ABSTRACT
Abstract Health policies in Brazil have sought to expand healthcare access and mitigate inequities, but recent revisions of their content have weakened the Brazilian Unified Health System. This study estimates three healthcare indicators across three national surveys conducted in 2008, 2013, and 2019 to assess the impact of changes to the National Primary Care Policy on racial inequities in healthcare. Considering the survey design and sampling weights, we estimated the prevalence of each outcome among both whites and Blacks for the whole country, and according to the Brazilian regions. We test the following hypotheses: compared to whites, Blacks showed higher frequency of coverage by the Family Health Strategy, lower frequency of health insurance coverage, and higher frequency of perceived difficulty accessing health services (H1); Racial inequities decreased in the ten-year period but remained constant between 2013-2019 (H2); Racial gaps have widened among regions with lower proportions of Blacks (H3). Our findings fully support H1, but not H2 and H3. Racial inequities either remained constant or decreased in the 2013-2019 period. By downplaying the importance of the universality and equity principles, the latest revision of the National Primary Care Policy has contributed to the persistence of racial inequities in healthcare.
Resumo As políticas de saúde no Brasil têm buscado expandir o acesso e mitigar as iniquidades, mas recentes revisões de seu conteúdo enfraqueceram o Sistema Único de Saúde. Este estudo estima três indicadores de saúde em três inquéritos nacionais, realizados em 2008, 2013 e 2019, para avaliar o impacto das mudanças na Política Nacional de Atenção Básica sobre as iniquidades raciais na saúde. Considerando o desenho da pesquisa e os pesos amostrais, estimou-se a prevalência de cada desfecho entre indivíduos brancos e negros para todo o país e segundo suas macrorregiões. Testamos as hipóteses: comparados aos brancos, negros apresentaram frequência maior de cobertura pela Estratégia Saúde da Família, menor de cobertura de plano de saúde e maior de dificuldade de acesso aos serviços (H1); as iniquidades raciais diminuíram no período de dez anos, mas estagnaram entre 2013-2019 (H2); as iniquidades raciais aumentaram entre as regiões com menores proporções de negros (H3). Os resultados apoiam integralmente H1, mas não H2 e H3. As iniquidades raciais permaneceram estáveis ou diminuíram entre 2013-2019. Ao contrapor os princípios de universalidade e equidade, a última revisão da Política Nacional de Atenção Básica contribuiu para a persistência das iniquidades raciais na saúde.
Subject(s)
Humans , White People , Health Services Accessibility , Brazil , Cross-Sectional Studies , Healthcare DisparitiesABSTRACT
Objective: To evaluate whether the color/race of a hypothetical patient is associated with the clinical decision to extract or restore a specific tooth, as well as with the recommendation for additional procedures for its adequate treatment. Material and Methods: Respondents assessed an anterior tooth with an extensive carious lesion and were asked: whether it should be extracted or restored; how much time should be spent in the first consultation; whether or not root canal retreatment was necessary; and whether complementary exams should be requested. While a Black hypothetical patient was assessed in the first stage of data collection, a White individual was subsequently shown to the study respondents. Results: The clinical decision on whether to extract or restore the decayed tooth was not associated with the patient's color/race (p=0.64). The mean time estimated for the first clinical consultation (p=0.28), the need for root canal retreatment (p=0.56), as well as the request for complementary exams were not associated with the patient's color/race (p=0.82). Analyses stratified by the participants' characteristics confirmed the lack of such an association. Conclusion: As opposed to previously published findings in Brazil, the patient's color/race was not associated with clinical decision making among undergraduate dental students.
Subject(s)
Humans , Students, Dental , Tooth Extraction/methods , Dental Restoration, Permanent/methods , Brazil/ethnology , Evaluation Studies as Topic/ethnologyABSTRACT
Aim: To estimate the prevalence and severity of dental caries in schoolchildren from the city of Florianópolis, SC, Brazil, in 2009 and to compare these results with data from previous studies carried out in the same institution since 1971. Methods: All 145 12- and 13-year-old school children enrolled in a public school were eligible for the study. Dental caries was assessed with the DMFS/DMFT indexes, the significant caries index (SiC) and their 95% confidence intervals (CI 95%).Results: The response rate was 68.2%. The DMFT ranged from 9.2 in 1971 to 0.78 in 2009,although different diagnostic criteria were adopted to estimate these counts. The prevalence of dental caries declined from 98.0% (CI 95% 96.0-100.0) in 1971 to 43.5% (CI 95% 33.7-53.4) in2009. There was a reduction of 47% in the mean SiC index between 2002 and 2009, i.e. from 3.4(CI 95% 3.0-3.8) to 1.8 (CI 95% 1.5-2.1). The mean DMFS index was 2.0, and it was composed of an average of 1.8 and 0.2 decayed and filled surfaces, respectively. Conclusions: Even though different diagnostic criteria were adopted during the study period, an effective decline in the prevalence and severity of dental caries in adolescents was observed throughout 38 years of monitoring.