Blacks have more access to basic health, while whites have it easily with high complexity

A new Brazilian study concluded that blacks and the poor have greater access to primary care services from the SUS (Sistema Único de Saúde). But, for highly complex procedures, the scenario changes: white and richer people are able to obtain them in a simpler way.

The explanation for the discrepancy is related to the geographic distribution of health services and the standard of housing in Brazilian cities by income and race. While primary care has high capillarity, including in peripheries with a strong presence of blacks and the poor, the high complexity is more restricted to the central regions of the municipalities, which facilitates reach for whites and richer people who commonly inhabit these areas.

The survey was carried out by researchers from Ipea (Institute of Applied Economic Research). Rafael Pereira, study coordinator, explains that the objective was to observe how social inequalities can affect the scope of public health.

“The neighborhood or the family where you were born defines in a very strong way the degree of access you have to public services. So we are concerned about portraying this inequality in access to health”, he says.

The survey analyzed the situation in the 20 largest Brazilian cities in 2019. The locations of SUS primary and high complexity care services were compiled in each of the municipalities.

The researchers also aggregated the racial and income profile of the inhabitants of the cities based on the 2010 census. Then, the geographic distribution of these populations was considered based on data from the IBGE (Brazilian Institute of Geography and Statistics).

In addition, the researchers considered information on the topography of the municipalities, the public transport network and the average speed of cars when moving in cities. These data made it possible to measure the differences in accessing health services on foot, by collective vehicles or by private transport.

Combining these estimates with the geographical distribution of health services, and also considering the housing characteristics of the municipalities, led the researchers to conclude that blacks and the poor are more likely to receive primary care from the SUS.

In large part, this happens because these establishments have greater capillarity in regions far from cities – in most of them, it is black people who live closer to these services and access them on foot.

Pereira explains that the presence of basic health units in different regions of the cities makes up the plan of the SUS to be a universal and equitable system. “That’s why when we look at access to basic healthcare, we don’t find inequality.”

On the other hand, whites and those with higher income have more circulation in high complexity services. Again, the geographic distribution explains the scenario, since these populations are more present in the central regions, where complex procedures are also located.

Pereira also points out that the study did not assess the quality of health services, only the ability to reach them. That is, other problems, in addition to access, may also exist.

“It’s no use for people to live next to the health center and, when they get there, they never have a doctor”, exemplifies the researcher.

To solve the problem, the authors of the study propose some strategies.

One of them is the adoption of policies to remove highly complex units from city centers and take them to other regions.

Another action pointed out by the researchers is to make it easier for more poor people and black people to inhabit the central regions of the municipalities.

“Historically, housing policies in Brazil have always pushed the low-income population to peripheries with less public services. This pattern has a historical role in aggravating this situation of access to hospitals”, explains Pereira.

Another option mentioned by the researcher is to improve public transport services between the most affected regions and the center. By doing so, the poor and black people would be better able to travel to places where high-complexity services are already established.