Amazonian biodiversity is increasingly threatened due to the weakening of policies for combating deforestation, especially in Brazil. Loss of animal and plant species, many not yet known to science, is just one among many negative consequences of Amazon deforestation. Deforestation affects indigenous communities, riverside as well as urban populations, and even planetary health. Amazonia has a prominent role in regulating the Earth's climate, with forest loss contributing to rising regional and global temperatures and intensification of extreme weather events. These climatic conditions are important drivers of emerging infectious diseases, and activities associated with deforestation contribute to the spread of disease vectors. This review presents the main impacts of Amazon deforestation on infectious-disease dynamics and public health from a One Health perspective. Because Brazil holds the largest area of Amazon rainforest, emphasis is given to the Brazilian scenario. Finally, potential solutions to mitigate deforestation and emerging infectious diseases are presented from the perspectives of researchers in different fields.

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Beyond diversity loss and climate change: Impacts of Amazon deforestation on infectious diseases and public health.

Advances in reducing poverty and inequalities in the 2000s had a paradoxical effect in Brazil. This article examines how socioeconomic transformations, and the complexity of health services, are expressed in the regions established for planning purposes and the inter-governmental management of the Brazilian Unified Health System. An effort was made to identify and explain differences in the compositions of the 438 existing health regions and their spatial distribution by comparing situations observed in 2016 with those in 2000. Factor analysis and grouping techniques were used to construct a typology in the two years of the series, which was based on a diverse set of secondary data sources. It was found that there was an evolution in terms of income levels and service provision within the health regions, with a significant improvement in the socioeconomic conditions of the population. These results suggest that there was a positive impact from the combination of strategies related to social, economic and regional policies for the promotion of development, which generated more widespread well-being within the affected areas. However, limitations remain regarding the policies implemented for the universalization of the health system.

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Regional health inequalities: changes observed in Brazil from 2000-2016

RESUMO Iniquidades de acesso ao Sistema Unico de Saude comprometem a garantia de cuidados primarios de saude para populacoes rurais e para outros grupos em situacao de vulnerabilidade. Estudo transversal que avaliou acesso de usuarios e cobertura assistencial de Equipes de Saude da Familia (EqSF) dos sete estados da regiao norte do Brasil e que aderiram a avaliacao externa do segundo ciclo Programa Nacional de Melhoria do Acesso e da Qualidade da Atencao Basica (PMAQ-AB). Os dados do PMAQ-AB foram relacionados a indicadores demograficos, socioeconomicos e de saude, por meio do coeficiente de correlacao de Spearman. Para o conjunto da regiao, a cobertura assistencial de equipes sediadas em area rural, urbana e urbana que declararam atender a populacoes rurais foi de 83,3%. Coberturas entre 90-100% foram encontradas para o Acre, o Amapa, Roraima e o Tocantins. Menores percentuais foram encontrados no Para (50,5%) e no Amazonas (60,5%). A extensao de cobertura encobre barreiras de acesso geografico ligadas a concentracao de equipes da Estrategia Saude da Familia nos espacos urbanos, situacao que se estende a 451 (25,3%) unidades e a 494 (22,9%) equipes encarregadas do atendimento de populacoes rurais, mas que atuam em espaco urbano, adicionando barreiras a chegada dos usuarios as unidades. Dificuldades no acolhimento a demanda espontânea, agendamento de consulta e disponibilidade de transporte para o atendimento tambem foram reportadas.

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Acesso e cobertura da Atenção Primária à Saúde para populações rurais e urbanas na região norte do Brasil

The regionalization is one of the premises for the current phase of decentralizing the Unified Health System – SUS and an important process to reduce
the significant inequalities in Brazil. Despite advances relevant, this article identifies how a new perspective regarding the regionalization of health care is needed in
order to establish a national project which is more effective and coherent with regional diversity in Brazil.

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Novas perspectivas para a regionalização da saúde

An explanation is required for the delay in implementing the regionalization strategy and the fragile nature of the combined decentralization and regionalization initiatives in Brazil. The article raises some hypotheses to clarify this intricate issue and reviews the structural conditioning factors of the regionalization process ongoing in the states. A national typology of the health care regions is prepared, differentiating them according to the degree of socio-economic development and the characteristics of the health care network and of the municipalities that form the Regional Management Boards (CGR), formally implanted by January 2010. Factorial and cluster analysis models were used to build the typology. Five major socio-economic groups of CGRs were identified, described according to their regional distribution, population, health care spending, profile of services offered (including the public-private sector mix) and health service coverage. The results obtained serve as guidelines for the constitution of health care networks and new initiatives at the regional level, in order to improve the regionalization policy and favour the construction of diverse and flexible regulatory instruments that are more in tune with the regional state of affairs.

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Condicionantes estruturais da regionalização na saúde: tipologia dos colegiados de gestão regional

This article presents the results of a study on Federal health policy in the Brazilian Legal Amazon (BLA) from 2003 to 2005, aimed at backing the development of regional health policies. The region has peculiar dynamics, an extensive border area, and adverse social indicators. The methodology included documental and financial analysis, participatory observation, interviews with heads of various Federal Ministries and State and Municipal health secretaries from the BLA; characterization of geographic situations in the BLA; and field studies in 15 municipalities. Institutional consolidation of health policy proved to be low in the Amazon during the study period, due to structural, institutional, and political difficulties. The identification of six geographic situations was useful for systematizing land use differences with repercussions on health, and which should be considered when implementing public policies. There is a certain gap between Federal actions and territorial dynamics, expressed as a mismatch between the current policy and its recognition by local administrators. In addition to establishing a regional policy for the Amazon, there is an evident need for differentiated policies within the region.

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Virna Carvalho David

Papers

Sistema de saúde universal e território: desafios de uma política regional para a Amazônia Legal