Health Equity in Brazil: Intersections of Gender, Race, and Policy
Health Equity in Brazil: Intersections of Gender, Race, and Policy
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巴西的卫生公平：性别、种族和政策的交叉点
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发表时间：
2017
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通讯作者：
K. Caldwell
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作者：
K. Caldwell
起亚·莉莉·考德威尔的书填补了巴西卫生政策和社会正义方面的学术空白。关于阶级、性别和种族如何影响获得医疗保健和健康结果的大量文献与对所有这些类别中的弱势群体的经历的研究很少形成鲜明对比；即贫穷的黑人妇女。考德威尔关注这一群体，她解释说，单独考虑种族、性别或阶级的分析无法完全捕捉他们独特的经历，从而证明了她的交叉方法的合理性。除了讨论一个重要且研究不足的主题外，本书还介绍了妇女和黑人妇女运动活动家对种族歧视、人权和健康相关问题的看法。因此，出于实质性和方法论原因，巴西的健康公平是一项相关贡献。这本书以三个观察开始。首先，尽管存在全民公共卫生系统，但巴西白人和非洲裔巴西人的健康结果仍存在显着差异。其次，女性的多项生育权利被剥夺，这对她们的健康产生了影响，这一问题对于黑人女性来说更为严重。第三，巴西是“种族民主国家”的神话虽然与事实相矛盾，但却是推进旨在纠正种族不平等的平权政策的持续障碍。这些观察结果为分析活动人士在引起人们对健康方面的种族差异的关注以及倡导改善非裔巴西人口，特别是黑人妇女的健康状况的政策方面所发挥的作用奠定了基础。第一章重点讨论女权主义活动家在将性别和种族问题纳入卫生政策辩论中的作用。考德威尔描述了这些活动人士如何挑战被视为有害妇女健康的政策，并倡导采取措施保护妇女的生殖权利。第二章解释了本书的交叉方法，并提供了证据表明黑人妇女因妇女生殖权利保护不足而受到更严重的影响。它还讨论了黑人妇女组织如何引起人们对健康方面种族不平等的关注。第三章和第四章分析了黑人活动人士为确认在讨论健康不平等时考虑种族和种族主义的重要性而进行的斗争。这些章节认为，巴西公共卫生系统中存在“制度性种族主义”，与白人相比，黑人的健康状况较差，而且镰状细胞性贫血（一种在非洲人后裔中患病率较高的疾病）的诊断和治疗不充分就表明了这一点。第五章讨论艾琳·皮门特尔（Alyne Pimentel）的案例，她是一位怀孕的贫穷黑人妇女，她因医疗过失以及缺乏足够的孕产妇和产科护理而死亡。这个案例用来说明性别、种族和阶级之间的交叉关系，这种关系塑造了巴西贫困黑人妇女的经历。在第 6 章中，考德威尔承认巴西艾滋病毒/艾滋病政策的成功，但批评该政策仅关注社会经济劣势这一事实，138 拉丁美洲政治与社会 60：3
Kia Lilly Caldwell’s book fills a gap in the scholarship on health policies and social justice in Brazil. The extensive literature on how class, gender, and race affect access to health care and health outcomes contrasts with the paucity of research on the experience of those at the underprivileged end of all these categories; namely, poor black women. Caldwell focuses on this group, and she justifies her intersectional approach by explaining that their unique experience cannot be fully captured by analyses that consider race, gender, or class separately. Apart from addressing an important and underresearched topic, this book also presents the perspective of activists in women’s and black women’s movements on issues related to racial discrimination, human rights, and health. Health Equity in Brazil is thus a relevant contribution for substantive and methodological reasons. The book starts with three observations. First, there is a significant disparity in health outcomes between white and African-descendant Brazilians, despite the existence of a universal public health system. Second, women are denied several reproductive rights, which has an impact on their health, and this problem is more severe for black women. Third, the myth that Brazil is a “racial democracy,” although contradicted by the facts, is a persistent obstacle for advancing affirmative policies aimed at redressing race inequalities. These observations set the scene for the analysis of the role activists have played in drawing attention to the racial disparity in health and in advocating policies to improve the health status of the Afro-Brazilian population, and of black women in particular. Chapter 1 focuses on the role of feminist activists in placing issues of gender and race in the debates about health policies. Caldwell describes how these activists have challenged policies seen as detrimental to the health of women and have advocated measures to protect women’s reproductive rights. Chapter 2 explains the book’s intersectional approach and presents evidence that black women are more harshly affected by the insufficient protection of women ́s reproductive rights. It also discusses how black women’s organizations have drawn attention to race inequalities in health. Chapters 3 and 4 analyze the black activists’ fight to affirm the importance of considering race and racism when discussing health inequality. These chapters argue that “institutional racism” exists in the Brazilian public health system, as shown by the worse health outcomes of black people when compared to the white population and by the insufficient diagnosis and treatment of sickle cell anemia, a disease with higher prevalence among African-descendants. Chapter 5 discusses the case of Alyne Pimentel, a pregnant poor black woman, who died due to medical negligence and to the lack of adequate maternal and obstetric care. This case is used to illustrate the intersectional relationship between gender, race, and class that shapes the experience of black poor women in Brazil. In chapter 6, Caldwell recognizes the success of the policy for HIV/AIDS in Brazil but criticizes the fact that it focused on socioeconomic disadvantage only and 138 LATIN AMERICAN POLITICS AND SOCIETY 60: 3