Qual é a agenda para o combate à discriminação no SUS?

Abstract

We rarely discuss or investigate discrimination in health services, although the material and symbolic repercussions are a central issue for improving effectiveness and equity in the Unified National Health System (SUS). The theme emerges occasionally as racial discrimination, generally based on statistical evidence dissociated from either conceptual formulations on race or the reality of discrimination processes.On this basis, a normative apparatus has been constructed in relation to racial equality in Brazil, expressed formally as affirmative policies which, in thesis, represent a contradiction with the egalitarian and universalist principle of the SUS. The chasm is thereby reopened between the democratic and liberal traditions, expressed in the subtle semantic distinction between the formulations "we are all equal despite our differences" and "we are all different despite our similarities".Fraser (In: Souza J. Democracia Hoje: Novos Desafios para a Teoria Democrática Contemporânea. Editora UnB; 2001. p. 245-82) discusses the dilemma between strategies to reduce social inequalities based on affirmative as compared to transformative approaches. The former create or reaffirm the identity of subgroups (racial, gender-based, and others), increasing the differentiation between them (dominant multiculturalism), while the latter involve restructuring the framework that produces them, i.e., destabilizing group identities and differentiations. Thus, the affirmative approach fails to alter the structure that generates disadvantages, while the transformative approach reduces inequalities. By dissolving the stigmatization of groups that are the object of disadvantages, the transformative perspective mobilizes solidarity and reciprocity.

Who experiences discrimination in Brazil? Evidence from a large metropolitan region

“…In our study, multivariable models show that identification as “black” was associated with higher odds of reported discrimination in all settings, except for discrimination experienced in healthcare settings—a finding consistent with other reports [22]. However, women and the poor were more likely to report having experienced discrimination in seeking healthcare—a finding that may have implications for the way the Brazilian health system tackles its ongoing process of quality improvement and “humanization”, that is, making the national health service more accommodating and appropriate for its users [39]. …”

“…Our study suggests that discussions in Brazil about discrimination—both within and outside the context of the health system-should not be limited only to questions about race. Although racism is clearly an issue in Brazil and elsewhere, this study supports recent calls to address a wider set of interrelated factors within and across different population groups [39]. …”

Vulnerabilidade social e câncer de mama: diferenciais no intervalo entre o diagnóstico e o tratamento em mulheres de diferentes perfis sociodemográficos

“…Moreover, there is evidence to show that racial harassment and discrimination experiences, alongside the perception of living in a discriminative society, contribute to inequalities in health 38 . The issue was addressed by Travassos and Bahia (2011) in an article suggesting that affirmative policies in Brazil reinforce subgroup identities (racial, gender and others), promoting stigma and shifting the focus away from the true causes of discrimination to the institutional domain; discrimination would be "fundamentally derived from relationships between healthcare professionals and patients" 39 .…”

Acessibilidade à atenção básica a famílias negras em bairro popular de Salvador, Brasil

“…However, this is not the stated aim of this research. 26 The fact that, in this study, we did not fi nd signifi cant records of discrimination in the health services does not invalidate the argument in defence of greater investment into investigation on the subject.…”