Abstract
Health policies in Brazil have sought to expand healthcare access and mitigate inequities, but recent revisions of their content have weakened the Brazilian Unified Health System. This study estimates three healthcare indicators across three national surveys conducted in 2008, 2013, and 2019 to assess the impact of changes to the National Primary Care Policy on racial inequities in healthcare. Considering the survey design and sampling weights, we estimated the prevalence of each outcome among both whites and Blacks for the whole country, and according to the Brazilian regions. We test the following hypotheses: compared to whites, Blacks showed higher frequency of coverage by the Family Health Strategy, lower frequency of health insurance coverage, and higher frequency of perceived difficulty accessing health services (H1); Racial inequities decreased in the ten-year period but remained constant between 2013-2019 (H2); Racial gaps have widened among regions with lower proportions of Blacks (H3). Our findings fully support H1, but not H2 and H3. Racial inequities either remained constant or decreased in the 2013-2019 period. By downplaying the importance of the universality and equity principles, the latest revision of the National Primary Care Policy has contributed to the persistence of racial inequities in healthcare.
Highlights
Inequities in healthcare access represent a breach of human rights, which result from unfair and avoidable social processes[1] that benefit some groups at the expense of others
We test three hypotheses: First, compared to whites, Blacks presented higher frequency of coverage by the FHS, lower frequency of health insurance coverage, and higher frequency of perceived difficulty accessing health services (H1); Second, racial inequities decreased over the ten-year period, but remained constant between 2013 and 2019 (H2); And, third, racial gaps have widened among regions with lower proportions of Blacks (H3)
Drawing from a larger body of research on health services assessment[38,39,53], as well as the broader literature on racial inequities in health[54,55], we tested three different hypotheses in this study: compared to whites, Blacks showed a higher frequency of coverage by the FHS, lower frequency of health insurance coverage, and higher frequency of perceived difficulty accessing health services (H1); Racial inequities decreased in the ten-year period, but remained constant between 2013 and 2019 (H2); And, racial gaps have widened among regions with lower proportions of Blacks (H3)
Summary
Inequities in healthcare access represent a breach of human rights, which result from unfair and avoidable social processes[1] that benefit some groups at the expense of others. This report showed that inequities in healthcare access are an issue for both central and periphery countries[4,5,6], but especially among those with no universal health systems[7]. The Unified Health System (Sistema Único de Saúde, hereafter abbreviated as SUS, according to its official name in Portuguese) is essential for promoting wellbeing, preventing and reducing the burden of adverse health outcomes among a population of around 210 million people, but especially among the neediest. Equitable care is important for Black Brazilians and other socially marginalized groups (e.g., women, LGBTQ+ people, Indigenous populations etc.), who have historically shown the worst health conditions across the entire population
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