Current panorama and challenges of the National Policy for Comprehensive Health of the Black Population – Public Health

Ionara Magalhães

The National Policy for Comprehensive Health of the Black Population (PNSIPN) lists a set of historical struggles of black social movements. In the field of disputes for an equitable and democratic society project, this struggle represents an important political milestone in the fight against structural racism. The PNSIPN is a transversal, counter-hegemonic policy, based on the recognition of racism as a determinant of the precarious health conditions of the black population. The PNSIPN has a specific and compensatory character, as universalist policies have not reached vulnerable populations and end up reproducing inequities. The PNSIPN aims to ensure anti-racist and non-discriminatory principles, corresponding, therefore, to an affirmative action in the SUS.

Morbimortality data (index of people dead from a specific disease within a given population group) of the black population reveal the insufficiency and inefficiency of government actions to reduce ethnic-racial inequalities. There is no innate predisposition to illness and premature mortality in black people. Indeed, there is a small list of genetically determined morbidities. However, diseases and social problems resulting from the racism that structures social inequalities prevail.

If health is determined by macroeconomic policies, social and cultural capital, living, environment and work conditions shaped by the distribution of money, resources and power relations, the health conditions of the black population are directly related to inequities social, and raise specific policy. In this sense, the institutionalization of the health of the black population in the SUS points to preventive, assistance and health promotion, provided for in the PNSIPN’s operational plans.

After twelve years of institution, the PNSIPN was effective in only 57 of the 5,570 Brazilian municipalities. Problems persist: lack of funding, insufficiency of technical support, lack of state and municipal technical committees for the health of the black population, lack of knowledge of the SUS user population about the PNSIPN and, above all, the culture of institutional racism. The technical health committees of the black population have a deliberative and executive character, they represent the dialogue between black communities and government institutions, in addition to their aim to guarantee the implementation of the policy. However, in 2018, there were not 10% of technical monitoring committees in all municipalities. Of course, a current investigation would reveal even more astounding data.

The management of the PNSIPN must be shared between the Union, states and municipalities, and provides for the exercise and strengthening of social control, the production of information, scientific and technological knowledge in the health of the black population, and the appreciation of popular health knowledge and practices, including religions of African origins. In addition, the policy advocates monitoring and evaluation of actions related to combating racism in different spheres of government and ensuring broad access for the black population to health actions and services.

In the context of the analysis of the implementation of the PNSIPN, it is highlighted that many health information systems do not have the “race/skin color” item. There are also no efforts by the management to make the compulsory registration of this field and sanctions for non-compliance with the filling, established by Ordinance 344/2017. In addition, there is a need to improve the collection, processing and analysis of data disaggregated by race/skin color/ethnicity for the production, monitoring, evaluation of indicators and targets aimed at promoting ethnic equity. race in health.

A major obstacle corresponds to the inclusion of the theme “ethnic-racial relations, racism and the health of the black population” in permanent education aimed at workers, managers and users in the training curricula of health courses. These themes are ignored by institutions or not recognized as fundamental by Brazilian society.

The implementation of the PNSIPN implies the strengthening of the SUS – the greatest public asset and greatest social policy in the country. However, attacks on the SUS, translated by chronic underfunding and underfunding, the destitution of social, civil and political rights, and the adoption of anti-democratic and conservative policies, directly affect the black population and, consequently, weaken the PNSIPN implementation process.

It is urgent that, in addition to technical committees, social organizations and black movements, the State establishes institutional mechanisms for managing and monitoring the implementation of the PNSIPN. Therefore, would the implementation of the PNSIPN be a technical or political issue? The biggest challenge of the PNSIPN is, undoubtedly, its implementation, which collides with the unfavorable structure, disposition and institutional policy. Surely, without proper implementation and evaluation, the policy cycle is not complete.

Therefore, in the current scenario of PNSIPN implementation, there are discontinuous, isolated, uncoordinated actions and the government’s lack of commitment to its implementation. The failure in the PNSIPN implementation process represents a threat to the civilizing project. Many advances have been disrupted and harmed the exercise of the black population’s right to health. In this correlation of forces, a long struggle for the democratization of health, for the rescue of institutional credibility and for the realization of a policy of historical legitimacy continues.

Ionara Magalhães she is adjunct professor at UFRB, member of the State Technical Committee for Health of the Black Population and of the Racism and Health WG at ABRASCO