considered at risk of infection.

Brazil’s Health Ministry estimates that at least one million people in the country are infected with Trypanosoma cruzi, the parasite that causes Chagas — often without knowing it. The disease has contributed to an average of 4,000 deaths per year over the last decade.

First diagnosed by Brazilian physician Carlos Chagas in 1909, the disease has long afflicted the country’s poorest populations. Triatomine bugs thrive in precarious housing conditions, particularly wattle-and-daub homes, hiding in crevices and infecting people — often by biting them on the face, which is where their Brazilian “barber bug” nickname comes from.

In the 1970s, amid a military dictatorship (1964-1985), Brazil decided to map Chagas transmission, revealing its widespread presence across multiple states. In 1983, the government launched a control program that involved spraying insecticides inside homes in vulnerable communities and raising awareness about the insect’s presence. Studies later confirmed that the program significantly reduced vector transmission.

Today, direct transmission from bugs is far less common, but a new challenge has emerged: oral transmission. 

The Amazon region — once largely unaffected by Chagas — has seen significant outbreaks linked to the consumption of fresh açaí berries, a staple in northern Brazil. Barbeiros can contaminate the fruit, and the parasite can survive both at room temperature and in standard refrigeration. Export-grade açaí undergoes a sterilization process called bleaching, which eliminates the parasite.

Measuring the economic impact

Chagas disease has an almost 100% chance of cure if diagnosed early, yet more than 70% of those infected are unaware of their condition. Early symptoms are mild or nonexistent, often mimicking other illnesses. Many of the most debilitating effects — an enlarged heart, irregular heartbeats, difficulty eating and chronic weakness — manifest only decades later, sometimes leading to premature death.

The delayed onset of symptoms has complicated efforts to assess the economic impact of controlling Chagas transmission. In their study, Montero and his coauthor, Jon Denton-Schneider, an assistant professor of economics at Clark University, sought to isolate the effects of Brazil’s prevention program by analyzing economic and social indicators in affected municipalities. 

Using a difference-in-differences methodology, they compared 575 municipalities participating in the program with a control group of more than 1,000 — excluding São Paulo, where transmission had already been controlled before the national initiative.

Accounting for national and state-level economic trends, the researchers found that the municipalities in the program experienced an additional 11% GDP growth over 20 years, which they attributed to Chagas prevention efforts. Census data further supported their findings, showing increased labor force participation and higher incomes in affected communities.

“We found the biggest effects 10 years after the campaign, which aligns with medical literature on the disease’s long-term impact,” Montero told The Brazilian Report.

The study also linked reduced childhood exposure to Chagas with a 2.8% increase in the share of non-white adults earning above-median incomes, a 0.5% increase in their children’s literacy rates, and a 16% decline in public spending on circulatory disease-related hospital care. The overall reduction in inequality may have lowered municipalities’ Gini coefficients by 1.1% in the long run.

“These results suggest that neglected tropical disease control can strengthen economic and fiscal health while mitigating racial disparities and intergenerational poverty,” the authors wrote.

A model for Latin America?

Montero acknowledges that isolating the precise effects of disease control remains challenging, as Brazil’s economy underwent significant transformations during the study period. Still, he believes the findings offer a compelling case for the broader benefits of public health interventions.

“We try our best to control for external factors, but it’s impossible to isolate everything,” he said. That said, the results are robust enough to support the idea that disease control and social equality go hand in hand.

Brazil’s experience, he added, could serve as a model for other Latin American nations struggling with neglected tropical diseases. “If we can eliminate Chagas, Latin America might become a little less unequal,” he said. 

“Brazil has been a leader in developing innovative and effective ways to combat these diseases. The data suggest that investing in public health can be a powerful tool for boosting incomes and reducing inequality.”

Quick catch-up

👠 A right-wing lawmaker in São Paulo has introduced a bill to ban street prostitution, arguing that it disrupts public spaces and infringes on residents’ rights, particularly when it takes place near family homes. Advocacy groups warn that such a measure would further marginalize sex workers, pushing them into more precarious conditions.

⚖️ The Inter-American Court of Human Rights convicted Brazil for human rights abuses against traditional quilombola¹ communities in Alcântara, Maranhão state. The case dates back to 2001. Brazil was sentenced to pay USD 4 million, and the money should be used to improve the lives of the community.

🧠 Brazil is facing an alarming surge in mental health-related work leaves, with nearly 500,000 employees taking time off in 2024 — the highest in at least a decade, according to data from the Social Security Ministry. Employees’ mental health should become a top concern for companies, especially as workers become more likely to job-hop.

1  Quilombolas are descendants of escaped enslaved people who formed independent, self-sustaining settlements (quilombos). These communities maintain distinct cultural identities, traditions and territorial rights recognized by the Brazilian Constitution since 1988.