UNIVERSITY OF CALIFORNIA, SAN DIEGO Health in Black and White: Debates on Racial and Ethnic Health Disparities in Brazil A dissertation submitted in partial satisfaction of the requirements for the degree Doctor of Philosophy in Anthropology by Anna Pagano Committee in Charge: Professor James Holston, Chair Professor Nancy Postero, Co-Chair Professor Thomas Csordas Professor Gerald Doppelt Professor Ivan Evans 2011 The Dissertation of Anna Pagano is approved, and it is acceptable in quality and form for publication on microfilm and electronically: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Co-Chair _______________________________________________________________________ Chair University of California, San Diego 2011 iii TABLE OF CONTENTS Signature Page .................................................................................................................... iii Table of Contents ............................................................................................................... iv List of Figures .................................................................................................................... vi List of Tables ..................................................................................................................... vii Acknowledgements .......................................................................................................... viii Vita .................................................................................................................................... xii Abstract of the Dissertation .............................................................................................. xiii PART I: RACE, MEDICINE, AND BIOPOLITICS IN BRAZIL ..................................... 1 Chapter 1: Introduction ....................................................................................................... 1 Race and Ethnicity ................................................................................................ 13 Biologization and the Re-Biologization of Race................................................... 15 Medicalization ....................................................................................................... 23 Medicalization of Race.......................................................................................... 25 Biopower and Biopolitics ...................................................................................... 28 Applying a Biopolitical Framework to the Medicalization of Race ..................... 29 Race and National Identity in Brazil ..................................................................... 33 Black Movement Activism.................................................................................... 45 Public Health in Brazil .......................................................................................... 47 Ethnographic Field Sites ....................................................................................... 50 Chapter 2: Everyday Narratives on Race, Racism, and Health ......................................... 58 Patients’ Narratives on Race and Health ............................................................... 64 Health Care Professionals’ Narratives on Race and Health .................................. 76 Patients and Providers: A Counter-Biopolitics ..................................................... 88 PART II: THE BLACK HEALTH AGENDA .................................................................. 91 Chapter 3: The Birth of the Black Health Agenda in Brazil ............................................. 91 Black Health Activism in Brazil ........................................................................... 92 The Black Health Agenda in São Paulo .............................................................. 102 The Black Health Agenda in São Luís ................................................................ 108 iv Chapter 4: The Black Health Epistemic Community in Brazil ....................................... 118 The Politics of Categorization ............................................................................. 122 The Imperative of Self-Declaration..................................................................... 134 Etiological Claims ............................................................................................... 141 Medicalizing Racism ........................................................................................... 154 Discourses of Difference ..................................................................................... 156 Implications for Citizenship ................................................................................ 161 Conclusion ........................................................................................................... 171 Part III: AFRO-BRAZILIAN RELIGIONS AND HEALTH ......................................... 174 Chapter 5: Health and Healing in Afro-Brazilian Religions ........................................... 174 Afro-Brazilian Religions: A Brief Background .................................................. 176 Mãe Letícia .......................................................................................................... 179 Pai Cesar .............................................................................................................. 184 Healing in Afro-Brazilian Religions ................................................................... 189 Chapter 6: Afro-Brazilian Religions and the State.......................................................... 207 Partnerships between Terreiros and SUS: Rehabilitating History ...................... 208 Razor Blades and Comic Strips ........................................................................... 215 Other Sources of Conflict .................................................................................... 220 Cultural Competence and the Terreiro ................................................................ 231 De-Sacralizing the Terreiro ................................................................................. 236 Conclusion ........................................................................................................... 243 Chapter 7: Afro-Brazilian Religions and Ethnic Identity Politics in the Brazilian Public Health Arena ........................................................................................................ 244 Terreiro Health Activists’ Identity Politics ......................................................... 247 Conclusion ........................................................................................................... 269 Chapter 8: Health in Black and White ............................................................................ 272 Bibliography .................................................................................................................... 281 v LIST OF FIGURES Figure 1. Household Income, 2000 ................................................................................... 54 Figure 2. Distribution of Race/Color (Pretos and Pardos), 2000 ...................................... 55 Figure 3. Public Health Facilities and Distribution of Population by Color in São Paulo, 2000 ........................................................................................................... 169 Figure 4. Population Density of São Paulo, 2000 ........................................................... 170 vi LIST OF TABLES Table 1. Characteristics of Sample Population ................................................................. 65 Table 2. Self-Identified Race or Color .............................................................................. 69 Table 3. Beliefs Regarding Health Outcomes between Blacks and Whites...................... 69 vii ACKNOWLEDGEMENTS First and foremost, I would like to thank my chair and mentor, Professor James Holston, for investing in my development as a scholar and for holding me to such high academic standards. Professor Holston’s influential scholarship on citizenship and the anthropology of Brazil has served as an indispensable model for my own work. Over the past seven years, I have been deeply inspired by his insistence upon maintaining excellence in anthropological inquiry; the elegance with which he presents his arguments; and his commitment to making anthropology relevant to the problems of modern society. Professor Holston’s example of careful scholarship combined with intellectual fervor will always remain with me. I owe an enormous debt of gratitude to my co-chair, Professor Nancy Postero, who has been a fantastic mentor throughout the conception and execution of my doctoral project. Professor Postero’s expertise in Latin American and political anthropology has marked my work in important ways. Her dedication to theoretical rigor and the public relevance of anthropology are complemented by her unique gift for mentoring junior scholars. Professor Postero has been a steadfast source of encouragement and a powerful role model along the way. Professor Thomas Csordas has supported and influenced my scholarship in numerous ways. Most importantly, having the opportunity to work with him led me to pursue medical anthropology.