Note from BW of Brazil: It’s no secret. The tentacles of racism reach so many areas of society that one would be completely out of touch with reality if they didn’t think it didn’t extend into the medical industry as well. As we have seen in previous posts, medical racism can be both subtle, as in a doctor not wanting to touch a black patient, or blatant, as when a doctor doesn’t provide a black woman with the proper anesthesia because of a long-running stereotype that they are more resistant to pain. The consequences are often fatal as we’ve seen with a number of deaths of black women due to complications or outright negligence during childbirth.
As we will see in the numbers below, the white population consistently carries an advantage in terms of access/treatment to/of health care ad also, as has been proven for many years, the preto and pardo (black and brown) populations are much more similar to each other than they are to the white population. In fact, in many of the stats, the pardo population is actually worse off than the preto, again debunking another myth that lighter-skinned blacks are necessarily better off than their darker skinned brethren. And also in reference to the statistics, as this is Brazil, I tend to send see things in regards to race as being even worse than they are presented as often times blacks can be classified as browns and browns as whites. I would also apply this logic to statistics regarding the murder of blacks/browns and whites. Whatever the case, below we see yet another report on how race can also be a factor in the doctor’s office.
Why do blacks have less access to health care than whites in Brazil?
In spite of some government actions, data show that the public health system continues to discriminate against blacks
by Rodrigo Capelo
Why do blacks have less access to health care than whites?
Rafaela, 15 years old, pregnant (1), during her pregnancy went to all the consultations the manual ordered. Seven. She was admitted in April into a public hospital in the West Zone of Rio de Janeiro, to give birth to a boy. Labor started at 3am on a Saturday, and the medical team, formed only by nurses, did not measure her blood pressure any time until 2pm. The girl began having seizures from eclâmpsia (2), a condition caused precisely by high blood pressure, when she finally was taken to the operating room for a cesarean section. In the procedure, the uterus was perforated. With the bleeding, she was then transferred to another hospital. The baby was born with three kilos and 335 grams, but the mother didn’t even see it. He died after a hysterectomy, when her uterus or part of it was removed.
The case has one important detail: Rafaela was black. Her death, accuse NGOs like Criola of the doctor and activist Jurema Werneck, could have been avoided if racial discrimination in health had already been eradicated in Brazil. Not that the maternity nurses had left the girl die deliberately because of her color. That’s not how racism works in health. It appears in small gestures. They failed to inform her during prenatal consultations about the risks of high blood pressure – the black population suffers more from this problem, and a 15 year old girl pregnant has an even higher risk. They failed to measure her blood pressure during delivery. “Sometimes people don’t even realize that they are being racists, but racism is there. It appears during the black’s turn and the registration ends. The service is provided with less care than with whites. The doctor doesn’t touch the body of the black. In dentistry it is even worse because most consultations occur in offices,” says José Marmo, dentist, also affiliated to the Criola NGO. “Racism does this. Small oversights accumulate and become serious until the person dies,” said Jurema.
Discrimination in the public health system is felt more by blacks more than whites, according to figures from the Pesquisa Nacional de Saúde (PNS or National Health Research) revealed in May, and it shows that it has a racial character. Of all the entire white population served, 9.5% left the hospital with the feeling of discrimination. The percentage is higher among pretos (blacks) (11.9%) and pardos (browns) (11.4%), both nomenclatures adopted by the Instituto Brasileiro de Geografia e Estatística (IBGE or Brazilian Institute of Geography and Statistics) whose sum represents the black population. Fewer pretos and pardos come out with a “boa” (good) or “muito boa” (very good) evaluation of care, 70.6% and 69.4%, compared to brancos (whites), in which 73.5% of them satisfied. And those are only the less “objective” data, which depend on the opinion of respondents. The concrete data (check the chart below) shows that blacks are disadvantaged in all aspects surveyed by PNS: they consult fewer doctors and dentists, have less access to prescription drugs in their attendance, have more dengue (3), have more health problems that impede feeding, have fewer health plans (except when the employer pays the bill, another inequality sign), use toothbrush, toothpaste and floss less.
There are some explanations for racial inequality in health. The first is prejudice itself: the discrimination against blacks, despite the Brazilian miscegenation, isn’t over. Economic inequality weighs, as the black population has less financial power to pay for a private health insurance than white. There is also the fact that the informality of employment is higher among pretos and pardos – black women who work as domestics sem carteira assinada (without a registered work card) are not entitled to health insurance, for example. And there is the geographic issue. “The network of SUS [Sistema Único de Saúde or Unified Health System] is more present in middle-class areas, and the black population by historical factors is concentrated in periphery regions,” says Irenaeus Barreto, an analyst from the Sistema Estadual de Análise de Dados de São Paulo (State Data Analysis System of São Paulo or Seade) that is dedicated to the research of racial inequality. “And even in the poorest regions the black population has more difficulty than the white. Poverty is crueler to blacks.”
It is difficult to conclude from the data if racism in health has decreased or increased in Brazil because they lack research. The 2015 PNS detailed by race and color is the first to do so. But there is an indication of this in the SUS numbers on maternal mortality. In 2004, 62,659 women died from childbirth, of which 47% were white and 43% black (the sum of pretas and pardas). Ten years later, in 2014, 63,408 deaths were recorded. Of these, 42% were brancas and 53% negras. In a period of ten years, however, not only did the number of women who continue to die from complications of pregnancy increase, the condition of the black parcel worsened while the white has improved. There is the exception that, in 2004, the filling in of the data was still precarious. There were doctors who marked “branca” instead of “preta” or “parda” to describe the patient on the form. That year, the investigations into the deaths of the mothers were also much less. Whether better or worse, the fact is that the situation is serious.
And the government?
It was October 27, 2006 when the then Minister of Health, Agenor Álvares, at the opening of a seminar on health of the black population in Rio de Janeiro, said that there was racism in SUS. Doctors, through their entities, rejected this. The argument used by the Sindicato dos Médicos do Rio de Janeiro (Medical Union of Rio de Janeiro) was that discrimination was social, between rich and poor, not by color, similar to the arguments used in areas such as education to reject quotas for blacks in universities. The minister based the information on data collected by the Oswaldo Cruz Foundation. Researchers analyzed medical records of 9,633 pregnant women and perceived that every 100 white patients, 16 received no anesthesia. Among 100 black women, the number rose to 23. Among those killed by diseases such as tuberculosis, AIDS and hypertension, the pattern was repeated.
The minister’s statement showed activists efforts. The problem is that bureaucratic attitudes – creating a Comissão Intersetorial de Saúde da População Negra no Conselho Nacional de Saúde (CNS or Black Population Health Intersectoral Commission on National Health Council) in 2008, establishing the Política Nacional de Saúde Integral da População Negra (National Policy of Comprehensive Health of the Black Population) in 2009, including in the Estatuto da Igualdade Racial (Statute of Racial Equality) sections dealing health in 2010 – did not turn into concrete actions. Jurema Werneck, of the NGO the Criola, occupied a vacancy of the Movimento Negro (black movement) in the CNS. She toured the country to study public policy, negotiating with health departments of municipalities, mobilizing authorities for better treatment of blacks in health care. Her conclusion is that there has been progress in recognizing racism as a problem in health, but little else. “The policy was not implemented as it should,” she says. “Agenor Álvares was the only one to face the problem seriously. After him some and other ministers said, but did nothing. The current one [Arthur Chioro] doesn’t even respond. Five years ago the saúde do negro (health of blacks) became law, and it continues to be ignored.”
Sought by the report, the Ministry of Health stated that “it understands the situation of vulnerability of the black population” and stressed the role of SUS in “promoting equity”. The agency quoted some data from PNS to defend the government’s performance: access to Farmácia Popular (Popular Pharmacy), higher among blacks (25.3%) than among whites (22.1%), and obtaining medicines via SUS, with blacks (35.2%) at an advantage to whites (30.2%). As for the feeling discrimination in the health system, the ministry added that 53.9% of the discriminated claimed as a reason the lack of money, 52.5% to social class and 13.6% to race and color.
Among actions of the federal government to combat inequality in health, the organ mentioned the Política Nacional de Saúde Integral da População Negra (PNSIPN or National Policy on Comprehensive Health of the Black Population), established in 2009, the “Campanha SUS Sem Racismo” (SUS Without Racism Campaign) launched in 2014 with distance learning courses for 5,000 health professionals across the country, and the opening of the second edict for research on the health of the black population, which will allocate R$2 million (US$655 thousand) to researchers to discover ways to adjust the public health system to curb discrimination. The result of the actions mentioned by the government can be measured concretely, only after 2018, when for the next round of NSP is scheduled.
Why do blacks have less access to health care than whites?
Statistics show unfavorable conditions of pretos (blacks) and pardos (browns) even in access to medical care and drugs
Access to care and medicines – People that consulted a doctor in the last 12 months
White 74.8% Black 69.5% Brown 67.8%
People that consulted a dentist in the last 12 months
White 50.4% Black 38.2% Brown 39.2%
People that managed to obtain all the medical prescriptions in the last doctor’s visit
White 84.2% Black 81.1% Brown 80.4%
Health Conditions – People that have already had dengue
White 10.6% Black 14.8% Brown 14.8%
People with an intense or very intense difficulty in eating because of dental problems
White 1.3% Black 2.2% Brown 1.7%
Financial Conditions: People that have a health plan (medical or dental)
White 37.9% Black 21.6% Brown 18.7%
People that have had some health plan (medical or dental) for more than a year
White 32.7% Black 17.3% Brown 15%
People that use toothbrush, toothpaste and dental floss to clean teeth
White 59.9% Black 43.6% Brown 47.1%
People whose health plan (medical or dental) is paid by employer
White 31.2% Black 34% Brown 34.5%
Discrimination – People who have felt discriminated against in health services
White 9.5% Black 11.9% Brown 11.4%
People who evaluated their health plan (medical or dental) as good or very good
White 73.5% Black 70.6% Brown 69.4%
(Original chart below)
PNS reveals that blacks have an unfavorable position in relation to whites in all aspects of health (Art: Giovana Tarakdjian)
1. The pregnant 15-year-old girl died after waiting 6 hours to have the child at the Hospital Municipal Mariska Ribeiro, in the Bangu region of west zone Rio. According to relatives, the young woman was victim of medical malpractice. Rafaela Cristina Souza Santos had complications during delivery and it was necessary to remove her uterus. She was transferred to the hospital, but succumbed soon after. Little Miguel was born healthy. Source: R7
2. Eclampsia is a condition in which one or more convulsions occur in a pregnant woman suffering from high blood pressure, often followed by coma and posing a threat to the health of mother and baby.
3. Dengue is a debilitating viral disease of the tropics, transmitted by mosquitoes, and causing sudden fever and acute pains in the joints.