Quota member doctors expand debate on race and gender in health – 01/06/2024 – Balance and Health

A new generation of health professionals has changed the traditional view of the male doctor, white and over 50 years old. They are young, black professionals, more diverse in terms of gender and sexuality and who often had their basic education in public schools. Many were the first generation in their families to have a higher education degree, and entered universities through programs such as Lei das Quotas, from 2012, or ProUni (University for All Program), from 2005.

This new generation also brings a diverse perspective to clinical practice, understanding that race, gender, sexuality, place of life and income influence health conditions, which must be considered in clinics and hospitals to reduce inequalities and provide more humanized care.

According to data from the 2023 Medical Demography, which uses the Inep system (National Institute of Educational Studies and Research), linked to the MEC (Ministry of Education), in the period from 2010 to 2019 there was an increase in black students (black and mixed race) in the country’s medical courses, increasing from 1,483 in 2010 (25.1%) to 9,326 in 2019 (27.7%).

The change occurred in part due to more declarations from new entrants, as well as an increase in the number of total vacancies available in the period. There was also an increase in graduates who attended public school in the same period, from 25.9% (2010) to 29.8% (2019).

“This movement, which began around 10 years ago with the quota policy, there are already studies that demonstrate how diversity in universities brings this discussion to academia, because it is the minority population that asks these questions and instigates the gender debate and race in the academic environment”, explains Abna Vieira, oncologist at Icesp (São Paulo State Cancer Institute) and Oncoclínicas and one of the founding members of the Diversity Committee at Sboc (Brazilian Society of Clinical Oncology).

The doctor cites a study published last year in the magazine Jama Network Open linking the 10% increase in black medical professionals in primary care in the country with the increase in life expectancy of 31 days for the black population. “And that’s the importance of representation, it literally saves lives,” she said.

This is, in part, because there is unconscious bias among many white doctors when treating black patients. A study in the United States shows that black women suffer more obstetric violence than white women. Another reason is health issues associated with minority groups are better understood by similar people.

“People listen better to their peers. So, they need to recognize themselves in those who are providing assistance, and from there we can establish more empathy, dialogue, and the patient’s vision of the treatment”, says the oncologist. There are also studies that indicate that the positive outcome of surgeries on female patients carried out by doctors is generally higher than those operated on by male surgeons.

According to Vieira, there is still a long way to go, as racism in the country continues to be strong, including within hospitals. “In residency, I had a patient who didn’t agree to see me, claiming I was too young, but he saw a resident doctor. [mesma idade] white. Even today I see people who pass me in the corridor and only wave after seeing my badge, as if it were confirmation that I am ‘a doctor, so it’s okay to be there’. It is difficult to combat veiled racism, but we have made progress, especially in congresses and scientific meetings”, she says.

Despite the recent increase in black and brown professionals in Brazil, there is still a long way to go to achieve racial equality in medicine: a survey carried out in 2020 with a public university in Rio de Janeiro, published in the Revista Brasileira de Educação Médica, shows that brown people are less than a quarter (23.6%) of doctors, black are 3.2%, while whites continue to be the largest portion (69.9%).

Similar data were found in the first Brazilian Oncology Census, published last November by Sboc (Brazilian Society of Clinical Oncology), which shows that 81% of oncologists are white, 26% are mixed race and 2% are black.

According to the latest IBGE (Brazilian Institute of Geography and Statistics) census, the majority of the population is brown (45.3%), followed by whites (43.5%) and blacks (10.2%).

Diversity in medicine matters because, in Brazil, as in other countries, health indicators are worse for the black population, due to the so-called social determinants of health, defined as social, economic, cultural, racial factors, among others, which influence the occurrence of health problems and their risk factors in the population. This is, for example, the case of sickle cell anemia, a disease whose prevalence is higher in the black population.

“We have the image that because it is a mixed-race country, the conditions that afflict the black population are associated with poverty, and not because of racism, which is false. If we do not have this perspective, we will not be able to bring about the importance of discuss racism in healthcare”, says oncologist and professor at the Oncology Outpatient Clinic at UFBA (Federal University of Bahia), Ana Amélia Viana. “All these issues that relate to diversity are affected by biases that people don’t want to discuss.”

According to data from the 1st epidemiological bulletin of the black population from the Ministry of Health, from October 2023, the five main causes of mortality in the black population in 2020 were: Covid, cerebrovascular diseases, ill-defined signs and symptoms, ischemic heart diseases and diabetes mellitus. Among brown people, the 5th most common cause was aggression.

According to Viana, it is important to encourage debate, including to expose the different service scenarios in private and public networks, since the needs of each system will be different. “The majority of medical students do not deal with the reality of the SUS [Sistema Único de Saúde] and, after training, they work in their specialty, without ever being exposed to that social vulnerability.”

Doctors understand that the inclusion of debate in medical schools is a gradual process, brought about by doctors who graduated in the last decade and who are now professors at medical schools. “Medicine courses do not address, for example, the health problems of the black population, of the indigenous population. These are topics brought up by black collectives, by black doctors, and which are able to gather data and take it to the higher levels of the faculty, but this needs to be expanded”, argues Vieira.

For the oncologist from Bahia, a way to expand the discussion would be, first, to recognize the limitation of care provided by white professionals in relation to other groups. “If you are not aware and do not actively seek to reduce these differences, you will run more risks. So the white doctor, he took an oath to provide care regardless of skin color and race, so I believe in empowerment”, he adds.

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