A influência da raça/cor da pele/etnia no acesso e utilização dos serviços de saúde entre mulheres

Abstract

Access to and utilization of health services have been extensively investigated topics. They encompass complex, multidimensional, and polysemic concepts that are fundamental attributes reflecting a country's level of social justice. Their determinants are related to multiple factors, including individual, social, political, organizational aspects of health systems and services, and societal structures such as racism. In the context of a structurally unequal country like Brazil, where different inequities intersect, specific groups, such as Black women, face greater vulnerability in accessing and utilizing health services, leading to consistently unfavorable health outcomes compared to White women. Hence, there is a need to discuss these topics in the context of racial inequities, while also emphasizing gender disparities. OBJECTIVES: This dissertation investigated racial inequities in access and use of health services among women; reviewed scientific evidence regarding the association between race/skin color/ethnicity and access/utilization of health services among women in Brazil through a systematic review with meta-analysis (Study 01). Additionally, it estimated the association between a low frequency of visits from a Community Health Agent (CHA) or a member of the Family Health Team (FHT) and being a Black woman in Brazil, based on data from the National Health Survey (NHS) from 2019 (Study 02). METHOD: Study 01 involved a systematic review with meta-analysis to evaluate the scientific evidence on the association between race/skin color/ethnicity and access/utilization of health services among women. Strict eligibility criteria were established for study selection, and the search was conducted in five electronic databases: PubMed, Virtual Health Library (VHL), Scopus, Web of Science, and MedRxiv. After data extraction and quality assessment by four researchers, measures of global association between race/skin color/ethnicity and access/utilization of health services among women were obtained through a random-effects meta-analysis model. The meta-analysis estimated the overall association measure (Odds Ratio) and its 95% confidence interval. The Higgins and Thompson indicator (I²) was also used to assess the statistical heterogeneity of the data. Study 02 was an epidemiological, population-based, observational, cross-sectional, analytical, exploratory study that used data from the 2019 National Health Survey. The dependent variable was the low frequency of visits from a CHA or a member of the FHT, and race/skin color/ethnicity was considered the main independent variable in the hierarchical analysis models, along with other demographic and socioeconomic variables to evaluate its influence on the studied association. RESULTS: The findings are presented in two articles. In Study 01, 428 records were identified, and only three studies met the eligibility criteria. Black race/skin color/ethnicity was associated with negative health outcomes related to access/utilization of health services in Brazil (OR = 1.49; 95% CI: 1.26-1.76; I² = 24.01%). In Study 02, the sample included 66,395 adult women, aged between 18 and 59 years, comprising 78.8% White and 21.2% Black women. The majority of women (55.9%) received less than two home visits from CHA or FHT. The crude association measures between Black race/skin color/ethnicity and a low frequency of home visits from a CHA or a member of the FHT were positive and statistically significant (OR = 2.21; 95% CI: 1.10-4.45; PR = 1.37; 95% CI: 1.06-1.77), and they persisted even after adjusting for age, education level, monthly income, perception of health condition, and residential location (rural area). CONCLUSIONS: Race is a determinant and constraint in accessing and utilizing health services. Compared to White women, Black women face racial inequities and inequalities in accessing services, even after adjusting for socioeconomic variables. The findings from the systematic review and the cross-sectional study demonstrated an association between race/skin color/ethnicity and access/utilization of health services, highlighting the need for the formulation and implementation of public policies and strategies aimed at eliminating racial inequities and promoting ethnic-racial equity throughout the Unified Health System.