The risks of being black in Brazil and the racism that kills – Public Health

Beatriz Almeida, Jessica Remedies, Maria Leticia Machado and Victor Nobre

“Every 23 minutes, a young black man dies in Brazil”. This is a phrase that became popular after a 2017 United Nations campaign and that calls attention to the violent deaths behind racial inequality in the country. It is a historical problem, but still current and, at the same time, it opens a window for debate on the living and health conditions of the black population in Brazil. Black Brazilians not only die more violently than whites, they also have, for the most part, precarious access to education, employment and housing. These factors contribute to worse health outcomes and should be a point of attention for public policy makers, especially when observed from a demographic point of view, due to the fact that blacks and browns account for more than half of the Brazilian population.

It is worth making a brief historical mention that dates back to Colonial Brazil. In addition to being one of the last countries in America to abolish slavery, Brazil was one of the countries that suffered the most perverse effects. In parallel, the proposed abolitionist laws, despite being important for the process of consolidating abolition, were configured in a palliative way, denoting an inconclusive process.

Inconclusive not from a legal point of view, but from a procedural point of view, taking into account that there is an unfinished construction of citizenship, either due to the absence of inclusive policies for the integration of the enslaved to society, or through the incipient maintenance of a logic of racial discrimination, which is still present in social and economic relations. The result is what theorist Silvio Almeida defines as “structural racism”, characterized “both as an ideology and as a practice of naturalizing inequality”.

From the point of view of health policies, the relationship with structural racism is even more evident, when the black population is the main user and dependent on SUS, accounting for 67% of total users, is the social group that has the worst health indicators, with frightening numbers of mortality. IBGE sample surveys revealed that 65% of maternal deaths in 2018 were black women; between 2011 and 2020 the black population had a higher prevalence of tuberculosis cases; black women and young people aged 20 to 29 years represent the largest population affected by syphilis.

The results largely come from the unhealthy conditions in which the black population lives. According to the last Census (2010), 79% of blacks did not have a bathroom at home; 69% lived in places without garbage collection and 62% without running water. The most current statistics, simultaneously, present even more worrying scenarios: in the context of the Covid-19 pandemic, insecurity food, increased significantly, falling mostly on households headed by black people (66.8%). Another point is the fact that the black population is not able to comply with social isolation and proper hygiene protocols, since who need to work, and the nature of their activities forces them to be constantly exposed.

Complementarily, the literature highlights structural racism not only in atypical situations – such as in a pandemic – but daily. Second study by researcher Jurema Werneck, the (low) health conditions most common in the black population can be divided into: genetically determined, acquired (derived from unfavorable socioeconomic conditions), with aggravated evolution or physiological conditions altered by socioeconomic conditions. Diabetes mellitus, for example, affects 50% more black women than white women, while tuberculosis and hypertension affect 57.5% and 27%, respectively..

Despite the numerous problems experienced by blacks, which are added to the absence of public policies for this population, it is necessary to highlight the initiatives that seek to mitigate these public health problems aimed at the category, such as the Comprehensive Health Policy for the Black Population ( PNSIPN). Published in 2009 as a result of the Interministerial Working Group, the PNSIPN it is based on two fundamental axes: I) defining objectives, management responsibility and strategies aimed at improving the health of the black population that uses the SUS and II) ensuring a greater degree of equity in relation to the realization of the human right to health of the black population. Since the publication of the PNSIPN, advances have been made, including the production of academic knowledge in the area, creation of areas and technical committees segment-oriented and the approval of Resolution 344/2017 on the question of filling out the race/color item, encouraging the measurement of epidemiological data on the health of the black population.

Despite advances, challenges still overlap, largely associated with structural and budgetary aspects. Since its creation, the PNSIPN has only been implemented in just 28% of Brazilian municipalities, indicating low adherence in the national territory, while, of these 28%, less than 10% have monitoring committees to assess the impact of the Policy on the health of the population. From a budgetary point of view, there is a complete blackout in the federal government and in the Ministry of Health of programs aimed at improving the health of the black population and anti-racist agendas. The last was in 2016, the 2034 Program, contained in the Pluriannual Plan (2016-2019).

It is, therefore, essential to encourage debates that retake the relevant role and protagonism of the PNSIPN in the fight against inequalities. After all, as pointed out by the Technical Committee on the Health of the Black Population, “recognizing that racist practices are within health care models and seeking to transform this scenario should be the objective of everyone involved in health care and with management instances.”. The health indicators reinforce the need to implement the PSNIPN for states and municipalities and expand the level of monitoring, considering that there is instruments and methodologies structured for this process.

The Institute of Health Policy Studies (IEPS), an institution dedicated to public health policies, guided by evidence and recognizing its role as a promoter of this debate, reinforces the commitment to contribute to a more equitable public health system, considering the urgency the mitigation of the ills and idiosyncrasies that the Brazilian black population faces, through the defense of fundamental guidelines such as the PNSIPN.

Beatriz Almeida she holds a degree in Public Policy and an assistant in public policy at the Institute of Health Policy Studies (IEPS).

Jessica Medicines she is a physical educator, master in Epidemiology and researcher of public policies at the Institute of Studies for Health Policies (IEPS).

Maria Letícia Machado she is a political scientist, a postgraduate student in leadership and public management, and a public policy researcher at the Institute for Health Policy Studies (IEPS).

Victor Noble he is a student of Economics and a researcher of public policy at the Institute for Health Policy Studies (IEPS).