Desigualdades raciais e de renda no acesso à saúde nas cidades brasileiras

The population's access to public health services contribute to reducing disease prevalence and raising life expectancy. In Brazil, the Sistema Único de Saúde (SUS) is guided by the principles of universality and integrality of care to all health needs. Despite the advances of the SUS, it faces permanent challenges in planning the coverage and equity of health services to reduce, spatial, and income inequalities in access to health care. Several studies explore the spatial dimension of socioeconomic inequalities in access to health services in Brazil, but few analyze inequalities within urban areas and bring evidence of racial inequalities. This study aims to contribute to this debate by presenting the first large-scale study analyzing in high spatial resolution the social and racial inequalities in access to health services in Brazil. The analysis covers access to public services of primary care and high complexity by public transport, car and on foot, considering the year 2019 in the 20 largest cities in Brazil. It presents detailed descriptive analyses on spatial inequalities of access to health care facilities within cities and on social inequalities considering the intersectionality between income levels and color/race. The results show that the distribution patterns of population, health facilities, and transportation networks in the largest Brazilian cities contribute to unequal access to health services. In general, the low-income population, regardless of race, has greater accessibility to primary care services due to their greater capillarity of these services. By contrast, the high-income population, mostly white, has greater accessibility to highly complex health services, due to the spatial concentration of these services and population groups in the central regions of major urban centers. The results of this study contribute to a better understanding of the geographical dimension of inequalities in access to health care in the largest Brazilian cities, showing how universal access to this essential service is conditioned by social, economic, and transportation-related factors.