O objetivo deste estudo é analisar a pressão sobre o sistema de saúde no Brasil decorrente da demanda adicional gerada pela COVID-19. Para tanto, foi realizado um conjunto de simulações para estimar a demanda de leitos gerais (microrregiões de saúde), leitos de UTI e equipamentos de ventilação assistida (macrorregiões de saúde) em diferentes cenários, para intensidade (taxas de infecção equivalentes a 0,01, 0,1 e 1 caso por 100 habitantes) e horizontes temporais (1, 3 e 6 meses). Os resultados evidenciam uma situação crítica do sistema para atender essa demanda potencial, uma vez que diversas microrregiões e macrorregiões de saúde operariam além de sua capacidade, comprometendo o atendimento a pacientes principalmente aqueles com sintomas mais severos. O estudo apresenta três mensagens relevantes. Em primeiro lugar, é necessário reduzir a velocidade de propagação da COVID-19 na população brasileira, permitindo um tempo maior para a reorganização da oferta e aliviando a pressão sobre o sistema de saúde. Segundo, é necessário expandir o número de leitos disponíveis. Ainda que o setor privado contribua para amortecer o déficit de demanda, a oferta conjunta dos dois setores não seria suficiente em várias macrorregiões. A construção de hospitais de campanha é importante, tanto em locais onde historicamente há vazios assistenciais como também naqueles onde já se observa uma pressão do lado da demanda. A terceira mensagem diz respeito à organização regionalizada dos serviços de saúde que, apesar de adequada em situações de demanda usual, em momentos de pandemia este desenho implica desafios adicionais, especialmente se a distância que o paciente tiver de percorrer for muito grande.

This paper analyses poverty and inequality dynamics among smallholders along the Transamazon High-way. We measure changes in poverty and inequality for original settlers and new owners, contrasting income-based with multidimensional indices of well-being. Our results show an overall reduction in both poverty and inequality among smallholders, although poverty decline was more pronounced among new owners, while inequality reduction was larger among original settlers. This trend suggests that families have an initial improvement in livelihood and well-being which tends to reach a limit later—a sign of structural limitations common to rural areas and maybe a replication of boom and bust trends in local economies among Amazonian municipalities. In addition, our multidimensional estimates of well-being reveal that some economically viable land use strategies of smallholders (e.g., pasture) may have important ecological implications for the regional landscape. These findings highlight the public policy challenges for fostering sustainable development among rural populations.

One of Daniel Hogan’s lasting impacts on international demography community comes through his advocacy for studying bidirectional relationships between environment and demography, particularly migration. We build on his holistic approach to mobility and examine dynamic changes in land use and migration among small farm families in Altamira, Pará, Brazil. We find that prior area in either pasture or perennials promotes out-migration of adult children, but that out-migration is not directly associated with land-use change. In contrast to early formulations of household life cycle models that argued that aging parents would decrease productive land use as children left the farm, we find no effect of out-migration of adult children on land-use change. Instead, remittances facilitate increases in area in perennials, a slower to pay off investment that requires scarce capital, but in pasture. While remittances are rare, they appear to permit sound investments in the rural milieu and thus to slow rural exodus and the potential consolidation of land into large holdings. We would do well to promote the conditions that allow them to be sent and to be used productively to keep families on the land to avoid the specter of extensive deforestation for pasture followed by land consolidation.

The Legal Brazilian Amazon, while the largest rainforest in the world, is also a region where most residents are urban. Despite close linkages between rural and urban processes in the region, rural areas have been the predominant focus of Amazon-based population-environment scholarship. Offering a focus on urban areas within the Brazilian Amazon, this paper examines the emergence of urban hierarchies within the region. Using a combination of nationally representative data and community based surveys, applied to a multivariate cluster methodology (Grade of Membership), we observe the emergence of sub-regional urban networks characterized by economic and political inter-dependency, population movement, and provision of services. These networks link rural areas, small towns, and medium and large cities. We also identify the emergence of medium-size cities as important nodes at a sub-regional level. In all, the work provides insight on the proposed model of ‘disarticulated urbanization’ within the Amazon by calling attention to the increasing role of regional and sub-regional urban networks in shaping the future expansion of land use and population distribution in the Amazon. We conclude with a discussion of implications for increasing intra-regional connectivity and fragmentation of conservation areas and ecosystems in the region.

In late 2015, the Brazilian Ministry of Health and the Pan American Health Organization classified the increase in congenital malformations associated with the Zika virus (ZIKV) as a public health emergency. The risk of ZIKV-related congenital syndrome poses a threat to reproductive outcomes that could result in declining numbers of live births and potentially fertility. Using monthly microdata on live births from the Brazilian Information System on Live Births (SINASC), this study examines live births and fertility trends amid the ZIKV epidemic in Brazil. Findings suggest a decline in live births that is stratified across educational and geographic lines, beginning approximately nine months after the link between ZIKV and microcephaly was publicly announced. Although declines in total fertility rates were small, fertility trends estimated by age and maternal education suggest important differences in how Zika might have impacted Brazil’s fertility structure. Further findings confirm the significant declines in live births in mid-2016 even when characteristics of the municipality are controlled for; these results highlight important nuances in the timing and magnitude of the decline. Combined, our findings illustrate the value of understanding how the risk of a health threat directed at fetuses has led to declines in live births and fertility.

No abstract

BackgroundThe Amazon environment has been exposed in the last decades to radical changes that have been accompanied by a remarkable rise of both Plasmodium falciparum and Plasmodium vivax malaria. The malaria transmission process is highly influenced by factors such as spatial and temporal heterogeneities of the environment and individual-based characteristics of mosquitoes and humans populations. All these determinant factors can be simulated effectively trough agent-based models.MethodsThis paper presents a validated agent-based model of local-scale malaria transmission. The model reproduces the environment of a typical riverine village in the northern Peruvian Amazon, where the malaria transmission is highly seasonal and apparently associated with flooding of large areas caused by the neighbouring river. Agents representing humans, mosquitoes and the two species of Plasmodium (P.falciparum and P. vivax) are simulated in a spatially explicit representation of the environment around the village. The model environment includes: climate, people houses positions and elevation. A representation of changes in the mosquito breeding areas extension caused by the river flooding is also included in the simulation environment.ResultsA calibration process was carried out to reproduce the variations of the malaria monthly incidence over a period of 3 years. The calibrated model is also able to reproduce the spatial heterogeneities of local scale malaria transmission. A “what if” eradication strategy scenario is proposed: if the mosquito breeding sites are eliminated through mosquito larva habitat management in a buffer area extended at least 200 m around the village, the malaria transmission is eradicated from the village.ConclusionsThe use of agent-based models can reproduce effectively the spatiotemporal variations of the malaria transmission in a low endemicity environment dominated by river floodings like in the Amazon.

Rural settlement in previously sparsely occupied areas of the Brazilian Amazon has been associated with high levels of forest loss and unclear long-term social outcomes. We focus here on the micro-level processes in one settlement area to answer the question of how settler and farm endowments affect household poverty. We analyze the extent to which poverty is sensitive to changes in natural capital, land use strategies, and biophysical characteristics of properties (particularly soil quality). Cumulative time spent in poverty is simulated using Markovian processes, which show that accessibility to markets and land use system are especially important for decreasing poverty among households in our sample. Wealthier households are selected into commercial production of perennials before our initial observation, and are therefore in poverty a lower proportion of the time. Land in pasture, in contrast, has an independent effect on reducing the proportion of time spent in poverty. Taken together, these results show that investments in roads and the institutional structures needed to make commercial agriculture or ranching viable in existing and new settlement areas can improve human well-being in frontiers.