Prospecting health policy finds effects of racial inequality on youth in Bahia

The Health and Racial Equality Promotion Secretariats of Bahia, in partnership with Agenda Jovem Fiocruz, delivered on March 12th the results of a survey on the health situation of young people and adolescents. These age groups represent 29.6% of the Bahian population, with young people between 15 and 29 years old making up 22.4%.

The research is the first phase – called prospecting – of developing a care policy for youth and adolescence for the Unified Health System (SUS) in the states of the Northeast, the result of a partnership between state governments in Bahia, Ceará, Rio Grande do North and the city of Recife with Agenda Jovem Fiocruz and the Samuel Barnsley Pessoa School Health Center (CSEB) of the USP Faculty of Medicine. Fiocruz Bahia was also part of the prospecting in this state.

The objective is to respond to the health demands of adolescents and young people from primary care, taking as inspiration the Care Line for Adolescents and Young People (LCA&J) implemented in the state of São Paulo. This is a “bottom-up” policy, that is, it is made based on the demands of the population. In the prospecting phase, each state can identify these local demands to direct health policies in the most appropriate way.

In Bahia, one of the main issues identified is racial inequality in health problems. However, SUS services are no longer recording patients’ race/color identification.

“We found great underreporting of the black and indigenous population in the data. This information is part of the health system’s routine, but it is still neglected”, said the researcher responsible for the project, Gilmara Silva de Oliveira. “This shows the importance of expanding ongoing training for SUS managers and workers, thinking about institutional racism as a social determinant of health conditions”, warned the scientist.

In total, 25% of consultations did not meet the race/color criteria of the patients. However, considering the data with this information, the black and brown population accounts for approximately 94% of hospitalization cases in all indicators analyzed. In Bahia, 81% of the population is considered black, with 58.6% being mixed race people and 22.4% black people.

The researchers recommend that the Ilhéus health macro-region be the pilot region for implementing the care policy. It was chosen because it presents a number of rural, quilombola and indigenous communities, in addition to already being the target of monitoring the health of adolescents, thanks to researchers from the Núcleo Jovem Bom de Vida, at the State University of Santa Cruz de (UFSC).

For Marilda Gonçalves, a researcher at Fiocruz Bahia, the research is especially important to improve attention and health care for young people and adolescents. “This study brings hope regarding the monitoring of adolescents, young people and their families, in several states of the Federation. It fills us with hope for a rapid change in the situation that has been described”, says the scientist.

Young people suffer from violence and pregnancy

The researchers collected data on SUS care in 2021. More than half (58%) of hospitalizations of young people and adolescents were women, caused by pregnancy, childbirth and the postpartum period (the period immediately after pregnancy). Of these hospitalizations, 7.6% resulted in pregnancy abortion.

The racial profile once again shows differences between Bahian women. Among white young women and adolescents, more than 70% had seven or more prenatal consultations. Among black women, this percentage is 65.6%, and among indigenous mothers, 52%.

In the Ilhéus region, 7.4% of women in this age group did not have any prenatal consultations, and more than half (53.8%) did not have 7 consultations.

The male population of young people and adolescents suffers mainly from aggression, especially among young black people. Of all deaths of young people and adolescents in Bahia in 2021, 91% were of mixed race (75.1%) and black people (8.6%).

Taking into account the entire young and adolescent population, 65.8% of deaths were caused by attacks, with a further 10% resulting from the actions of security forces.

Young men and adolescents accounted for 80.5% of hospitalizations for “external causes” in the SUS in 2021, a category that includes accidents, violence and poisoning: 42% of all hospitalizations of young men and adolescents were due to “external causes” that year .

Care Line

Lines of Care are a strategy for organizing health care in the SUS, which seeks to articulate the entire network of services in a territory from Basic care to care for a specific population or health issue. The objective of the Fiocruz Youth Agenda, the CSEB LCA&J Research Team and the state secretariats is to develop a Line of Care specifically for young people and adolescents, a public that receives little attention from health services.

“Young people have different needs according to their age group and other social markers. For example, not all young people are teenagers”, explains André Sobrinho, coordinator of Agenda Jovem Fiocruz. “Despite suffering from various health problems, young people have difficulty accessing services. Therefore, a Care Line can offer better support to this population. This requires alignment between research and management, which opens up many possibilities for adapting to the territory”, he adds.