Desigualdades en salud para la población afrodescendiente de las Américas

Resum

Background: There are indications that the people of African descent of the Americas, as well as other ethnic groups, present more unfavorable health outcomes than the rest of the population. Numerous initiatives exist today to improve the situation in which people of African descent live, including the proclamation of the International Decade for People of African Descent (2015-2024) by the United Nations General Assembly. The need for evidence on ethnic inequalities in health responds to numerous international and regional commitments, including the 2030 Agenda for Sustainable Development and its pledge to leave no one behind. Objectives: The general objective is to analyze the health care of the Afro-descendant population of the Americas to identify inequalities. As specific objectives, the following were proposed: 1) Analyze regional policy efforts to address ethnic inequalities; 2) Conduct a systematic review of the literature to find evidence of health inequalities amongst people of African descent and other groups in the Americas and 3) Analyze racial discrimination and the quality of health services for the Afro-descendant population of the Americas, through a group of experts as key informants. Methodology: The study conducted in this thesis is divided in three stages. The first analyzed work promoted to address ethnic inequalities by the main international organizations, searching the websites and also the publications of organizations and entities that work with the Afro-descendant population in the region of the Americas. During the second, a systematic review of the literature was conducted to identify what evidence exists in the field of public health on the health inequalities amongst people of African descent in the Americas, related to their ethnic conditions, in comparison with other population groups in the same field. For this, bibliographic sources, and scientific databases (LILACS, PUBMED, MEDLINE and IBECS) were reviewed and institutional and academic repositories were consulted. In the third stage, a study with qualitative methodology was completed, conducting in-depth interviews with key informants. These included leaders of African descent, officials from the ministries of health, international health agencies, and international technicians specialized in Afrodescendant health and interculturality, from six countries. The extracted information was categorized and coded, generating the citations and concept maps. The concurrency coefficients made it possible to establish the link between the codes of each category studied with the central analytical category, and the concept maps were elaborated with the Atlas.ti v.8.2 software. Results: The Pan American Health Organization recognizes that people of African descent in the Americas face discrimination and exclusion, worse living conditions and health outcomes, which led it in 2017 to unanimously approve a policy on ethnicity and health and, in 2019, a strategy and action plan on ethnicity and health (2019-2025). We have observed operational problems with the use of the ethnic racial variable in surveys, censuses and registries that make it difficult to study the existence of discrimination within the group. Structural and functional racial discrimination is associated with spatial segregation in urban and rural areas, as well as with social class, gender inequalities and other conditions that constitute access barriers and problems in the quality of health care. All the above shows the non-availability of health services in the places where people of African descent live; it has been shown that the contributions of traditional medicine and midwifery enhance universal health coverage in these settings; how the adoption of measures within the framework of intercultural health could help improve the health outcomes of people of African descent; and how analyzing the differences between countries would allow the identification and dissemination of good practices that are successful. Conclusions: Racial discrimination is present in health services, and in the unavailability of these services in places where people of African descent live. There is evidence of the undervaluation given to people of African descent when providing health services, the stigmatization they suffer from some types of health issues and the problems associated with the quality of services. There is a need to continue promoting intercultural approaches and to involve leaders of African descent in any matter related to their health and well-being. The results reveal the need for political commitment and a consensual strategic framework to advance towards equity in health.