Social and racial inequalities from COVID-19 in São Paulo, Brazil

How can social and racial inequalities be linked to COVID-19?

In Brazil there are structural inequalities. Structural inequality refers to the disparity in wealth, resources, and other outcomes that result from the discriminatory practises of institutions. Extreme Brazilian social inequality is a legacy of Portuguese colonialism and years of historical accumulation of exclusionary political and social institutions.

Across Brazil there are indigenous people living in every state representing 305 different ethnic groups and 274 indigenous languages.

Social and racial divisions stem from Brazil being the last nation in the Americas to abolish slavery (in 1888), and from the late recognition of people’s right to vote (not granted until 1988).

Between 1501 and 1888 slave trading brought an estimated 3.6 million enslaved people from Africa to Brazil. Out of the current Brazilian (214 million) population ~50.7% consequently identify as Afro-Brazilian (including both preto (black) or pardo (mixed ethnicity)). Ethnicity in Brazil has continued to diversify. For example, in the early twentieth century, a wave of Japanese migrants arrived due to bilateral government policies, restrictions on US Asian immigration in the 1920s, and economic hardship in Japan due to modernisation. Many of these workers suffered the same social prejudices as freed slaves and have remained a large ethic group, the largest Japanese diaspora anywhere in the world outside of Japan.

Modern-day division persists affecting Afro-Brazilians’ access to healthcare, education, employment and wealth. For example, throughout the twentieth century people of colour suffered discrimination with job adverts including the phrase “boa aparência” (“good appearance”), meaning that only light-skinned people need apply.

A huge wave of rural to urban migration, which began in the 1970s, has cemented inequality as people of colour still lack landownership and remain concentrated in urban favelas.

In these informal settlements poverty rates are high and young black men are the most vulnerable to violent crime. In terms of the absolute number of murders per year, Brazil has the highest homicide rate in the world.

In 2020, COVID-19 disproportionally affected particular groups in Brazilian society due to extreme differences in income (affecting access to healthcare) and social differences between different barrios (districts). Often, in these areas, there is a high occurrence of comorbidity.

One of the outcomes from the pandemic has been the reaffirmation of data as a crucial to understanding the spread of disease. Datasets, such as the Johns Hopkins’ COVID-19 dashboard, can advocate for equity by identifying the pre-existing social determinants of health.

Case study São Paulo

Sabrina Li et al. researched the differential effects from COVID-19 on disadvantaged groups in São Paulo. The research uncovered social and racial inequalities in the risk of hospitalisation and death by COVID-19.

Through analysing mobile phone data, it was observed that individuals in wealthier neighbourhoods (predominantly white residents) self-isolated to a greater extent, did so earlier, and sustained that isolation for a longer period of time.

Whereas people from the poorest 40% of census tracts had an 8% higher risk of hospitalisation and were 60% more likely to die from COVID-19. The research concluded:

• Income is negatively correlated with risk of hospitalisation

• People that travelled to and from the greater metropolitan region of São Paulo were at a higher risk

• There is a racial disparity in risk of death when looking at death among patients by hospital type (public vs. private)

Due to income inequality and poor health, disadvantaged areas such as Vila Andrade, suffered more than the wealthy centre of São Paulo. The map below shows that in 2016, before COVID-19 struck, residents in the outer districts already died younger due to lower life expectancy.