by Sandra Martins
Discussing racism as a major cause of unequal treatment among Brazilians, compromising the health and lives of more than half of society, was the motto of the conference Health of the Black Population in Debate: a policy of the SUS (The Sistema Único de Saúde or Unified Health System)*, held in the international hall of the school (1). The existence of a specific policy for the black population is evidence of this issue and seeks to correct the distortions that hinder equal treatment of black men and women. “In this way, we don’t have as healthy lives because racism does not permit this. We become ill more and with more severity, as well as die more. For us, it has been harder to diagnose, treat, prevent and promote health. This is what is approached in the policy related to the health of the black population health: Racism is bad for your health for anyone who is a victim of racism,” said Jurema Werneck, of the NGO Criola during the meeting.
The conference had as its backdrop the International Year of People of African Descent and the Day of Black Consciousness and supported the Pro-Health of the Black Population Mobilization. Stimulating discussion on the importance of public policies that address the population of African descent, including their health, was the purpose of the event, organized by the Office of Social Cooperation of ENSP (1) and was attended by Isabel Cruz, of the Núcleo de Estudos sobre Saúde e Etnia Negra (Nesen/UFF or Center for Studies Health and Ethnicity Black) and a member of the National Committee of the Health of the Black Population of the Ministry of Health and Jurema Werneck, coordinator of the NGO Criola and of the National Health Council.
Throughout the construction of public policies in health, since the installation of the Santas Casas de Misericórdia (2) in 1582, until the creation of the Sistema Único de Saúde (SUS or Unified Health System) in 1990, persists the problem for a considerable portion of Brazilian society still not being contemplated in a dignified manner: For various reasons, Brazil still has not been able to protect, prevent and treat the black population. This is why the Health of the Black Population Program was created, to help improve the SUS, said Jurema Werneck, emphasizing that this is not the only proposal for improving SUS but it is one of them.
Jurema noted that much of the present knowledge in our daily lives came through trafficked and enslaved Africans to the Brazilian soil and was preserved through the memory of the religious space. Different techniques of health promotion, that included the concept of fighting for its preservation and a future, despite the adverse conditions, were part of the concept of health of this population and were offered to Brazilian culture. The preservation of this memory was essential to our health because it came with the use of plants (teas, baths, infusions), minerals (stones, crystals) etc.
Among other techniques to restore balance and durability of health could be counted prayers, dances, food, the set of cowrie shells and diagnostic techniques whether we like it or not. Today we have this religious war, which is not religious, it is the ethnicity of people attacking other people because they are different. But before that war, everyone, regardless of their religious origins, culture and as a people, everyone benefited and benefit from this history thus far. But we have to remember that this knowledge came from there, and was preserved in religious spaces, says Jurema.
The struggle for a health policy in Brazil that includes this memory, or at least should, according to Jurema Werneck, would mean the inclusion of a more investigative look at this black population that is always demeaned. But in order for such concerns to enter the national agenda, groups organized in favor of the racial issue, denominated the Movimento Negro, had to keep itself mobilized and build a common agenda of demands: the overthrow of the myth of racial democracy and denouncing racism; production of qualitative and quantitative data on the impacts of racism on health; practice of racial equity in health in Brazil and in the world, creating the concept of the health of the black population (away from academia, that did not accept the data presented by researchers who had these concerns); the defense and preparation of a preliminary draft of national policy, the institution of the policy and the monitoring of the implementation.
The concept of the health of the black population is based on three pillars: racism present in social relations, in institutions and in public policies; differences and disparities in the incidence, prevalence, mortality, burden of diseases and other adverse health conditions, and Afro-Brazilian culture diagnostic procedures, relief and healing that must be recognized and valued. According to Jurema, to speak of the health of the black population these three aspects should be considered, otherwise nothing will change. Racism continues in various ways and everyone knows it.
Although the National Health Council had approved a National Policy for Comprehensive Health of the Black Population in 2006, it was not put into practice: it lacked the pact between the Health Ministry and the secretaries of health of the states and municipalities, according to what was released in 2008; it lacked the publication of the decree (992), which was released in 2009, and even then, its implementation required a federal law, the Racial Equality Statute (Law 12.288 of 20/07/2010). This legislation includes a discussion of the policy of the health of the black population. The problem, according to the doctor and activist (Werneck), was not solved, but now there is a law that serves to rub in the face of those who are not complying with the law.
There is strong resistance to the implementation of the policy in all government agencies that do not face an important aspect, which is institutional racism, to be battled including the training of health professionals. Academy is also a major source of resistance. They still continue to produce articles stating that we are making up (the fact) that black people die more, Werneck critiques. Unfortunately, academia is an instrument for the delay for not contributing to the debate in a qualified manner and to expedite the consolidation of an antiracism agenda and the implementation of policies, like, for example, the implementation of the National Policy of Comprehensive Health of the Black Population and the National Policy of Sickle Cell Disease.
To deal with institutional racism measures aimed at strengthening civil society through their organizations and movements are necessary. Civil society must continue to tackle racism, it is not over yet, and mobilization and participation must continue. Werneck praised the initiative of fostering participatory management through health councils and pointed out that it is fundamental to include this issue in its agenda of debates. The SUS must confront institutional racism. Fiocruz (1), that is part of SUS, must face the attacks that the system has undergone. SUS is what will one day save our lives. The health plan is for some. And when one needs something of high complexity, the path is SUS.
The mediator of the meeting, Carla Moura Lima (Ph.D in Education in Biosciences and Health at IOC/Fiocruz (Instituto Oswaldo Cruz) and a member of GT (Grupo de Trabalho – Work Group) of Popular Education in Health of Abrasco (3), recalled that academia should be a place of knowledge production without obstruction, but that there are also engaged researchers who suffer penalties, as is happening with one of the two researchers of ENSP and another from Fiocruz, who are being sued by ThyssenKrupp Atlantic Steel Company for having publicly denounced the impacts to the environment and residents in an area of Santa Cruz. We do have exceptions, even in academia. And I hope this is a first provocation to discuss the health of the black population here in this institution. Because if Fiocruz trains qualified and combative staff, it’s not (just) a little contribution to SUS. Debates like these are fundamental to enriching the training of researchers and health professionals. And who wins is the population, when the debate is about the health of the black population.
To talk about racial disparities and inequities in health, titular professor of Nursing at UFF (Universidade Federal Fluminense (Federal Fluminense University), Isabel Cruz, utilized social indicators that highlighted the racial aspect showing the persistent gap between blacks and whites, discussing the problem in relation to managers, officials elected by society and administrators. They have the notion of the collective and don’t take measures to contain these inequities and disparities. The society constitutes a perversity that even the people who theoretically should be protected from adverse situations, because of their origin, their racial status, are depreciated or dead. Because the look of the discriminator sees a black (person), and not a person, a human being, but one thing that he/she despises; as this person is also seen as a threat to their power in society. Because this fight is also about power.
|Health of the Black Population in Debate|
Reflecting on the dimensions of institutional racism indicates possibilities of establishing strategies for its prevention and combat. Isabel warns that institutional racism is the leading cause of morbidity and mortality in the black population and questions how the racial differences could be eliminated in the results of the SUS. The answer to this question is not an easy task, much less an immediate solution. There are several types of racism: individual, relationships, name-calling, racism that is within us, that that is internalized, and structural and institutional racism that is in Brazil as a whole.
In her understanding, racism must be consciously combated and not discreetly tolerated, because racism kills, even on the inside. And, among the measures of the promotion of racial equity in the SUS, it signals paths. However, the first step is to train the eye to these issues. Then consider the need to understand the perspective of the user, with the creation of SUS manuals; creating an agency on the health of the black population with the responsibility of implementing the National Policy of Comprehensive Health of the Black Population (macro level), review and correction of each policy, process or procedure that reveals racial inequity or disparity in income (macro level), create commissions to investigate how and why inequities and disparities are reproduced (micro level); proactive (continuous) and non-reactive strategies; racial equity as the gold standard for evaluation of public policies, since racism is a crime against human rights.
A possible path of dialogue, also a provocation, was presented by Isabel Cruz to the public debate on this, consisting of researchers, health professionals and residents, many members of management councils: the establishment of management councils and discussion about the inequities and inequalities within the context in which they are operating and deploying a commission for racial equality within healthcare facilities, such as the commission of hospital infection. This type of initiative is already underway in the Grupo Hospitalar Conceição, a model institution for the Ministry of Health, in Porto Alegre, which has a committee to promote racial equality. This committee is tripartite (user, manager and health professional) and began to discuss institutional racism and promoting racial equity strategies, whether in power relations within the institution itself, or in relation to the user. Here is the suggestion of creating a Cepir, which can help in the implementation of the health policy of the black population.
Another indication of the solution presented by the speaker is the agreed upon targets within the different health units, which must be included in planning. We should show disparities and say that we want differentiated goals. I want to erase inequalities and there have to be proposals of action for this. It’s this kind of attitude (like the name of an NGO in (the neighborhood of) Manguinhos (in Rio), Mulheres de Attitude (or Women With Attitude) that we have, we have to have men with attitude, elderly with attitude, homosexuals with attitude, overweight with attitude, everyone has to have attitude. It’s to come to the bargaining table and to say that you want this and that.
As a proposal for moving this agenda forward,Mayalu Matos, coordinator of the Office of Social Cooperation of ENSP, affirmed that the Health of the Black Population campaign in the year 2012 was being included in the planning work of ACS/ENSP and urged the collaboration of those present to work together in this endeavor: I hope to count on your collaboration also, the population of Manguinhos is here, partners, councilors and added another important point to be included in the working agenda which is to continue this debate within academia, of Fiocruz and school.
* – The Sistema Único de Saúde (or Unified Health System) is Brazil’s publicly funded health care system. SUS was created after the Brazilian Constitution of 1988, which assured that health care is a “right of all and an obligation of the State”.
(1) ENSP – Escola Nacional de Saúde Pública of Fundação Oswaldo Cruz – National School of Public Health of the Oswaldo Cruz Foundation in Rio de Janeiro
(2) A brotherhood whose mission is to treat and support the sick and disabled.
(3) Associação Brasileira de Saúde Coletiva (Brazilian Association of Collective Health)
(4) Assessoria de Cooperação Social da Escola Nacional de Saúde Pública (Social Assistance Cooperative of the National School of Public Health)
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