Primary Care and the Reproduction of Health Inequity in a Central São Paulo Neighborhood Público
Pingel, Emily (Spring 2021)
Abstract
This dissertation bridges public health scholarship on health disparities with a medical sociology focus on culture and history, investigating relationships within a neighborhood primary care clinic in São Paulo, Brazil. I argue that the health of neighborhood residents is contingent upon the material configurations of the neighborhood and the cultural imaginaries at hand among neighborhood residents and health professionals. Relying upon fifteen months of ethnographic fieldwork, including 450 hours of participant observation and 58 in-depth interviews, I seek to expand a body of work theorizing race, racism, and health within spatial context. I offer three innovative contributions in service of this goal: 1) I center my analysis on multi-professional health service teams, moving the sociology of health professions beyond examining the role of a singular group (i.e., physicians), and 2) I reinvigorate the sociological perspective on culture and community health and 3) I incorporate digital communications into the study of patient-provider interactions.
Table of Contents
Table of Contents
Chapter 1: Introduction. 1
Health Equity in Brazil 2
The Neighborhood of Bom Retiro and the Bom Retiro Public Health Clinic (BRPHC). 4
Research Questions. 5
Theoretical Background. 6
Inequalities and Health. 6
The Social Determinants of Health. 15
Racial and Socioeconomic Inequalities in Brazil 20
Racial Health Disparities in Brazil 26
Chapter 2: Immigrants, Migrants, and Paulistanos: Racialized Geographies of Labor and Health in São Paulo, Brazil 30
Introduction. 30
Race, (Im)migration and Housing in São Paulo. 31
Space, Place, and Racialization. 34
The Bom Retiro Public Health Clinic 36
Methods. 39
Results. 42
Racialized Geographies in Bom Retiro. 42
Racialized Geographies and the Utilization of Primary Care Services 50
Racialization through the Lens of Class and Gender. 57
Conclusions. 62
Chapter 3: Seeing Inside: How Stigma and Recognition Shape Community Health Worker Home Visits in São Paulo, Brazil 65
Introduction. 65
Home Visits in Bom Retiro. 67
Recognition and Stigmatization. 69
Cultural Schemas of “the Other”. 71
Methods. 74
Participant Observation. 74
In-Depth Interviews 76
Data Analysis 78
Results. 79
Home Visits and the Roles of Community Health Workers. 79
“Open Arms”: Visiting Older Adult Patients 82
“It’s complicated”: CHWs Interactions with Immigrant Patients 84
Attending Patients with Stigmatized Identities 91
Implications and Conclusion. 96
Chapter 4: Virtual Aspirations: How Women in São Paulo, Brazil use WhatsApp to Communicate their Desires for Safety and Stability 102
Introduction. 102
Women’s Experiences of Uncertainty and Loss 102
The Integrative Practices and Nutrition Group (ING) 106
Affective Desires 110
Methods. 112
Results. 115
Convivência through the ING.. 116
Threats of Precarity. 118
Messages of Fear 119
“Light and Enjoyable”. 123
Conclusion.. 128
Chapter 5: Conclusion. 130
Race, Racism, Immigration and Health. 130
Culture, Affect, and Space in the Context of Health. 133
Public Health Implications. 135
Future Research.. 137
Concluding Remarks. 141
References. 143
Appendix I: Patient Interview Guide. 160
Appendix II: Health Professional Interview Guide. 164
About this Dissertation
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