Black population health: from lack of knowledge among health professionals to the urgency of education with an anti-racist perspectiveAbstract
The fight against racism in health implies rethinking professional training. Health training and continuing education in health should follow the provisions of the National Policy for Comprehensive Health of the Black Population (PNSIPN, Brazilian acronym), CNS Resolution No. 569, and Curricular Guidelines for Education on Ethnic-Racial Relations. This article reflects on the importance of continuing education in health (PEH) aimed at combating racism in health services. Based on reports from professionals in mental health care services, we demonstrate that health training from an anti-racist perspective is almost nonexistent. The reports demonstrate the low presence or silence of the approach to the health of the Black population and issues related to racism and anti-racism. In addition to denouncing the absences, we highlight the perception of professionals regarding the need for an approach to issues related to the promotion of the health of the black population as a commitment to the principles of the Unified Health System (SUS, Brazilian acronym) in the various training processes in and within health. We are based on regulations related to the education of ethnic-racial relations and the health of the black population.
Keywords:
Health Training; Continuing Education; Anti-Racism; Health of the Black Population; Racism.
Resumo
A luta antirracista na saúde implica repensar a formação profissional. A formação em saúde e a educação permanente na saúde deveriam observar o que determina a Política Nacional de Saúde Integral da População Negra (PNSIPN), a Resolução CNS nº 569 e as Diretrizes Curriculares para a educação das relações étnico-raciais. O artigo busca refletir sobre a importância da educação permanente em saúde (EPS) voltada ao combate do racismo nos serviços de saúde. A partir de relatos de profissionais de um serviço de atenção à saúde mental, demonstramos que a formação em saúde, a partir de uma perspectiva antirracista, ainda é quase inexistente. Os relatos demonstram a pouca presença ou silenciamento da abordagem da saúde da população negra e temas relacionados ao racismo e antirracismo. Para além da denúncia das ausências, ressaltamos a percepção de profissionais acerca da necessidade de existir, nos diversos processos formativos, a abordagem de temas relacionados à promoção da saúde da população negra, enquanto um compromisso com os princípios do Sistema Único de Saúde (SUS). Nos fundamentamos nas normativas relacionadas à educação das relações étnico-raciais e à saúde da população negra.
Palavras-chave:
Formação em Saúde; Educação Permanente; Antirracismo; Saúde da População Negra; Racismo.
Introduction
Primary Health Care (PHC) is configured as a territorially based care model whose central mission is to coordinate care and organize Health Care Networks (HCNs). Health systems structured from comprehensive primary care, based on person-centered care, with coordination, continuity, integrality, and network articulation, demonstrate better health outcomes and greater equity in access to and use of services, as well as lower health budget expenditures (Brazil, 2024).
According to the National Primary Care Policy (PNAB), it is a set of actions aimed at the individual and the community, including promotion, protection, prevention, diagnosis, treatment, rehabilitation, health maintenance, and harm reduction. It offers comprehensive care, improving the health and autonomy of individuals, considering social determinants. Multidisciplinary teams carry out the actions, adhering to democratic principles and valuing local cultural aspects (Brazil, 2017).
The reality of care in PHC services is characterized by its complexity and a context permeated by uncertainties. In this scenario, daily clinical care must be provided in response to local demands. For care to be effective, it is essential to consider people’s subjective experiences in relation to health, suffering, and illness and understand them within their life and sociocultural contexts. This perspective allows for the construction of shared approaches, based on mutual respect and the humanization of health care (Brazil, 2013).
Thus, a high degree of decentralization and capillarity structures PHC, closely integrating it into the daily lives of the population. Its organization is based on the principles of universality, equity, and comprehensiveness and its guidelines provide for regionalization and hierarchization, territorialization, person-centered care, and community participation, among other essential aspects (Brazil, 2017).
Health Care Networks (HCNs) are organizational structures that coordinate actions and services of different levels of complexity, ensuring continuous, comprehensive, and coordinated care for users of the Brazilian Unified Health System (SUS). Primary Health Care (PHC) acts as the preferred entry point and coordinator of care, integrating services such as emergency care, specialties, and hospital care. In this way, HCNs facilitate access, improve communication between services, and increase care effectiveness for the population (Brazil, 2010).
In the field of mental health, Psychosocial Care Centers (CAPS) are the specialized services that are part of the Health Care Network, responsible for this care. They have multidisciplinary teams composed of social workers, doctors, occupational therapists, psychologists, nurses, nursing technicians, and monitors. These professionals work in an interdisciplinary manner to provide priority care to people with any type of mental disorder (Brazil, 2015).
When highlighting the principles of the Unified Health System (SUS), such as universality, equity, and comprehensiveness, we draw attention to racial and ethnic specificities, among others. Therefore, it is necessary to bring to light the historical formation of the Brazilian territory, marked by colonization and the process of enslavement to which the Indigenous peoples and peoples of African origin were subjected, and its consequences that persist in the current scenario as determinants of health and disease.
In this text, we will focus on the Black population in Brazil, which faces a history marked by profound inequities and social injustices stemming from the legacy of slavery, which dehumanized individuals originating from the African continent and their descendants. For centuries, Black people were exploited as a workforce in the economic cycles of sugar, gold, and coffee, among other diverse labor activities, a process that contributed to the consolidation of exclusionary social structures that persist to this day (Coutinho; Silva, 2024).
Lélia Gonzalez forcefully analyzed racial violence through the exploitation of enslaved labor and its socioeconomic and structural consequences for society. According to her, “racism, as an ideological construct and a set of practices, underwent a process of perpetuation and reinforcement after the abolition of slavery, insofar as it benefited and benefits certain interests” (Gonzalez, 2020, p. 169).
Epidemiological data reveals the effects of racism in Brazilian society, particularly in the health of the black population. According to the 2022 Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE), 10.2% of Brazilians identified as black and 45.3% as mixed-race, totaling 55.5% of the population identified as black (IBGE, 2022). The 2019 National Health Survey (PNS) indicates that 76% of people exclusively dependent on the SUS (Unified Health System) for prevention and rehabilitation actions were black (Brazil, 2019). In 2023, the Ministry of Health published two special issues of the Epidemiological Bulletin on the Health of the black Population. Although the results presented in several texts demonstrate an improvement in health indicators, there is a persistent difference between the groups that make up the Brazilian population. In the case of assistance to postpartum women, the number of prenatal consultations has been increasing considerably; however, “there is a gradient by race/color with a higher proportion of seven or more consultations among mothers who declared themselves to be of white race/color (80.9%), followed by yellow (74.3%), black (68.7%), brown (66.2%), and indigenous (39.4%)” (Brazil, 2023, p. 12).
The Bulletin also reports that, between 2010 and 2020, there was little change in the proportion of low birth weight babies-8.4% in 2010 and 8.6% in 2020-but the data indicate that there was “an increase in the proportion of low birth weight live births among the black, brown, and indigenous race/color categories [...] among black mothers, rising from 8.0% in 2010 to 10.1% in 2020” (Brazil, 2023, p. 15).
Other data reveal that among the five leading causes of death among black people (both black and mixed-race) in 2020 were cerebrovascular diseases (CVD), ill-defined causes, ischemic heart disease (IHD), as well as diabetes mellitus and assaults. The latter stood out “among the five leading causes of death in the mixed-race category in the three years analyzed: the second leading cause in 2010, the third in 2015, and the fifth in 2020” (Brazil, 2023, p. 37).
Epidemiological data demonstrate the need for and importance of specific actions, in health and other areas, aimed at the black population as a way to reduce inequalities and inequities. The National Policy for Comprehensive Health of the black Population (PNSIPN) turned 15 years old in 2024, and its effective implementation is still a challenge fraught with obstacles imposed by structural and institutional racism.
Batista et al. (2020) organized a brief history of the process that culminated in the approval of the PNSIPN in 2009. Presented in the form of a “Timeline on the health of the black population,” it begins in 1980 with mention of “campaigns against the extermination of children and sterilization of black women” and the publication of Ordinance No. 992 by the Ministry of Health, which formalized the PNSIPN, and reaches 2019, when the coordination of the policy was “transferred to the Coordination for Guaranteeing Equity of the Department of Strategic Programmatic Actions of the Secretariat of Primary Health Care.” The authors highlight the importance of the sanitation movement and the black movement during the National Constituent Assembly, which enabled the achievement of rights that made possible the approval of public policies related to health and the fight against racism.
Thus, the PNSIPN (Brazil, 2009) is configured as a strategic tool in confronting racism in health, but it also contributes to combating other forms of violence, such as gender-based violence, which permeate social structures, aligning itself with the principles and guidelines of the SUS (Brazilian Unified Health System).
Jurema Werneck (2016) highlights that racism is a central factor in the production of health inequities affecting the black population, regardless of region, education level, or stage of life. Institutional racism, in turn, hinders the care of this population in health services, since, in Brazil, racial discrimination, explicit or subtle, is based especially on skin color.
Considering the objectives of this text, we highlight that the PNSIPN (National Policy for the Comprehensive Health of the black Population) has as its first guideline the “inclusion of the themes of Racism and the Health of the black population in the training and continuing education processes of health workers and in the exercise of social control in health” (Brazil, 2009). Continuing education aimed at combating racism in health services, as well as in the training of future health professionals, is of fundamental importance.
Based on accounts from professionals working in a mental health care service, collected during master’s research, we will seek to demonstrate that health education from an anti-racist perspective is still almost nonexistent. However, our interest here is not in denouncing these absences but rather in highlighting the professionals’ perception of the need for health education and continuing education to address topics related to promoting the health of the black population as a commitment to the principles of the Brazilian Unified Health System (SUS).
Understanding racism and its effects on the health of the black population
For Frantz Fanon, racism is a strategic element of the colonization process. White Europeans imposed various forms of violence-physical, psychological, ethnic, and cultural erasure, among others-that led black people to see them as the reference point for what it meant to be. Black people are thus objectified and, as objects, are destroyed in their very existence. Analyzing the violence suffered by black people from the perspective of social construction, in a colonizer/colonized relationship where there is a strategy of dehumanization and animalization of the colonized, the author exposes a systematic negation of the other, “a furious decision to deny the other any attribute of humanity” (1968, 212). Thus, for the author:
Colonialism compels the dominated people to constantly ask: “Who am I in reality?” The defensive positions born from this violent confrontation between the colonized and the colonial system are organized into a structure that then reveals the colonized personality (Fanon, 1968, p. 212).
Understanding racism as a cultural phenomenon is crucial to analyzing it in its historical, social, and political complexity. Studying the relationship between culture and racism necessarily implies considering the dynamics of their reciprocal action. Starting from the conception of culture as the set of behaviors, both physical and mental, that originate from the interaction between human beings and their environment as well as with each other, it is possible to affirm that racism constitutes a cultural element (Fanon, 1956).
Structural racism permeates the construction of individuals’ worldviews and organizes institutional relations, being constantly reproduced in different social contexts, including primary health care and health training processes, technical schools, and higher education. It is essential to recognize that the effective realization of the right to health for all people, especially the black population, requires the incorporation of the racial issue as a central axis in the policies and practices of the Brazilian Unified Health System (SUS). This implies developing systematic actions for the promotion, protection, and recovery of health that consider racial inequalities and their social determinants to guarantee equitable and anti-racist care (Silva et al., 2022). These aspects are reflected as an immense barrier to the health of the black population.
This issue is of paramount importance in public health; therefore, it is essential that health professionals pay close attention to the health of the black population, considering this segment in a holistic manner and recognizing that its members are socially affected by various forms of oppression (Coutinho & Silva, 2024). Therefore, health training and continuing education in health should be organized from an anti-racist perspective and incorporate themes related to the black population and their health.
We understand that social and living conditions directly influence various aspects of human existence, affecting everything from birth to old age and death. In the case of the black population, these conditions are marked by structural inequalities, resulting in significantly unfavorable morbidity and mortality indicators. These statistics reflect not only a context of historical exclusion but also the persistence of social and racial inequities that limit access to fundamental rights, such as health, education, and decent work (Pereira et al., 2024).
These challenges imply how this population can, or cannot, access the rights that are, a priori, guaranteed by law, since entering a health unit, although a right for all does not grant effective care. As Oliveira and Rosa point out:
[...] a person entering a health unit does not guarantee that they will be welcomed, considering all their specific needs, because guaranteeing the principle of universality (of fundamental importance for access for all people) does not necessarily guarantee equity (that each person who accesses the unit has their individual needs considered in the care process) (Oliveira; Rosa, 2025, p. 157).
According to Oliveira and Rosa (2025), based on research and their experiences in health services, it is essential to recognize institutional racism as an obstacle to the comprehensive care of black people. This would be one of the reasons for the approval of the PNSIPN (National Policy for the Comprehensive Care of black People).
It is worth remembering that, in addition to their important contribution to legal advancements, black social movements maintain a constant struggle in the development of anti-racist projects and experiences that contribute to overcoming racial inequalities in the conditions of birth, life, illness, and death (Werneck, 2016). This movement was decisive in the construction of the PNSIPN (National Policy for the Comprehensive Health of the Black Population), approved in 2006 and instituted in 2009.
It should also be highlighted how violent the consequences of racism are within institutions, as Silva et al. (2022, p. 4) point out:
Racism reproduces the denial of rights, the lack of access to health services, the production of death, and the failure to achieve well-being for black bodies. This is manifested through the production and reproduction of a dark, funereal dimension, permeated by contexts of suffering, violence, and structural racism in its various expressions in the trajectory and experience of black professionals and users in primary health care.
The barriers to access faced by the black population in health services must be understood as a collective responsibility, involving health professionals, municipal managers, and other institutional actors in their respective roles and competencies. In this sense, valuing continuing education in health and a real commitment to the implementation of the National Policy for the Comprehensive Health of the black Population (PNSIPN) are essential pillars for promoting an equitable and anti-racist health system.
Health training and continuing education in health from an anti-racist perspective
Regarding the fight against racism in the Brazilian Unified Health System (SUS), the National Policy for the Comprehensive Health of the Black Population (PNSIPN) presents itself as an essential instrument in opposition to the numerous inequalities that continue to limit access to care and health for the black population (Damião et al., 2025). A critical approach to racism and anti-racism in health policies requires the incorporation of elements that go beyond the daily routine of services, considering not only users but also the lived experiences of black people as workers in the health system (Silva et al., 2022).
The health of the black population has received little attention, both in educational institutions and in health services, directly reflecting the prevailing social structure. This reality emphasizes the critical need to create mechanisms for controlling, monitoring, and evaluating health-related courses, as well as continuing education, in relation to compliance with standards concerning the approach to content associated with Afro-Brazilian history and culture, combating racism, and re-educating ethnic-racial relations. Topics related to the recognition of racism as a social determinant of the health conditions of black men and women; racism and mental health; the prevalence of sickle cell disease in the black population; the issue of race/color; specificities of the health of the Quilombola population, among many others (Batista et al., 2020; Monteiro, 2012); need to be included in the training processes of health professionals.
Monteiro (2012) understands Continuing Education in Health (CEH) as “a tool that allows the necessary transformation in health practices to make it possible to address the racial issue” and that permeates teaching, management, health care, and also social control. He highlights the importance of preparing technicians who work in CEH to include the ethnic-racial issue in the planning of training actions.
It should be emphasized that since 2003 there have been laws mandating that Afro-Brazilian, African, and Indigenous history and culture be included in the curriculum of elementary and secondary education in all modalities, such as technical courses. In 2004, the National Curriculum Guidelines (DCN) for education on ethnic-racial relations and for the teaching of Afro-Brazilian and African history and culture were approved. Opinion CNE 03/2004, from the aforementioned guidelines, outlines the content, authors, and methods for working with this theme, from early childhood education to higher education.
Monteiro (2012) reminds us that at the 12th National Health Conference (CNS) in 2003, specifically regarding health, actions related to racial and ethnic issues were discussed in ten (10) of its thematic areas, with the health sector focusing on the following topics: “health education management, training of health professionals, continuing education, and in-service education.” In 2017, Resolution No. 569 of the National Health Council (CNS) approved common principles and guidelines for undergraduate courses in the health sector, aligned with the SUS, among which it is highlighted that health training must be committed to overcoming inequities and, transversally, the curricula must involve “knowledge, experiences, and systematized reflections on human rights and people with disabilities [...] education on ethnic-racial relations and the history of Afro-Brazilian, African, traditional, and indigenous culture” (Brazil, 2017).
The problem is that the training-in undergraduate health courses-is still far from complying with the aforementioned laws and regulations.
Monteiro, Silva, and Araújo (2021, p. 5) state that:
…we know very little about how undergraduate health programs are implementing the National Curriculum Guidelines for Racial Equality (DCNERE) and the National Policy for the Promotion of Racial Equality (PNSIPN). There are few studies, and some initiatives with specific approaches or implementations are known because members of the Racism and Health Working Group are involved in them. This can also be said in relation to continuing education, since members of the black movement who worked (and still work) in public health, including in management positions, were primarily responsible for promoting courses, in-service training, and other actions.
Although this scenario has undergone some change in recent years, driven by the resumption of the Human Rights (HR) agenda and specifically the health of the black population in the current Federal Government, starting in 2023, the effects on training processes require time to reach the daily routine of PHC.
As Coutinho and Silva (2024) rightly pointed out in a recent study on the performance of nursing professionals in PHC, they affirm the need for anti-racism campaigns aimed at health professionals and patients, addressing issues ranging from race/color to social determinants of health.
Thus, we understand that deconstructing racism requires the collective recognition of its systemic and structural nature. Its confrontation implies transforming both the institutional structures of power and the social and subjective relations that sustain it. To repair its effects, concrete changes are needed in institutional dynamics and the distribution of power, coupled with the strengthening of anti-racist public policies (Damião et al., 2025).
Health education, specifically in undergraduate courses, needs to consider not only what is determined by the National Policy for the Comprehensive Health of the Population (PNSIPN) but also what CNE Opinion 03/2004 addresses regarding affirmative action, Afrocentric worldviews, and other aspects. It is necessary to recognize the existence of racism in its various forms and the diverse ways it affects the lives of the victims of discrimination and those who discriminate against them. Health professionals cannot begin their careers acting as promoters of exclusionary and often violent practices that perpetuate social inequalities.
Health education, both in undergraduate courses and continuing education in health, needs to incorporate discussions on how racism affects the health of the black population, understand the specific health needs of this population, and explore ways to combat racism in healthcare.
The lack of knowledge and the knowledge of professionals regarding the black population’s health
The narratives presented below were collected during a qualitative master’s thesis involving surveying... This research involved bibliographic and documentary research, questionnaire application, and interviews with mental health professionals with higher education degrees from different areas of knowledge. The research was duly submitted to and approved by the Research Ethics Committee (CEP), registered under Certificate of Presentation for Ethical Appraisal (CAAE) No. 55457322.1.0000.5504, and the semi-structured interviews were reported and authorized. Two CAPS (Psychosocial Care Centers) located in territories predominantly composed of self-declared black and brown people in a city in the countryside in the state of São Paulo were selected, identified from information in the IBGE Automatic Data Retrieval System (SIDRA). The project was presented to the technical team of the selected services and to the higher-level professionals invited to participate in the research. Eight professionals agreed to participate.
The choice of professionals with higher education degrees stemmed from one of the research objectives: to understand how the topic of black population health has been discussed in the curricula of undergraduate health courses. The interviews were preceded by the completion of an online questionnaire with 10 questions about personal information and professional training (undergraduate, postgraduate, and continuing education). For the interview, a script with six (6) open-ended questions related to the participants’ knowledge of black population health and their role in providing care to black and non-black people was used, such as the development of individualized therapeutic plans (ITPs).
For the analysis of the narratives, statements from research participants addressing the educational process (in higher education and in continuing education courses in health and graduate programs) were selected. One example is the curricular organization of the courses offered in relation to the coverage of content on racial issues and specifically regarding the PNSIPN. Narratives that, in some way, demonstrated knowledge or lack of knowledge about such topics were also selected, regardless of whether they were related to formal formative spaces. The analysis of the collected data was carried out based on the objectives and guidelines of the PNSIPN, as well as the recommendations for mental health care provided for in the ordinances and guidelines that regulate the Psychosocial Care Network (RAPS). We emphasize that fictitious names were used to preserve the identity of the participants.
The data collected demonstrated that some participants showed significant knowledge about the topic in question, while others showed minimal or no knowledge, that is, they were unaware of the PNSIPN (National Policy for the Comprehensive Health of the Black Population). Despite this, all agreed on the need to include anti-racist themes and content about the health of the black population in training processes.
One of the interviewees, Juliana, a 25-year-old white occupational therapist, contributed by critically affirming the unpreparedness of professionals regarding the health of the black population. She says, “I think the team is not prepared, and even I, as someone who is training (referring to residency in public health), did not have this knowledge during my training program, and now I am facing these issues” (Juliana Interview, 2022). This struggle must be collective, and the involvement must truly be led by all the people who make up these spaces. Several authors, such as Oliveira and Rosa (2025), affirm that discussing ethnic-racial relations in health is not the responsibility only of black professionals. On the contrary, white people need to recognize how they contribute to maintaining the social structure, historically marked by their privileges. They need to adopt an anti-racist stance, seek knowledge, and question their practices.
We understand that the responsibilities foreseen in the PNSIPN must be carried out by managers and professionals, including the correct completion of the race/color question, respecting users’ self-declaration, so that health policies are developed according to reality (Coutinho; Silva, 2024).
It is impossible to discuss the implementation of health policy for the black population and professional practice detached from health education, since racism is socially constructed and perpetuated, being present directly or indirectly in the daily lives of institutions, including those providing care and training in health, manifesting itself in inequalities in care, inequities in access to services, and disparities in the care of diseases common among black people (Silva et al., 2022).
Silva et al. (2022) further highlight that, unfortunately, the field of health, in general, still adopts a training marked by a technocratic and biological bias, centered on disease instead of considering the individual and their relationship with social structures. This approach reveals an unsustainable contradiction in the face of the conception of health as a reflection of people’s living and working conditions, as proposed by the political-sanitary perspective of the SUS (Brazilian Unified Health System). This point resonates with Juliana’s impression of her training process:
[...]There was a lot of biological material and very little social science material, so I only came into contact with it in one or two subjects at the end of my undergraduate studies. So, I think it is not very thorough, and it is not very in-depth; it is very superficial, and if you want to have more contact, you have to do scientific initiation, and there was not even scientific initiation in that area, not at the time I was studying it (Interview with Juliana, 2022).
The statement from another participant, Rodrigo (white, 26 years old, doctor), contradicts the previous account:
During college, we did not have anything. All the situations in which the black population was discussed were in those first few minutes of class when they talked about epidemiology: “So the disease is more prevalent in the black population...” and “The black people are the population that has most cases of tuberculosis...” and then it was mentioned, and at no other time was there a real debate about what it means to be black in Brazil, what the health-disease process is, or the impact you see in the country, one of the last to have the end of slavery. [...] There is no debate about what it is like to live in the suburbs and far away. Anyway, but that was it; they mentioned it, and they talked about the population rule and about a gene “X,” and that was the most I got in college (Interview with Rodrigo, 2022).
How can we guarantee ethical, humane, and high-quality professional practice for all, where professionals foster a welcoming environment with active listening during healthcare services? How can we ensure care in a way that does not reproduce triggers of racial violence? The statement by Rodrigo, a 26-year-old young man, demonstrates that the medical course he completed did not incorporate what the aforementioned norms and legislation dictate. Knowing that the black population “is the population that has the most tuberculosis” did not contribute to understanding the phenomenon or acting to change it.
Among the non-black participants, there is an important recognition of their position as white professionals and the implications for serving black people, which is made explicit in Juliana’s speech, highlighting the importance of training in the subject, for example:
I think this implies that we are unaware of and uninterested in this suffering and how this issue of race affects mental suffering since we are white and do not have certain experiences that cause this kind of suffering. So, I think that is why continuing education is important for us to understand what others suffer, things we will never face, so there are things that cannot be solved just through empathy (Juliana Interview, 2022).
This understanding is fundamental and aligns with Frantz Fanon’s thoughts on the feeling and notion of the body among black people in the face of the violence that the colonization process establishes in social experiences. Based on his experience, the author points out that, “In the white world, the colored man encounters difficulties in elaborating his body schema. Knowledge of the body is a purely negational activity. It is knowledge in the third person (Fanon, 2020, p. 126).” It is necessary for white people to question the reasons that imply a lack of knowledge-because they are white-about the experiences that produce suffering for black people. After all, who causes such suffering? Studying what racism and racial discrimination are and their consequences for the health of the black population, among other marginalized groups, is essential.
Despite Juliana’s criticism that the experience of black people cannot be fully understood through empathy alone, it should be reiterated that it is possible, through listening and building relationships, to connect with the experiences of those being served, constructing shared care, as foreseen in one of the guidelines of the Brazilian Unified Health System (SUS), which is person-centered care.
Understanding colonization as a process that violates bodies throughout history, especially those of the black population, is necessary, since it is from this understanding that the social determinants that affect these people unfold. In this sense, continuing education is an essential tool in professional training. This is evident in Rodrigo’s statement, who demonstrated knowledge about social determinants, being the only professional among those interviewed who had taken a continuing education course on the health of the black population offered by the Oswaldo Cruz Foundation. His interest in the course was driven by his involvement with a black collective at the medical school. Rodrigo says:
Discussing the health of the black population means leaving the walls of the institution, making home visits, getting to know the territory, understanding the logic of violence, protection, and care that exists in that territory, identifying the key figures within that population, and being able to activate the health system if needed (Interview with Rodrigo, 2022).
In addition to person-centered care, Rodrigo’s speech also includes another PHC tool consistent with territorialization and values local cultural aspects, a fundamental attitude for building comprehensive care (Brazil, 2017).
Although training in ethnic-racial relations education is necessary for health professionals, higher education institutions have not included the National Policy for the Comprehensive Health of the Black Population (PNSIPN) in their curriculum, reproducing institutional racism (Silva et al., 2022), as evidenced in the experience of all participants. Ygor, a 31-year-old white psychologist, states that “if I had contact with it, I don’t remember it from my training; in fact, I think the only contact I can point to was when you presented your research project” (Ygor Interview, 2022).
Adriana, a 34-year-old mixed-race psychologist, says, “I didn’t actually get to experience the [health] policy for the black population” (Interview with Adriana, 2022). Furthermore, Carlos, a 29-year-old white occupational therapist, reiterates the previous statements: “A large part of the professionals don’t know [the health policy for the black population]; as I have just told you, I don’t know it either, so, initially, studying this public policy [...] thinking together about strategies to be able to implement this policy [...] I believe that’s a first step” (Interview with Carlos, 2022).
According to Pereira et al. (2024), it is necessary to continuously invest in the qualifications of health professionals, both black and non-black, so that they can identify the specific demands of the black population and offer care that goes beyond physical issues. Although there is some qualification in health services, there is still a lack of in-depth study on the subject during academic training, which would contribute to broadening understanding and ensuring greater representation among black professionals and users. Since racism is socially produced and reproduced, it manifests itself, directly or indirectly, in the daily life of institutions, including the SUS (Brazilian Unified Health System) health services. Thus, it is present in the practice of health work and in the training processes of professionals in the field (Silva et al., 2022). Coutinho and Silva (2024) understand the need for continuing education projects for professionals working in PHC, considering that it is an action foreseen in the PNSIPN (National Policy for the Comprehensive Health of the Black Population) and the responsibility of municipal management.
Some of the interviewees agree with the need for continuing education and the importance of municipal management taking on this task, as can be seen in the statements of Alex, a 44-year-old black psychologist, and Francisco, a 31-year-old white psychologist:
[...] At this moment, laws and such are needed to have a curricular change, but I believe that the municipality could act in this way, offering the possibility for the most diverse professionals to learn a little more about the population, about what it is like to be black, about what it is like to be thrown into this fierce economy without having the conditions or the preparation. In short, I think that the secretariat could act in this way (interview with Alex, 2022).
[...] “Capacity building” refers to the sense of how individuals are impacted in their process of becoming ill by experiences of racism in a society that is extremely marked by it, since its constitution, a very poorly processed, slave-owning past... So, I think that, in general, the municipal administration needs to be more proactive and more attentive. It seems to me that, at this moment, it is very much preoccupied with these issues, you know? (Interview with Francisco, 2022)
Some participants, in addition to pointing out the need for health management to invest in continuing education, agree on the need for educational institutions to adapt their curriculum, as Jéssica, a 30-year-old black nurse, says:
We really need to hold institutions accountable, and not just the institutions that offer healthcare in general; universities also need to implement this in the training curriculum for students in residencies and postgraduate programs, and basic education also needs it. And I think the strategies start there, in basic education, in the training of these future healthcare professionals, so that, once they are trained, there needs to be a very large investment from the institutions to provide ongoing and continuous education on this subject (interview with Jéssica, 2022).
The urgency of effectively implementing and valuing the PNSIPN is recognized so that the actions of managers, council members, and professionals in the SUS take into account the social vulnerabilities and racism present in the health/disease process of this population, using the policy as an essential guiding document (Oliveira; Rosa, 2025).
According to Petronilha Gonçalves e Silva, rapporteur of Resolution CNE/CP 01/2004, the re-education of ethnic-racial relations begins with how we address one another, breaking with hierarchical relationships permeated by notions of superiority and inferiority. It is necessary to abandon forms of judgment based on prejudices that, through discriminatory actions, lead to inequalities. Therefore, the training of professionals from an anti-racist perspective is essential.
Final considerations
Education for ethnic-racial relations implies questioning the hierarchical relationships informed by people’s race/color. Interviewed healthcare professionals reveal that, although certain knowledge about the health of the black population is necessary and should be integrated into training processes, two fundamental aspects need to be included in health education and continuing education: breaking with technocratic and biologistic approaches; questioning the perspective centered on disease and medicalization as a cure; understanding individuals and their relationship within and with social structures, implying ethnic-racial relations; and understanding that the living conditions and, therefore, the health of the black population are inseparable from the processes of colonization, slavery, and other post-abolition processes, including state strategies to keep this population marginalized or even exterminate it.
The interviews reveal a lack of discussion regarding the health of the black population in the health training undertaken by most participants. Some knowledge of the topic stems from the experience of being a black person or from the interest of one of the self-declared white participants. Some interviewees revealed that their first contact with the PNSIPN (National Policy for the Comprehensive Health of the Black Population) was during the presentation of the research project in the selected services.
Understanding what racism is, how it operates, and its consequences for the health of the black population, is essential. There is agreement on the need to incorporate the National Policy for the Comprehensive Health of the black Population (PNSIPN) into health training curricula and continuing education and for municipal, state, and federal governments to undertake this task, with public agents responsible for defining resources, including financial ones, for its implementation.
-
Financial support:
The study was conducted without funding.
Data Availability Statement
The research data is not available.
References
-
BATISTA, L. E. et al. Indicadores de monitoramento e avaliação da implementação da Política Nacional de Saúde Integral da População Negra. Saúde e Sociedade, São Paulo, v. 29, n. 3, e190151, 2020. Disponível em: https://www.scielo.br/j/sausoc/a/8H7Wv9P5Lp7Xz7yYwLhGvRf/ Acesso em: 1 jul. 2025.
» https://www.scielo.br/j/sausoc/a/8H7Wv9P5Lp7Xz7yYwLhGvRf/ - BRASIL. Ministério da Saúde. Portaria nº 4.279, de 30 de dezembro de 2010 Estabelece diretrizes para a organização da Rede de Atenção à Saúde no âmbito do Sistema Único de Saúde (SUS). Brasília: Ministério da Saúde, 2010.
- BRASIL. Ministério da Saúde. Rastreamento Departamento de Atenção Básica. 1. ed. Brasília: Ministério da Saúde, 2013.
- BRASIL. Ministério da Saúde. Portaria nº 992, de 13 de maio de 2009 Institui a Política Nacional de Saúde Integral da População Negra. Diário Oficial da União, Brasília, 14 maio 2009.
- BRASIL. Ministério da Saúde. Conselho Nacional de Saúde. Resolução nº 569, de 8 de dezembro de 2017 Sobre princípios gerais para as diretrizes curriculares nacionais dos cursos de graduação da área da saúde. Diário Oficial da União, Brasília, 26 fev. 2018.
- BRASIL. Ministério da Saúde. Centros de Atenção Psicossocial e Unidades de Acolhimento como lugares da atenção psicossocial nos territórios Brasília: Secretaria de Atenção à Saúde, 2015.
-
BRASIL. Ministério da Saúde. Portaria nº 2.436, de 21 de setembro de 2017 Aprova a Política Nacional de Atenção Básica. Brasília: Ministério da Saúde, 2017. Disponível em: www.bvsms.saude.gov.br Acesso em: 20 nov. 2025.
» www.bvsms.saude.gov.br - BRASIL. Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Boletim Epidemiológico, Brasília, v. 1, n. Especial, out. 2023.
- BRASIL. Ministério da Saúde. Secretaria de Atenção à Saúde. Plano Nacional de Saúde 2024 - 2027 Brasília: Ministério da Saúde, 2024.
- COUTINHO, A. P. S.; SILVA, M. B. T. Políticas de saúde da população negra na atenção primária. Revista Remecs - Revista Multidisciplinar de Estudos Científicos em Saúde, São Paulo, p. 29-38, 2024.
- DAMIÃO, J. J. et al. Reflexões sobre o racismo no cuidado em saúde e o acompanhamento do Programa Bolsa Família. Saúde e Sociedade, São Paulo, v. 34, n. 1, 2025.
- FANON, F. Os condenados da terra Rio de Janeiro: Civilização Brasileira, 1968.
- FANON, F. Pele negra, máscaras brancas São Paulo: UBU Editora, 2020.
- FANON, F. Racismo e cultura. In: CONGRESSO DOS ESCRITORES E ARTISTAS NEGROS EM PARIS, 1., 1956, Paris. Número especial de Présence Africaine, p. 78-90, jun.-nov. 1956.
- GONZALEZ, L. Por um feminismo-afro-latino-americano: ensaios, intervenções e diálogos Rio de Janeiro: Zahar, 2020.
-
INSTITUTO BRASILEIRO DE GEOGRAFIA E ESTATÍSTICA (IBGE). Censo Demográfico 2022: Características do município de Campinas IBGE Cidades, 2022. Disponível em: https://cidades.ibge.gov.br/brasil/sp/campinas/panorama Acesso em: 19 nov. 2025.
» https://cidades.ibge.gov.br/brasil/sp/campinas/panorama -
INSTITUTO DE ESTUDOS DE POLÍTICAS DE SAÚDE. Relatório Técnico nº 2/2023: Saúde da População Negra Brasília: IEPS, 2023. Disponível em: https://agendamaissus.org.br/wp-content/uploads/2023/06/ieps-boletim02-saude-populacao-negra.pdf Acesso em: 19 nov. 2025.
» https://agendamaissus.org.br/wp-content/uploads/2023/06/ieps-boletim02-saude-populacao-negra.pdf - MONTEIRO, M. C. S. Desafios da inclusão da temática étnico-racial na Educação Permanente em Saúde. In: WERNECK, J.; BATISTA, L. E.; LOPES, F. (org.). Saúde da população negra Petrópolis: DP et Alii, 2012. p. 142-152.
- MONTEIRO, R. B.; SANTOS, M. P. A.; ARAÚJO, E. M. Saúde, currículo, formação: experiências sobre raça, etnia e gênero. Interface: Comunicação, Saúde, Educação, Botucatu, v. 25, p. 1-17, 2021.
- OLIVEIRA, D. A.; ROSA, J. S. Política Nacional de Saúde Integral da População Negra (PNSIPN). In: SILVA, M. M.; MONTEIRO, R. B.; CARRIL, L. (org.). Relações Étnico-Raciais em Políticas Públicas São Carlos: Pedro & João Editores, 2025.
- PEREIRA, R. S. V. et al. Racismo e distopia nos serviços de atenção primária: uma revisão de escopo. In: SOUSA, I. C. (org.). Abordagens e estratégias para a Saúde Pública e Saúde Coletiva 2 Ponta Grossa: Atena, 2024. p. 129-142.
- SILVA, L. B. et al. “Mesmo que a gente seja a mão que cuida”: médicas negras e racismo estrutural no contexto da atenção primária à saúde. Ciência & Saúde Coletiva, Rio de Janeiro, v. 27, n. 11, p. 4401-4410, 2022.
-
SILVA, P. B. G. Aprender, ensinar e relações étnico-raciais no Brasil. Educação, Porto Alegre, v. 30, n. 3, 2008. Disponível em: https://revistaseletronicas.pucrs.br/faced/article/view/2745 Acesso em: 10 jun. 2025.
» https://revistaseletronicas.pucrs.br/faced/article/view/2745 - WERNECK, J. Racismo institucional e saúde da população negra. Saúde e Sociedade, São Paulo, v. 25, n. 3, p. 535-549, 2016.
Edited by
-
Editors:
José Miguel Olivar, Jorginete Damião
