Racism and health: the need for urgent action

In their Article in The Lancet Global Health, Poliana Rebouças and colleagues1Rebouças P Goes E Pescarini J et al.Ethnoracial inequalities and child mortality in Brazil: a nationwide longitudinal study of 19 million newborn babies.Lancet Glob Health. 2022; 10: e1453-e1462Google Scholar present notable data from Brazil, showing higher mortality of children younger than 5 years born to Indigenous (HR 1·98 [95% CI 1·92–2·06]), Black (HR 1·39 [1·36–1·41]), and Brown or Mixed race (HR 1·19 [1·18–1·20]) women than those born to White women, and in particular deaths due to preventable diseases such as malnutrition, diarrhoea, influenza, and pneumonia. This study adds to an important set of efforts, which transcends Brazilian borders, to provide scientific evidence regarding the deleterious effects that social inequalities rooted in ethnoracial disparities produce. Preventable diseases and deaths have social rather than biological causes and therefore, there is room for political, economic, and cultural action. In the present case, the authors draw attention to the impact of racism on the death of children younger than 5 years. We know that it is not only structural, institutional, or interpersonal racism that underlies the scenario presented. Thriving literature, originating mainly from intersectional Black feminism, has been highlighting the urgency of facing “interconnected systems of oppression”2Hooks B Writing beyond race: living theory and practice.1st edn. Routledge, New York; London2013Google Scholar that produce differences, supremacy, subalternities, privileges, diseases, and deaths. In Brazil, there is an ominous intersection between the differences of social class, race-ethnicity, gender, and region or place of residence, which almost naturalises our astonishment when observing the hierarchy in the risk of dying among Indigenous, Black, Brown, and White children presented in the study. However, there is nothing natural that explains such a disparity; on the contrary, it is the product of a genocidal, slavocratic, discriminatory, sexist history that structures Brazilian society and the absence of public policies committed to reducing multiple social inequities. We have already observed the harmful effects of this absence and dismantling of public policies aimed at reducing inequality. It is not by chance that Brazil has recently returned to the UN's world map of hunger.3The HumanitarianPandemic puts Brazil back on the world hunger map.https://www.brasilsemfome.org.br/blog/pandemic-puts-brazil-back-on-the-world-hunger-mapDate: 2021Date accessed: August 3, 2022Google Scholar In the period following Rebouças and colleagues’ study,1Rebouças P Goes E Pescarini J et al.Ethnoracial inequalities and child mortality in Brazil: a nationwide longitudinal study of 19 million newborn babies.Lancet Glob Health. 2022; 10: e1453-e1462Google Scholar 125·2 million people have been estimated to face the challenge of some type of food insecurity in the country, especially those who live in households headed by Black or Brown or Mixed race people and in households with children younger than 10 years.4Rede Brasileira de Pesquisa em Soberania e Segurança Alimentar e Nutricional2o Inquérito Nacional sobre Insegurança Alimentar no Contexto da Pandemia da Covid-19 no Brasil—Rede Brasileira de Pesquisa em Soberania e SAN. Rede PENSSAN.https://pesquisassan.net.br/2o-inquerito-nacional-sobre-inseguranca-alimentar-no-contexto-da-pandemia-da-covid-19-no-brasil/Date: 2022Date accessed: August 3, 2022Google Scholar Moreover, childhood vaccination coverage is declining,5Revista ConsensusA queda da imunização no Brasil. Revista Consensus.https://www.conass.org.br/consensus/queda-da-imunizacao-brasil/Date: 2017Date accessed: August 3, 2022Google Scholar which implies an increase in infections and hospital admissions for vaccine-preventable diseases.6Sanches D Contarato A Oliveira W Doenças imunopreviníveis: uma análise das estatísticas oficiais de saúde para enfermidades com prevenção. Diretoria de Análise de Políticas Públicas da Fundação Getúlio Vargas.http://dapp.fgv.br/doencas-imunopreviniveis-uma-analise-das-estatisticas-oficiais-de-saude-para-enfermidades-com-prevencao/Date: 2018Date accessed: August 3, 2022Google Scholar As a result, the country is increasingly moving away from Sustainable Development Goal 3.2, which proposes to end preventable deaths of children younger than 5 years by 2030.7United NationsSustainable Development Goals. Goal 3: Ensure healthy lives and promote well-being for all at all ages.https://www.un.org/sustainabledevelopment/health/Date accessed: August 5, 2022Google Scholar Another health indicator sensitive to precarious or absent political efforts is maternal mortality, which suffered a scandalous increase during the COVID-19 pandemic8Brasil. Boletim Epidemiológico.https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/boletins-epidemiologicos/edicoes/2022/boletim-epidemiologico-vol-53-no20Date: 2022Date accessed: August 3, 2022Google Scholar and disproportionately affected poor and Black women. This set of indicators signalled a general worsening of health conditions, mainly due to the State's lack of commitment to the promotion of equity. In addition to the discussion on racism and health, Rebouças and colleagues’ Article1Rebouças P Goes E Pescarini J et al.Ethnoracial inequalities and child mortality in Brazil: a nationwide longitudinal study of 19 million newborn babies.Lancet Glob Health. 2022; 10: e1453-e1462Google Scholar has several other strengths, such as the use of robust data, produced through modern linkage techniques.9Coeli CM Pinheiro RS de Camargo Jr, KR Conquistas e desafios para o emprego das técnicas de record linkage na pesquisa e avaliação em saúde no Brasil.Epidemiol Serv Saúde. 2015; 24: 795-802Google Scholar The use of these data enhances the richness of the results, the possibilities of understanding the studied phenomena, and the analytical perspectives that can be carried out from official sources of data that still exist in the country. Therefore, the Article is also a form of resistance to the explicit attacks that Brazilian science has been subjected to in recent years, because it provides the academic community with important information that can be used for the proposition of public policies. Scientific denialism, data censorship, and underfunding for research and education are important expressions of these successive attacks that Brazilian science has undergone.10Araújo LF Pilecco FB Correia FGS Ferreira MJM Challenges for breaking down the old colonial order in global health research: the role of research funding.Lancet Glob Health. 2021; 9e1057Google Scholar Finally, emphasising that social, racial, generational, regional, and gender inequalities, among many others, produce symbolic and material effects in the daily lives of survivors is not enough. Commitment to food justice, social justice, and environmental justice perspectives need to be addressed on the public policy agenda if the current civilisation is truly dedicated to the development, equity, and wellbeing of all, whether at the individual, local, regional, or global levels. We declare no competing interests. Ethnoracial inequalities and child mortality in Brazil: a nationwide longitudinal study of 19 million newborn babiesSubstantial ethnoracial inequalities were observed in child mortality in Brazil, especially among the Indigenous and Black populations. These findings demonstrate the importance of regular racial inequality assessments and monitoring. We suggest implementing policies to promote ethnoracial equity to reduce the impact of racism on child health. Full-Text PDF Open Access