The United Nations has declared reducing inequality as one of its Sustainable Development Goals (SDGs) both within and among countries. This includes a target for countries to adopt social protection policies that “progressively achieve greater equality.” Healthcare is a core concern of those social protection policies, and a recent study shows that expanding access to primary healthcare has gone hand-in-hand with reducing racial inequality in Brazil.
The research, led by Dr. Thomas Hone of Imperial College of London’s School of Public Health, provides important support for continued efforts to expand primary care access in the face of economic and political turmoil in Brazil. Public health students and professionals looking to produce this type of impactful work can pursue an online Global Master of Public Health from Imperial College from anywhere in the world.
Brazil is a compelling case study for policies that address both healthcare access and inequality. It is a large developing economy with one of the highest levels of income inequality in the world, as well as severe disparity in health outcomes across income as well as educational, racial, and socio-economic lines. In particular, black and pardo (mixed race) populations suffer from lower average incomes, higher incidence of infectious diseases, higher mortality rates, and shorter life expectancy.
The Estratégia Saúde da Família (ESF) has been one of the most prominent policies seeking to reach these populations and achieve universal healthcare in Brazil. Under the ESF, family health teams deliver a broad range of free primary healthcare services at the community level. Since its start in the 1990s, the ESF has grown to provide services for more than 120 million Brazilians, with the greatest focus in municipalities with smaller populations, higher levels of poverty, and higher percentage of black and pardo people.
Previous research showed that the ESF has been broadly effective in lowering infant mortality, avoidable hospitalizations, and deaths from cardiovascular and respiratory diseases. This new Imperial College study sought to specifically evaluate how the program has impacted different racial populations. Researchers examined municipal-level mortality and demographic data for nearly 600,000 Brazilians and compared it with municipal ESF coverage.
The conclusions are stark: expanding ESF coverage resulted in a decline in the rate of avoidable deaths among black and pardo populations of 15.4% between 2000 and 2013, more than double the 6.8% decline in white populations. This decline was specifically driven by fewer deaths from infectious diseases, nutritional deficiencies and anaemia, diabetes, and cardiovascular disease.
While these results point to significant progress made in reducing inequality due to the ESF, the study also revealed this sobering finding: the rates of avoidable deaths in the black and pardo populations were still 17-23% higher than in the white population over the same time period. Thus, the Imperial research found that it is critical to continue prioritizing the expansion of this program, especially in Brazil’s current economic and political climate.
This study is an important contribution to the literature because the limited research to-date on linkages between expanding primary healthcare and reducing inequality has occurred solely in high-income country contexts. Thus, the study’s authors filled a significant gap by providing a relevant case study for other developing countries.
To do this work, Imperial College’s Dr. Thomas Hone led a team of researchers from several institutions across Brazil, including the Centre for Data and Knowledge Integration to Health (CIDACS) and the Instituto de Saúde Coletiva in Salvador, the Center for Epidemiological Studies in Health and Nutrition at the University of São Paulo, and the Institute of Social Medicine at Rio de Janeiro State University.
If working on globally-relevant problems with leading international research institutions sounds like the next step for your career, Imperial College’s 100% online Global Master of Public Health degree might be the next step in your education.