Mapping the Margins in Health Services Research: How Does Race Intersect With Gender and Socioeconomic Status to Shape Difficulty Accessing HealthCare Among Unequal Brazilian States?

Abstract

Research on healthcare inequities has centralized whether marginalized racial, gender, or socioeconomic (SES) groups are afforded equitable access to care, yet scant investigations have focused on how race intersects with other social statuses to shape difficulty accessing health services. Contextual specificity has also been under-researched in this field of knowledge. Data from 59,249 respondents 18 years of age and over from the 2013 Brazilian National Health Survey were analyzed using multilevel regressions models. We test 3 hypotheses: racial, gender, and socioeconomically oppressed groups are each more likely to report difficulty accessing health services (H1); compared to high-SES white men, low-SES Black women report expressively higher frequencies of the outcome (H2); and intersectional healthcare inequities are larger among low-SES Brazilian states (H3). Partially supporting H1 and H2, results suggest that race and SES, but not gender, are each strong predictors of difficulty accessing healthcare, with low-SES Black respondents facing the highest odds of reporting this outcome. Although H3 was not supported, intersectional groups residing in low-SES Brazilian states were more likely to report difficulty accessing healthcare. This study demonstrated that, together with contextual specificity, the intersections of race with other axes of marginalization should be at the forefront of research and policy addressing healthcare inequities.

The door is open, but not everyone may enter: racial inequities in healthcare access across three Brazilian surveys

“…The higher coverage by the FHS among Blacks has not been followed by lower perceived difficulty accessing health services, though, which also confirms our H1. Mirroring previous research findings [HM Constante and JL Bastos 17 , who further adjusted the analysis for a range of covariates, such as level of education and gender], our results consistently show that perceived difficulty accessing health services was higher among Blacks than whites across the entire period of observation and in all Brazilian geographic regions. This subjective indicator of healthcare access may not be grounded on lived experiences within the health system, but can certainly affect healthcare seeking behaviors and the overall satisfaction with care, which will then influence future experiences with service provision.…”

“…Building on a recent publication 17 that documented racial inequities in difficulty accessing health services in Brazil, the present study analyses racial inequities in healthcare over a period of ten years. The study aimed to estimate racial inequities in access to health services in three different policy scenarios.…”

The Impact of COVID-19 on HIV Care in Rio de Janeiro, Brazil 2019–2021: Disparities by Age and Gender

“…These factors have contributed to socioeconomic disadvantage and worse health outcomes, including high infant and maternal mortality, low life expectancy, poor health, and social infrastructure [ 36 ]. Further, the COVID-19 pandemic has been shown to disproportionately impact racial minorities in other countries, and health care inequalities for black and pardo groups in Brazil have been shown typically parallel those of racial and ethnic minorities in the United States, China, and the United Kingdom [ 37 ]. For instance, a study of 101 black Americans living with HIV in California showed that those who had more negative impacts from COVID-19 demonstrated lower ART adherence [ 38 ].…”

Discriminatory experiences among gay, bisexual, and other men who have sex with men, and transgender and non-binary individuals: a cross sectional analysis

“…In Brazil, recent studies have demonstrated the benefits of instruments that consider shared experiences at the intersections of race, gender, sexual orientation, and other axes of inequality. 13 , 14 However, no previous investigation has focused on MSM and TGNB, examining the varying salience of specific forms of discrimination, such as racism.…”

“… 18 Ultimately, racism jeopardizes the possibility of several opportunities, including access to health care, which directly contributes to worse health outcomes for Black compared to White Brazilians. 14 , 19 …”