Black and mixed-race Brazilians die younger and receive worse healthcare than White Brazilians, yet the policies meant to close these gaps have never been rigorously evaluated. This project will measure how racial health inequalities in Brazil have changed over time, and test whether specific policies—including the National Health Policy for Black People, university quotas, and the Bolsa Família welfare programme—have actually reduced them. The researchers will also examine less visible drivers of inequality, such as how health-system financing and unconscious bias among clinicians affect treatment decisions for Black patients. If successful, the work will produce the first systematic evidence on what works to reduce racial health inequalities in a large middle-income country. That evidence could reshape how Brazil allocates health funding, trains its clinicians, and designs future policies. Because Brazil’s racial dynamics mirror those in many other low- and middle-income countries, the findings may also inform health-system reforms across Latin America and beyond. The project will simultaneously train a new generation of Black Brazilian researchers, strengthening the country’s capacity to study and address its own inequalities long after the grant ends.
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RESEARCH QUESTION How have racial health inequalities in Brazil evolved over time, and what are the roles of policies and the health system in exacerbating or mitigating them? BACKGROUND Racial/ethnic health inequalities are large and unjust. Health systems can ameliorate these inequalities, but evidence gaps are hampering progress. Gaps include weak evidence on policy interventions to address racial/ethnic health inequalities in LMICs. Brazil is a country with large racial inequalities. Evidence from Brazil can inform interventions in other LMICs. Black and Pardo (mixed race) Brazilians are disadvantaged across many socioeconomic domains. They have lower healthcare access and quality and have worse health outcomes than White Brazilians. The magnitude and trends of racial health inequalities in Brazil are not well documented and causal methods are infrequently applied to racial inequalities. Brazil has introduced specific policies to improve Black population health, but these remain unevaluated, as do the racial impacts of other health system factors. This policy context, high-quality data systems, and an engaged and active civil society make this the right moment to advance this important research agenda. AIMS AND OBJECTIVES 1. Co-produce indicators on racial inequalities in health and healthcare access. 2. Identify the impacts of health system factors (such as financing arrangements and implicit bias in health professionals) on racial health inequalities and explore political, civil society, managerial, and economic factors as drivers of racial health inequalities. 3. Evaluate race-related policies (National Health Policy for Black People), affirmative action (educational quotas), and welfare policies (Bolsa Familia), understanding health system and health inequalities impacts. 4. Engage stakeholders in the research and advocacy activities. 5. Strengthen research capacity, especially for Black researchers. 6. Build capacity among key stakeholders to uptake research results and influence policy. METHODS This is a mixed methods approach triangulating three research work packages (WPs) and one CEI WP: WP1: A comprehensive analysis of routine datasets to provide panorama of the trends in racial inequalities in health outcomes and in healthcare access and quality. WP2: Quantitative, quasi-experimental studies examining racial impacts of policies (the National Health Policy for Black People), financing, affirmative action policies (educational quotas) and welfare policies (Bolsa Familia). WP3: Qualitative approaches to analyse implicit bias and associated healthcare professionals’ treatment decisions (survey and vignettes) and to investigate policy process and implementation mechanisms driving inequalities (interviews, case studies). WP4: CEI involving stakeholder mapping, an advocacy strategy, a coproduced synthesis of project findings, policy engagement and refinement, and dissemination activities. ANTICIPATED IMPACT AND DISSEMINATION Outputs: Academic papers, policy briefs, monitoring indicators, stakeholder workshops, data dashboards/visualizations, social media campaigns, and conference presentations. Medium/longer terms impacts: Brazil-based evidence on racial/ethnic health inequalities and health system factors driving these; improved race-conscious policies; capacity for evidence production and usage; and health services that better address racial/ethnic health inequalities.
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