HEALTH POLICIES FOR THE BLACK POPULATION: CHALLENGES IN THE IMPLEMENTATION OF EQUITY IN THE SUS

Abstract

The Unified Health System (SUS) has consolidated itself as one of the largest public health systems in the world, based on principles of universality, comprehensiveness, and equity. Created to guarantee the right to health of the entire Brazilian population, the SUS faces the challenge of meeting the specificities of vulnerable social groups, including the black population. In Brazil, this segment represents a significant portion of society, with about 56% of Brazilians declaring themselves black or brown, however, a historical trajectory of exclusion and social inequalities has reflected in negative health markers for this population, evidencing a distancing from the ideal of equity. Through this, this study aims to analyze the main challenges faced in the implementation of health policies aimed at the black population in Brazil, focusing on the obstacles to the promotion of equity in the SUS. To this end, an integrative literature review was carried out, adopted as a research question: "What are the challenges faced in the implementation of public health policies aimed at the black population in the SUS, considering the principles of equity and confronting structural racism?" This question was structured based on the PICO strategy: P (Population) – black population in Brazil; I (Intervention) – public health policies in the SUS; C (Comparison) – not applicable; The (Outcome) – challenges and strategies for equity in health. The search for studies was carried out in the PubMed, SciELO, LILACS and Scopus databases. Studies published between 2013 and 2023 that directly addressed the challenges faced in the implementation of public health policies for the black population in the context of the SUS were included. Eligible articles should be available in Portuguese, English or Spanish. Opinion articles, systematic reviews, and studies that did not have a direct relationship with the objectives of this review were excluded. The results revealed that, despite the formal recognition of equity as a principle of the SUS, practical operationalization encounters significant barriers, including political resistance and lack of adequate resources. The thematic analysis of the reviewed studies allowed the identification of three central axes: structural racism in the SUS, challenges in the implementation of the PNSIPN, and strategies to reduce health inequalities. The reviewed literature also highlights local and regional initiatives that have contributed to the promotion of more equitable care, suggesting that these experiences can be replicated on a larger scale. This study reinforces the importance of integrating the social determinants of health into public policies and strengthening social participation in the formulation and execution of government actions. It is concluded that addressing racial disparities in health requires coordinated efforts between managers, health professionals, and civil society, with the implementation of intersectoral strategies that promote structural changes and the construction of a truly inclusive and equitable health system.