The Social Determination of Racial Inequities in Oral Health Among Indigenous Peoples.

Abstract

Objectives: To foster a critical analysis of the racial inequities affecting the oral health (OH) of Indigenous peoples in Brazil, framed by the social determination of the health-disease-care process (SDHP).

Methods: This critical literature review articulates the themes of colonisation, Indigenous peoples' oral health and racial inequities in health through the lens of SDHP. It explores how racial inequities affecting the oral health of Indigenous peoples in Brazil are socially determined, understanding that their health and illness profiles depend on the socioeconomic and legal contexts in which they are historically embedded.

Results: Racial inequities in OH are not determined by race, but by racism-a historical-political system of domination that violates civil rights. For Indigenous peoples, as victims of racialisation, this injustice reflects a colonial legacy of exclusion, state tutelage, extermination and violence. OH serves as a strong indicator of the exercise of citizenship, exposing material/structural disparities throughout life and across generations. Globally and in the Brazilian context, neoliberal policies exacerbate these inequities among Indigenous peoples, leading to increased oral illness and diminished access to healthcare. Racism must be understood not merely as a risk factor but as a structural foundation of poor OH conditions.

Conclusions: Reducing racial inequities in oral health for Indigenous peoples requires intersectoral strategies. Changes are needed in the domains of power across the legal, educational and healthcare systems. This involves intervening in public policies and redirecting OH research, education, management and services to recognise the historical oral health needs of Indigenous peoples in Brazil and the impacts of colonialism and racialisation.