Brazil’s efforts to expand access to primary health care has led to dramatic reductions in health inequalities between racial groups, a new study contends.
Brazil’s free primary healthcare system was launched in the 1990s with an emphasis on improving access to poor parts of the country. Black and pardo (mixed-race) populations in particular saw enormous increases in health care coverage, according to government statistics.
Since then, Brazil’s primary health system has become the country’s main platform for achieving universal health coverage, as well as the largest community-based primary healthcare program in the world. The expansion of the system — called the Family Health Strategy — has already been associated with a 5 percent reduction in deaths from cardiovascular disease and up to a 22 percent reduction in infant mortality.
Now, researchers from Imperial College London and Fiocruz in Brazil have analyzed 13 years of mortality data to determine the effect of the primary healthcare system on preventable causes of death — such as vaccine-preventable infections, diabetes, hypertension, heart disease, and asthma — between racial groups.
The study found that black/pardo Brazilians experienced a 2-fold greater reduction in mortality than white Brazilians, with the mortality rate dropping 15.4 and 6.8 percent in each group, respectively.
One of the authors, Thomas Hone, from Imperial College London, said the study was the the first time in Brazil anyone has explored the association between racial health inequalities and primary care.
“Brazil has stark inequalities including in income, wealth, and health, that make it one of the most unequal countries in the world,” Hone said to Humanosphere.
“These large disparities allow us to generate evidence that may help other countries with persistent inequalities,” Hone said, “But also hopefully provide evidence on how to improve the lives of some of the poorest and most vulnerable people on the planet.”
According to the report, Brazil’s black and pardo populations continue to have higher illiteracy, lower average incomes, and use healthcare services less than their white counterparts. In terms of health outcomes, they also have lower life expectancy, are affected more by infectious diseases, and have higher mortality rates from external causes, drug overdoses, and homicides.
Still, Brazil’s black/pardo population has reaped enormous and disproportionate health benefits from expanded access to primary healthcare. The researchers say these findings should serve as further evidence that expanding universal healthcare will be critical for reducing inequality in Brazil, and that Brazil’s experience provides important lessons for the rest of the world seeking to reduce health disparities.
In recent years, financial and political turmoil has threatened funding for Brazil’s healthcare system and other social protection policies. Last year, with the economy falling deeper into recession, right-wing President Michel Temer announced plans to replace the country’s universal healthcare with U.S.-style compulsory health insurance.
Supporters of the change say that under Brazil’s universal healthcare system, policymakers have largely failed to provide truly equal access to all citizens. Across the country, poorer municipalities with funding problems are plagued by outdated clinics, unsanitary conditions, and overcrowded facilities. Supporters of the current system argue that adopting a U.S-style healthcare system will only deepen inequality by reserving access to care for the elite.
Hone is one of a growing number of health experts calling for policymakers to recognize the benefits, however imperfect or incomplete, of Brazil’s existing strategy of emphasizing equal access to a primary healthcare system.
“Brazil is at a crossroads in terms of preserving fundings for health and social welfare programs,” he said. “Demonstrating impact of these programs is essential, we hope, in preserving government commitment.”
The researchers say their findings could help guide Brazil and other low and middle-income nations in the effort to achieve the United Nations’ Sustainable Development Goal to achieve Universal Health Coverage by 2030. To do so will require financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
