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Study indicates that primary health care can reduce racial inequality


Fiocruz Bahia


Almost 130 years after the abolition of slavery in Brazil, racial inequality remains structurally rooted in the country. The mortality rate due to conditions sensitive to primary care (avoidable deaths) is between 17% and 23% higher in Brazilians who self-declared to be black or pardos. However, the expansion of primary care plays an important role in reducing social inequities in health, and can help reversing these numbers.

These are some of the results pointed out in the study Association between expansion of primary healthcare and racial inequalities in mortality amenable to primary care in Brazil: a national longitudinal analysis, published in the open access scientific journal PLoS Medicine.

Upon analyzing the impact of the expansion of the Family Health Strategy (Estratégia de Saúde da Família - ESF, in Portuguese) program during the period from 2000 to 2013, researchers identified a two times higher reduction in avoidable mortality in populations who self-declared to be black or pardos when compared to white populations. Although the expansion of ESF was associated with a 6.8% reduction in mortality due to Primary Care Sensitive Conditions among white people, the reduction among blacks and “pardos” was of 15.4%.

The work was led by researchers from Imperial College London Thomas Hone and Christopher Millet in collaboration with researchers from the Center for  Data and Knowledge Integration for Health (Cidacs/Fiocruz) Davide Rasella and Mauricio Barreto. To reach such conclusions, the study used statistical modeling based on data from 1,622 Brazilian municipalities, selected according to adequate records of vital statistics.

The study underscores the poorly studied relationship, especially in low- and middle-income countries, between the expansion of the primary health care network and health inequities, including racial inequities. The evidence found still reinforces previous studies demonstrating that there is an association between the expansion of primary care and the reduction in avoidable mortality.

The authors emphasize the need to expand and consolidate the Family Health Strategy in poorer and smaller municipalities, in rural areas and urban peripheries where socially vulnerable populations live in order to significantly reduce health inequities and ensure compliance with the 10th Sustainable Development Goal (SDG).

"The possibility of reducing spending on health and social policies can have harmful effects and reverse the consistent trends of improving the health standards of our population," says the coordinator of Cidacs and one of the collaborators of the study Mauricio Barreto, in reference to the austerity policies recently adopted by the Brazilian federal government.

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