BRAZIL:
Racism Reflected in Health System
Mario Osava

RIO DE JANEIRO,(IPS) - Brazil's minister of health, Agenor Álvares, has admitted that the public health system is imbued with racism, stirring up more controversy over policies for specific treatment plans targeting Brazilians of African descent.

There are clear signs of discriminatory practices, one possible factor in the higher incidence among Afro-descendants of a number of illnesses, the minister said at a seminar on the special policies two weeks ago in Rio de Janeiro.

There have been similar critical responses to other programmes designed to correct social inequalities in Brazil. Some say that poverty, not ethnic origin, is the reason that health indicators are worse among blacks, while others argue that Brazil's racial mix has eliminated genetic differences.

Recognition of different needs and of racism by the ministry of Health is a "victory" for a 15-year struggle to promote "a different view" of prevention and treatment of the illnesses affecting the black population, Fátima Oliveira, a black doctor who was executive secretary of the Feminist Health Network for four years, until May, told IPS.

Ministry of Health statistics document a higher proportion of mortality and morbidity among black people from AIDS, tuberculosis, leprosy, and uterine and prostate cancer, as well as a higher maternal mortality rate.

According to official figures, black people on average live five years less than whites in Brazil, who have a life expectancy of 71 years.

The illnesses mentioned "are not exclusive to or typical of black people," but their higher incidence indicates that the black population faces negative social conditions that increase their morbidity, and that they do not get adequate treatment from medical services, Oliveira said.

There is also sickle cell anaemia, of African origin, which is directly linked with genetics, she emphasised, as well as the known predisposition of black people to high blood pressure, which may be one of the factors that determine their higher maternal mortality rate. That is why it is a serious fault if the public health prenatal service fails to regularly measure blood pressure in pregnant black women, she said.

"Differential health care for black people requires education and training for health professionals so that they understand the need for a different approach, as well as for overcoming their prejudices," said Oliveira, whose book "Health of the Black Population in Brazil" arose out of a study carried out for the Pan American Health Organisation (PAHO) in 2001.

The black movement has named Oct. 27 the Day of National Mobilisation for the Health of the Black Population, in order to protest the inequality they experience at the hands of the Unified Health System, which is supposed to offer services on an equal and universal basis.

In the southern city of Sao Paulo, the movement is celebrating another victory. The second Municipal Conference on the Health of the Black Population ended on Friday, establishing guidelines and actions to correct inequalities in health.

In order to promote policies that address the specific needs of this population, the mayor's office created the Special Coordination for Black People's Affairs (CONE), covering health, education and culture.

"Yes, there is racism in the health system, because black people face prejudice, or inadequately trained staff, who do not deliver differential care and are unfamiliar with the specific health problems faced by blacks," Joao Carlos Benicio, technical adviser to CONE, told IPS.

Afro-descendants make up one-third of Sao Paulo's population of 11 million people. The vast majority of black and mixed race people are poor, and the "colour stigma" means they suffer from double discrimination, Benicio said.

The general opinion among Brazilians that racism does not exist in this country of 187 million people "prevents serious discussion of the subject" and is an obstacle to adopting policies to correct inequalities, such as quotas for black people at universities, he complained.

Making black people "invisible" is characteristic of Brazilian racism, he said. That is why the debate about the need for differential health care has been going on for nearly 10 years in this country, in spite of the fact that the black movement has demanded it for three decades, he added.

The lack of proper training of public health service personnel is in breach of regulations and recommendations of the World Health Organisation, and the health system has even been left without medicines for sickle cell anaemia, the CONE adviser said.