Comparative Analysis of the Constitution and Implementation of Race/Skin Color Field in Health Information Systems: Brazil and South Africa

Abstract

The inclusion of race/skin color in Health Information Systems makes it possible to measure health inequities. Brazil and South Africa correspond to countries marked by profound inequalities, multiracial constituted that suffered from the historical process of colonization, and had racism legitimized as a structuring model of state development. The objective is to compare the information systems of Brazil and South Africa regarding the configuration and implementation of the item race/skin color. This is a qualitative, descriptive study, based on the content analysis proposed by Bardin. A survey on race/skin color was carried out in health department documents and ministerial sites in both countries. The collected material was processed and analyzed utilizing the IRAMUTEQ R software, version 0.7 alpha 2, with a test × 2 > 3.80 (p < 0.05), and by the TABNET application version 4.14 and Excel software, version 2016. In Brazil and Africa South, several health information systems did not include race/skin color. In both countries, health information systems were boosted in the mid-1990s. In Brazil, of the systems that provide data by race/skin color, the inclusion occurred after claims by the black movement. In South Africa, through the creation of the respective systems. The historical configuration of the question of race/skin color in both countries was guided by political and ideological references. In multiracial and unequal countries, race/skin color is a central political category to promote health equity.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Guimarães ASA. Racismo e anti-racismo no Brasil. São Paulo: Fundação de Apoio à Universidade de São Paulo; 1999.

    Google Scholar 

  2. 2.

    Williams DR. Race and health: basic questions, emerging directions. Ann Epidemiol. 1997;7:322–33. https://doi.org/10.1016/s1047-2797(97)00051-3.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Paixão M, Carvano LM. Censo e Demografia. A variável cor ou raça nos interior dos sistemas censitários brasileiros. In: Sansone L, Pinho OA, editors. Raça: novas perspectivas antroplógicas. 2 ed. rev. Salvador: Associação Brasileira de Antropologia: EDUFBA; 2008. 447 p.

    Google Scholar 

  4. 4.

    American Sociological Association (ASA). The importance of collecting data and doing scientific research on race. Washington, DC: American Sociological Association; 2003.

    Google Scholar 

  5. 5.

    Faro A, Pereira ME. Raça, racismo e saúde: a desigualdade social da distribuição do estresse. Estud Psicol. 2011;16:271–8. https://doi.org/10.1590/S1413-294X2011000300009.

    Article  Google Scholar 

  6. 6.

    de Araújo EM, Costa M da CN, Hogan VK, de Araújo TM, Dias AB, Oliveira LOA (2009) A utilização da variável raça/cor em Saúde Pública: possibilidades e limites. Interface - Comunic., Saude, Educ. https://doi.org/10.1590/S1414-32832009000400012

  7. 7.

    Oliveira F. Saúde da população negra: Brasil ano 2001. Organização Pan-Americana da Saúde: Brasília; 2003.

    Google Scholar 

  8. 8.

    Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009;32:20–47. https://doi.org/10.1007/s10865-008-9185-0.

    Article  PubMed  Google Scholar 

  9. 9.

    Muniz J. O uso da variável raça-cor em estudos quantitativos. Rev Sociol Polit. 2010. https://doi.org/10.1590/S0104-44782010000200017.

  10. 10.

    Anjos G. A questão “cor” ou “raça” nos censos nacionais. Indic Econ FEE. 2013;41(1):103–18.

    Google Scholar 

  11. 11.

    Francis AM, Tannuri-Pianto M. Raça endógena no Brasil: ação afirmativa e construção de identidade racial entre jovens adultos. Desenvolvimento Econ Mudança Cult. 2013;61(4):731–53.

    Google Scholar 

  12. 12.

    Penna FP. África do Sul e Brasil: diplomacia e comércio (1918-2000). Rev Bras Polít Int. 2001;44(1):69–93.

    Article  Google Scholar 

  13. 13.

    Projeção da população do Brasil e das Unidades da Federação. https://www.ibge.gov.br/apps/populacao/projecao/. População brasileira às 16:13:51 de 21/4/2020. Accessed Apr 30 2020.

  14. 14.

    Giovanella L, Mendoza-Ruiz A, Pilar A de CA, da Rosa MC, Martins GB, Santos IS, D. B. Silva, J.M. de L. Vieira, de Castro V.C.G., da Silva P.O., Machado CV. Sistema universal de saúde e cobertura universal: desvendando pressupostos e estratégias. Cien Saude Colet. 2018. https://doi.org/10.1590/1413-81232018236.05562018.

  15. 15.

    Machado CV, Baptista TW de F, Nogueira C de O. Políticas de saúde no Brasil nos anos 2000: a agenda federal de prioridades. Cad Saúde Públ. 2011. https://doi.org/10.1590/S0102-311X2011000300012.

  16. 16.

    Stats SA (Statistics South Africa). Mid-year population estimates. 2018. http://www.statssa.gov.za/publications/P0302/P03022018.pdf

  17. 17.

    Chopra M, Lawn JE, Sanders D, Barron P, Karim SSA, Bradshaw D, et al. Achieving the health millennium development goals for South Africa: challenges and priorities. Lancet. 2009;374:1023–31. https://doi.org/10.1016/S0140-6736(09)61122-3.

    Article  PubMed  Google Scholar 

  18. 18.

    Coovadia H, Jewkes R, Barron P, Sanders D, McIntyre D. The health and health system of South Africa: historical roots of current public health challenges. Lancet. 2009;374:817–34. https://doi.org/10.1016/S0140-6736(09)60951-X.

    Article  PubMed  Google Scholar 

  19. 19.

    Nogueira O. Preconceito racial de marca e preconceito racial de origem: sugestão de um quadro de referência para a interpretação do material sobre relações raciais no Brasil. Tempo soc. 2007;19. https://doi.org/10.1590/S0103-20702007000100015.

  20. 20.

    Oliveira F. Ser negro no Brasil: alcances e limites. Estud av. 2004;18:57–60. https://doi.org/10.1590/S0103-40142004000100006.

    Article  Google Scholar 

  21. 21.

    Adjai C, Lazaridis G. Migration, xenophobia and new racism in post-Apartheid South Africa. Int J Soc Sci Stud. 2013. https://doi.org/10.11114/ijsss.v1i1.102

  22. 22.

    Gomes ABS, Cunha JH. Educação e Afrodescendência. Ed. UFC: Fortaleza; 2008.

    Google Scholar 

  23. 23.

    Brasil AS, Trad LAB. O Movimento Negro na construção da Política Nacional de Saúde Integral da População Negra e sua relação com o Estado brasileiro. In: Batista LE, Werneck J, Lopes F, editors. Saúde da população negra. Brasília, DF: ABPN - Associação Brasileira de Pesquisadores Negros; 2012.

    Google Scholar 

  24. 24.

    Brasil, Ministério da Saúde. Secretaria de Gestão Estratégica e Participativa. Departamento de Apoio à Gestão Participativa e ao Controle Social. Política Nacional de Saúde Integral da População Negra: uma política para o SUS. Brasília: Editora do Ministério da Saúde; 2017.

    Google Scholar 

  25. 25.

    Naudé C-P. Wat nou met nasiebou? (what now with nation-building?). 2010. http://www.beeld.com/Rubrieke/Gasrubriekskrywers/wat-nu-met-nasiebou-20100406. Accessed 3 Dec 2019.

  26. 26.

    Bardin L. Análise de conteúdo. Lisboa: Edições 70; 1997.

    Google Scholar 

  27. 27.

    Bornman E. The rainbow nation versus the colors of the rainbow: nation-building and group identification in post-Apartheid South Africa. 2013. https://www.researchgate.net/publication/286207031_The_rainbow_nation_versus_the_colors_of_the_rainbow_Nation-building_and_group_identification_in_post-Apartheid_South_Africa. Accessed 10 Jan 2020.

  28. 28.

    National eHealth Strategy. South Africa 2012/13–2016/17. https://www.isfteh.org/media/south_africa_national_ehealth_strategy_2012_2016. Accessed 18 Nov 2019.

  29. 29.

    Herselman M, Botha A. Strategies, approaches and experiences: towards building a south African digital health innovation ecosystem. Pretoria: CSIR Meraka; 2016.

    Google Scholar 

  30. 30.

    Pinto LF, de Freitas MPS, de Figueiredo AWS. Sistemas Nacionais de Informação e levantamentos populacionais: algumas contribuições do Ministério da Saúde e do IBGE para a análise das capitais brasileiras nos últimos 30 anos. Cien Saude Colet. 2018;23:1859–70. https://doi.org/10.1590/1413-81232018236.05072018.

    Article  PubMed  Google Scholar 

  31. 31.

    Adorno R de CF, Alvarenga AT de, Vasconcellos M da P. Quesito cor no sistema de informação em saúde. Estudos Av. 2004. https://doi.org/10.1590/S0103-40142004000100011

  32. 32.

    Osório RG. O sistema classificatório de “cor ou raça” do IBGE. In: Bernardino J, Galdino D, editors. Levando a raça a sério: ação afirmativa e universidade. Rio de Janeiro: DP&A; 2004. p. 85–135.

    Google Scholar 

  33. 33.

    Gouvea MC, Xavier AP. Retratos do Brasil: raça e instrução nos censos populacionais do século XIX. Educ Soc. 2013. https://doi.org/10.1590/S0101-73302013000100006.

  34. 34.

    Cuore RE, Catanante BR. A metodologia dos censos demográficos no Brasil: desigualdades educacionais da população negra. Rev Magistro. 2016;1(13):97–117.

    Google Scholar 

  35. 35.

    Loveman M. National colors: racial classification and the state in Latin America. New York: Oxford University Press; 2014.

    Google Scholar 

  36. 36.

    Nobles M. History counts: a comparative analysis of racial/color categorization in US and Brazilian censuses. Am J Public Health Res. 2000. https://doi.org/10.2105/ajph.90.11.1738.

  37. 37.

    Bah SM. The making, unmaking and remaking of a national but stratified vital statistics system in the Republic of South Africa. PSC Discussion Papers Series. 1998;12(3).

  38. 38.

    Statistics South Africa (Stats SA). Using the 2001 Census: approaches to analysing data. Pretoria: Statistics South Africa. p. 2007.

  39. 39.

    Posel D. Race as common sense: racial classification in twentieth-century South Africa. Afr Stud Rev. 2001;44(2):87–113.

    Article  Google Scholar 

  40. 40.

    Khalfani AK, Zuberi T. Racial classification and the modern census in South Africa, 1911-1996. Race Soc. 2001. https://doi.org/10.1016/S1090-9524(03)00007-X.

  41. 41.

    Gounden V. Reflections on identity conflicts and nation building in contemporary South Africa. South Asian Journal of Peacebuilding: Peace Prints; 2010.

    Google Scholar 

  42. 42.

    Chimere-Dan O. Population policy in South Africa. Stud Fam Plan. 1993;24(1):31–9.

    CAS  Article  Google Scholar 

  43. 43.

    Boaduo NA. The rainbow nation: conscience and self adjudication for social justice, governance and development in the New South Africa. J Pan Afr Stud. 2010;3(6):129–42.

    Google Scholar 

  44. 44.

    Gqola P. Defining people: analysing power, language and representation in metaphors of the new South Africa. Transf: Crit Perspect S Afr. 2001;47:94–106.

    Google Scholar 

  45. 45.

    Barron P. A 20-year review of the health sector in South Africa, unpublished technical input paper prepared for the National Department of Health and the Department for Performance monitoring and Evaluation in the Presidency. 2013. https://www.dpme.gov.za/news/Documents/20%20Year%20Review.pdf. Accessed 10 Oct 2019.

  46. 46.

    Twenty year review South Africa 1994–2014. https://www.dpme.gov.za/news/Documents/20%20Year%20Review.pdf. Accessed 16 Aug 2019.

  47. 47.

    Matsoso MP, Fryatt R. National Health Insurance: the first 16 months. S Afr Med J. 2013;103:156–8. https://doi.org/10.7196/SAMJ.6601.

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    National Department of Health (NDH). Annual report 2016/17. South Africa. 2017. https://www.gov.za/documents/department-health-annual-report-20162017-7-sep-2017-0000. Accessed 7 Sept 2019.

Download references

Acknowledgments

The authors would like to thank the Bahia Research Support Foundation (FAPESB) for granting a doctoral research scholarship to the corresponding author.

Author information

Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Ionara Magalhães de Souza, Edna Maria de Araújo, Gail Denise Hughes, Brian Eduard van Wyk, and Verona Mathews. The first draft of the manuscript was written by Ionara Magalhães de Souza and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ionara Magalhães de Souza.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

de Souza, I.M., Hughes, G.D., van Wyk, B.E. et al. Comparative Analysis of the Constitution and Implementation of Race/Skin Color Field in Health Information Systems: Brazil and South Africa. J. Racial and Ethnic Health Disparities (2020). https://doi.org/10.1007/s40615-020-00789-5

Download citation

Keywords

  • Race and health
  • Information system
  • Black population
  • Brazil
  • South Africa