Moving race and health: the health's governance of international migrants in São Paulo

Abstract

This research analyzes how processes of racialization of international mmigrants in the Metropolitan Area of São Paulo are being institutionally elaborated within local bureaucracies of the Family Health Strategy (Estratégia Saúde da Família - ESF), and how these processes of racialization are articulated with types of access to and quality of use of primary health services by the immigrants. The research is connected with the increasing of transnational migration flows, with a new race/color profile, and effects to municipals public health governance. The city of São Paulo has been historically considered as an urban gateway for those flows. Since the beginning of the twenty-first century, Brazil has gained a new flow of immigrants because of increases in intra-American and South-Global routes. This has changed the racial profile of the classical European and white immigration of the last century. The new immigrants are being classified by the Brazilian State as blacks, pardos and indigenous people. Due to the increase in displacements, international agencies for the governance of populations in move began to foster local regulations to govern these social groups, especially their health. Therefore, local public policies are constantly pressured to be adapted to the needs of the immigrant population, such as policies of the ESF. The research analyzes how processes of racialization of these immigrants are mediated by different State health practices in bureaucracies of the ESF. One way is the most visible practice, such as legislation. Another is the daily practices of the State, such as moral categorizations of users which has inclusive and excluding effects to the public services. The literature in the fields of race relations, international migration and public policy has given little attention to the contemporary connection between the racialization of immigrants and racial inequalities in local health, especially, to the access and qualitative use of basic services. In this sense, the research will contribute to a better understanding of the relationship between global/local racial hierarchies of groups and the effects of race on access and use of local primary health care services. The focus will be on various actions of governance by the State, from the institutional to the most ordinary practices of population's governmentality in street level bureaucracies. The research strategy consists of analysis of State documents regulating the basic health of immigrants, and ethnography of the daily and local governance of the immigrant´s basic health in a health unity, in São Paulo. This postdoctoral research expands the analysis of the interfaces between race and health, started in the doctoral dissertation (2019), which analyzed the implementation of the Brazilian health focalization on the Black Population, in the city of Rio de Janeiro. It also privileges the understanding of the connection race/health through the current Brazilian public policy of preventive health care, the ESF. However, the postdoctoral analysis focus on other social group in process of racialization in Brazil and in a different national metropolis: the international immigrant users of the National Public Health System (Sistema Único de Saúde - SUS) in the city of São Paulo. Methodologically, the analysis of the effects of health governances on racial groups privileges the ethnography of direct interactions between state agents and users in street levels bureaucracies. (AU)