Ethnic inequalities are often associated with social determinants of health. This study seeks to identify the latest scientific evidence on inequalities in the health of people of African descent in the Americas. For this, a systematic review of the literature on health and people of African descent in the Americas was carried out in the LILACS, PubMed, MEDLINE, and IBECS databases. Institutional and academic repositories were also consulted. Evidence was obtained on the presence and persistence of health inequalities in the population of African descent in the Americas from the identification of five types of quantitative and qualitative evidence: (1) ethnic/racial concept and variables; (2) relations with other social determinants; (3) health risks; (4) barriers and inequalities in health services; and, (5) morbi-mortality from chronic diseases. Studies with qualitative methods revealed invisibility, stereotypes, and rejection or exclusion as main factors of inequality. This review evidenced the existence of health inequalities, its interconnection with other adverse social determinants and risk factors, and its generation and perpetuation by discrimination, marginalization, and social disadvantage. These conditions make people of African descent a priority population group for action on equity, as demanded by the 2030 Agenda for Sustainable Development.

Afrodescendants are systematically affected by discrimination in the Americas and few multi-country studies addressed ethnic inequalities in health and wellbeing in the region. We aimed to investigate gaps in coverage of key health outcomes and socioeconomic inequalities between Afrodescendants and non-Afrodescendants populations in Latin American and Caribbean countries. Using national household surveys (2011–2019) from ten countries, we analyzed absolute inequalities between Afrodescendants and a comparison group that includes non-Afrodescendants and non-Indigenous individuals (henceforth non-Afrodescendants) across 17 indicators in the continuum of reproductive, maternal, newborn, child, and adolescent health. These include indicators of family planning, antenatal care, delivery assistance, child nutrition, immunization coverage, child protection, access to improved water, sanitation and hygiene, adolescent fertility, and early childhood mortality. Inequalities between country-specific subgroups of Afrodescendants were also explored. The slope index of inequality was used to assess wealth-based inequalities within each ethnic group. Afrodescendants represented from 2·8% (Honduras) to 59·1% (Brazil) of the national samples. Of the 128 combinations of country and indicators with data, Afrodescendants fared worse in 78 (of which 33 were significant) and performed better in 50 (15 significant). More systematic disadvantages for Afrodescendants were found for demand for family planning satisfied, early marriage, and household handwashing and sanitation facilities. In contrast, Afrodescendants tended to present lower c-section rates and lower stunting prevalence. Honduras was the only country where Afrodescendants performed better than non-Afrodescendants in several indicators. Wealth gaps among Afrodescendants were wider than those observed for non-Afrodescendants for most indicators and across all countries. Gaps in health outcomes between Afrodescendants and non-Afrodescendants were observed in most countries, with more frequent disadvantages for the former although, in many cases, the gaps were reversed. Wealth inequalities within Afrodescendants tended to be wider than for non-Afrodescendants. Pan American Health Organization, Bill and Melinda Gates Foundation, and the Wellcome Trust.

Review of the burden of vision impairment and blindness and ocular disease occurrence in Indigenous Peoples of the Americas. We systematically reviewed findings of the frequency of vision impairment and blindness and/or frequency of ocular findings in Indigenous groups. The database search yielded 2829 citations, of which 2747 were excluded. We screened the full texts of 82 records for relevance and excluded 16. The remaining 66 articles were examined thoroughly, and 25 presented sufficient data to be included. Another 7 articles derived from references were included, summing a total of 32 studies selected. When considering adults over 40 years old, the highest frequencies of vision impairment and blindness in Indigenous Peoples varied from 11.1% in high-income North America to 28.5% in tropical Latin America, whose rates are considerably higher than those in the general population. Most of the ocular diseases reported were preventable and/or treatable, so blindness prevention programs should focus on accessibility to eye examinations, cataract surgeries, control of infectious diseases, and spectacles distribution. Finally, we recommend actions in six areas of attention towards improving the eye health in Indigenous Peoples: access and integration of eye services with primary care; telemedicine; customized propaedeutics; education on eye health; and quality of data.

The WHO urges countries to consider the link between racial discrimination and health and, in particular, the need for further research to study the links between health outcomes and racism, racial discrimination, xenophobia, and related intolerance. This article is carried out within the framework of approximation work towards health-related ethnic inequalities among the population of African descent of the Americas. A qualitative methodology was used to conduct 20 in-depth interviews with a group of key informants composed of leaders of African descent, officials from the ministries of health, international health agencies, and international technicians specialised in African descent health and interculturality from six different countries. The extracted data were categorised and encoded, generating quotations and concept maps with Atlas.ti v.8.2. The concurrency coefficients made it possible to link the codes of each subcategory with the central analytical category. The racial discrimination experienced by people of African descent and the quality of health services received poses a problem. Discrimination is faced in all countries, affecting access to services and the quality of health care, and greater discrimination against women is also detected. This shows the need for an activistpolicy and for the inclusion of specific variables in surveys, censuses, and records in order that they may be researched. Claims are made about the complementary role that traditional medicine may play and the fact that the intercultural approach may be a useful strategy for addressing inequalities. The interviewees agree with the reference theory on the existence of racial discrimination and segregation regarding the African descent population of the Americas and how this translates into ethnic inequities in the field of health. Proposals have been put forward both on how to deepen research and how to contribute to the reduction of ethnic inequalities in health issues.

En América Latina se han venido impulsando importantes esfuerzos para lograr la equidad en salud y hacer frente a las desigualdades que enfrentan los pueblos indígenas de la región. Existen numerosos compromisos internacionales y regionales, incluida la Agenda 2030 para el Desarrollo Sostenible y su lema de “no dejar a nadie atrás”, que sirven como marco de referencia para avanzar hacia la eliminación de las inequidades en salud. Sin embargo, ha sido importante fomentar el reconocimiento por parte de los países de la necesidad de adoptar enfoques diferenciados que contemplen le pertenencia étnica, no solo desde un plano de determinantes sociales de la salud, sino también desde el valor de la cultura, los conocimientos y las tradiciones para avanzar la situación de salud de los pueblos indígenas. Las desigualdades han quedado aún más visibilizadas con la llegada de la COVID-19 y sus devastadoras consecuencias para los pueblos indígenas, entre otros grupos. A través de los diálogos de saberes, se puede contribuir a los avances en el logro del acceso y de la cobertura universal en salud. Desde la Organización Panamericana de la Salud (OPS) se están promoviendo esfuerzos para implementar esta metodología en el ámbito de la salud y generar mínimos interculturales para avanzar hacia la equidad.