Acceso de la población negra a servicios de salud: una revisión integrativa

revisión integrativa de la literatura a partir de la siguiente pregunta: ¿Cómo ocurre el acceso de la población negra a los servicios de salud? Se realizó una búsqueda en las bases de datos Scholar, LILACS y SciELO, utilizando el descriptor “acceso a los servicios de salud” y el término “población”, lo que resultó en una muestra con 12 artículos.

Resultados:

los estudios demuestran que la dificultad de acceso es un factor fundamental para la calidad de vida de las personas, lo que afecta directamente los servicios preventivos, principalmente en la salud de la mujer e impacta más aún en el proceso de padecimiento de la población negra dentro de sus particularidades.

Consideraciones Finales:

diversos factores limitantes afectan el acceso de la población negra a los servicios de salud, desde institucionales hasta estructurales.

Descriptores:
Grupo de Ascendencia Continental Africana; Accesibilidad a los Servicios de Salud; Salud de las Minorías Étnicas; Atención Primaria de Salud; Política de Salud

Title/author year/country	Design n=	Objectives	Results
Utilização de serviços de saúde por população quilombola do Sudoeste da Bahia, Brasil. Gomes KO et al.⁽⁸8 Gomes KO, Reis EA, Guimarães MDC, Cherchiglia ML. [Use of health services by quilombo communities in southwest Bahia State, Brazil]. Cad Saúde Pública. 2013;29(9):1829-42. doi: 10.1590/0102-311X00151412 Portuguese. https://doi.org/10.1590/0102-311X0015141... ⁾, 2011. Brasil.	Cross-sectional, cohort n=797	Analyze the use of health services by the Quilombola population of Vitoria da Conquista, Bahia, Brazil.	The prevalence of health services use by the Quilombola population (57.1%) was lower than that found in other populations. In São Paulo, SP, and Pelotas, RS, the prevalence of 64.4% and 60.6% of health services use was observed, respectively. The services use proportion in the last 15 days in these communities was low (8.3%) compared with national data (13.4% in 1998, 13.9% in 2003, and 14.2% in 2008).
Equidad de etnia en el acceso a los servicios de salud en Bogotá, Colombia. Ariza-Montoya JF, Hernández-Álvarez ME⁽⁹9 Ariza-Montoya JF, Hernández-Álvarez ME. [Ethnic equity in accessing health services in Bogotá, Colombia, 2007]. Rev Salud Pública [Internet]. 2008 [cited 2018 May 16];10(1):58-71. Available from: https://scielosp.org/pdf/rsap/2008.v10suppl1/58-71/es Spanish. https://scielosp.org/pdf/rsap/2008.v10su... ⁾, 2007. Colombia.	Qualitative, documentary study. n=39	Trace inequalities in access to health services resulting from ethnicity in Bogotá.	Ethnic inequalities exist in Bogotá, with regard to access to health services, with evidence of violation of rights, discrimination and lack of recognition of ethnic differences.
Non-Adherence to antiretroviral treatment by people living with HIV/AIDS in black communities in South Africa: socio-cultural challenges. Kheswa J⁽¹⁰10 Kheswa JG. Non-adherence to antiretroviral treatment by people living with HIV/AIDS in black communities in South Africa: socio-cultural challenges. Mediterranean J Soc Sci. 2014;5(14):450-57. doi: 10.5901/mjss.2014.v5n14p450 https://doi.org/10.5901/mjss.2014.v5n14p... ⁾, 2014. South Africa.	Reflection article.	Provide an integrated approach to strengthen the support base necessary for adherence to antiretroviral treatment.	The results show that, due to discrimination and, consequently, to the difficulty of access, people living with HIV/AIDS experience more of its side effects, such as depression and Kaposi's sarcoma, until death.
Mulheres negras e brancas e os níveis de acesso aos serviços preventivos de saúde: uma análise sobre as desigualdades. Goes EF, Nascimento ER⁽¹¹11 Goes EF, Nascimento ER. [Black and white women and the accessibility to preventive health services: an analysis of inequalities]. Saúde Debate. 2013;37(99):571-9. doi: 10.1590/S0103-11042013000400004 Portuguese. https://doi.org/10.1590/S0103-1104201300... ⁾, 2013. Brazil.	Descriptive and quantitative n=10,291	Determine differentials of the sociodemographic characteristics and the levels of access to preventive services of women in Bahia, according to race/color.	The study shows that 15.4% of white women have a good level of access, while only 7.9% of black women have it. It is concluded that the barriers to access to health services of black women are racial inequalities and institutional racism.
Uso dos Serviços Públicos de Saúde para DST/HIV/Aids por comunidades remanescentes de quilombos no Brasil. Silva MJG, Lima FSS, Hamann EM⁽¹²12 Silva MJG, Lima FSS, Hamann EM. [Use of STD/HIV/AIDS-Oriented public health care services by Quilombo communities in Brazil]. Saúde Soc. 2010;19(2):109-20. doi: 10.1590/S0104-12902010000600011 Portuguese. https://doi.org/10.1590/S0104-1290201000... ⁾, 2010. Brazil.	Qualitative and quantitative n=218	Describe the conditions of the black population's access to diagnosis and care for STD, HIV/Aids	Black people have greater difficulties in health and care services, complaints of STD symptomatology and higher frequency of self-medication when compared with non-blacks.
Acessibilidade à atenção básica a famílias negras em bairro popular de Salvador, Brasil. Trad LA, Castellanos MEP, Guimaraes MCS⁽⁴4 Trad LAB, Castellanos MEP, Guimarães MCS. Accessibility to primary health care by black families in a poor neighborhood of Salvador, Northeastern Brazil. Rev Saúde Pública. 2012;6(46):1007-13. doi: 10.1590/S0034-89102012000600010 https://doi.org/10.1590/S0034-8910201200... ⁾, 2012. Brazil	Ethnographical, founded on basic anthropology Interpretative. n= 42	Analyze the accessibility of black families from a popular neighborhood to primary health care services.	The barriers to access to health services that are interposed between the provision of services and the fulfillment of the black population's needs are economic, organizational and cultural barriers.
The Influence of access related factors on adherence to clinical practice guidelines for muscle invasive bladder cancer. Stimson CJ et al.⁽¹³13 Stimson CJ, Resnick MJ, Patel SG, Zaid HB, Cookson MS, Penson DF, et al. The influence of access related factors on adherence to clinical practice guidelines for muscle invasive bladder cancer. Urology Practice. 2012;1(3):127-33. doi: 10.1016/j.urpr.2014.05.004 https://doi.org/10.1016/j.urpr.2014.05.0... ⁾, 2014. USA.	Descriptive and quantitative n=27,585	Test whether access-related characteristics are associated with adherence to guidelines for invasive muscular bladder cancer and whether the association between access-related characteristics and adherence to guidelines varies according to geographic region.	Race, status of insurance, income and hospital volume showed variation between regions as predictors of treatment with radical cystectomy/dissection of pelvic lymph nodes.
Comunidade quilombola: análise do problema persistente do acesso à saúde, sob o enfoque da Bioética de Intervenção. Vieira ABD, Monteiro OS⁽¹⁴14 Vieira ABD, Monteiro PS. [Quilombola community: analysis of the persistent problem in health attention under the focus of the Intervention Bioethics]. Saúde Debate. 2013;37(99):610-18. doi: 10.1590/S0103-11042013000400008 Portuguese. https://doi.org/10.1590/S0103-1104201300... ⁾, 2013. Brazil.	Descriptive and quantitative n=12	Contextualize the socio-epidemiological profile related to the living conditions of the Kalunga Quilombola community from the perspective of Intervention Bioethics.	The results indicate problems related to social and health issues, difficulties in promoting the inclusive processes of universality and equity in health for blacks.
Política Nacional de Saúde Integral da População Negra: implementação, conhecimento e aspectos socioeconômicos sob a perspectiva desse segmento populacional. Neto JAC⁽¹⁵15 Chehuen Neto JAC, Fonseca GM, Brum IV, Santos JLCT, Rodrigues TCGF, Paulino KR, et al. [The National Comprehensive Health Policy for the Black Population: implementation, awareness and socioeconomic aspects from the perspective of this ethnic group]. Ciênc Saúde Colet. 2015;20(6):1909-16. doi: 10.1590/1413-81232015206.17212014 Portuguese. https://doi.org/10.1590/1413-81232015206... ⁾, 2014. Brazil.	Cross-sectional, descriptive, quantitative n=391	Investigate the black population's knowledge about the policy, its potential benefits and the difficulties of access to health.	About 90% of respondents reported not knowing the existence of a health policy for the black population and 53% declared a possible racial discrimination. When asked about the black population's access to health, the black people considered this access to be more difficult (56.4%).
Oportunidade perdida para diagnóstico oportunista de diabetes Mellitus em comunidades quilombolas do sudoeste da Bahia, Brasil. Souza CL, Barroso SM, Guimarães MDC⁽¹⁶16 Souza CL, Barroso SM, Guimarães MDC. [Missed opportunity for timely diagnosis of diabetes mellitus in Afrodescendant communities in the southwest of the state of Bahia, Brazil]. Ciênc Saúde Colet. 2015;19(6):1653-62. doi: 10.1590/1413-81232014196.08662013 Portuguese. https://doi.org/10.1590/1413-81232014196... ⁾, 2013. Brazil.	Population-based, cross-sectional. n=548	Estimate the prevalence and the factors associated with the loss of opportunities for diagnosing Diabetes (PDO) in Quilombola communities, located in the rural area of Vitória da Conquista, Bahia, Brazil.	The loss of opportunity for opportunistic diagnosis (PDO) of DM in this population was 42.6% and corroborates data from other studies on PDO. The index of access to services was evaluated as poor in 28.4% of the individuals. A proportion of self-reported DM of 8.2%, higher than the Brazilian average of 5.6%.
Assessing equitable care for Indigenous and Afro descendant women in Latin America. Castro A, Savage V, Kaufman H⁽¹⁷17 Castro A, Savage V, Kaufman H. Assessing equitable care for Indigenous and Afrodescendant women in Latin America. Rev Panam Salud Publica [Internet]. 2015 [cited 2019 Apr 16];38(2):96-109. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26581050 https://www.ncbi.nlm.nih.gov/pubmed/2658... ⁾, 2015. USA.	Literature review.	Trace and understand the barriers to equitable care within the health environments that women of ethnic minorities find in Latin America and examine possible strategies to mitigate the problem.	Health provider discrimination against indigenous and Afro-descendant women is a primary barrier for access to quality health in Latin America. Discrimination is motivated by prejudice against populations of ethnic minorities, women and the poor in general.
O encontro mais estranho de todos: discriminação étnica e racial no sistema de saúde dos Estados Unidos. Sherman AJ⁽¹⁸18 James SA. The strangest of all encounters: racial and ethnic discrimination in US health care. Cad Saúde Pública. 2017;33(Suppl 1):e00104416. doi: 10.1590/0102-311x00104416 https://doi.org/10.1590/0102-311x0010441... ⁾, 2017. USA.	Literature review.	Selectively analyze studies published after 2003 on the probable contribution of the unconscious bias of physicians to the disparities of U.S. health services.	The reviewed studies found an unconscious "pro-white" bias in the attitudes of physicians in relation to interactions with patients, although some evidence suggests that black and female physicians may be less prone to this bias. Limited social contact between white physicians and racial/ethnic minorities outside medical environments, as well as severe time pressures that physicians often face during encounters with patients who have complex health problems, may increase their susceptibility to the unconscious bias

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[1] Corresponding author: Veronica Batista Cambraia Favacho. E-mail: vv.favacho@gmail.com