Gender and racial inequalities in the access to and the use of Brazilian health services

Cobo, Barbara; Cruz, Claudia; Dick, Paulo C.

doi:10.1590/1413-81232021269.05732021

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ARTICLE • Ciênc. saúde coletiva 26 (09) • Sept 2021 • https://doi.org/10.1590/1413-81232021269.05732021 copy

Gender and racial inequalities in the access to and the use of Brazilian health services

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This paper aims to evaluate gender and racial inequalities in the access and use of health services in Brazil Based on the 2019 National Health Survey (PNS). Its main objective is to understand how white, black, or brown men and women seek medical care in Primary Health Care, the gateway to the Brazilian health system. Analyses from a gender perspective show that cultural and social patterns affect individual actions and choices and mainly access to and use of health services. The results also show that men and women reproduce the expected gender behavior, socially and culturally constructed, which impacts their self-assessment of health status, care, and their exposure to the risk of disease and death. The intersectional analysis reveals that racial inequalities are aligned with those observed between men and women, exponentiating vulnerabilities for self-identified black or brown people, reflecting the structural socioeconomic inequalities of Brazilian society. In this context, the universality and integrality recommended in the Unified Health System contribute as a public policy to the guarantee of rights, equalization of opportunities, and adequate access to equal care.

Key words:
Inequalities; Gender; Health services; Health policies

Lifestyles	Men (%)	Women (%)
Recommended consumption of vegetables and fruits	10.2	15.4
Consumption of minimally processed foods	22.9	24.4
Regular consumption of soft drinks	11.6	7.2
Consumption of alcoholic beverages at least once a week	37.1	17.0
Alcohol abuse in the previous 30 days	26.0	9.2
Driving after alcohol consumption in the last 12 months	20.5	7.8
Current users of tobacco products	16.2	9.8
Recommended level of leisure physical activity	34.2	26.4
Recommended level of physical activity at work	49.2	34.4
Recommended level of physical activity in commuting	31.2	32.2
Recommended level of physical activity in domestic chores	9.1	21.8

Chronic Noncommunicable Diseases	Total (%)	Men (%)	Women (%)	Difference M-W (percentage points)
Arterial hypertension	23.9	21.1	26.4	5.3
Chronic spine problem	21.6	18.3	24.5	6.2
High cholesterol	14.6	11.1	17.6	6.5
Depression	10.2	5.1	14.1	9.0
Diabetes	7.7	6.9	8.4	1.5
Arthritis or rheumatism	7.6	3.7	11.0	7.3
Other mental diseases (1)	6.5	4.1	8.6	4.5
Heart disease	5.3	4.9	5.6	0.7
Asthma	5.3	4.4	6.1	1.7
Cancer	2.6	2.1	2.9	0.8
WRMD (Work-Related Musculoskeletal Disorder)	2.5	1.7	3.2	1.5
Stroke	2.0	2.0	2.0	0.0
Chronic renal failure	1.5	1.4	1.6	0.2

Gender or color/race	2008 (%)	2013 (%)	2019 (%)	Percentage variation 2008/2019 (%)	Mean appointments in 2019
With appointments last year
Men	59.8	64.5	71.6	19.8	3.5
Women	79.1	79.9	84.3	6.5	4.5
White	74.1	77.2	82.3	11.0	4.1
Black or brown	69.1	71.3	77.3	11.9	4.2
White men	62.8	68.7	75.8	20.8	3.6
Black or brown men	57.1	60.9	68.3	19.7	3.4
White women	81.3	82.5	86.4	6.3	4.4
Black or brown women	77.1	77.7	82.8	7.4	4.6
People with appointments last year and good or very good self-assessed health
Men	54.0	60.2	67.9	25.7	2.8
Women	75.3	76.1	81.0	7.7	3.8
White	69.9	73.3	79.4	13.7	3.5
Black or brown	63.2	65.9	72.3	14.5	3.3
White men	57.5	64.8	72.9	26.7	3.0
Black or brown men	50.6	55.8	63.3	25.2	2.7
White women	78.1	79.2	84.0	7.6	3.8
Black or brown women	72.3	73.0	78.5	8.5	3.7
People with appointments last year and regular. poor. or very poor self-assessed health
Men	77.1	75.2	80.2	4.0	4.9
Women	88.0	86.9	89.6	1.9	5.6
White	86.6	86.4	89.1	2.9	5.5
Black or brown	82.5	80.7	85.1	3.2	5.3
White men	80.6	79.7	84.5	4.9	5.4
Black or brown men	74.6	72.0	77.9	4.4	4.5
White women	89.8	89.9	91.3	1.7	5.6
Black or brown women	86.7	85.0	88.7	2.4	5.6

Fator	Coeficiente	Razão de chances (IC 95%)
Intercept	1.97	-
Gender
Men	-	1
Women	-0.15	0,86 (0,79; 0,95)
Color or race
White	-	1
Black or brown	0.07	1,07 (0,96; 1,19)
Age group
Less than 30 years	-	1
30-49 years	-0.16	0,85 (0,74; 0,98)
50-64 years	-0.25	0,78 (0,67; 0,90)
65 years and over	-0.32	0,73 (0,62; 0,85)
Self-assessed health
Very poor, poor, or fair	-	1
Good or very good	-0.07	0,93 (0,84; 1,04)
Reason for search	-	1
Accident	-	1
Disease	-0.65	0,52 (0,40; 0,68)
Tests	-1.34	0,26 (0,20; 0,35)
Prevention or follow-up	-1.32	0,27 (0,20; 0,35)
Location searched
Hospitals or public outpatient clinics	-	1
Hospitals, offices, or private outpatient clinics	0.15	1,17 (1,04; 1,31)

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

B Cobo worked on the project organization, design, bibliographic review, data analysis, writing, and final review. C Cruz worked on the design, bibliographic review, writing, and final review. PC Dick worked on the design, methodology, data analysis, writing, and final review.