Racial health inequalities in Brazil and the United States through history

André Marega Pinhel
4 April 2024

Health, disease and race interacted in a very particular way in the medical thinking of Brazil and the United States at the turn of the 19th to the 20th century. Comparing the two cases can help us to better understand how the history of a racialized medical science was organized.

In the second half of the 19th century, Brazil was plagued by various contagious diseases. Smallpox, yellow fever, and tuberculosis are just a few examples. They spread in urban centers where housing conditions, access to food, and healthcare were precarious. It was a sick country (SCHWARTZ, 1993), and specialized technical personnel was required to sanitize the nation.

In this context medical knowledge began to be recognized by official institutions; we are talking about the first medical schools, in Bahia and Rio de Janeiro. In these centers the curriculum began to be structured based on clinical evidence, and medical-scientific thought flourished in specialized journals. This scenario was accompanied by the appearance of “hygienist doctors”: active figures in the political scene who, sometimes with authoritarianism and violence, projected their influence into sanitary guidelines and city planning.

The emergence of the specialized technical personnel was associated with major changes in medical epistemology. Opposing the environmental paradigm, which focused its explanation of illness on exposure to multiple external factors, Pasteurian theory proposed a single etiology for the infectious-contagious diseases: contamination by microorganisms. However, the overcoming of the environmental paradigm by Pasteurian logic occurred with a gradual and debated transition. Part of this process is due to the political and social dimension of sanitary measures, which used resources operated by these two epistemologies to interpret the ills experienced in urban centers.

Analysts of the period discuss to which extent the conception of human races influenced this epistemological transition. One hypothesis (CHALHOUB, 1996) proposes that the specialists recognized the susceptibility of some human races to certain pathogens and guided their actions based on this paradigm. Black people would have been exposed to certain tropical diseases in Africa, which granted them some immunity, compared to European whites, who were exposed to these pathogens for the first time in Brazil. This epistemology would result in racialized and selective health policies, focused on sanitary actions for certain diseases and territories.

However, there are disagreements regarding the alleged racialization of health policies at the turn of the century. Maio (2010), argues that the influence of specialists in conducting a centralized and authoritarian sanitary policy was quite limited by low budget. He goes further and indicate that attributing a racialist paradigm to the medicine of the period means transposing logics operated in other countries to the Brazilian reality; notably, the one developed in the USA. Both authors agree, however, that there was a particular combination between distinct medical epistemologies, which would characterize a unique and original tropical medicine being born in the country.

To test this assertion, our research turned to the medical archives of the period to assess: (a) the supposed originality of the national sanitary theory and (b) eventual dialogues between Brazilian and American writings. Our research relied on a technique called Optical Character Recognition to search for the keyword “race”. The results show that the intellectual health program of the time was characterized not by originality, but rather, by an ambiguity regarding the interaction between race and contamination.

In the USA, after the Civil War, “scientific” racism was dedicated to categorizing and project the population according to their race. These theses found an echo in population counting and health studies since these offered an empirical database to test theories of racial superiority. Furthermore, population counts have direct political implications, since political representation has been based on this since the American constitution. Census data and vital statistics, the main innovation of the period, were used to test the hypothesis that black and indigenous populations were in decline and predict their likely date of extinction.

This hypothesis was based on the supposed predisposition of racial groups to certain diseases, such as tuberculosis. A debate held in 1887 between Washington Matthews, a US Army surgeon, and Thomas Mays, a Philadelphia doctor, is illustrative of how this issue was addressed. The specialists discussed whether the environmental factors of contact with “civilization” were harmful or beneficial to the prevalence of tuberculosis among Indigenous peoples. At this point the Koch’s bacillus, the cause of tuberculosis, had already been isolated and described (since 1882); but as we can see, the transition between environmental theory and microbial logic was also gradual here, and there was also interaction with the logic of human races.

In Brazil, on the other hand, the entry of the racial issue into public health seems to play a secondary role, as the main epidemic outbreaks in the urban centers began to be controlled in the first decade of the 20th century through public disinfection actions. The race variable returned to the scene from the 1920s, in clinical studies conducted using administrative records, but maintaining the pattern of laterality previously observed. At that time, the eugenics paradigm already dominated the medical field, which contributed to giving some evidence to the race variable.

After analyzing similarities and distances between the two schools, we can state that the so-called originality of Brazilian sanitary theory has little support. Both relied on arrangements between environmental theory, Pasteurian logic, and the notion of human races. From a comparative perspective, it is not possible to safeguard the Brazilian case as original, although the scale of adherence to such arrangements among US specialists cannot be tested. The main difference seems to be the importance given to the race variable: from a component and exploratory element in the Brazilian case, to explanatory and determinant in the American case. However, there seems to be a common background to both theories: a moralistic conception, which attributes the misfortunes and diseases faced by the black population to their “naturally” inferior condition from a civilizational perspective centered on whiteness as the domain of the healthy body.

Imag source: obras raras. Licensed under Creative Commons


CHALHOUB, S. Cidade febril: cortiços e epidemias na corte imperial. São Paulo: Compania das letras, 1996.

HAMMONDS, E.; HERZIG, M. R. The natural diference: science and race in the USA from Jefferson to Genomics. Cambridge : MIT press, 2009.

MAIO, M. C. Raça, doença e saude pública no Brasil: um debate sobre o pensamento higienista do século XIX. Rio de janeiro: Fundação Oswaldo Cruz, 2010.

SCHWARCZ, L. M. O espetáculo das raças: ciêntistas, instituções e questão racial no Brasil (1870-1930). São Paulo: Compania das Letras, 1993.

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