Healthy Brazil: a multisectoral strategy for tackling neglected diseases and promoting health equity

Health inequities remain a defining challenge of the 21st century, disproportionately burdening marginalized populations with diseases long eradicated in high-income settings. In Brazil, where socioeconomic disparities intersect with vast geographic and climatic diversity, diseases such as Chagas disease, leprosy, and malaria persist as markers of structural neglect—particularly in Indigenous communities, slum dwellers, and those trapped in cycles of poverty. A notable success in tackling these issues has been achieved through the Bolsa Família program, which was launched in 2003. This conditional cash transfer program provides financial aid to low-income families, with prerequisites such as ensuring children’s attendance in school and regular health check-ups. The program has significantly reduced extreme poverty and improved health outcomes. By alleviating financial burdens, it has enabled families to better access healthcare services, leading to notable improvements in maternal and child health, vaccination rates, and nutrition.¹

To continue address health inequalities In February 2024, Brazil launched the Healthy Brazil Programme (Programa Brasil Saudável)—a landmark intersectoral strategy uniting 14 ministries with the goal of eliminating 11 socially determined diseases and five vertically transmitted infections by 2030. The programme aims to dismantle entrenched health inequities by aligning sectors such as housing, education, environment, and Indigenous rights with national health goals, effectively operationalizing the WHO’s “Health in All Policies” ethos in a middle-income country setting.²

The Social Determinants of Disease is crucial for viewing poverty-related diseases as both social injustices and biomedical challenges. This shift translates into five concrete actions: 1) Digital innovations, including Prevenir TB, AppHans, and TeleMal, are improving diagnostic reach in rural and remote areas; 2) a revised certification guide for the elimination of vertical transmission of HIV, syphilis, hepatitis B, and Chagas disease has standardised integrated approaches across health systems³; 3) R$300 million has been allocated to HIV/tuberculosis prevention in highly vulnerable settings such as favelas; 4) domestic production of essential drugs (e.g., artesunate-mefloquine for malaria) has been prioritised, bolstering resilience amid global supply-chain fragility; 5) R$35·5 million has supported 70 national research initiatives, including vaccine trials for leprosy and schistosomiasis, signalling renewed investment in Brazil’s scientific ecosystem.

This interministerial approach reflects an understanding that disease control is inseparable from improvements in social protection, housing, education, and environmental conditions.⁴

The initial results show evidence of impact. During its first year, the programme has demonstrated measurable progress in four different disease: Lymphatic filariasis was officially eliminated as a public health problem in 2024—achieved through sustained community engagement, mass drug administration, and reinforced surveillance.¹ Malaria control improved with a 40% increase in rapid diagnostic testing and the introduction of tafenoquine, a single-dose cure for Plasmodium vivax, particularly in the Amazon.⁵ A national prevalence survey confirmed that all assessment units met WHO criteria for the elimination of trachoma as a public health problem; The dossier for validation of HIV vertical transmission elimination was submitted to PAHO/WHO in June 2025.⁶

These milestones offer early validation of the programme’s multisectoral model—combining biomedical, digital, and social tools in an integrated framework.

Despite progress, structural barriers remain. The Yanomami territory, Brazil’s only focus of onchocerciasis, illustrates the complexity of health governance where illegal mining, environmental degradation, and transboundary disease transmission (with Venezuela) co-exist.^7,8 Climate change, through rising temperatures and altered rainfall patterns, threatens to exacerbate vector-borne and soil-transmitted helminth infections, demanding adaptive strategies aligned with environmental and health resilience frameworks.⁹

Additionally, regional disparities persist. While southern states report declining burdens of neglected tropical diseases, the Amazon and Northeast regions continue to lag, mirroring historic inequities in infrastructure and health system capacity. Data fragmentation remains a further obstacle, undermining real-time monitoring and coordinated responses.¹⁰

Brazil’s experience offers transferable lessons for low- and middle-income countries: Intersectoral governance is not optional—engaging non-health ministries is essential to disrupt entrenched cycles of disease; Innovation must be equitable—novel diagnostics and therapies (e.g., HTLV screening in pregnancy) must prioritise marginalised populations to avoid exacerbating disparities. Climate resilience is health resilience—vector control efforts must align with broader climate adaptation plans, including innovations such as insecticide-treated hammocks and microbial larvicides.⁹

In conclusion, the Healthy Brazil Programme is a testament to the transformative potential of political will. Yet, its long-term success hinges on sustained funding, community engagement, and addressing systemic inequities—tasks requiring courage in an era of competing priorities. As Brazil advances toward 2030, its journey offers a roadmap for integrating health equity into the global agenda. The alternative—allowing preventable diseases to endure as relics of inequality—is a moral and pragmatic failure the world can no longer afford.

Declaration of interests

The authors declare no conflict of interest.