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Photo: Anti-racism protest June 2020, Niterói, Brasil | Michelle Guimarães
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Iris Silva Brito,
ACAP, Sydney Australia

COVID19 in Brazil:
Black Lives Matter

I am Iris Silva Brito, social work lecturer at the Australian College of Applied Psychology. I am black, I am a woman, and I am a migrant. I was born in Brazil and in my early 30s migrated to Australia. My sisters, brothers and their families and my elderly father still live in Brazil. I am witnessing through my family the devastating impact of Covid-19 as it unfolds. I would like to invite you to join me in this reflection on the disastrous implications when governments and civil society, fail to take into consideration the socio-economic and racial inequalities present in society when designing responses to the pandemic. To assist the reflection, I use two vignettes taken from news reports to show how Covid-19 impacts very differently the lives of the poor (and mainly Black) and wealthy (and often White) Brazilians.

Joana

Joana is a 58-year-old woman with some Afro-Brazilian ancestry. She works as a housekeeper in one of the wealthiest areas of Sao Paulo city.

She is a married mother of three adult children and grandmother of two pre-schoolers. Joana is getting older and is in close contact with the local health care clinic due to several health concerns. She lives in a small suburban house with her extended family (parents, daughter and grandchildren). Most family members are either unemployed or underemployed. Her daughter, who was working as a salesperson in a small retail clothing shop, lost her job as COVID19 hit.

Joanna currently works in a posh suburb close to the city centre. She uses the crowded public transport system to travel to work. A trip from home to the city centre where she works takes approximately one hour and 30 minutes. Her house is over-crowded, and the house is located in an area where the local infrastructure is precarious. She has three siblings, each one with a family of their own.

They managed to rent a place near Joana’s home. One of her joys is to gather the family every week for a shared meal—a chance for the four generations to relax and share music, food and laughter.

Marcos

Marcos is a white male, 60 years old, marketing consultant, married with two adult children and four teenage grandchildren. Marcos lives in the heart of Sao Paulo city in a penthouse apartment.

He has a consulting firm employing seven communications professionals.

He employs a housekeeper and several caretakers to maintain his luxury apartment in town.

Marcos has a house in the countryside to rest and relax with friends and family over the weekends.

He regularly checks his health accessing private health care. He lives shielded from the crowded lives of others.

Marcos enjoys a close relationship with his family and, like most Brazilians, travels with his family to his parents’ home for Sunday lunches.

Marcos comes from a wealthy family that owned large coffee plantations.

Every year, Marcos travels overseas with his wife, children and grandchildren to enjoy time together and unwind from work commitments.

Inequality, Health Care and COVID19 

The above fictitious characters illustrate the degree of inequality cemented over generations present when the Coronavirus hit the country. Covid-19 entered Brazil with a person who returned from a trip to Italy (de Souza et al. 2020). A male (not unlike Marcos), from a privileged elite, with the means to regularly travel overseas. This person was living life in a bubble of privilege, travelling, enjoying life protected from the misery of those on the margins of society. Returning to Brazil, this person showed Covid-19 symptoms. As soon as the symptoms appeared, he sought medical care and immediately received a diagnosis and treatment. In Brazil, those with private health care insurance, like Marcos, have access to private hospitals – one per room – providing quality health care that often surpasses that available to average citizens in the Global North.

The first registered Covid-19 fatality in Brazil was of a woman (not unlike Joana) resided in an underprivileged part of Sao Paulo city. The woman felt unwell for a few days but was unable to access to public health care. She was admitted to hospital on 11th March 2020 and died the day after admission. The fact that her death was Covid-19-related death only emerged 50 days later (O Globo 2020). In Brazil, two-thirds of Covid-19 testing is contracted out to private laboratories, which are only accessible to those who can afford private health insurance. Free diagnostic screening is very limited. People living in conditions such as Joana and the first registered Covid-19 victim live in a two-class health system that restricts health care for the poorer segments of society who can only rely on an underfunded public health system and were ‘first-class’ health care is available at a price for those that can afford it.

The white male, like Marcos in the above vignette, accessed the diagnostic services that allowed him to receive the required care. He was able to self-isolate and thus protect his immediate family, friends and the wider community. By contrast, the woman was unable to access the diagnostic services and health care that could have saved her life and prevented her family and friends from contracting the virus. In this case, four other members of her family died from Covid-19 shortly after her death (O Globo 2020).

When reviewing Brazilian COVID-19 statistics, one feature stands out. The growing numbers of Covid-19 deaths appear to be in places where the population is mainly black, poor and where the gap between the rich and the poor are accentuated. In Brazil, eight out of 10 people dying from Covid-19 are of Afro or Indian descent (Canzian 2020). Oliveira et al. (2020) confirm this statistic, and reveal further the racial inequality contained in the figures. According to the authors, black Brazilians are often unable to access hospitals in the current pandemic whereas this is rarely the case the hospital admission involves a white person. The death rate of black Brazilians is much higher, which highlights not only their restricted access to vital health care services, it also pinpoints the social inequality experienced by many poor black Brazilians that limit their access to goods and services that might cover their basic needs (Oliveira at a. 2020). More importantly still, it highlights that physical space - a luxury in Brazil’s crowded slums – is (as 19-century epidemiologists in crowded European cities knew), a crucial public health commodity that enables those infected to protect their loved ones and their communities.

The same holds true in countries such as the USA where Covid-19 is impacting on the non-white population much more than the White population (Our World in Data (2020); Oliveira et al. (2020). US data from the Centre for Disease Control and Prevention highlights this disparity clearly foregrounding the need to pay attention to the historical inequality caused by structural racism that is exacerbated by Covid-19. The research shows a clear link between “age, race/ethnicity, SARS-CoV-2 infection, disease severity, underlying medical conditions (especially diabetes), socio-economic status (e.g., poverty and access to health care), behavioural factors (e.g., ability to comply with mitigation recommendations and maintain essential work responsibilities), and out-of-hospital deaths” highlighting a massive gap in research in this area (CDC 2020 p.928).  Covid-19 exposes how inequalities created along racial and class divides have potentially fatal implications for Black segments of the poorer population both in the US and in Brazil.

Socio-economic Inequality

Covid-19 entered Sao Paulo and Rio de Janeiro via middle and upper-class suburbs. From there, the virus migrated to the favelas where it has spread fast due to inadequate housing, poor nutrition, poor infrastructure and inability to comply with the social isolation recommendations published by the state and municipal governments. This highlights the cruel reality that poor Black Brazilians have very few options, very little choice, and are condemned to live with the virus rather than live to avoid it.

Socio-economic inequalities and particularly the lack of access to physical space are placing working class black Brazilians at greater risk of Covid-19 contamination and potentially death. The life and death of the first Covid-19 registered victim is a clear illustration of this. Housing and accommodation are often shared with several generations living in the same home if not the same room. Social mapping of the region where the first victim of Covid-19 lived, outlines issues commonly encountered in neighbourhoods populated by poor Black Brazilians: The area has a high unemployment rate, particularly among men and young people, turning women into the sole bread winner of a family; the miserable crowded public transport available to locals turning the average commute of 1 hour and 50 minutes into an endurance test; and a lack of basic social infrastructure (Rede Nossa Sao Paulo 2019). Women living in these socio-economically disenfranchised communities often work in the care economy. They travel to the homes of more affluent Brazilians to work as cleaners, babysitter, carers of older people and so on. Here, they interact closely with children and adults who frequently travel to countries such as the USA and other European countries. It is at their workplace that black women are exposed to infectious diseases, such as Covid-19. The exposure to the virus among the poor are often not by choice but dictated by necessity.

In such a context, public health campaigns cannot but be infective. Two basic assumptions underpinning the world-wide response to the pandemic do not apply to the Brazilian context. The assumptions are: 1) that Brazilians have equal access to resources, goods and services to avoid contamination (socio-egalitarianism); and, 2) that the virus does not discriminate between people based on skin colour (racial-egalitarianism).

To date, the focus has been on self-distancing, isolation, curfews, mask, and hand-washing. Some of these measures have been proven a hindrance in the eradication of the virus in Brazil. The reality is that many Brazilians do not have the option of going home to social isolate. Some have a home but inside of it space is scarce and self-distancing an impossibility. Curfews can result in an inability to earn a living and purchase food. Hand sanitizers and face-mask purchasing is another measure that only adds extra cost to the already stretched budget of poor Black families. This socio-egalitarianism assumption that underpins Covid-19 responses does not hold true in the Brazilian society.

The lives of the poor are also in jeopardy due to the myth that Covid-19 does not discriminate people by skin colour, and its impact is felt equally across the population as a whole along ‘racial-egalitarian’ lines. Racial egalitarianism is still an entrenched belief among Brazilians. Hasenbalg & Huntingotn questioned this wide-held assumption of racial democracy in Brazil. They provided a historical, cultural, socio-political analysis of how this well-established belief became not only ingrained in society, but also was politically used to exacerbate social stratification and racial discrimination in the country. Their analysis takes us back to the colonial times, when the Portuguese crown held the country hostage and institutionalized slavery. Given the large numbers of slaves and the reduced number of white women, the population soon started to become racially mixed and a large number of Mulatos (the child of a white and black persons) were born. With the abolition of slavery and economic growth, the country started a program of European migration. Black former slaves started to compete with white immigrants for work. Due to lack of particular skills, Blacks started to only find employment in unskilled areas such as domestic work, tenant farming etc. This was not a problem for the Portuguese aristocracy as they held the social and economic power and for the Europeans because they had an unfair competitive advantage – they were white and had some industrial traning. The systematic employment of white immigrants instead of Blacks created kept Blacks at the margins of society unable to climb the social structures (Hasenbalg & Huntington 1983).

Thirty seven years after Hasenbalg & Huntington’s study, Oliveira et al. (2020) sadly reaffirmed this argument when discussing the structural racism underpinning the Covid-19 response. According to the authors, Brazilian society is still economically and socially divided and the so called racial democratic egalitarianism is, in fact, rendering public health policy blind and oblivious to suffering of a Black majority. Dua (2020) alerts us to the fact that we may never understand the full implications of Covid-19 for Blacks and other non-white populations if we ignore the socio-economic, cultural and racial determinants of health. To show how the current research on Covid-19 is myopic in its focus, she conjures up Pubmed.gov data illustrating that out of 728 articles on ‘Covid-19 only 52 mention ‘social determinants of health in connection with ‘Covid-19’ (p.23). In summary, public health campaigns that do not take into consideration socio inequalities are ill-conceived and have little chance of success.

Implications for Social Workers

The pandemic amplifies and exposes existing inequalities. It reiterates the importance of taking into consideration the unique experiences of people and their intersecting identities. Intersectionality is a lens often absent in recently published analyses of Covid-19. Social work needs to look critically at the generalised analysis and the impact the subsequent responses have had on the poor and disenfranchised. We need to ask to ourselves: Where is our socio-economic and political research in this area? Are we succumbing to the health care mantra? Despite agreeing with the urgency for a worldwide response to the health crisis, one cannot remain silent in the face of the biased assumptions underpinning government-supported measures to contain the virus. Although effective, and viable (in some instances), the approaches disregard the existing power and privilege structures. The design fails to acknowledge the broader socio-economic and political systems. The efforts to contain infections and deaths only benefit some segments of the population. A ‘one-size’ fits all approach perpetuates inequalities and does little to support the most disadvantaged in this pandemic.

Public policy measures that disregard the interlocking disadvantages that are present in our society, especially in the lives of Blacks and other minorities kill people. Some may ask whether are we entering the age of necropolitics (use of social and political power to decide who lives and who does not)? While this is debatable, the fact that, Black lives do matter is not.

References

Canzian, F. 2020. 8 em cada 10 mortos no Brasil pelo coronavirus tem comorbidades: cardiopatia e diabetes lideram, Folha de Sao Paulo, 4th April 2020. Retrieved from folha.uol.com.br
Centre for Disease Control, July 17 2020. Morbidity and Mortality Weekly Report. Characteristics of persons who died with COVID-19COVID-19- United States, Feb.12-May 18, 2020. Retrieved cdc.gov
Dua, A. 2020. The wrong questions. New Scientist. 12 September. No. 3299.
De Souza, W.M., Buss, L.F., Candido, D.d.S.et al.2020. Epidemiological and clinical characteristics of the COVID-19 epidemic in Brazil.Nature Human Behaviour4,856–865. doi.org
Globo. 2020. Jornal Hoje, Sao Paulo. Filha da prineira vitima de covid no Brasil perdeu os avos e dois tios com a doenca apos a morte da mae Jornal. Retrieved from globo.com
Hasenbalg, C. & Huntington, S. 1983. In Humboldt Journal of Social Relations. Vol.10.No.1 pp 129-142
Oliveira, R.G., Cunha, A.P., Gadelha, A.G.S., Carpio, C.G., Oliveira, R.B., Correa, R.M. 2020. Desigualdades raciais e a morte como horizonte: Consideracoes sobre a COVID-19 e o racism estrutural. In Cadernos de Saude Publica. DOI 10.1590/0102-311X00150120
Our World in Data. 2020. Data explorer. Cumulative confirmed COVID-19 Deaths. Retrieved from ourworldindata.org
Rede Nossa Sao Paulo. 2019. Viver, trabalho e renda 2019. Retrieved from nossasaopaulo.org