Brazilian welfare policies have been tested on 114 million people, but nobody has systematically checked whether they actually improve health. This research group will link social security payment records with health data from Brazil’s 100 Million cohort—one of the world’s largest linked datasets—to evaluate how anti-poverty programmes affect non-communicable diseases such as diabetes and heart disease. The problem is that low- and middle-income countries are rapidly expanding welfare systems without knowing which policies work best for health. Brazil offers a unique opportunity because it already has both the policies and the data infrastructure to assess them. The team will expand the range of social determinants available in the cohort, conduct natural experiments comparing different policy approaches, and train researchers in Brazil and the UK to sustain this work. If successful, this research could transform how governments design welfare programmes globally. Instead of guessing, policymakers would have rigorous evidence on which social policies reduce health inequalities—potentially reshaping social protection systems across dozens of countries. The training component ensures that analytical capacity remains in Brazil long after the grant ends.
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Strengthening data linkage to reduce health inequalities in low and middle income countries: building on the Brazilian 100 million cohort Environment The Institute of Health and Wellbeing (IHW) is co-located in the colleges of medicine and social sciences in the University of Glasgow (GU). Within IHW, the Social and Public Health Sciences Unit (SPHSU) is core funded by the MRC. The IHW and SPHSU focus on the social determinants of health (SDH), the evaluation of the impact of non-health sector programmes on health, and the use of linked data from health and other sectors. GU is at the forefront of data linkage, with Pell being Deputy Director of Farr Scotland. As the availability of linked data on health and its social determinants is improving in many low and middle income countries (LMICs), we are uniquely positioned to begin to understand how to improve population health and reduce inequalities in health on a global scale and to build capacity in such research. SPHSU and IHW provide an excellent scientific environment with dedicated lectures and tailored seminars to build academic and non-academic skills. SPHSU has a knowledge team supporting communications, public engagement, and knowledge transfer/exchange. GU will contribute financially to this programme through investigator time and supporting study visits as detailed in Justification of costs. Background Brazil has a history of introducing welfare policies to alleviate poverty. Rigorous evaluation of these policies may help to determine ‘what works’ to improve health across LMICs. This is timely since many LMICs are considering developing and reforming welfare policy. Brazil also has high quality linked health and social data covering a huge population, with the potential to link further data from other sources. It is the unique combination of the existence of welfare policies and the data with which they can be assessed that makes Brazil the ideal country to partner us in this project. The 100 Million (100M) cohort in Brazil brings together social security data (payments for welfare and other government support) with mainly infectious diseases health outcomes data for 114 million people in Brazil. We will add to these data to allow SDH research into the increasing epidemic of non-communicable diseases (NCDs) in LMICs. We will address many of the sustainable development goals (SDGs), and will monitor progress towards these. We will exploit opportunities afforded by the newly established 100M cohort. First, we will expand the range of data available, allowing a greater array of SDH to be studied. Second, we will conduct natural experiment studies to evaluate the health and equity impacts of specific policies. Third, we will build research capacity within Brazil and GU to ensure this work is sustainable. Collaborators We have started building a good working relationship between GU and Fundação Oswaldo Cruz (Fiocruz) teams through a research visit to Salvador to develop this proposal. Fiocruz has previously worked with the LSHTM, including setting up the 100M cohort. We will strengthen these relationships by holding face-to-face meetings embedded within week-long study visits, as well as maintaining regular contact through videoconference. We will agree a formal contract for conducting the research between the institutions to minimise potential risks. We will jointly develop a training course on robust evaluation methods for public health, running this course and developing it into a summer school will help maintain relationships over the long term. Training Our vision is to build a research workforce within GU, Brazil and other LMICs with skills to study SDH using linked data, particularly to evaluate policies. First, we will improve researchers’ understanding of global health and enable them to gain specific skills including research methods and uses of the 100M cohort by arranging short visits for researchers between institutions. Second, GU will ho
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