Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina. Campus Universitário Trindade. 88040-970 Florianópolis SC Brasil.
Departamento de Enfermagem de Saúde Pública, Escola de Enfermagem Anna Nery, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil.
Cien Saude Colet. 2021 Sep;26(9):3981-3990. doi: 10.1590/1413-81232021269.47412020. Epub 2021 Feb 20.
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.
巴西的卫生政策一直致力于扩大医疗保健的可及性并减轻不平等现象，但最近对政策内容的修订削弱了巴西的统一卫生系统。本研究通过对 2008 年、2013 年和 2019 年进行的三次全国性调查，评估了国家初级卫生保健政策的修订对卫生保健领域种族不平等现象的影响。考虑到调查设计和抽样权重，我们估计了全国范围内以及根据巴西地区的白人及黑人的各项结果的流行率。我们检验了以下假设：与白人相比，黑人更有可能获得家庭健康战略的覆盖、更不可能获得医疗保险覆盖，并且更有可能感到难以获得医疗服务（H1）；在十年期间，种族不平等现象有所减少，但在 2013-2019 年期间保持不变（H2）；在黑人比例较低的地区，种族差距有所扩大（H3）。我们的研究结果完全支持 H1，但不支持 H2 和 H3。2013-2019 年期间，种族不平等现象要么保持不变，要么有所减少。国家初级卫生保健政策的最新修订版淡化了普遍性和平等原则的重要性，导致了卫生保健领域种族不平等现象的持续存在。
