Health and Development in the Amazon we “want”

Salud y desarrollo en la Amazonía que “queremos”

Abstract

The purpose of the article is to discuss the functioning of the Genetic Heritage Management Council (CGen, acronym in Portuguese) from the enactment of Law No. 13,123 / 2015 until December 2019, to understand its role as coordinator of the benefit-sharing policy. CGen’s work context was presented and the theoretical framework of public policy coordination was discussed. The research was carried out based on the analysis of the minutes of the 24 meetings held by the Board, seeking to identify the frequency of full members, the participation of listeners, and the most discussed topics at the meetings. The CGen was found to be a leader in law enforcement, which seeks to use communication and standardization as mechanisms for its coordination. However, the low participation of beneficiaries of the policy and representatives of states and municipalities calls into question the effectiveness of the policy.

Keywords:  Development; Health; Amazon

Resumen

El objetivo de este estudio es analizar los aspectos teórico-empíricos del desarrollo de las Estaciones de Transbordo y Carga (ETC) y los desafíos para la salud. El sitio de estudio fue el Distrito de Miritituba en el municipio de Itaituba, Estado de Pará. Los datos primarios se obtuvieron en 2017 y 2018, con observación directa y aplicación de un guión de entrevista a representantes de la comunidad. El análisis de contenido se realizó en una perspectiva descriptiva, reflexiva y crítica, considerando los aspectos cualitativos del campo. Los resultados del estudio apuntaron a cuestiones teóricas y prácticas al preguntar sobre el tipo de desarrollo para la Amazonía. Se concluyó que la planificación para y en la Amazonía debe incluir a las poblaciones tradicionales de la región, así como señalar modelos alternativos de desarrollo, especialmente en lo que se refiere a la salud y supervivencia de culturas, ecosistemas y diversas formas de vida.

Palabras-clave: Desarrollo; Salud; Amazonas.

Resumo

O objetivo do presente estudo é analisar os aspectos teóricos-empíricos do desenvolvimento com as Estações de Transbordo e Carga (ETC) e os desafios à saúde. O local do estudo foi o Distrito de Miritituba no município de Itaituba, Estado do Pará. Os dados primários foram obtidos nos anos de 2017 e 2018, com observação direta e aplicação de roteiro de entrevista aos representantes comunitários. Realizou-se análise do conteúdo na perspectiva descritiva, reflexiva e crítica, considerando os aspectos qualitativos do campo. Os resultados do estudo apontaram para as questões teórica e prática ao questionar sobre o tipo de desenvolvimento para a Amazônia. Concluiu-se que o planejamento para e na Amazônia necessita incluir as populações tradicionais da região, assim como apontar para modelos alternativos ao desenvolvimento, especialmente quando está em questão a saúde e a sobrevivência de culturas, ecossistemas e as várias formas de vida.

Palavras-chave:  Desenvolvimento; saúde; Amazônia

Introduction

The Amazonian region was transformed into the obscure object of desire of many individuals and it is still seen as global provider of spaces, goods and services in natura, such as raw materials and energy extracted from its soil, underground, flora, fauna and fluids - such as water and air - in order to supply the insatiable forges of both national and global economies. (Armando Mendes in lecture held at BNDES, on July 21^st, 2010 (SIFFERT, et al. 2014, p. 27).

The dimension of human needs’ satisfaction addressed by Celso Furtado (2000c) and Amartya Sen (2010) becomes a concern when it is associated with the concept of development. This dimension is often conflicting or ambiguous, mainly when the aspirations of a given social group do not meet society’s expectations and needs. Policies focused on promoting development standards are implemented in different territories without necessarily meeting these expectations (DALLABRIDA, 2017). Thus, the current study has analyzed one of these public policy development experiences in the Amazonian region, at Middle Tapajós River, Pará State.

The imposing pictures of Transshipment and Loading Stations (TLS) are the brand of the bulk carrier business, since they feature the gears of silos and piers that have changed the landscape of Tapajós River. They are impressive pictures - mainly the ones taken in the night shift - that evidence a development type that does not seem to match the geography and / or landscape of the region. The grandiose metal structures seen both by land and by Tapajós River water - which reflect lights at night and expels the dust of intense road flows during the day - simultaneously highlights and conceals the logics of such a development type. The concept of development by SEN (2010) was herein adopted to explain the meaning of this reality in the public policy scope, by taking into consideration the association of health and satisfaction of human needs with improvements in the living conditions of Amazonian citizens.

We herein start from the broader sense of health, as proposed by the World Health Organization (WHO), according to which, health is a full state of physical, mental and social well-being, rather than just lack of diseases. This concept was reinforced by the 8^th National Health Conference Report, which has stated that food, housing, education, income, environment, labor, transportation, employment, leisure, freedom, access to and ownership of land, and access to health are the necessary conditions to ensure health (RELATÓRIO FINAL, 1986).

Thus, the aim of the current study was to analyze the theoretical-empirical aspects of development by taking into consideration Transshipment and Loading Stations and health-related challenges. The study was conducted in Itaituba County, Pará State, most specifically in Miritituba District. According to the local health system, more than 5,534 inhabitants lived in this district until December 2017 (despite the fragility of these data, they are important, given the lack of official IBGE data). Primary data were collected in 2017 and 2018 through direct observation and interview script application to nine Community representatives. Data triangulation (MINAYO, ASSISI; SOUZA, 2005) was used for content analysis (BARDIN, 2011), based on a qualitative, descriptive, reflective and critical perspective.

The current study resulted from a two-year research experience based on theoretical-empirical data; it presents the dynamics of the theoretical-conceptual aspect of development in the Amazonian territory by taking into consideration political organizations focused on development and by pointing out the implications of such a development to both the health and satisfaction of the needs of populations living in the investigated region. Results in the current study are expected to contribute to the debate about development types put in practice in, and for, the Amazon region.

Theoretical-conceptual aspects of development and health

Minayo (2002) has acknowledged that the “participation of different individuals involved in proper interventions can help promoting fair development” (p.187). The present study understands the idea of development as the involvement of different individuals in decision-making and participatory processes to promote sustainable socio-environmental changes. According to Sen (2010), development understood as freedom should not be circumscribed to certain achievements, whether they are of the social, political or economic type. The expansion of such a freedom is the main way to achieve what could be development, which should take place by means of active partnership processes, such as the creation of opportunities through education and health services.

Sen (2010) has also acknowledged that the dynamic implementation and functioning of companies that meet social responsibilities can influence economic development processes. However, based on the governments’ participation, an empirical thread must take place in society to intensify economic growth and social opportunities. Sen has emphasized that successful public policies depend on their close relationship with society in order to enable individuals’ free-living conditions. According to him, “development consists in ruling out the deprivation of freedom that limits individuals’ choices and opportunities to carefully play their role of agent” (SEN, 2010, p. 10).

Accordingly, it was possible following the trails of public development policies outlined for the Amazonian region, most specifically in the Middle Tapajós River region, Pará State, by bearing in mind that “the ends and means of development require placing the Freedom perspective in the center of the stage” (SEN, 2010. p. 77). Thus, it is necessary taking into consideration that development at local scale can be “an endogenous process observed in small units [...] with the participation of human clusters, they can promote economic dynamism and help improving the quality of life of the population” (BOISIER, 1999. p. 9).

In addition, the typology of “development is inserted in the broader and complex reality it interacts with and whose positive and negative influences and pressures are capable of affecting it” (BOISIER, 1999. p. 9). For example, development at regional scale comprises structural changes associated with a permanent process of the region and the society living in it. Thus, development results from the interrelationships and abilities of individuals living in local societies to make continuous movements based on their potentials, priorities and specificities (BOISIER, 1999).

According to Boisier, it is important removing barriers capable of hindering individuals’ quality of life. Any influence on the development process that leads to difficulties and hinders the improvement of individuals’ living conditions, points towards what Massey (2008) called “responsibility of place”. Thus, this development process is associated with stages of changes taking place in social structures, and it takes into account the interventions of public policies aimed at changing individuals’ quality of life. It also comprises the participation of individuals living in the place, since it can help reversing such a structure based on a given condition, as well as expanding their involvement through aspects associated with well-living, i.e., aspects that are not necessarily linked to consumer society’s components.

Development seen as freedom condition (SEN, 2010) and its association with health are more complex (PORTELA, 2013), since both health and freedom converge towards the autonomy of individuals and their ability to work in decision-making processes involving their lives. Individual skills mainly depend, among other things, on economic, social and political provisions. Instrumental roles played by freedom comprise different, but interrelated, components such as economic conveniences, political freedoms, social opportunities, guaranteed transparency and protective security.

The concept of human health addressed by Porto (2012, 94) is close to Sen’s (2010) thoughts about development, since he acknowledged that health can be understood as “[...] processes and conditions providing humans with several existence levels and with organization to enable virtuous life cycles [...] that go through implacable biomedical, ethical, social and cultural dimensions.” This concept of health converges to the definition by the World Health Organization (WHO), according to which, health is not limited to biomedical functionality, to lack of diseases and to greater longevity, on the contrary, “to reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs and to change or cope with the environment” (PORTO, 2012, p. 95).

Based on this epistemological context, the Health Sciences and Applied Social Sciences fields engage in an interdisciplinary dialogue that helps understanding temporality as constituent part of this process. Thus, according to Sen (2010, p.77), “people have to be seen as active - given the opportunity - in conforming their own fate, rather than just as passive beneficiaries of results from ingenious development programs.” In addition, “[...] the State and society play broad (sustainability) roles in strengthening and protecting human skills” (SEN, 2010, 77); this process demands long periods-of-time and must be mainly associated with improvements in social life and with freedom of choice.

Matters pointed out by SEN (2010), who linked development to freedom, are associated with Boisier’s (1990) thoughts about local and regional development; thus, they are relevant to help better understanding the outcomes of public policies planned for the Amazonian region, since the 1970s. According to Castro (2005), the effects of public policies aimed at promoting development during this period have pointed towards “severe environmental issues resulting from the developmental model that disregarded environmental impacts” (CASTRO, 2005, p. 12). However, the aforementioned author stated that “it took another decade for the effects of these policies to be perceived and to become a relevant issue”, and to rethink the development typology at the public policies scope.

Impacts resulting from development type are associated with what Boaventura de Souza Santos (2007) called ecology of trans-scale, due to political and business articulations that opened room for different development projects over the last few years in the Amazonian region. The environmental effects of this predatory development model are felt in the most remote places in this region. Among them, one finds Yanomami peoples’ struggle against prospector companies. Development policies’ outcomes are contradictory, mainly because they promise socio-environmental improvements that do not come (CASTRO, 2005). In addition, the effects of these policies on traditional populations and ancestral territories are unsettling. Thus, the definition of development as social practice is complex and requires critical analysis.

According to Buarque de Holanda (s/d), development means the “act or effect of developing”, i.e., making, growing, progressing, advancing, among other synonyms. Based on Santos et al. (2012), development holds the idea of progress and growth. In economic terms, development means both progress and growth; it is associated with improvements in productive bases (SANDRONI, 2010). Finally, the etymology of the word “development” (FIGURE 1) points towards a criticism, which shows that the noun indicates “without moving towards reversing the action, or even, without involvement” (DINIZ 2006 apud SANTOS et al., 2012, p. 46). Thus, this word brings along non-compromise, “non-involvement” with the environment, which dissociates lifestyles from issues taking place in individuals’ surroundings.

This issue draws attention to prefix des, at the beginning of the word “development”, which refers to lack of movement capable of reverting or changing a given action, to not moving with quality, awareness, “inwards” in order to reverse certain scenarios and situations capable of affecting social and environmental life. Thus, it is necessary “reversing” and “turning” the situation in a participatory manner so one can weigh on new development forms including the option of “degrowing” (Azam, 2019). It indicates the promotion of involvement as condition for changes in social conditions - posed and imposed by a given development model - to take place.

Figure 1
Etymological representation of the word development.

According to Sen (2010), category “development” can be understood as the expression of improvements towards society, based on the interrelationship of political freedoms with social opportunities, by taking into account empirical thread and social skills. These aspects are considered essential at the time to choose one’s desired life, whereas these choices can be expanded by public policies and influenced by social individuals’ ability to promote the idea of being together, as suggested by Massey (2008) in the “responsibility of place”.

Development seen as freedom, in the sense described by SEN (2010), is associated with the prevailing freedoms of individuals in the choice-making process, not just with the vital ones, such as food, education, health and safety. Actually, it is also associated with how to exercise citizenship in a broad manner, including their right to participate in political, economic, cultural and social processes at temporal or spatial scale. Thus, one can infer that the flow of bulk trucks and carriers caused by TLSs can boost the economy in Miritituba District, either directly or indirectly, despite the uncertainty about whether, or not, it has effect on social choices and opportunities capable of promoting individuals’ dignified life and sustainability.

This factor refers to the concept of sustainability, which is associated with the idea that development can help better understanding desirable effects for regions hosting TLSs. This concept is based on Minayo (2002), Sen (2010) and Tambellini; Miranda (2012), who understand sustainability as factor associated with equitable and balanced development, based on freedom of choice and on the integrated social participation of different individuals to value the attributes of specific, or non-specific, places in their entirety. Thus, sustainable attitudes and practices emerge from participatory strategies aimed at promoting identity and alterity, with emphasis on socio-environmental care relationships that lead to health promotion.

Development-oriented geopolitical organization

The geographical aspects and natural attributes of several places in the Amazon region are attractive to economy demands (SIFFERT et al., 2014), since they form a type of capillarity network boosted by interests of the private sector. Based on this reality, the Brazilian State sets selective clippings with organizational bias to promote changes in the economy and society through public policies.

According to Becker (2010), selective clippings assume different scales and temporalities that mostly emerge from actions planned by the State, based on public policy formulations. This planning type is radicalized by geopolitics, which understands territory from the geostrategic perspective used to implement policies focused on promoting the so-called development. Thus, it is necessary understanding spatial strategic practice modes and intensities in order to differentiate region, regionalization and territory as aspects of political organization processes.

Region is considered a geographical category used to explain the space instruments and elements as processes resulting from different regional shapes and contents in the spatial historical dimension (LIMA, MACHADO; ALBUQUERQUE, 2012). According to Becker (2005, 71), “region is a geopolitical construction seen as knowledge field to analyze relationships between power and geographic space”. As for Milton Santos (2008, p. 160), region has also become the functional place of the whole, “convenience spaces”, mainly for hegemonic interests in resources favorable to capital expansion; consequently, capital acceleration capable of transforming regions’ shape and content is clearly observed.

Although “place” is not part of the political organization in the development planning sphere, like region and territory, it is possible seeing the unity and contiguity of historical events. Thus, region and place “are subspaces to the same laws of evolution, according to which, the empiricized time is seen as condition of possibility, whereas the geographical entity is seen as condition of opportunity” (emphasis in the original text) (SANTOS, 2008, p. 161).

Based on the development planning scope, regionalization is an important “[...] instrument used to indicate and draw regions in a given territory, based on technical, political, economic, social and cultural criteria, depending on the project to be implemented” (LIMA, MACHADO; ALBUQUERQUE, 2012, p. 824). Certainly, regionalization refers to regional clippings established to organize and articulate territorial space, power distribution and the establishment of interrelationships among different individuals in order to reach a specific goal.

It is the case of the regionalization process implemented in Pará State, in 2007, due to its territorial dimension (1,247,954,67 km²). It encompasses 144 counties (Pará, 2010); its estimated population in 2017 comprised 8,366,628 inhabitants (IBGE, 2018). According to the Institute of Economic, Social and Environmental Development of Pará State (Instituto de Desenvolvimento Econômico, Social e Ambiental do Pará - IDESP, 2014b, p. 6), this territorial and population dimension “imposes difficulties for the acquisition of information used to support the elaboration of public policies that take into account each county”.

Thus, 12 integration regions (IR) were formed for state planning and internal management improvement purposes, namely: Araguaia, Low Amazonas, Carajás, Guamá, Tucuruí Lake, Metropolitana, Marajó, Caeté River, Capim River, Tocantins, Xingu and Tapajós. Such a division is strategic, both for the government and the private sector. These two segments have joined forces to work towards reducing interregional inequalities and valuing natural resources, cultural diversity and economic activities in these regions to create new job positions and income (IDESP, 2014a; PARÁ, 2010).

Since late 20^th century and early 21^st century, the federal government, in partnership with the states, has been developing strategies focused on regional development policies. According to Castro (2012), from 2007 onwards, these policies were intensified through programs, policies and projects focused on meeting the needs of remote regions in the Amazon, where there is small State participation through public policies. Thus, the multimodal transport system was planned based on the implementation of National Integration and Development Axes (ENID - Eixos Nacionais de Integração e Desenvolvimento) in the Amazonian region. According to Becker (2007), this axis type is associated with the concept of large regions qualified as new territorial divisions with large contiguous areas that are established by governments in order to meet political demands.

Tapajós was strategically selected among all 12 integration regions (IR) in Pará State, based on the development policy viewpoint of Brazil and Pará State’s economy and infrastructure. According to Siffert et al. (2014), this policy encompasses a set of infrastructure works focused on waterways and highways, as well as on connecting transshipment and loading stations through the logistical axis. The aim of this axis is to optimize the flow of agribusiness products deriving from the Midwestern region, among other Brazilian regions, a fact that accounts for creating job positions and income for both local and regional populations.

The initial strategy adopted to expand the grain transport matrix was called Logistic Midwest Freight Corridor; it enabled paving the BR-163 highway in the stretch from Sinop County (Mato Grosso State) to Itaituba County (IR of Tapajós, Pará State). The logistic corridor of the “Northern Arc” border region aimed at favoring the logistics focused on grain export. Becker (2007) has criticized this strategy by saying that it was not enough to promote development, although it was associated with the country’s economic policy. Results in the current study converge to this proposition, given the contradiction observed between large investments in infrastructure to the detriment of investments in essential basic services in the medium Tapajós region.

In many cases, development planning based on public policies leads to the appropriation and domination of resources and spaces, as observed in Miritituba District’s TLSs, ports and bulk backyard ports. Thus, the concept of territory presupposes understanding space appropriation and domination processes. However, in the strict sense, territory is a political term (BECKER, 1988) referring to geographic spaces (SANTOS; SILVEIRA, 2004); thus, it must be understood as the extension of several construction and appropriation forms featured by diverse and interconnected power relationships. Therefore, territory is a space where power manifestations take place, and where historically constructed practices and activities meet each other (HELLER, 2016). Finally, territory results from society’s relational reproduction, from territorialization and temporalities (MASSEY, 2008), as well as from historical procedures that persist in current daily routines.

Empirical evidence points out that society-environment relationships and, consequently, life reproduction in its multiple dimensions (LEFEBVRE, 1991, CARLOS, 2007) - which involve economic, political and cultural powers and determine historical temporality and spatiality - take place in the territory. The political organization for planning purposes defines region and regionalization as the exclusive role played by the State. They are depicted by integrated development regions, such as the Tapajós integration region, as well as by health regions (BRASIL, 2006), as governmental interference results.

The development “we want” and implications for health

The implementation of huge projects in the Amazonian region raised concern about development promotion - which has been planned since the 1970s - and national sovereignty security. The effects of such a development comprised intense migratory processes, environmental degradation, precarious living conditions and infrastructure. These factors got even worse due to burns and to the advancement of agricultural boundaries in recent years. According to Lima (2016), lack of both territorial planning and conditions to monitor the action of these projects have had significant impact on the living environment, as well as direct effects on human health.

Scholars such as Freitas; Giatti (2009) have pointed out the importance of conducting studies to indicate human health conditions associated with the socio-environmental scenario due to the intervention of large ventures, whose effects compromise health and social well-being, mainly in remote regions in the Amazon. Several impacts could be avoided or mitigated during these projects’ planning stages if they could count on the participation of different sectors of society, such as the health sector. Silveira and Neto (2014) draw attention to the contributions that agents working in the health sector could make to these processes - from licensing and developing large-scale works to social processes aimed at minimizing the effects of these ventures on human quality of life and health.

Based on Pereira (2014), the social participation of different sectors can help mitigating frequent environmental impacts caused by social or economic processes. The aforementioned author highlighted the daily dynamics of riverside towns in Tocantins State’s Amazon Forest and islands, as well as in ravines and floodplains in Cametá County, Pará State. These towns have undergone major transformations since the 1970s, which were intensified from the 1990s onwards. During this period, riverbank dwellers - the so-called riverside dwellers - started participating in resistance movements by reorganizing, rearranging and inducing new territorialities that have configured and redefined the region based on power relationships.

Transformations such as those may result from the implementation of what Pereira (2014) classified as the “economy” of power, which influences society to experience processes capable of redirecting individuals’ everyday lives. Massey (2008) called the effect of this event the geometry of power. Thus, the transformation process taking place in everyday life contexts in Amazonian locations, such as the Miritituba District, points out organization aspects, social and economic strategies, their interconnection with the environment and its consequences.

Many specificities of the Amazonian region, mainly at local scale, are no longer privileged to the detriment of economic specificities. Thus, it is necessary paying more attention to the implementation of the so-called development. Celso Furtado (1957) has emphasized that development policies trigger a process that can contribute to worsening economic, political, social and environmental disparities and exclusions by disregarding territorial space features. On the other hand, the human health issue in zones surrounding major development projects or social processes in the Amazonian region has been historically defended by social movements, which often complain about the impacts and externalities (VICENTIN; MINAYO, 2003) affecting the quality of life in this region.

The impacts caused by large projects on the daily lives of individuals living in Miritituba District are disheartening, since they intensify tensions in the environment and affect the local life. The movement recorded in the road-river economic structure, from 2017 to 2018, is certainly not the same as that observed on the other side of the river (FIGURE 2), where Itaituba County’s (A) City Hall is located in. This side of the river is privileged with urban infrastructure, hospitals, health service units, among others. On the other hand, Miritituba District (B), which houses at least 5 TLSs and 3 large fuel ports, does not have basic service units such as hospitals, banks or even a harbor infrastructure suitable for the intense flow of people and cargo at the District’s port entrance.

Miritituba District is not just a territory, it is a place with social totality (SANTOS, 2008), since changes taking place in it were determined by social, economic and political issues. Thus, the road-river bulk transport policy implemented in this District triggered a development type that draws the attention and instigates the population, as reported by a 65-year-old citizen who has been living in the place for over 30 years: “Who is this development for? What are the benefits it will bring to the residents of this place, besides some job positions, the water catchment station, the construction of both the gym and the Social Assistance Reference Center (CRAS), and the donation of teaching materials and food?” The resident himself answered this question, “But we all know who this development is for, it is for big business, rather than for the local population, that is the truth”.

Figure 2
Photographic representations of the front part of Itaituba County and Miritituba District.

Reports such as this one have shown that forces capable of transforming the economy can worsen the impacts of road-river activity on social and environmental dimensions. In the case of Itaituba District (FIGURE 3), the bulk ports (A) boost the road-river activity (B), but, at the same time, they pose risks to the daily environment and expose individuals to adverse conditions. They also limit fishing activities (C); lead to unsafe traffic, due to the flow of bulk trucks; and affect the quality of the air because of intense dust (D) in the Transportuary way.

Figure 3
Photographic representation of bulk ports and road-river transport effects on Miritituba District, Itaituba County -PA.

The impact of the road-river activity on the environment during summer is explained by the large amount of dust generated by the traffic of trucks, which intensely affects the lives of Nova Miritituba neighborhood residents, among other neighborhoods. The local population faces other issues during the rainy season, such as mud, and the risk of accidents due to lack of roadsides and sidewalks. According to local healthcare professionals, this context leads to issues such as respiratory diseases, as well as to external consequences such as motor vehicle accidents and stress resulting from the noise generated by the trucks. Residents question this development type since they are the ones mostly affected by the consequences of socio-environmental changes.

According to Sen (2010), development seen as freedom can be substantiated by local participation, although this concept is far from the Amazonian reality. This development type is imperative, if one takes into consideration other effects that stood out in residents and health workers’ reports. The intense road and river-based activity in Miritituba District, in association with the presence of truck drivers and other transport workers - who circulate across the region - contributes to increase illicit drugs and alcohol consumption, as well as impairs the creation of job positions, and the leisure and income perspectives of adolescents and young individuals. These issues lead to social vulnerability experienced by different groups and individuals living in this place.

Workers who come to the region in search for a job and who do not find it, can help increasing alcohol and drug consumption. Based on the interviews, there was increased demand for mental healthcare due to depression, suicide attempts, and alcohol and drug abuse in the last four years. Transport workers, among others, were attracted to the region in 2013 due to the implementation of bulk ports. Health workers have reported that several individuals who went to the region in search for work opportunities, and who did not have their expectations met, got depressed and resorted to alcohol and/or illicit drugs. This fact played fundamental role in increasing the demand for services at the Psychosocial Care Center (CAPS - Centro de Atenção Psicossocial) in Itaituba County.

According to the reports of health workers and other interviewed actors, which were also confirmed by field observations, there was increase in the number of cases of children and adolescents living under social vulnerability conditions associated with pregnancy, as well as with alcohol and drug abuse. These aspects play relevant role in the analysis applied to the effects of bulk projects implemented in Miritituba District. Thus, it is essential conducting studies focused on assessing the impacts of this venture type on socially vulnerable groups living in the Amazonian region.

Based on the perspective of social health determinants and on the broad concept of health, it was possible seeing that the impact of these ventures on individuals’ lives cannot be limited to disease analysis; it is also necessary taking into consideration violence, labor, culture, housing and environmental issues.

The current experience with TLSs in Miritituba District, and the past experiences with development policies implemented in the region, remind us of Armando Mendes’ words (apud ANDRADE et al., 2014, p. 29): “The Amazonian citizens can no longer stand to remain invisible and inert while they watch the spoliative use of Amazonian lands and the Amazon being reduced to an inert object [...]”. Unfortunately, the events of the past remain active in contemporary times.

Transformations observed in the Amazonian region - which were influenced by exogenous issues - keep happening due to significant demands from the economy, political elites and capitalist entrepreneurs. According to Mendes (1974) and Mahar (1978), these transformations have been taking place since late 19^th century, due to the extraction of forest products, such as wild rubber, to supply both the national and international markets. Based on the aforementioned authors, this exploration has changed the region, although it had low effect on the quality of life of local populations.

Armando Mendes’ speech - delivered at BNDES on July 21^st, 2010 - has evidenced such a fact, when he said: “The Amazonian region was converted into the obscure object of desire of many individuals and it is still seen as emeritus global provider of spaces, goods and natural services [...]”, such as “[...] raw materials and energy extracted from its soil, underground, flora, fauna and fluids - such as water and air - in order to supply the insatiable forges of both the national and world economies” (LASTRE et al, 2014, p.13; SIFFERT et al, 2014, p. 27). Certainly, several places in the Amazon region, and their historical organization and daily life elements, remain as background, although faded, in the global and local economic scenario. It is necessary breaking away from the dominant paradigm that leads to predatory and excluding extractivism.

Conclusions

The health issue associated with TLS-based development in Miritituba District, in the current article, resulted from the interdisciplinary dialogue between Health Sciences and Social Sciences applied to society. The ideological perspective of development based on road-river bulk transport activities happening at real time and place frustrates individuals’ expectations about the social well-being of local populations. Interrelationships among economic activities, the environment and health were herein investigated; results pointed towards contradictory theoretical and practical outcomes. The current study has questioned the development type (and its strategy) implemented in the Amazonian region, since the prevailing logic lies on economic development to the detriment of the physical, psychological and social well-being of populations living in this region. Above all, the study addressed the economy based on a grain type that has no connection to the Amazonian history, life and culture.

The challenge does not lie on thinking about alternative developments for the Amazonian region, but on thinking about alternatives to development (LANGE, 2016). The challenge of critical thinking lies on putting forward degrowth (AZAM, 2019) and economic slowdown options, as well as on taking into consideration the rights of nature (SOLÓN, 2019). It is about acknowledging and investing in other worldviews and practices that were previously taken as “underdeveloped” in order to build more diverse societies. Based on the Itaituba County example, the hegemony of one model over many others that have coexisted in the place for centuries is a path that leads to destruction and death. On the other hand, we believe in the challenge of including other alternative forms to the development of integral life and broad health.

Finally, the question that remains in our minds refers to the development alternatives we “want” or desire, by taking into consideration other worldviews, cultures, lifestyles, knowledge and different logics of thinking and developing life. The challenge of how to coexist with such different development logics in a territory rich in social, ethnic, cultural and linguistic diversity remains. There are many Amazons, but one of them seems to have prevailed: the agribusiness and pasture one. The alternative to the development “we want” lies on more equitable relationships and on the broad sharing of epistemologies to enable the “good living” and happiness of all individuals.

Acknowledgment

The authors are grateful to the National Council for Scientific and Technological Development (CNPQ - Conselho Nacional de Desenvolvimento Científico e Tecnológico) for funding the current research and for granting the scholarship to the first author during the research process.

References

• AZAM, G. Decrescimento. In: SOLÓN, P. Alternativas sistêmicas. São Paulo: Elefante: 2019.
• BARDIN, L. Análise de conteúdo. São Paulo: Edições 70, 2011.
• BECKER, B. Geopolítica na Virada do III Milênio. Garamond, Rio de Janeiro 2007.
• BECKER, B. Novas territorialidades na Amazônia: desafio às políticas públicas. Bol. Mus. Para. Emílio Goeldi. Ciências Humanas. Belém, v. 5, n. 1, p. 17-23, jan.- abr. 2010. Available at: <http://www.museu-goeldi.br/editora/bh/artigos/chv5n1_2010/dossie_novas (becker). pdf> Access on: Aug. 02^nd, 2017.
  » http://www.museu-goeldi.br/editora/bh/artigos/chv5n1_2010/dossie_novas (becker). pdf
• BOISIER, S. Desarrollo (Local): ¿De Que Estamos Hablando? Santiago de Chile: ILPES, 1999. Available at: <http://www.flacsoandes.edu.ec/web/imagesFTP/12 459 48918. Desarrollo_Local_De_que_estamos_hablando2.pdf>. Access on: Jan. 27^th, 20 17.
  » http://www.flacsoandes.edu.ec/web/imagesFTP/12 459 48918. Desarrollo_Local_De_que_estamos_hablando2.pdf
• BRASIL. Ministério da Saúde. Secretaria Executiva. Departamento de Apoio à Descentralização Coordenação de Integração Programática. Ministério da Saúde, Brasília, 2006. Available at: <https://bvsms.saude.gov.br/bvs/publicacoes/regio nalizacao2006.pdf>. Access on: May 03^rd, 2020.
  » https://bvsms.saude.gov.br/bvs/publicacoes/regio nalizacao2006.pdf
• BRASIL. Ministério da Saúde - Nota Técnica. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Nota técnica - Itaituba. (NotaTecnica DAB_ITAITUBA_PA_150360). Referência maio de 2018. S.d. Available at: <http://dab2.saude.gov.br/sistemas/notatecnica/frmListaMunic.php>. Access on: Sep. 20^th, 2018.
  » http://dab2.saude.gov.br/sistemas/notatecnica/frmListaMunic.php
• CARLOS, A. F. O lugar no/do mundo. São Paulo: Hucitec, 2007.
• CASTRO, E. Dinâmica socioeconômica e desmatamento na Amazônia. Novos Cadernos NAEA. v. 8, n. 2, p. 5-39, dez. 2005. Available at :< http://www.periodicos. ufpa.br/index.php/ncn/article/view/51/53>. Access on: Aug. 02^nd,2017.
  » http://www.periodicos. ufpa.br/index.php/ncn/article/view/51/53
• CASTRO, E. Expansão da fronteira, megaprojetos de infraestrutura e integração sul-americana. Caderno CRH, v. 25, n. 64, p. 45-61, 2012. Available at:<http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-49792012000100004>. Access on: Nov. 06^th, 2016.
  » http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-49792012000100004
• FEARNSIDE, P. M. A Hidrelétrica de Teles Pires: O enchimento e a morte de peixes. In: _______. (Org.). Hidrelétricas na Amazônia: Impactos Ambientais e Sociais na Tomada de Decisões sobre Grandes Obras. Vol. 2. 1ed. Manaus: Editora do INPA, 2015, p. 109-113.
• FREITAS, C. M. de; GIATTI, L. Indicadores de sustentabilidade ambiental e de saúde na Amazônia Legal. Brasil. Cad. Saúde Pública, Rio de Janeiro, 25(6):1251-1266, jun, 2009.
• FURTADO, C. Perspectivas da Economia Brasileira. Curso de Treinamento em Problemas de Desenvolvimento Econômico, ministrado no BNDE. Available at: <http://www.redcelsofurtado.edu.mx/archivosPDF/furtado4.pdf>. Access on: Jan. 21^st, 2017.
  » http://www.redcelsofurtado.edu.mx/archivosPDF/furtado4.pdf
• FURTADO, C. Teoria e política do desenvolvimento econômico. 10ª ed. Rio de Janeiro, Paz e Terra, 2000.
• HELLER, A. O cotidiano e a história. Trad. Carlos Nelson Coutinho e Leandro Konder. Ed. 11ª. Rio de Janeiro/São Paulo: Paz e Terra, 2016.
• HERNÁNDEZ, F. del M.; MAGALHÃES, S. B. Ciência, cientistas e democracia desfi gurada: o caso Belo Monte. Novos Cadernos NAEA, v. 14, n. 1, p. 79-96, jun. 2011. DOI:http://dx.doi.org/10.5801/ncn.v14i1.599.
  » http://dx.doi.org/10.5801/ncn.v14i1.599.
• IBGE. Instituto Brasileiro de Geografia e Estatística. Cidades. 2018. Available at: <https://cidades.ibge.gov.br/brasil/pa/panorama>. Access on: Jan. 18^th, 2018.
  » https://cidades.ibge.gov.br/brasil/pa/panorama
• IDESP. Instituto de Desenvolvimento Econômico, Social e Ambiental do Pará. Barômetro da sustentabilidade: Região de Integração Tapajós: relatório técnico. Belém: IDESP, 2014b. 125 p. Available at: <http://seplan.pa.gov.br/ppasite/perfisregionais/Perfil_Regiao_Tapajos.pdf>. Access on: Jan. 21^st, 2017.
  » http://seplan.pa.gov.br/ppasite/perfisregionais/Perfil_Regiao_Tapajos.pdf
• IDESP. Instituto de Desenvolvimento Econômico, Social e Ambiental do Pará. Região de Integração Tapajós: Relatório técnico/ Instituto de Desenvolvimento Social, Econômico e Ambiental do Pará. Belém: IDESP, 2014a.
• KOHLHEPP, G. Conflitos de interesse no ordenamento territorial da Amazônia brasileira. Estudos Avançados 16 (45), 2002.
• LANGE, M. Introdução: Alternativas ao desenvolvimento. In: DILGER, G.; LANG, M.; PEREIRA FILHO, J. Descolonizar o Imaginário: debate sobre pós-extrativismo e alternativas ao desenvolvimento. São Paulo: Fundação Rosa Luxemburgo, 2016. Pp. 24-44.
• LEFEBVRE, H. A vida cotidiana no mundo moderno. São Paulo, Editora Ática, 1991.
• LIMA, L. D. de.; MACHADO. C. V.; ALBUQUERQUE, M. V. de. Regionalização da Saúde no Brasil. In. GIOVANELLA, L.; ESCOREL, S. LOBATO, L. de V. C.; NORONHA, J. C. de; CARVALHO, A. I. de. (Org.) Política e Sistema de Saúde no Brasil. Ed. 2, ver. e amp. Rio de Janeiro: Editora FIOCRUZ, 2012, p. 823-852.
• LIMA, M. de O. Saúde Ambiental e Ocupacional na Amazônia. Cad. Saúde Colet., 2016, Rio de Janeiro, 24 (1): 1-2. Available at:< http://www.scielo.br/pdf/cadsc/v24n1/1414-462X-cadsc-24-1-1.pdf>. Access on: Nov. 05^th, 2016.
  » http://www.scielo.br/pdf/cadsc/v24n1/1414-462X-cadsc-24-1-1.pdf
• MAHAR, D. J. Desenvolvimento Econômico da Amazônia: uma análise das políticas governamentais. Rio de Janeiro, IPEA/INPES, 1978.
• MASSEY, D. Pelo espaço: uma nova política da espacialidade. Rio de Janeiro: Bertrand, Brasil, 2008. 312 p.
• MASSEY, D. Um sentido global do lugar. In: ARANTES, A. A. (Org.). O espaço da diferença. Campinas: Papirus, 2000. p. 176 - 185.
• MENDES, A. A Invenção da Amazônia. (Coleção Amazônia - Série Tavares Bastos). Universidade Federal do Pará. Belém, 1974.
• MORIN, E. Ciência com Consciência. 82ª ed. Rio de Janeiro: Betrand Brasil, 2014.
• PARÁ, Secretaria de Estado de Integração Regional. Diretoria de Integração Territorial. Atlas de Integração Regional do Estado do Pará. Belém, PA. SEIR, 2010.
• PEREIRA. E. A. D. As encruzilhadas das territorialidades ribeirinhas: Transformações no exercício espacial do poder em comunidades ribeirinhas da Amazônia Tocantina Paraense. 474 f. Tese (Doutorado em Geografia Humana) - Universidade Federal Fluminense. Niterói. Rio de Janeiro, 2014.
• ITAITUBA-PMS. PLANO MUNICIPAL DE SAÚDE: 2018/2021. Secretaria Municipal de Saúde de Itaituba. Itaituba-Pará, 2018.
• PORTELA, L. E. Saúde e Desenvolvimento. 2013. Available at: <https://www.abrasco.org.br/site/outras-noticias/sistemas-de-saude/saude-e-desenvolvimento/1141/>. Access on: Jun. 10^th, 2014. Recife: Abrasco, 2013.
  » https://www.abrasco.org.br/site/outras-noticias/sistemas-de-saude/saude-e-desenvolvimento/1141
• RELATÓRIO FINAL da 8ª Conferência Nacional de Saúde. Ministério da Saúde, 1986. Available at: <https://bvsms.saude.gov.br/bvs/publicacoes/8_conferencia_nacional_saude_relatorio_final.pdf> Access on: Aug. 17^th, 2021.
  » https://bvsms.saude.gov.br/bvs/publicacoes/8_conferencia_nacional_saude_relatorio_final.pdf
• ROSCOCHE, L. F.; VALERIUS, D. M. Os impactos da usina hidrelétrica de Belo Monte nos atrativos turísticos da Região do Xingu (Amazônia - Pará - Brasil). Revista Eletrônica de Administração e Turismo. V. 5, n. 3, jul. - dez. de 2014. Available at: <lhttps://periodicos.ufpel.edu.br/ojs2/index.php/AT/article/view/2905/3547> Access on: Jan. 26^th, 2018.
  » https://periodicos.ufpel.edu.br/ojs2/index.php/AT/article/view/2905/3547
• SANDRONI, P. Novíssimo dicionário de economia. Editor Best Seller. São Paulo. 2010.
• SANTOS, B. de S. Para além do Pensamento Abissal: Das linhas globais a uma ecologia de saberes. Revista Crítica de Ciências Sociais, 78, 3-46. Available at: < https://www.ces.uc.pt/myces/UserFiles/livros/147_Para%20alem%20 do%20pensamento%20abissal_RCCS78.pdf>. Access on: May 01^st, 2020.
  » https://www.ces.uc.pt/myces/UserFiles/livros/147_Para%20alem%20 do%20pensamento%20abissal_RCCS78.pdf
• SANTOS, E. L.; BRAGA, V.; SANTOS, R. S.; BRAGA, A. M. da S. Desenvolvimento: um conceito multidimensional. Desenvolvimento Regional em debate Ano 2, n. 1, jul. 2012. Available at: < file:///C:/Users/55929/Downloads/215-Texto%20do%20artigo-804-1-10-20120801%20(4).pdf>. Access on: Nov. 18^th, 2020.
• SANTOS, M. Da totalidade ao lugar. São Paulo: Editora da Universidade de São Paulo, 2008. 176p.
• SAQUET, M. A. Por uma geografia das territorialidades e das temporalidades: uma concepção multidimensional voltada para a cooperação e para o desenvolvimento territorial. 1ª ed. São Paulo: Outras expressões, 2011.
• SEN, A. Desenvolvimento como liberdade. (Trad. Laura Teixeira Motta). São Paulo, Companhia de Bolso, 2010, p. 461.
• SIFFERT, N, CARDOSO, M., MAGALHÃES, W. de A., LASTRES, H. M. M. (Org.). Um olhar territorial para o desenvolvimento: Amazônia. Rio de Janeiro. BNDES, 2014. Available at: <https://web.bndes.gov.br/bib/jspui/bitstream/1408/1787/1/livroUm% 20olhar%20territ orial%20para%20o%20desenvolvimento Amaz%C3%B4nia_P.pdf> Access on: Nov. 22^nd, 2014.
  » https://web.bndes.gov.br/bib/jspui/bitstream/1408/1787/1/livroUm% 20olhar%20territ orial%20para%20o%20desenvolvimento Amaz%C3%B4nia_P.pdf
• SILVEIRA, M.; NETO, M. D. de A. Licenciamento ambiental de grandes empreendimentos: conexão possível entre saúde e meio ambiente. Ciência & Saúde Coletiva, 19(9):3829-3838, 2014. Available at: <http://www.scielo.br/pdf/csc/ v19n9/1413-8123-csc-19-09-3829.pdf>. Access on em: Dec. 17^th, 2016.
  » http://www.scielo.br/pdf/csc/ v19n9/1413-8123-csc-19-09-3829.pdf
• SOLÓN, P. Alternativas sistêmicas. São Paulo: Elefante: 2019.
• SCHWEICKARDT, J. C.; FERLA, A. A.; CECCIM, R. B.; LIMA, R. T. de S.; KADRI, M. R.; OLIVEIRA, P. de T. R de. Educação e práticas de saúde na Amazônia: tecendo redes de cuidado. (Org.). (Saúde & Amazônia; 2). Porto Alegre: Rede UNIDA, 2016. 316 p.
• SCHWEICKARDT, J. C.; LIMA, R.T.S.; CECCIM, R.; FERLA, A. A; CHAVES, E.S. Regionalização da Saúde: construção da universalidade e integralidade no Sistema Único de Saúde. In: SCHWEICKARDT, J. C.; LIMA, R.T.S.; CECCIM, R.; FERLA, A.A; CHAVES, E.S. (Orgs.). Educação Permanente em gestão regionalizada da saúde: saberes e fazeres no território do Amazonas. Porto Alegre: Rede Unida, 2015. P. 229.
• TAMBELLINI, A. T.; MIRANDA, A. C. de. Saúde e Ambiente. In. GIOVANELLA, L.; ESCOREL, S. LOBATO, L. de V. C.; NORONHA, J. C. de; CARVALHO, A. I. de. (Org.) Política e Sistema de Saúde no Brasil. Ed. 2, ver. e amp. Rio de Janeiro: Editora FIOCRUZ, 2012.
• VICENTIN, G; MINAYO, C. G. Saúde, Ambiente e Desenvolvimento Econômico na Amazônia. Ciência & Saúde Coletiva 8(4):1069-1085, 2003. Available at:https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232003000400028&lng=en&nrm=iso&tlng=pt Access on: Nov. 18^th, 2020.
  » https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232003000400028&lng=en&nrm=iso&tlng=pt

• Note
  The current article results from the PhD dissertation in Environmental Sciences and Sustainability in the Amazon, oriented by PhD. Professor Júlio Cesar Schweickardt, at Federal University of Amazonas - Manaus City - AM.

Publication Dates

• Publication in this collection
  15 Apr 2022
• Date of issue
  2022

History

• Received
  24 Nov 2020
• Accepted
  13 Nov 2021