Racial and income inequalities in access to health in Brazilian cities

Abstract

People’s access to public health services can importantly contribute to reducing the prevalence of diseases and increasing life expectancy. Despite the advances of Brazil’s Unified Health System (SUS), the country faces a permanent challenge in improving the coverage and equity of health services to reduce racial, spatial, and income inequalities in access to health. Several studies have explored the spatial dimension of socioeconomic inequalities in access to health services in Brazil, but few analyze such inequalities within cities and bring evidence on racial inequalities. This paper presents the first large-scale study in Brazil examining the social and racial inequalities of access to health services at a high spatial resolution. The analysis covers access to public services of primary care and high complexity by public transport, automobile, and walking for the 20 largest cities in Brazil in 2019. The results show that the low-income population, regardless of race, has greater accessibility to primary care services in general. In contrast, the high-income population, mostly white, has substantially better accessibility to high-complexity health services. Yet, we find that racial inequalities in access to health become much smaller when controlling for income. The results contribute to a better understanding of the geographical dimension of inequalities in access to health in major Brazilian cities, showing how access to healthcare is strongly conditioned by social, economic, and transport-related factors.