The door is open, but not everyone may enter: racial inequities in healthcare access across three Brazilian surveys

Abstract

Health policies in Brazil have sought to expand healthcare access and mitigate inequities, but recent revisions of their content have weakened the Brazilian Unified Health System. This study estimates three healthcare indicators across three national surveys conducted in 2008, 2013, and 2019 to assess the impact of changes to the National Primary Care Policy on racial inequities in healthcare. Considering the survey design and sampling weights, we estimated the prevalence of each outcome among both whites and Blacks for the whole country, and according to the Brazilian regions. We test the following hypotheses: compared to whites, Blacks showed higher frequency of coverage by the Family Health Strategy, lower frequency of health insurance coverage, and higher frequency of perceived difficulty accessing health services (H1); Racial inequities decreased in the ten-year period but remained constant between 2013-2019 (H2); Racial gaps have widened among regions with lower proportions of Blacks (H3). Our findings fully support H1, but not H2 and H3. Racial inequities either remained constant or decreased in the 2013-2019 period. By downplaying the importance of the universality and equity principles, the latest revision of the National Primary Care Policy has contributed to the persistence of racial inequities in healthcare.

Influência da Composição Racial Brasileira no Controle da Pressão Arterial: A Necessidade de Novos Olhares além do Tratamento Medicamentoso

“…13 There is also the increase in the incidence of all non-communicable diseases from 2013 to 2019, as reported in the Brazilian National Health Survey (PNS). 4 In fact, data stratified by race/ethnicity from the 2019 PNS showed that Black and pardo individuals, mainly women (57.8%), reported worse health status. Besides, White people reported higher attendance at medical appointments than Black people, regardless of sex.…”

“…[1][2][3] A lot of this evidence has been gathered from populations where there had been little racial mixing and, for this reason, understanding the impact of specific racial characteristics of the Brazilian population on the occurrence, diagnosis, and control of hypertension is imperative. 4,5 The study by Sousa et al 6 provides a new perspective on the influence of race on the treatment and control of BP in Brazilian adults. Using a robust database of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), the authors evaluated the association of self-reported race/skin color with BP control in individuals under different monotherapy antihypertensive regimens.…”

“… 1 - 3 Quase todas essas evidências foram geradas em contextos populacionais com pouca miscigenação e, por isso, é imperativo o entendimento do impacto das características raciais específicas da população brasileira sobre ocorrência, diagnóstico e controle da hipertensão arterial. 4 , 5…”

“…A miscigenação racial, característica da população brasileira, traz grandes questões socioeconômicas ao país e, de forma associada, desafios importantes para o cuidado em saúde. 4 , 5 Na perspectiva dos determinantes sociais do processo saúde doença, fatores relacionados à composição racial de uma população (incluindo racismo) podem contribuir para a ocorrência de iniquidades em saúde e, assim, influenciar negativamente os desfechos relacionados. 1 , 2 , 9 , 10 Desta forma, dificuldades no acesso aos serviços de saúde, às medidas de prevenção e proteção da saúde e aos tratamentos mais adequados podem ser frequentes.…”

“…13 Cita-se também o aumento de incidência de todas as doenças crônicas não transmissíveis analisadas pela Pesquisa Nacional de Saúde (PNS) na comparação entre 2013 e 2019. 4 …”