Racism and the Production of Care in the Brazilian Unified Health System (SUS): Challenges for Primary Health Care

Abstract

The struggle of the organized Black movement led to the approval of the National Policy for Comprehensive Health of the Black Population (PNSIPN – acronym in Portuguese) in 2009, a milestone in the recognition of institutional racism within the Unified Health System (SUS – acronym in Portuguese). This article aims to analyze the production of care for the Black population within the context of Primary Health Care (PHC), in the Greater ABC region, considering challenging to the principle of equity and to the implementation of the PNSIPN. This is a qualitative study involving twentyfour semi-structured interviews with managers, social actors, health professionals, and users of the Brazilian SUS. The narratives revealed political and institutional barriers to implementing the PNSIPN, including professionals’ lack of awareness, the absence of race/color data in health information systems, and resistance to recognizing racism as a structuring element of the health-disease process. Drawing on Sueli Carneiro, the study argues that the raciality dispositif selectively activates biopower— deciding who is entitled to “make live” and who is condemned to “let die.” Achieving racial equity within SUS requires acknowledging institutional racism as a determinant of inequities and incorporating antiracist practices in health services. The right to health remains denied to the Black population.