Health, biodiversity, and natural resource use on the Amazon frontier: an ecosystem approach

Abstract

This study aims to improve the health of rural Amazonian communities through the development and application of a participatory ecosystem approach to human health assessment. In the study area marked seasonal fluctuations dictate food availability, water quality and disease outbreak. Determining the causal linkages between ecosystem variables, resource use and health required a variety of forms of inquiry at multiple scales with local participation. Landscape spatial mapping of resource use demonstrated the diversity of the ecological resources upon which communities depend. Household surveys detailed family and individual consumption and production patterns. Anthropometric measurements, parasite loading, water quality and anemia levels were used as indicators of health status. This was complemented with an ethnographic and participatory health assessment that provided the foundation for developing community action plans addressing health issues. Discussion is focused on three attributes of an ecosystem approach; (a) methodological pluralism, (b) cross-scale interactions and (c) participatory action research.

Ecosystem approaches and health in Latin America

“…These premises have also appeared in recent books published on the theme in Canada 34,35 , whose focus has influenced the research produced in Latin America 21,22,23,24,25 . Thus, it is no coincidence that the five selected articles have their research results published in the special issue of Cadernos de Saúde Pública/Reports in Public Health entitled An Ecological Approach to Human Health: Emerging and Communicable Diseases, which resulted from an event organized and financed by the Canadian International Development Research Centre (IDRC) at the Brazilian National School of Public Health in November 1999.…”

“…The other four articles 21,22,23,24 involve assembling pictures that allowed combining a larger set of information divided into two major groups, systematized in Tables 2, 3, 4, and 5. The first set dealt with spatial scales, collecting information at the individual/family/household/residential (Table 2), neighborhood/village/community (Table 3), landscape/municipal (Table 4), and regional/national/global levels ( Table 5).…”

“…Hygiene practices associated with environmental health 21 Access to quality water for human consumption 21 Vector-favorable household microclimatic conditions 24 Construction materials 23,24 Forms and places in landscape occupation (whether near the forest or periphery) 22,23 Location and type of building materials (closer to the forest and more isolated from the village) 23 Socioeconomic status and food expenses 21 Income by source 21 Productivity in the economic activity 21 Health education as an element for reducing care for malaria cases 22 Availability of financial resources limiting the use of health services and preventive measures 22 Fish tanks as sources of both family income and potential vector foci 22 Impact of morbidity on the disease influencing productivity 24 Subsistence economy 24 Land tenure, family farming, and family income 24 Access to foodstuffs with quality diet 21 Family-level decisions (mother) on use of preventive measures or health services 22 Women making decisions on the family's health and home improvements 22 Morbidity and deterioration of living conditions 24 Schooling 24 Social stigma of persons with diseases 24 Jobs for housing improvements 24 Community participation in control and surveillance strategies (including schools) 24 Knowledge, beliefs, and practices leading to actions favoring or preventing disease 22 Practices allowing greater exposure to vector in the household or peri-domicile 22 Interruption of work activities to provide care for sick individuals 22 Perception of the disease 24 Incorporation of rural culture in the urban environment 24 Use of housing 24 Home ownership 24 Sustainable conditions for vector and species domiciliation 24 Fami...…”

“…Number of houses favoring or preventing the problem 22 Location of houses favoring or preventing contact with vectors 22 Homebuilding rate in recently occupied areas 22 Forms and distribution of landscape occupation 22 Vector-favorable organization of peri-domiciliary space 24 Community's degree of dependence on the ecosystem 24 Macroeconomic projects 24 Residential grouping 23 Level of community organization 23 Number of inhabitants 23 Disease prevalence 23 Geographic location 23 Time since village was settled 23 Level of grouping (nuclear versus scattered villages) points to better or worse community participation and lower disease prevalence 23 Access to foods given their prices 21 Increase in the number of fish tanks as sources of family income 22 Groups for production and distribution of mosquito nets to poorest families 22 Forms of organization for marketing the community's produce 24 Improvements in facilities (railroads) for marketing the community's produce 24 Social practices (games, conversation) at times of greatest mosquito attack 22 Access to education 21 Access to health services 21 Community organization 21 Community resources and installations 21 Community history 21 Prioritization of municipalities in control and education related to the disease 24 Formation of farmers' cooperatives 24 Community participation through groups to eliminate mosquito attack sites 22 Lack of community organizations 24 Lack of economic culture 24 Dispersion of dwellings forces residents to cross the forest more often for visits or participation in community activities 23 Domiciliary and peri-domiciliary vector species, woodpiles, synanthropic reservoirs 24 Dispersion of dwellings 24 Peri-domi...…”

“…Economic dimensions 22,23,24 can be classified in three major groups, related to: (1) the negative impact of morbidity and mortality resulting from disease (Tables 2 and 3); (2) the positive impact of intervention through reduction of morbidity and mortality, highlighting the need for the government to take responsibility for these expenditures (Tables 2 and 3 Ecosystem productivity (soil fertility) 21 Ecological diversity 21 Presence of natural resources 21 Use of natural resources (agriculture, fishing, hunting, gathering, etc.) 21 Economic activities 22 Forms of work and their relationship to the landscape 22 Municipal government assumes costs of continuing the program 22 Increase in unemployment rate 22 Decrease in town's economic capacity due to public debt, corruption, and low income level 22 Contribution by municipal government to control programs (staff, transportation, vehicles) 24 Lack of commitment to disease control by local authorities 22 Reorganization of health services with new responsibility for municipal government 22 Politics plays central role in the health sector 22 Lack of people's trust in politicians and lack of belief in social and economic leaders 22 Lack of inter-sector approach to social development and problem-solving activities 22 Lack of medical care for persons with the disease 24 Lack of prenatal follow-up of the disease in endemic areas 24 Whether community organization is dependent on external agents 22 Community participation in prevention and health promotion activities is dependent on health authorities, without considering the community's preferences and priorities 22 Large number of traditional healers, as the first choice of care before the hospital or health post 22 Lack of municipal funding for health; health system centralized 24 employment, access to and utilization of natural resources, migratory flows resulting from impoverishment in given regions, etc.)…”