The concept and measurement of race and their relationship to public health: a review focused on Brazil and the United States

Abstract

Race has been widely used in studies on health and healthcare inequalities, especially in the United States. Validity and reliability problems with race measurement are of concern in public health. This article reviews the literature on the concept and measurement of race and compares how the findings apply to the United States and Brazil. We discuss in detail the data quality issues related to the measurement of race and the problems raised by measuring race in multiracial societies like Brazil. We discuss how these issues and problems apply to public health and make recommendations about the measurement of race in medical records and public health research.

Does life-course socioeconomic position influence racial inequalities in the occurrence of uterine leiomyoma? Evidence from the Pro-Saude Study

“…Currently, there are three ways of categorizing race in Brazil that are worth emphasizing: (1) that of the Brazilian census, which distinguishes among five discrete categories of skin color -white, brown, black, Asian ("yellow"), and Native Brazilian ("indigenous"), the fifth of which considers ancestry and ethnicity differently from the other four; (2) that of popular discourse, which uses a diverse 24 ; and (3) that of black political activists, who defend the use of the category "negro" or "of African descent" rather than "brown" and "black". The objective of the latter classification system is to reestablish the identification of ancestry, and consequently of collective identity, among African descendants in Brazil 22 . Results from this study, however, point to differences between brown and black women, which reinforce the need to consider these distinct racial categories in health research in societies like Brazil's.…”

“…The investigation of such biological mechanisms, possibly resulting from phenotypic features, would not mean an endorsement of genetic inheritance as the basis for racial classifications. The wide variability of humans' external physical characteristics, commonly used to describe racial groups, seems to reflect changes and adjustments, over the mil-lennia, to variations of climate and other environmental factors, as well as historical and social conditions 22,59,60,61 .…”

“…In addition, unlike the United States, where origin and ancestry determine race, racial classification in Brazil is based on phenotypic characteristics, mainly skin color. As a result, racial identification tends to be more complex and fluid in the Brazilian context, resulting in the use of distinct terms to identify the skin color/race of the population 22 . Until now, information about uterine leiomyomas has been based on studies that analyzed the variable of race in a dichotomous way (white/non-white); Brazil's distinct perspective on matters of skin color/race could increase our understanding of the relationship between race and uterine leiomyomas.…”

Racial inequalities and perinatal health in the southeast region of Brazil

“…During the interview, skin color was self-reported, with the subject choosing one of the following closed alternatives in response to the question: "What is your skin color? ": mulatto (brown), black, white, yellow, and native, according to the standards used by the Brazilian Institute of Geography and Statistics (IBGE) (13,16).…”

“…In Brazil, the term race is normally used to refer to phenotype (physical appearance) rather than to ancestrality (origin), as is the case in the US. While US research is based on categories of "pure" races, in Brazil the "brown" or "mulatto" category is commonly used also to refer to cross-bred individuals (13). The determination of race in health studies is usually done by the interviewer, whereas the more recommended procedure is self-classification (11).…”