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Em todos os continentes, freqentemente possvel identificar processos scio-polticosem que questes de ndole tnico-racial esto presentes, quase sempre mescladas a ou-tras, de fundo religioso e/ou nacional. O que muda, historicamente, a natureza dessa in-terseo (Fredrickson GM. Racism: A Short History. Princeton: Princeton University Press;2002). A produo acadmica mundial a respeito crescente: nos bancos de refernciasbibliogrficas Web of Science, a mdia anual de artigos indexados por racismo aumentouprogressivamente nos ltimos trs qinqnios: 159 (1990/1994), 286 (1995/1999) e 321(2000/2004). menos freqente a investigao dos efeitos desse fenmeno sobre a sadepopulacional, e.g. no Brasil, onde vem se intensificando o debate a respeito das desigual-dades raciais e de aes afirmativas voltadas para sua superao. Os artigos deste Frumrenem evidncias relevantes para esse debate e apontam elementos de uma agenda de

pesquisa que deve subsidiar crescentemente a sade pblica brasileira.Chor & Lima destacam temas conceituais e metodolgicos relacionados pesquisa

no campo. Apresentam tambm evidncias empricas instigantes: indgenas e pretos mor-rem proporcionalmente em idades mais precoces, mas a anlise da mortalidade por cau-sas inspira a busca de hipteses mais especficas. Por exemplo, entre homens jovens (15-29 anos), as desigualdades raciais na mortalidade foram primordialmente atribuveis sagresses, e pardos encontraram-se em posio intermediria entre pretos e brancos. En-tre homens e mulheres na faixa de 40-69 anos, entretanto, apesar de a mortalidade pordoenas cerebrovasculares ter sido tambm maior entre pretos, entre pardos foi inferiorquela registrada para brancos. O que esses fatos (ou artefatos?) revelariam?

Cardoso et al. trazem subsdios importantes para pesquisadores e para gestores dosbancos de dados de mortalidade (SIM) e nascidos vivos (SINASC) no pas. Eles observam que

a introduo do registro da caracterstica raa/cor nesses sistemas, em meados da ltima d-cada, foi seguida de rpida diminuio da proporo de dados faltantes; porm, essa situaoainda insatisfatria, com amplas desigualdades regionais e intra-regionais na qualidade dosdados, e sujeita a retrocessos. Assim mesmo, ao conduzir criativas anlises de sensibilidadevariando as premissas quanto distribuio dos dados faltantes, os autores produziram evi-dncias robustas da pior situao de indgenas e negros quanto s mortes infantis.

Finalmente, Lopes apresenta-nos um painel da produo acadmica recente nasreas da demografia, sociologia e economia, assim como textos de ativistas do movimentosocial negro e outros, disponveis nas pginas de rgos governamentais. A autora ampliaassim a documentao das desvantagens sociais generalizadas da populao negra noBrasil quanto a emprego, renda, habitao e educao, alm de reunir evidncias adicio-nais no campo das desvantagens em sade, e.g. quanto esperana de vida ao nascer e s

causas externas de morte. Lopes destaca a abrangncia e a complexidade das aes neces-srias superao das desigualdades raciais na sociedade brasileira, e enfatiza a pertinn-cia da aferio mais direta e circunstanciada dos efeitos da discriminao racial sobre asade. A propsito, Chor & Lima ressaltam as evidncias empricas existentes, em pasescomo os Estados Unidos e Inglaterra (e os primeiros esforos nacionais a respeito), de quecircunstncias scio-econmicas adversas explicam apenas parcialmente o pior quadrode sade de grupos tnico-raciais no-brancos, que seria influenciada por efeitos mais di-retos da experincia de discriminao racial.

Eduardo Faerstein

Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.

eduardof@umich.edu

Frum: raa, racismo e sade no Brasil

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On all continents of the world, it is frequently possible to identify the socio-politicalprocesses in which issues of an ethnic/racial nature are present, nearly always mixed withother issues of a religious and/or national type. What changes historically is the nature ofthis intersection (Fredrickson GM. Racism: A Short History. Princeton: Princeton Universi-ty Press; 2002). There is a growing international academic literature on this area: in thebibliographic reference bases Web of Science, the annual average number of articles in-dexed under the term racism has increased steadily in the last three five-year periods,from 159 in 1990-1994 to 286 in 1995-1999 and 321 in 2000-2004. There is less researchconcerning the effects of this phenomenon on the populations health, for example inBrazil, where the debate has intensified concerning racial inequalities and affirmative ac-tions to overcome them. The articles in this Forum bring relevant evidence to this debate

and identify elements for a research agenda that can increasingly support public healthconcerns in the country.

Chor & Lima highlight conceptual and methodological issues related to research inthe field. They also present instigating empirical evidence: indigenous and black individu-als die proportionally at earlier ages, but the analysis of mortality by causes recommendsthe search for more specific hypotheses. For example, among young males (15-29 years ofage), racial inequalities in mortality were attributable primarily to aggressions, and brownindividuals (pardos) occupied an intermediate position between blacks and whites. How-ever, among men and women in the 40-69-year age bracket, although mortality due tocerebrovascular diseases was also greater among blacks, among brown individuals it waslower than among whites. What do these facts (or artifacts) reveal?

Cardoso et al. provide an important contribution to researchers and managers of the

national databases on mortality (SIM) and live births (SINASC) in Brazil. They emphasizethat after race/color began to be recorded in these systems in the mid-1990s, there was arapid decrease in the proportion of missing data; however, these authors note, the situationis still unsatisfactory (with broad regional and intra-regional inequalities in data quality) andis subject to relapses. Even so, by conducting creative sensitivity analyses and varying thepremises as to the distribution of missing data, the authors produce robust evidence of theunfavorable situation of the indigenous and black populations in relation to infant mortality.

Finally, Lopes gives us an overview of recent academic output in the fields of de-mography, sociology, and economics, as well as papers by activists from the black socialmovement and others, available on government agency websites. The author thus expandsthe documentation of the widespread social disadvantages of the Brazilian black popula-tion in employment, income, housing, and education, in addition to gathering additional

evidence in the area of health disadvantages, e.g., in life expectancy at birth and externalcauses of death. Lopes highlights the range and complexity of actions needed to overcomeracial inequalities in Brazilian society, while emphasizing the pertinence of more directand contextualized measurement of the effects of racial discrimination on health. In thissense, Chor & Lima underscore the existing empirical evidence in countries like the UnitedStates and England (and the first Brazilian efforts in this direction) that adverse socioeco-nomic circumstances only partially explain the unfavorable health situation of non-whiteethnic/racial groups, a situation influenced by the more direct effects of racial discrimination.

Eduardo Faerstein

Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.

eduardof@umich.edu

Forum on race, racism, and health in Brazil