Opinion – Public Health: Health of the Black Population: what to expect from the next government?

The health of the black population has returned to the public debate and is on the agenda in the discussions of the transitional government. On the last November 29th, symbolically still in the Month of Black Consciousness, the technical groups of Health and Racial Equality held a joint meeting, with representatives of 42 entities of the black movement, to dialogue with their leaders about the propositions for the next administration.

It is not news that the current government was marked by neglect and major setbacks in the policies of historical reparation for the black population. During the last four years, virtually no resources and/or health promotion actions were allocated to this historically marginalized portion of the population. What we saw, on the contrary, was a true attack on affirmative action policies.

It is true that the National Policy for Integral Health of the Black Population (PNSIPN), the result of decades of work by social movements, especially black women, was already facing implementation difficulties, despite a few advances, due to the low adherence of states and counties. One advance, for example, was Ordinance No. 344, from the Ministry of Health, published in 2017, which determined the mandatory collection of the race/color item through self-declaration in health services, but which is still in the process of being implemented.

Currently, the resumption of the health of the black population on the national agenda, in itself, is already a new achievement, which again indicates the political capacity of the black movement in Brazil. With this resumption, it is expected to renew the breath to reactivate the PNSIPN as a public policy attentive to the need for affirmative action. Both the WG on Health and the WG on Racial Equality of the transitional government have shown efforts in this direction and deserve to be seen with good eyes, given that among the representatives of these groups there are people historically committed to this agenda so dear to the Brazilian population.

Health system must be attentive to the diversity of the black population

At the end of November, in one of the great debates of the 13th Brazilian Congress of Collective Health, which hosted important moments for the anti-racist struggle, such as the Black Population Health Meeting, Drª. Jurema Werneck, Director of Amnesty International, already announced that “our message repeats a catchphrase launched tirelessly: nothing about us without us – that broad we, of indigenous peoples, blacks, women, LGBTQIA+ people, residents of the north and northeast regions and the slums and outskirts of the south and southeast, the countryside, the quilombos, the forests, the waters and the cities and not just white men on the left (or worse, on the right)”.

As you can see, there is a lot of diversity in the black population. Thus, talking about the health of the black population is talking about the health of the quilombola populations, the health of the homeless population, the health of peripheral populations and those with greater difficulties in accessing health services, the health of the main victims of multiple forms of violence. Finally, the health of populations that are at the intersection of a series of risks and injuries of the so-called social determinants of health, which are political problems, and as such must be treated and resolved with public policies.

Black leaders understand that it is necessary to face institutional racism in the field of health with a certain boldness, in perfect harmony with the guidelines and principles of the SUS. One of the intentions of the WGs of the transitional government is to resume and advance even further in initiatives such as the Technical Committee for the Health of the Black Population in the Ministry of Health, the Brasil Quilombola Program and the Juventude Viva plan, which focuses on combating violence against young people, especially black men and women. It is necessary to implement these and other health promotion actions to reduce racial inequalities and promote improvements in the living conditions and well-being of the Brazilian black population.

PNSIPN needs social adhesion and commitment from states and municipalities

In this context, a strong and powerful health system, beyond the economic issues that involve it, is essential. We know that the challenges for the implementation of a policy such as the PNSIPN are huge and involve the mobilization of various actors in society, such as managers and decision makers, including the Legislature. It is necessary to ensure that the PNSIPN gains greater support from the states and municipalities, after all, without due agreement between the federative entities, the efforts made may be inept. In this sense, it is also a challenge to agree and/or renegotiate goals and indicators for monitoring the PNSIPN. Among the actions of this policy, care, health promotion and prevention of diseases in the most prevalent diseases of the black population should be included, such as training for health professionals focused on sickle cell disease, diabetes and hypertension, as well as campaigns and population awareness actions, prevention and treatment of these conditions.

We understand that, in addition to political discourse, facing institutional racism, with popular participation and broad cooperation, must be an essential measure to expand and improve assistance to this population, in all instances, with due attention to regional inequalities and the great diversity present in the expression “black population”, often considered as a box, but which contains countless other disparities. Here, once again, the use of the race-color issue is a matter of first order for the analysis, planning and conduction of policies in an adequate manner.

The Federal Constitution of 1988 determines, in its article 196, that health is a right of all and a duty of the State, a right guaranteed through social and economic policies aimed at reducing the risk of disease and other harms, which guarantee universal access and egalitarian to actions and services for its promotion, protection and recovery. Certainly, rescuing and strengthening the PNSIPN, with associated practical actions, as indicated by the transition groups, contributes in this direction. For this, it is necessary that the system works for everyone, with equity and due attention to these issues; it is necessary that politics be re-signified in relation to society and, here, it is important that social rights and socioeconomic issues are on the negotiation table and the actions aimed at them reach those who need it most.

In view of this, it is expected that ordinances and norms that have increased inequalities against the black population will be repealed, jeopardizing their access to health spaces and the provision of basic services, as seen in the COVID-19 pandemic.