Comparison between two race/skin color classifications in relation to health-related outcomes in Brazil

Posted in Articles, Brazil, Caribbean/Latin America, Health/Medicine/Genetics, Media Archive on 2012-01-02 19:09Z by Steven

Comparison between two race/skin color classifications in relation to health-related outcomes in Brazil

International Journal for Equity in Health
Volume 10, Number 1, (2011-08-25)
pages 35-42
DOI: 10.1186/1475-9276-10-35

Claudia Travassos
Instituto de Comunicação e Informação Científica e Tecnológica em Saúde (ICICT/FIOCRUZ), Avenida Brasil

Josué Laguardia
Instituto de Comunicação e Informação Científica e Tecnológica em Saúde (ICICT/FIOCRUZ), Avenida Brasil

Priscilla M. Marques
Instituto de Comunicação e Informação Científica e Tecnológica em Saúde (ICICT/FIOCRUZ), Avenida Brasil

Jurema C. Mota
Escola Nacional de Saúde Pública Sérgio Arouca (ENSP/FIOCRUZ), Rio de Janeiro, Brasil

Celia L. Szwarcwald
Instituto de Comunicação e Informação Científica e Tecnológica em Saúde (ICICT/FIOCRUZ), Avenida Brasil

Background 

This paper aims to compare the classification of race/skin color based on the discrete categories used by the Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE) and a skin color scale with values ranging from 1 (lighter skin) to 10 (darker skin), examining whether choosing one alternative or the other can influence measures of self-evaluation of health status, health care service utilization and discrimination in the health services.

Methods 

This is a cross-sectional study based on data from the World Health Survey carried out in Brazil in 2003 with a sample of 5000 individuals older than 18 years. Similarities between the two classifications were evaluated by means of correspondence analysis. The effect of the two classifications on health outcomes was tested through logistic regression models for each sex, using age, educational level and ownership of consumer goods as covariables.

Results 

Both measures of race/skin color represent the same race/skin color construct. The results show a tendency among Brazilians to classify their skin color in shades closer to the center of the color gradient. Women tend to classify their race/skin color as a little lighter than men in the skin color scale, an effect not observed when IBGE categories are used. With regard to health and health care utilization, race/skin color was not relevant in explaining any of them, regardless of the race/skin color classification. Lack of money and social class were the most prevalent reasons for discrimination in healthcare reported in the survey, suggesting that in Brazil the discussion about discrimination in the health care must not be restricted to racial discrimination and should also consider class-based discrimination. The study shows that the differences of the two classifications of race/skin color are small. However, the interval scale measure appeared to increase the freedom of choice of the respondent.

Introduction

During the 20th century in Brazil, the discussion on race-related issues – either social, economic, educational and/or political ones – was restricted to certain fields of study, such as sociology and social anthropology. More recently, the debate has spread towards public health, and various studies in this area deal with race as a determining factor for health inequity. Such studies include race and/or skin color as one of their variables, but the complexity surrounding racial classification influences and, therefore, hampers the analysis of race as a variable, especially when it is considered as a social construct instead of a biogenetic entity.

The significance of phenotypic distinctions in racial classifications is related to the importance given to race as a basis for the social differentiation and stratification. Besides, in racialized social systems the placement of people in racial categories involves some form of hierarchy that produces definite social relations between races.

Opposed to the North-American bipolarity, Brazilians identify their skin color in a multiple mode, which is less categorical and more contextual. It is the product of a complex equation involving physical traits, socio-economic origin and region of residence that may result in a set of categories spread through a light-dark continuum. As shown by Sansone, Brazilian skin color terminology varies according to strategies individuals use to manage racial relations in several contexts (work, family, leisure, friendships) and also according to their age, education, and income.

The official classification of race/skin color in Brazil is composed by five categories—White [Branco], Brown [Pardo], Black [Preto], Yellow and Indigenous. Despite the controversies, some scholars have argued in favor of this classification: it refers to an objective, precise, “demographic” characteristic more suitable for census purposes than other measures that they consider more related to color identity. However, the way Brazilians identify their race/skin color may fit better in a classification spread through a light-dark continuum…

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