Iniquidades nos serviços de saúde brasileiros: uma análise do acesso e da discriminação racial a partir da Pesquisa Nacional de Saúde (PNS), 2013

Abstract

The black population is identified in several studies as vulnerable because it is disadvantaged in socioeconomic aspects, morbidity and mortality profile and access to health services. The inability of the institutions, structures and organizations of society to attend to this population in an equitable way can be evidenced both in the difficulty of access to health services and through the practice of racial discrimination perpetrated by health care providers. This study aims to analyze the difficulty of access and discrimination by race/color in Brazilian health services, considering the data from the “Pesquisa Nacional de Saúde (PNS, 2013)”. It is a cross-sectional study based on the PNS data, 2013, with 60.202 people over 18 years. Questionnaires were used in the survey on obtaining care, not seeking health services and on discrimination by health care providers. We analyze the prevalence of difficulty of access and discrimination by race/color practiced by health care providers in relation to the socioeconomic characteristics and health conditions of the studied population; bivariate analysis with attainment of Prevalence Ratios (PR), Confidence Intervals of 95% (95% CI) and p values (p <0,05); and multivariate model using the Poisson regression, with Wald test for robust estimation, for significant variables in the bivariate analysis (p<0,2). The difficulty of access was found for 18,11% (CI 95% 16,88-19,41) of the individuals and associated with black skin color, residing in the central-west region, in the rural area, being a smoker, selfassessment of bad/very bad health and having no private health insurance. The prevalence of race/color discrimination practiced by health care providers was 1,45% (95% CI 1,29-1,62) and was associated with being black, being between 25-39 years-old, being a smoker, possessing four morbidities, having poor/very poor health self-assessment, being a public health service user and residing in the urban area of the country. We found that racial discrimination and the difficulty of access to Brazilian health services reach the majority of the black population. We observe the legitimacy of institutional racism through the Brazilian health services, emphasizing SUS (the Universal Healthcare System), which proposes to be universal, inclusive and integral. We reinforce the need to strengthen health policies with the aim to transform this panorama.