Ethno racial issues in pharmaceutical education: a curricular analysis of brazilian federal higher education institutions

Abstract

Background

The inclusion of ethnic-racial issues in Pharmacy Education, is grounded in educational policies that emphasize the principles of comprehensiveness and equity in healthcare, as well as the development of competencies related to social justice. However, this theme remains insufficiently integrated into the curricula of undergraduate programs in countries like Brazil, even in the face of governmental initiatives and the nation’s own diverse ethnic and racial composition.

To characterize the incorporation of ethno-racial themes in the undergraduate Pharmacy curricula of all Brazilian Federal Higher Education Institutions (IFES).

Methods

A descriptive study was conducted using undergraduate Pharmacy curricula. Data extraction was carried out independently by two researchers, with discrepancies discussed and resolved through consensus. Extracted information included ethno-racial themes (i.e., African Continental Ancestry Group, Indigenous Peoples, health inequities, racism), document characteristics, subject profiles, and covered content. Textual analyses were performed using Iramuteq software, employing Hierarchical Descending Classification (HDC).

Results

Among the analyzed curricula (n = 50), just over half (56%) included subjects addressing ethno-racial themes. Among these, the majority were classified as mandatory (64.9%), belonged to the Social and Behavioral Sciences field (56%), and were not specifically focused on ethno-racial issues (86.5%). HDC generated a dendrogram with five classes: classes 2 and 1 were more closely related to educational norms, while classes 5, 4, and 3 were associated with content addressing anthropological concepts, public policies involving Black and Indigenous populations, traditional knowledge, and a more biological approach to racial issues.

Overall, a minority of IFES pedagogical projects addressed ethno-racial issues, with the content predominantly providing superficial references to educational guidelines rather than emphasizing their historical and social significance.

Conclusion

The results suggest the need for institutional actions to support the implementation of educational policies aimed at promoting social justice and patient-centered care.

Background

The emergence of health models grounded in a biopsychosocial and patient-centered perspective highlights the need to develop competencies that conceptualize ethnic and cultural diversity beyond static definitions, particularly within health education curricula, government policies, and professional practice frameworks [1,2,3,4]. According to the literature, the concept of cultural competence has evolved within the healthcare field to support effective practices that respect the specificities of patients, families, and communities. However, several barriers to the consolidation of such practices persist [5,6,7,8,9,10,11].

Regarding these barriers, studies have demonstrated that ethnocentric practices in healthcare affect both the academic training of healthcare professionals and the delivery of services, as well as the formulation of health policies [7, 12, 13] Historically, such practices have privileged white populations, marginalizing Afro-descendant, Indigenous, and immigrant groups, thereby exacerbating health disparities across these populations [10, 11, 14,15,16]. Ethno-racial issues are complex and multifaceted, manifesting across diverse spheres of social life, including education, politics, economics, and culture. They encompass historically constructed and perpetuated inequalities, alongside struggles and forms of resistance tied to identity, belonging, and the power dynamics and discrimination faced by racialized groups [17]. Ethno-racial inequalities and racism are widely recognized as critical social determinants of health. In healthcare, racism manifests both institutionally and individually. Institutional racism encompasses policies and practices that generate or perpetuate the vulnerability of specific individuals or social groups. Individual racism, often implicit, expresses itself through stereotypes or biases favoring or disadvantaging particular racial groups, thereby influencing healthcare professionals’ delivery of treatment, attention, and care. This dynamic culminates in a racial hierarchy within healthcare settings [1, 2].

Eliminating racism is crucial to achieving global public health goals [5] In the United States, healthcare professionals are expected to actively confront racism within the healthcare system, both in patient care and professional relationships [6]. To this end, the Accreditation Council for Pharmacy Education (ACPE) [7] emphasizes the importance of pharmacy students recognizing social determinants of health and critically reflecting on their own biases. A primary goal of pharmacy education is to prepare the workforce to meet current and future healthcare demands. Therefore, educators and students must be equipped to identify and address disparities manifesting in various forms, such as unequal access to medications among racialized groups, including African Americans [7, 12].

The teaching of ethno-racial issues in health education has predominantly focused on disparity statistics, cultural competence, and social determinants of health. While these approaches are important, they often fail to adequately address the root causes of health inequities, such as institutionalized racism [18]. Moreover, they can contribute to misconceptions, such as the biological interpretation of race, and overlook the roles of implicit bias and structural historical contexts [6]. The application of Critical Race Theory (CRT) in pharmacy curricula is argued to help students recognize the causes and consequences of racism and unjust practices affecting racialized individuals. CRT aims to identify, analyze, and transform the structural and cultural dimensions of society that sustain the subordination and marginalization of racially diverse populations. It posits that social structures are not racially neutral and that this reality shapes both individual cognition and interpersonal interactions [6, 19].

Since 2003, Brazilian educational policies and normative documents have directed the inclusion of content on the history and culture of indigenous, African, and Afro-Brazilian populations at all education levels, responding to social movements’ demands [20,21,22]. Consequently, health courses have adjusted their curricular guidelines to align with social demands and ethnic diversity [14, 15]. Pharmacy guidelines curricular emphasize the need to educate culturally competent pharmacists for social justice and health equity through ethno-racial relations [15, 16]. Nevertheless, few studies have examined their implementation. Thus, this study aims to characterize the inclusion of ethno-racial themes in Brazilian Federal Higher Education Institutions’ Pharmacy courses.

Methods

A descriptive study was conducted involving the analysis of undergraduate Pharmacy curricula between September 2021 and July 2022. Out of more than 750 Pharmacy schools in Brazil (public and private) [23], only 50 were part of the Federal Higher Education Institutions (IFES) system. All these IFES Pharmacy programs were included in the study. They were selected for convenience, as their curricular documents were accessible due to greater institutional transparency, which facilitated data collection.

The list of IFES Pharmacy courses was obtained from the National Institute for Educational Studies and Research database in September 2021 [16]. Websites of all Pharmacy courses were located, and curricular matrices and pedagogical projects were extracted for analysis. Missing documents were requested from the respective IFES via email or the Integrated Ombudsman and Information Access Platform.

Data extraction was conducted independently by two researchers (NCC and FCAN), with terminology discussions held beforehand to ensure consistency. Extracted variables included the document’s year of creation, presence of ethno-racial content in subjects, course region, year of the course in which the subject was offered, subject name, workload, nature (optional or mandatory), and content and/or syllabus.

The definition of ethno-racial content adopted in this study was grounded in literature on the teaching of ethno-racial issues in health education, as well as curricular guidelines and normative documents [15, 16, 20, 21]. Ethno-racial content in subjects was analyzed for the presence of terms and themes related to the African Continental Ancestry Group, Indigenous Peoples, race, ethnicity, racism, cultural competence, health inequities, Afro-Brazilian, and Indigenous health. Subjects were categorized as “theme-specific” if they were exclusively dedicated to teaching ethno-racial issues, and as “addressing the theme” if they included relevant content within broader disciplines. Additionally, subjects were classified into three broad areas—Social, Behavioral, and Administrative Sciences; Clinical Sciences; and Basic/Other Sciences—following the classification proposed by Nunes-da-Cunha et al. (2016) [24].

After data extraction and classification by two independent researchers, a third researcher (M.R.S.) reviewed the results to identify and assess any discrepancies. These divergences were examined and discussed in joint meetings involving all three researchers, facilitating a collaborative and iterative consensus-building process. This approach clarified conceptual differences and refined the coding process, ensuring coherence and standardization in data interpretation across the research team. Once consensus was achieved, descriptive analyses using absolute and relative frequencies were conducted. Additionally, the content of each subject and pedagogical project addressing ethno-racial themes was compiled into a corpus for subsequent textual analysis.

Textual analysis and data processing were conducted using Iramuteq software, which facilitates the quantification and statistical treatment of textual data. This includes calculations such as word frequency distributions, co-occurrence patterns, and statistical associations between terms using tests like chi-square (χ²). These quantitative analyses are integrated with qualitative approaches, enabling a rigorous and reliable interpretation of content while preserving the contextual meaning of words [25, 26].

The software provides various analytical tools, including classic lexicographic analysis, factorial correspondence analysis, similarity analysis, and word clouds. In this study, Hierarchical Descending Classification (HDC) was applied. HDC organizes text segments into classes based on shared vocabulary by segmenting the corpus according to word root frequency. For HDC analyses to be effective, a minimum of 75% of text segments must be retained to enable accurate classification of textual material [26].

Using correlation-based logic, Iramuteq segments the textual corpus by employing a list of reduced word forms and an embedded dictionary, generating a hierarchical structure of word classes. These classes are formed based on statistically significant associations between words, primarily identified through chi-square tests. The final output includes a dendrogram—a graphical representation of the text classification—along with associated lexicons and text segments. Subsequently, the dendrogram, lexicons, and text segments were analyzed to draw inferences and interpretations of the material, supported by relevant literature [25,26,27].

Results

General data

This study included all 50 Pharmacy courses at IFES in Brazil. Among the analyzed curricula, 28 (56%) included subjects addressing ethno-racial themes, while 22 (44%) pedagogical projects mentioned content related to the theme. Regarding the publication year of these documents, 48 (96%) were dated after 2004, and 17 (34%) were published and/or revised after 2017 (The description of the subjects included in this study is provided in the appendix).

Given Brazil’s vast territorial expanse and significant cultural and economic diversity influencing curricular structures, data were stratified by region. In the Central-West (100%), South (62.5%), and Southeast (56.3%) regions, the majority of institutions offered courses addressing ethno-racial aspects. Conversely, in the Northeast (46.7%) and North (20%) regions, fewer than half of the institutions included such content.

Table 1.

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The study analyzed the incorporation of ethno-racial themes in the undergraduate pharmacy curricula of federal higher education institutions (IFES) in Brazil. Of the 74 subjects addressing the topic, 48 (64.9%) were mandatory. Among these, 27 (56%) belonged to Social, Behavioral, and Administrative Sciences, and 47 (98%) included content related to ethno-racial issues, with only one subject specifically dedicated to the theme.

Overall, the majority of subjects (56.8%) belonged to the Social, Behavioral, and Administrative Sciences, had a workload of less than 60 h (59.5%), and 26 (35.1%) did not specify the academic year in which the course was offered. Among the 48 subjects that specified the academic year, 17 (23%) were offered in the first year. Regarding thematic incorporation, 64 (86.5%) addressed ethno-racial content, while only 10 (13.5%) were categorized as specifically focused on ethnic-racial issues.

Textual analysis

Textual analysis was conducted using Iramuteq software to group, by similarity, the content of subjects and pedagogical projects addressing ethno-racial issues. The textual corpus comprised 1,163 unique words appearing 4,525 times. Hierarchical Descending Classfication (HDC) analysis, which classifies text segments based on their respective vocabularies, retained 83.33% of the total corpus. Following word occurrence processing, HDC generated a dendrogram defining five thematic classes and the relationships between them.

Initially, following partition logic, two subcorpora were formed, isolating Class 2 (20%) and Class 1 (13.8%). Subsequently, a new partition separated Class 5 (25%) from a subdivision comprising Classes 3 (25%) and 4 (16.2%). The dendrogram considered the first 20 words, which, upon review and insertion into text segments, confirmed the presence of ethno-racial themes in the analyzed documents. Class interpretation was performed from left to right, as directed by the software.

Class 2 explicitly referenced regulations guiding ethno-racial issues in education, including current laws and resolutions from the National Council of Education. The most representative text segment in this class stated: “The PPC considers the resolution, which deals with the National Curricular Guidelines for Ethnic-Racial Relations Education and for the Teaching of Afro-Brazilian and African History and Culture.”Fig. 1

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Class 1 is closely related to Class 2 due to similarities in content, as both address legal issues. However, Class 1 differs by focusing on strategies to implement guidelines and ordinances, such as supervised internships, community involvement, undergraduate research, and theoretical training through mandatory and elective courses in both undergraduate and graduate programs. This is illustrated in the following excerpt: “In the PPC, topics related to the national curricular guidelines for ethnic-racial relations education and for the teaching of Afro-Brazilian and Indigenous history and culture are addressed transversally across various activities and mandatory and elective subjects, such as the study of ethnic-racial relations, Afro-Brazilian history, and culture within collective health courses…”.

In the second partition, three classes emerged, exhibiting both thematic proximity and divergence. This group examined the approach to ethno-racial issues in student education. Class 5 primarily encompassed content related to anthropological concepts in health, as illustrated by the text segment: “…the strategy to address ethnic-racial relations will be based on transversality among curriculum units, with a more direct focus in certain subjects, such as cultural anthropology, which should address political and historical consciousness of Brazilian diversity as a means to promote human equality, appreciation of the cultural and aesthetic heritage of peoples of African descent, deconstruction of stereotypes, and overcoming prejudice and discrimination through reflection, inquiry, and discussion of the institutional, historical, and discursive roots of racism…”.

Class 4 pertains to public policies and topics involving knowledge of traditional and Indigenous peoples, including phytotherapy, ethnobotany, ethnopharmacology, Indigenous comprehensive health policies, pharmaceutical services for Indigenous and quilombola communities, traditional knowledge, and integrative practices. A representative text segment is “History of Phytotherapy in the World and in Brazil,” highlighting the use of plants in Afro-Brazilian and Indigenous cultures, which are integral to the development of phytotherapy in Brazil.

Class 3, while sharing content related to environmental issues and public policies with Class 4, adopts a more specialized focus on deontology and pharmaceutical legislation, incorporating ethno-racial issues from biological and pharmaceutical development perspectives. This is evident in statements such as: “…in the Genetics subject, biological aspects of ethnic similarities and differences are discussed in light of the concept of race and its relation to prevalent genotypes in certain populations. Meanwhile, in Ethics and Pharmaceutical Legislation, the legal framework concerning ethics, pharmaceutical, and sanitary legislation in pharmaceutical practice is explored, alongside knowledge and respect for human rights and ethno-social and cultural conditions.” Thus, this class appears more oriented toward basic and professional sciences relevant to practice, guiding pharmacists in their professional roles.

Discussion

Of the curricula analyzed, just over half included content related to ethno-racial issues. This finding highlights a structural deficiency, particularly considering that Brazil has the largest Black population outside of Africa. Previous studies have similarly observed that Brazilian health education tends to undervalue the inclusion of content addressing ethno-racial issues and their impact on the health of racialized populations [14, 15]. In the United States and Canada—where Black or African American populations represent 13.6% and 2.5% of the total population, respectively—pharmacy curricula frequently omit the socio-political dimensions of race and its impact on health [28, 29]. Therefore, educational institutions need to value the inclusion of topics related to the care of these populations.

In the last 20 years, educational legislations, evaluation instruments, and specific indicators recommending the development of competencies related to Ethnic-Racial Relations could stimulate the introduction of these themes in pharmacy education [16, 20]. However, this analysis indicates that Brazilian institutions are falling short of these recommendations. Similarly, in the United States, the Accreditation Council for Pharmacy Education (ACPE) underscores that pharmacy students and professionals must possess knowledge of and sensitivity to patients’ individual characteristics, including culture, race/ethnicity, socioeconomic status, gender, diversity dimensions, and identity [7]. Although the curricular inclusion of health disparities and cultural competence is mandatory, there is a lack of evidence regarding their inclusion in curricula [30, 31]. Therefore, the implementation of these issues is fundamental for the technical knowledge of pharmacists to be used to improve the care of vulnerable populations [32, 33].

In the textual analysis, thematic classes were generated using Iramuteq software, which organizes text segments according to lexical similarity and statistically significant associations (via chi-square testing). These classes represent clusters of conceptually related content within the analyzed materials. In this context, Class 2 pertained to regulatory frameworks, suggesting that legal and policy documents serve as initial mechanisms for integrating ethno-racial themes into pharmacy education. However, a substantial portion of the documents lacked depth in articulating how these principles are operationalized. Notably, the 2015 ACPE standards do not explicitly address diversity and equity in healthcare as distinct componentes [7] but instead incorporate them within broader domains such as cultural sensitivity and professional communication. In Brazil, a study on racial equity in health, conducted with coordinators of health-related academic programs, revealed that institutional compliance was more frequently cited than a substantive recognition of the theme’s relevance as the reason for its curricular inclusion. However, the integration of ethnic-racial education should not be driven solely by regulatory mandates. Rather, it must reflect a deeper educational imperative—one rooted in historical consciousness and a commitment to reparative justice for marginalized populations [15, 34].

Regarding the regional stratification of data, the findings revealed that the Central-West, South, and Southeast regions had the highest inclusion of ethnic-racial themes in institutional documents. This outcome is particularly noteworthy given that the largest proportions of Black and Brown populations in Brazil reside in the North and Northeast, while Indigenous populations are predominantly concentrated in the Central-West and North. These disparities raise critical questions about regional mismatches between demographic realities and curricular responsiveness [35]. However, this can be explained because the South and Southeast regions show greater compliance with norms, as per INEP data; [23] the Southeast region has the highest number of institutions with a score of 5 on the IGC quality indicator (ranging from 1 to 5), and among the states with institutions scoring 4, these regions also predominate. However, higher compliance with legislation does not necessarily equate to greater advancement in addressing ethnic-racial issues. According to the 2022 Brazilian Annual Public Security Yearbook, these same regions report some of the highest rates of racial offenses and racism. Notably, the Central-West region exhibits the highest average number of racism incidents against Indigenous peoples across federal entities.(36) These intersections demonstrate that the racial issue in Brazil is complex and requires careful analysis by researchers.

In Class 1, representative words such as subject, content, mandatory, optional, and transversal are related to strategies for implementing educational policies on ethnic-racial relations. According to Pearson and Hubball (2012) [37], a comprehensive approach to designing an integrated pharmacy curriculum should encompass both horizontal and vertical dimensions, alongside structural and pedagogical strategies that promote integrative learning. Indeed, a variety of teaching methods and longitudinal, multifaceted integration are essential to effectively deconstruct structural racism and its impact on health outcomes [38, 39]. Therefore, Pharmacy faculty must integrate horizontally and vertically into the didactic and experimental components of the curricula, the educational content on ethnic-racial issues and their effects on health and well-being outcomes.

Subjects addressing ethnic-racial issues were mostly from the social and behavioral sciences, mandatory, and non-specific to the theme. As discussed later, the prevalence of mandatory subjects in this area represents progress. In a study by Nunes-da-Cunha (2016) [24, 40], countries such as the United States and Canada had a higher concentration of subjects in the social and behavioral sciences compared to European countries (26% of European curricula, with only 6% of American and Canadian schools not offering subjects in this area). Conversely, in India and Jordan, Pharmacy curricula do not include courses in social, behavioral, and health policy sciences. In the Social Sciences area, the inclusion of subjects addressing social health determinants, such as ethnic-racial inequalities and institutional racism, can contribute to the development of a multicultural perspective and to the establishment of competent and anti-racist professional relationships [30, 31].

In the study investigating how Pharmacy schools in the United States and Canada included topics such as health disparities, cultural competence, and health literacy, it was identified that the depth remains at the introductory level mainly in elective experiences, and some as mandatory [15, 39]. Regarding the best teaching model for these contents, there is no consensus in Pharmacy on best practices. Some researchers who documented the integration of equity, social justice, or systemic racism into training programs emphasize the importance of incorporating these approaches longitudinally, transversely, and interdisciplinarily from the beginning of training [14, 37]. In this context, practical subjects in Social and Administrative Sciences, and Pharmaceutical and Biological Sciences should seek the integration of these contents, as seen in a longitudinal study with Pharmacy students in the United States, where the integration of cultural competence concepts throughout the curriculum increased perception, understanding, and application of health literacy [29, 39].

Unlike Classes 1 and 2, which show contents present in pedagogical projects, the remaining classes are related to course syllabi. In Class 5, themes such as ethnocentrism, diversity, discrimination, race, and racism can be identified, addressed in Humanities and Behavioral Sciences subjects, such as Cultural Anthropology and Health Anthropology. Studies indicate that addressing the concept of race and the consequences of racism in the healthcare system can be challenging, and although the teaching of anti-racism in Pharmacy programs is not incipient, there is currently no literature on pedagogical methods and the impact of such teachings on student opinions and behaviors [30, 39]. However, the teaching of these themes represents progress in discussions on ethnic-racial issues, as discrimination and racism can impact professional practice and health outcomes for patients, from implicit bias against black patients to eligibility criteria in pharmacotherapy follow-up services [28, 41, 42].

In Class 4, the ethnic-racial theme was addressed with a focus on the indigenous population, through elective subjects such as Indigenous Health and Pharmaceutical Care for Indigenous Peoples, and in non-specific curricular units addressing indigenous history and culture, traditional knowledge, and the use of medicinal plants/phytotherapy, movements of struggle, and public policies. The inclusion of these themes is valuable, as there are inequalities affecting this population worldwide, related to factors such as unequal access to social and health systems, intrinsically linked to racism and colonialism [43].

In the elective course held in Canada with the aim of training students to work effectively in providing pharmaceutical care to indigenous peoples, it pointed to the need for mandatory and practical subjects to improve understanding of indigenous history and its impact on health care [44]. However, caution should be exercised while approaching this public, as they may perpetuate stereotypes due to inadequate knowledge of indigenous cultures. The adoption of decolonized and indigenized teaching, with anti-racism training, may be a path that meets the needs of these populations, increasing the acceptability and effectiveness of pharmaceutical services [45, 46].

Ethnic-racial relations were also taught through subjects such as Genetics and Hematology, as can be seen in Class 3. Although some guidelines address the most important diseases for ethnic reasons in racialized populations, such as Sickle Cell Anemia, Glucose-6-Phosphate Dehydrogenase deficiency, Hypertension, and Diabetes mellitus, the biological approach to race/ethnicity should be critically analyzed. Since genomic research has pointed out that there are no differences justifying race as a biological category, race is a social construct [47]. However, it continues to be considered a biological variable in diagnostic algorithms and/or treatment decisions [48].

Thus, recommendations using this marker are increasingly criticized for being biased, unscientific, and capable of increasing disparities in healthcare. Nonetheless, there are situations where pharmacokinetics, effectiveness, and/or drug safety differ between groups and are linked to a combination of environmental, social, and pharmacogenetic factors [49, 50]. The relationship between race/ethnicity and health is multifactorial, and underlying reasons must be properly investigated to avoid racial prejudice, stereotypes, and the pathologization of racialized groups [49].

According to existing literature, social determinants are major contributors to healthcare inequities, with particular emphasis on ethnic-racial disparities and the impact of racism [48] Racism — whether systemic, cultural, interpersonal, or institutional — plays a significant role in sustaining these inequities, posing a serious threat to public health, hindering progress toward equity, and creating barriers to patient care [20, 21]. In the United States, pharmacy education increasingly emphasizes the integration of structural and cultural competence into curricula, ensuring that students are equipped to recognize and challenge systemic inequalities. However, caution is needed to prevent such approaches from unintentionally reinforcing stigma in clinical encounters [31, 39, 48]. Therefore, a deeper understanding of the social, economic, and political health determinants should be the focus of the education of pharmacists and pharmacy students, aiming to eliminate racially biased clinical practices.

Ultimately, from the representative words found in this study, one can discern the opposing positions that influence curriculum structures and their barriers to cultivating culturally competent pharmacists. The educational arena is shaped by social, political, economic, and cultural forces, involving significant phenomena such as social justice and anti-racist education. Hence, the curriculum should be the central and structuring space for public policies in national education and content selection. In the real-life scenario, the curriculum is not neutral and caters to the interests of dominant classes, especially in defining what should be learned and taught [51]. Despite legislative guidance and incentives for the inclusion of ethnic-racial content in curricula, the authors observed that only a portion of educational institutions has actively contributed to the anti-racist struggle and the fight against institutional, structural, and implicit racism, adversely affecting patient-centered care by future pharmacists.

In light of the presented results, no consensus or model was found for the inclusion of ethnic-racial themes in the education of pharmacy students. Concepts encompassing racism, discrimination, prejudice, race/ethnicity, whiteness, class, and other topics related to Brazilian racial relations should be incorporated into the curricular frameworks of undergraduate Pharmacy programs. Additionally, the notion of coloniality, understood as a power model that constituted modernity, allowed Europe to establish itself as the universal and true producer of scientific knowledge, while disqualifying and ignoring Americans, Africans, and Asians as knowledge subjects. This should also be addressed in Pharmacy education since it still is a current issue in contemporary times. The establishment of Undergraduate curriculum remains Eurocentric, with a predominance of white researchers and minimal participation of Black and Indigenous individuals as knowledge producers [52].

Varga [53] proposes that the ethnic-racial issues should be addressed through topics such as the dissemination of racism in public policies and Brazilian institutions, the trajectory of health policies and practices as social products resulting from interactions and historical conflicts between different sociocultural formations, domination policies, and interethnic relations. Regarding more specific topics related to the Indigenous population, it is needed to address ethnology and history, issues and struggles, health policies, environmental sanitation, epidemiological profile, and health data. Furthermore, prevalent diseases among racial groups and their relation to institutional racism and health determinants, morbidity, and mortality profiles by gender, age, region, and race/color/ethnicity, and the health of the Black population, as recommended in the National Policy for Comprehensive Health Care of the Black Population [21], should be covered. However, the inclusion of these topics should extend beyond theory, involving outreach and research with rural, Black, Quilombola, and Indigenous populations.

In conclusion, this study presents both strengths and limitations. Among its strengths, to the best of our knowledge, it constitutes the first comprehensive mapping of the incorporation of ethnic-racial themes in the education of pharmacy students at Federal Higher Education Institutions (IFES) in Brazil. These findings provide a foundation for critical reflection on current approaches to race and ethnicity within health education. However, some limitations must be acknowledged. The analysis was restricted to the written dimension of curricula, which may not fully capture the actual teaching practices related to ethnic-racial themes in pharmacy education. Furthermore, the study sample was limited to IFES, representing only 7% of all higher education institutions offering pharmacy programs in Brazil, thus limiting the generalizability of the results to the broader national context. Consequently, further research encompassing a wider range of institutions is necessary to deepen understanding in this area.

Conclusion

After characterizing the incorporation of ethnic-racial issues in the undergraduate pharmacy curricula of Federal Higher Education Institutions (IFES), this study found that only half of these institutions included such topics, primarily within mandatory courses in the Social, Behavioral, and Administrative Sciences. The textual analysis revealed a predominant reference to Brazilian educational guidelines, suggesting a stronger emphasis on regulatory compliance rather than fostering historical awareness or addressing reparations for racialized groups.

Given these findings, further research is needed to better assess pharmacists’ training concerning race and ethnicity, as well as the impact of such education on advancing health equity and combating racism. Additionally, pharmacy faculty should be well-versed in anti-racist, decolonial, and critical pedagogical frameworks to deepen their understanding of the historical, social, environmental, and political determinants that render race and ethnicity significant risk factors for health disparities, along with their root causes and structural consequences. Ultimately, comprehensive and practical governmental initiatives are essential to implement public and educational policies that reveal and dismantle racial inequities, thereby promoting social justice and patient-centered care within pharmacy practice.

"Workload refers to the total number of hours assigned to the subject in the official curriculum."

Data availability

Datasets used and/or analyzed during the current study made available by the corresponding author upon request.

Abbreviations

ACPE :

Accreditation Council for Pharmacy Education

CRT:

Critical Race Theory

HDC:

Hierarchical Descending Classification

IFES :

Federal Higher Education Institutions

INEP:

National Institute of Educational Studies and Research Anísio Teixeira

PPC:

Course Pedagogical Project

References

Research

Open access

Published:21 October 2025

Ethno racial issues in pharmaceutical education: a curricular analysis of brazilian federal higher education institutions

Nayara Costa Cavalcante1,

Fernando de Castro Araújo-Neto2,3,

Millena Rakel dos Santos3,

Alessandra Rezende Mesquita4 &

…

Divaldo Pereira de Lyra Jr 4

Show authors BMC Medical Education volume 25, Article number: 1468 (2025) Cite this article

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