budgeting led to concrete advancements in democracy. The results concluded that participatory budgeting served as a platform for democratic societies to be able to partner with public institutions and international partners to be able to “promote activities for democracy and transparency at the local level.” Increased government transparency allows civic societies to have more impact within their own communities, as well as understand the importance of civic engagement. After more than a decade, the high number of participants suggests that participatory budgeting encourages increasing citizen involvement, according to the paper. Also, Porto Alegre's health and education budget increased from 13% (1985) to almost 40% (1996), and the share of the participatory budget in the total budget increased from 17% (1992) to 21% (1999). Research also shows that participatory budgeting has a greater impact over longer periods of time. In a paper that updated the World Bank's methodology, which expanded statistical scope and analyzed Brazil's 253 largest municipalities that use participatory budgeting, researchers found that participatory budgeting reallocates spending towards health and sanitation. The longer that a municipality used participatory budgeting, the more health and sanitation benefits accumulated. Participatory budgeting does not merely allow citizens to shift funding priorities in the short-term—it can yield sustained institutional and political change in the long term. Improvement in citizens' well-being Participatory budgeting has been shown to increase citizen's overall well-being. For example, studies show that the increase in participatory budgeting in Brazil correlated to improvements in the country's infant mortality. This research found that infant mortality rates are substantially lower in governments that use participatory budgeting compared to those that do not. This is due to the fact that infant mortality disproportionately affects poorer income groups more than middle-upper groups, with participatory budgeting leading to an increase in pro-poor investments, such as health and sewage infrastructure. These results suggest that countries who “sustain participatory budgeting programs may be part of general improvements in governance that produce[s] more durable access to healthcare.” Participatory budgeting has led to advancements in government because democratic governments with this kind of budgeting are able to make better use of public funding. A World Bank paper by Bhatnagar, et al. concludes that participatory budgeting can lead to improved conditions for the poor. Although it cannot overcome wider problems such as unemployment, it leads to "noticeable improvement in the accessibility and quality of various public welfare amenities". The paper suggests that