Contrary to the greater access to higher education that black and brown Brazilians have experienced in recent decades, the racial imbalance in longevity increased in the country from 2001 to 2021, according to the most recent Ifer (Folha de Equilíbrio Racial Index).
Prepared by Insper researchers Sergio Firpo, Michael França (both also columnists for Sheet) and Alysson Portella, the indicator helps to measure the distance between racial inequality and a hypothetical scenario of balance, in which the presence of black people in privileged strata reflects their weight in the population from the age of 30.
In addition to survival, it captures the balance for higher education and income, ranging between -1 and 1 point. The closer to -1, the greater the representation of whites in relation to blacks; values very close to 1, on the other hand, indicate a scenario in which the black population would be at an advantage.
In Brazil, survival data are at the level considered as relative balance between blacks and whites, that is, the indicator ranged from 0.2 to -0.2 points. But there was a worsening from 2001 to 2021, when the index went from -0.052 to -0.130.
The calculation of the survival component in Ifer is done as follows: the group of whites 10% older is extracted and the age that separates them from the remaining 90% is calculated. Thus, even though black Brazilians are more frequent targets of violence, this is not the main factor reducing longevity.
“We saw a certain balance in longevity, but over time we ended up moving towards an imbalance and it is necessary to begin to understand what is causing this to happen, test the public policies implemented and improve access to the health system”, says France.
Differences in access to private health plans and cutting-edge medicine between blacks and whites ended up being reflected in an imbalance in recent years, according to experts. The difference in protection of the two groups during the pandemic and the need to improve equal care in the SUS (Unified Health System) also weighed.
The data also show that the wealth and greater economic dynamism of the Southeast states are not reflected in the decline in the difference in longevity between blacks and whites, with São Paulo and Rio de Janeiro moving from racial balance to a level of imbalance in favor of whites .
In São Paulo, the indicator that measures longevity changed from -0.163 to -0.207 point; in Rio de Janeiro, from -0.173 to -0.251, keeping the two states at the bottom of the index. In these regions, we chose to use three-year moving averages, and the series ranges from 2004 to 2021.
At the other end, the positive highlight goes to the states in the North of the country, which occupy the first four places. But even in most of these places there was a worsening: Amazonas was 0.013 and went to -0.018, Pará went from -0.015 to -0.042 and Tocantins fell from 0.019 to -0.047 points.
According to sanitarians, one of the hypotheses for the North region’s advantage in this indicator may be the self-identification process, which varies from one region to another. Those who see themselves as black in the South do not necessarily see themselves that way in the North.
In the Southeast states, however, inequality between wages is more present and it is necessary to consider that the number of black residents in the peripheral regions of large cities is historically greater than that of whites.
INEQUALITY OF ACCESS TO HEALTH WORSE SCENARIO
Ana Léia Moraes Cardoso, 44 and Graça Epifânio, 51, are examples of this imbalance. Despite not knowing each other, they share many experiences in common: both are quilombola leaders and have experienced firsthand the difficulties in accessing healthcare in their respective communities.
For them, the imbalance in access to medical care and the difference in treatment between blacks and whites is not a statistic, but everyday life.
Graça, from the Quilombo Carrapatos da Tabatinga, in Bom Despacho (MG), 157 km from Belo Horizonte, worked as a health technician for 15 years and saw this inequality firsthand. “The black patient is already measured by his clothes and cannot express the pain he is feeling at that moment, he just gives thanks to God for being treated”, he says.
She, who has also worked in her community, highlights the importance of having black health professionals in the public system, as access to basic care through a person who instills confidence in the community helps to make people lose their fear. .
Ana, from the Quilombo de Laranjituba, near Moju (70 km from Belém do Pará), is a nursing technician and a medical student. For her, racism is part of the set of obstacles in accessing more complex services and health education policies for disease prevention and well-being promotion.
The isolation of communities is another problem. The difficulty of locomotion of people, often affected by chronic diseases, prevents treatment. “Everything favors that people end up dying from diseases that are treatable. Many depend on boats or precarious roads”, says Ana.
The Covid-19 pandemic, in addition to increasing the difficulties in accessing basic and necessary services to face the disease, showed how the lack of preparation in the care and knowledge of the reality of black people.
Researchers from UFMG (Federal University of Minas Gerais), the non-governmental organization Vital Strategies and UnB (University of Brasília) studied the level of disparity between deaths of blacks, browns and whites in Brazil during the pandemic. Blacks (blacks and browns) had a risk of death 9 percentage points higher than whites, according to the survey.
In the Quilombo de Laranjituba, Ana points out that there was an internal mobilization to raise awareness about Covid and provide basic social assistance to the population. “We know that black people are born, grow and die differently. During the pandemic, we saw this more intensely”, says Ana.
TARGETED PUBLIC POLICIES HAD BACKWARDS
In the view of researchers in the field, epidemiological indicators have shown for decades that the black population is in a worse situation than the white population. Public policies, such as the Statute of Racial Equality, recognize this.
According to Hilton Silva, a professor at UFPA (Federal University of Pará) and UnB, affirmative actions in the health area were put on the agenda at the same time as the university quota system, but this advance was more visible in the field of education than in health.
Silva says that available data indicate that a very small number of states and municipalities implement policies aimed at the black population. In multiannual municipal plans, the topic is also rare in the field of health.
“The future government will need to reinforce the importance of policies and [a conscientização da] existence of structural racism in the country —which the government that is ending did not do”, adds Silva, who is also part of the coordination of WG Racismo e Saúde da Abrasco (Brazilian Association of Collective Health).
Rudi Rocha, professor at FGV (Fundação Getulio Vargas) and research coordinator at Ieps (Institute of Studies for Health Policies) agrees that there are social determinants of health that affect access to medical services.
Factors such as housing, income, sanitation, security and education contribute to the increase in inequality between blacks and whites. “The labor market has also deteriorated in recent years and informality has increased, which has reduced access to private healthcare”, says Rocha.
The low representation of the black population in the spheres that design public policies aimed at this group also impedes the advancement of equality.
According to the Continuous National Survey (Continuous National Household Sample Survey), carried out by the IBGE (Brazilian Institute of Geography and Statistics), the number of blacks in the state of São Paulo is around 21.80 million inhabitants, equivalent to 48, 3% of the population of São Paulo.
However, of the 94 state deputies in Alesp (São Paulo Legislative Assembly), only 10 declare themselves to be black. In the 2022 elections, this number rose to 18, representing 19.2% of the House.
Rocha adds that the increase in the number of elderly people can accelerate inequality in health, since this group needs more complex treatments. “This means that the demand for highly complex health services will grow, for example, to treat chronic diseases, which need access to continuous medication and monitoring.”
Policies such as the PNSIPN (National Policy for the Integral Health of the Black Population), established in 2009 by the Ministry of Health and approved by the Federal Council of Medicine, can increase the quality of life of the population.
The initiative ranges from educating health professionals to a better understanding of the reality of the black population and a specific look at diseases with a higher incidence among blacks, such as diabetes and hypertension.
Rony Coelho, researcher of public policies for the black population at Ieps, regrets, however, that this policy was abandoned after the end of the Dilma Rousseff government, in 2016.
“There is an overlapping of inequalities. And when we compare people of the same socioeconomic level and of different colors, blacks will have worse rates and what explains this is society’s own racism.” it says.
This is the second edition of Ifer made by economists. Last week, a report by the Sheet had already shown that the drop in the imbalance between blacks and whites in the last 20 years was timid and motivated by the improvement in education (which is already showing signs of losing steam). In the same period, income and longevity indicators were disappointing.
Read the work of Ifer formulators:
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