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Environmental Health and Development in Legal Amazon: Socio-Economic, Environmental and Sanitary Indicators, Challenges and Perspectives

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Environmental Health and Development in Legal Amazon: Socio-Economic, Environmental and Sanitary Indicators, Challenges and Perspectives 233 Saúde ambiental e desenvolvimento na Amazônia legal: indicadores socioeconômicos, ambientais e sanitários, desafios e perspectivas Environmental health and development in legal amazon: socio-economic, environmental and sanitary indicators, challenges and perspectives Rosana Lima Viana Resumo Ministério da Saúde. Núcleo Estadual do Maranhão. São Luís, MA, Brasil. Este artigo tem por objetivo discutir os processos E-mail: [email protected] de determinação socioambiental nos estados que Carlos Machado de Freitas compõem a Amazônia Legal, com base na análise Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio de indicadores socioeconômicos, ambientais e sani- Arouca. Centros de Estudos da Saúde do Trabalhador e Ecologia tários. Nesse sentido, os resultados demonstraram Humana. Rio de Janeiro, RJ, Brasil. uma região dinâmica e muito heterogênea, com E-mail: [email protected] uma população crescente e concentrada principal- Leandro Luiz Giatti mente em áreas urbanas, combinando crescimento Universidade de São Paulo. Faculdade de Saúde Pública. Depar- econômico e degradação ambiental a um rápido e tamento de Saúde Ambiental. São Paulo, SP, Brasil. precário processo de urbanização e aos projetos E-mail: [email protected] de desenvolvimento voltados para a exploração de recursos naturais. O resultado é um quadro com- plexo de problemas de saúde, com expressividade das doenças infecciosas e parasitárias relaciona- das às intensas mudanças ambientais e às difíceis condições de vida, decorrentes principalmente da persistência de imensas desigualdades nos indica- dores sociais e econômicos. Tais vulnerabilidades produzem efeitos negativos no quadro ambiental e sanitário da região. Palavras-chave: Condições de Vida; Degradação Ambiental; Indicadores em Saúde Ambiental; Saúde Ambiental. Correspondência Ministério da Saúde. Núcleo Estadual do Maranhão. Av. Jerônimo de Albuquerque, nº 16. Centro. São Luís, MA, Brasil. CEP 65060-645. Saúde Soc. São Paulo, v.25, n.1, p.233-246, 2015 233 DOI 10.1590/S0104-12902016140843 Abstract Introdução This article discusses the processes of determin- O debate técnico-científico sobre a relação saúde, ing the environmental situation in the states that ambiente e desenvolvimento na Amazônia brasi- are part of the Brazilian Legal Amazon, based on leira, disponível em periódicos científicos, ainda é the analysis of socio-economic, environmental and muito restrito, apesar da quantidade expressiva de sanitary indicators. The indicators showed a very artigos que abordam os aspectos ecológicos, biológi- dynamic and heterogeneous region, with a growing cos e sociais da região em questão. De modo geral, os population mostly concentrated in urban areas, artigos disponíveis nesses periódicos sobre a saúde combining economic growth and environmental na Amazônia dizem respeito a aspectos epidemio- degradation associated with a rapid and precari- lógicos ou clínicos de doenças endêmicas (como a ous urbanization process, and with development malária, a dengue, a leishmaniose e as hepatites vi- projects focused on the exploitation of natural rais). Por outro lado, os artigos relativos ao ambiente resources. The result is a complex picture of health e ao desenvolvimento restringem-se a abordagens problems, with the presence of infectious and disciplinares sobre a biodiversidade, ao uso da terra, parasitic diseases related to severe environmental ao desmatamento e ao desenvolvimento sustentável changes and poor conditions of life, caused mainly (Freitas; Giatti, 2009; Confalonieri, 2005). by inequalities in social and economic indicators Raros são os estudos que buscam articular de that produce vulnerabilities and negative effects on forma multidisciplinar os temas “saúde, ambiente the environmental and sanitary context. e desenvolvimento” na Amazônia brasileira. Em Keywords: Living conditions; Environmental Deg- portais eletrônicos como o Pub-Med e o Scielo, radation; Environmental Health Indicators; Envi- que abrangem uma produção significativa da área ronmental Health. biomédica e da saúde coletiva, apenas três artigos foram encontrados sobre o assunto (Briceño-León, 2007; Vicentin et al., 2003; Freitas; Giatti, 2009). Partindo da hipótese de que o modelo de desen- volvimento econômico adotado na Amazônia brasi- leira produziu mudanças ambientais significativas e não conseguiu afetar positivamente os indicado- res sociais e sanitários, este estudo tem por objetivo discutir os processos de determinação da situação socioambiental nos estados que compõem a Amazô- nia Legal, a partir de seus indicadores socioeconô- micos, ambientais e sanitários disponíveis. Sendo assim, a determinação socioambiental corresponde aos processos que, no nível das macropolíticas, moldam as estruturas de produção (bens e serviços) e distribuições de riquezas, simultaneamente con- formando os processos ambientais (ciclos do clima, das águas e dos solos, por exemplo) e a situação de saúde das populações (Sobral; Freitas, 2010). A escolha dessa região como objeto de análise justifica-se por apresentar particularidades ambien- tais (clima, ecossistemas e biodiversidade) e demo- gráficas (sociodiversidade com baixa densidade e população concentrada nas cidades) que, combina- 234 Saúde Soc. São Paulo, v.25, n.1, p.233-246, 2016 das com processos econômicos, como a agricultura Pesquisas Espaciais). A organização dos dados e extensiva, pecuária, exploração mineral, hidrelétri- discussão do estudo partiu da hipótese central do cas e indústrias, produzem efeitos nas condições de estudo apresentada na introdução, sendo observa- saúde das populações relacionadas ao seu modelo das as evoluções e comparações dos indicadores da de desenvolvimento (Freitas; Giatti, 2009). Amazônia brasileira (e seus estados) com os alcan- çados no país, como também as possibilidades de Material e métodos cruzamento entre os dados. A referência principal na coleta dos indicadores foi o ano do último Censo Este trabalho é uma análise de processos de de- Populacional (2010) realizado no país (IBGE, 2010), terminação da situação socioambiental e de saúde visando à construção de um quadro com dados dis- (fatores sociais, econômicos, culturais e ambien- tintos em sua origem, porém próximos em relação tais, entre outros que influenciam a ocorrência de aos anos de coleta. problemas de saúde na população), conforme Sobral Por fim, é importante considerar que, se por um e Freitas (2010), com a utilização de variáveis quan- lado, a sistematização e análise de dados secundários tificáveis (indicadores) e de revisão bibliográfica. e a construção de indicadores vêm sendo largamente A delimitação da área de estudo compreendeu a utilizada para análises globais (de países ou mesmo superfície total dos 9 estados que compõem a Ama- regiões), permitindo uma visão mais ampla sobre zônia Legal (Acre, Amapá, Amazonas, Mato Grosso, determinados temas, espaços geográficos e políticas Pará, Rondônia, Roraima, Tocantins e Maranhão). públicas, por outro, apresenta limitações. A primeira Após essa etapa, foi realizada busca bibliográfica é que cada um dos dados utilizados foi coletado e nas bases SciELO e MEDLINE (PubMed) dos últi- construído a partir diferentes padrões de qualidade, mos 10 anos, utilizando-se como critério de busca validade, confiabilidade, cobertura, sensibilidade e os descritores (termos de busca) “saúde, ambiente especificidade, resultantes de um contexto em que há e desenvolvimento” e “Amazônia”. A busca serviu grande variabilidade local na capacidade de coletar para uma revisão que previamente identificou os dados e que interferem na qualidade dos dados. A temas que têm sido priorizados nas pesquisas sobre segunda é que, mesmo que os limites apontados an- as relações de saúde, ambiente e desenvolvimen- teriormente não existissem, cada indicador é, por sua to, com o objetivo de contextualizar e discutir os natureza, uma redução da complexidade a um único e indicadores. unidimensional valor (Van Bellen, 2005). Posteriormente, foram levantados dados e in- Essa característica de redução da realidade, toda- dicadores socioeconômicos, ambientais e de saúde via, constitui a potencialidade de síntese representada da região. A organização dos dados e indicadores pelos indicadores, o que contribui fundamentalmente teve por objetivo visualizar as possíveis relações para viabilizar estudos entre escalas ampliadas e per- e interações existentes entre os determinantes mite análises multidisciplinares (Van Bellen, 2005; socioeconômicos, as mudanças ambientais e seus Corvalán et al., 2000). No Brasil, há ampla tradição impactos na exposição e nos efeitos diretos sobre na produção de indicadores socioeconômicos e demo- a saúde das populações (Freitas; Giatti, 2009). gráficos, assim como indicadores de saúde. Alguns A coleta dos dados foi realizada eletronicamen- indicadores ambientais, como aqueles que requerem te via websites disponibilizados por instituições monitoramento de qualidade ambiental, são mais públicas brasileiras. Os indicadores de saúde fo- recentes e têm mais limitações. Porém, neste estudo, ram coletados na RIPSA (Rede Intergerencial de mesmo alguns indicadores ambientais, como aqueles Informações para o Setor Saúde), e os indicadores relacionados ao acesso à água e ao saneamento básico, econômicos e socioambientais nas publicações do são produzidos em base censitária e por isso possuem IBGE (Instituto Brasileiro de Geografia e Estatís- melhor qualidade, periodicidade e abrangência na- tica), PNUD (Programa das Nações Unidas para o cional (IBGE, 2012;
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