Socioenvironmental vulnerabilities in smallscale fishing: challenges and achievements for Healthy and Sustainable Territories in Pernambuco

Santos, Mariana Olívia Santana dos; Medeiros, Ana Catarina Leite Véras; Silva, Evelyn Siqueira da; Machado, Rafaella Miranda; Gonçalves, José Erivaldo; Gurgel, Aline do Monte; Gurgel, Idê Gomes Dantas

doi:10.1590/2358-28982024E18718I

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ORIGINAL ARTICLE • Saúde debate 48 (spe1) • Aug 2024 • https://doi.org/10.1590/2358-28982024E18718I copy

Socioenvironmental vulnerabilities in smallscale fishing: challenges and achievements for Healthy and Sustainable Territories in Pernambuco

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This study adopted a theoretical-methodological perspective anchored in the Ecosystem Approach to Health, the Social Reproduction of Health, and the Social Determinants of Health to analyze the socioenvironmental vulnerability and health of populations exposed to crude oil during the COVID-19 pandemic and present pathways for comprehensive community reparation. We employed action research as a strategy for dialogic interaction with the subjects of the territories and the construction of emancipatory experiences in the struggle for health, the environment, and sustainable development. We presented a general outlook on the social determination of the health of small-scale fishing communities and the promotion of community-institutional dialogues. The results reinforce the need for environmental health studies that combine academic knowledge with the wisdom of water peoples in the pursuit of truth, justice, and reparation. To do so, it is necessary to unveil environmental injustice, racism, and conflicts, engaging in dialogue about the development model and neo-extractivism in society as essential challenges and opportunities for promoting Healthy and Sustainable Territories.

KEYWORDS
Vulnerability to disasters; Health surveillance; Occupational health; Oil spill; COVID-19

Objective	Theoretical-practical-methodological aspects for the construction of Sustainable and Healthy Territories
Objective 1 - Characterize the population and the territory studied per sociodemographic, epidemiological, occupational, and environmental characteristics	- Cross-sectional observational epidemiological study, targeting small-scale fishing workers from 16 municipalities on the coast of Pernambuco, registered by the Secretariat of Environment and Sustainability (SEMAS) and distributed across 27 fishing colonies or associations. Data was collected via a structured questionnaire divided into 14 blocks and administered by trained interviewers using the Fiocruz HcMaps digital application. A final sample of 1,259 small-scale fishermen was obtained from the population of 12,472 fishermen, considering a 40% prevalence of health effects after oil exposure and a 4% error, proportionality by sex and region of residence and the inclusion criteria - being over 18, being a small-scale fisherman, active during the oil spill, and being registered in the SEMAS spreadsheet, and exclusion from the study - fishermen away from work at the time of the oil spill; death; neurological or psychiatric condition that hinders participation in the research; refusal, not responding to invitations, and not attending on the day of the interview. Descriptive statistics were used for analysis, by relative frequency distribution and measure of central tendency - mean.
Objective 2 - Identify the contexts of socio-environmental vulnerabilities related to exposure to crude oil and the COVID-19 pandemic in the study territories	- Review studies on the relationship between the production process and the illness of Brazilian small-scale fisherwomen; documentary research to characterize socio-environmental conflicts and health impacts resulting from oil using the method proposed by the Global Environmental Justice Atlas (EJAtlas). Open access documents made available by governmental and non-governmental organizations and publications from newspapers were analyzed; descriptive-analytical study of socio-environmental vulnerabilities in the oil disaster and the COVID-19 syndemic. For the descriptive-analytical study of socio-environmental vulnerabilities, the theoretical-methodological approach of social reproduction and health was used through an analysis matrix that represents the interrelationship and interdependence of reproductions in the Biocommunal, Consciousness and Conduct, Technoeconomic, Political, and Ecological dimensions.
Objective 3 - Identify early metabolic changes and the effect biomarkers related to exposure to environmental contaminants in oil-affected areas	- Environmental exposure assessment study to identify exposure indicators and effects on the bodies of fishermen in the municipalities most affected by the arrival of oil (Cabo de Santo Agostinho, Ipojuca, Sirinhaém, and Tamandaré). Venous blood samples were collected from 102 fishermen who had direct or indirect contact with oil in order to analyze biomarkers of oxidative stress, such as malondialdehyde (MDA), catalase and glutathione. After collection, the samples were stored in an ultra-freezer at -80 °C until analysis. The MDA samples were analyzed per standard operating protocol provided by Fiocruz-RJ using blood plasma. They were analyzed in triplicate using a spectrophotometric method and the absorbances were recorded. The MDA concentrations were calculated using a calibration curve generated from a commercial MDA standard, with R²=0.97.
Objective 4 - Analyze the subjects’ perceptions about the dangers and damage to health and the environment resulting from the socio-health, environmental, and economic impacts of the crude oil spill	- Participatory Mapping: developed on the southern coast with people affected by the disaster-crime, in three stages: 1) pre-cartographic: prior visits for diagnosis, identification and coordination with community leaders; 2) cartographic: construction of social maps; 3) systematization and validation: data sorting and verification of internal coherence of the identified processes. The statements captured were analyzed based on the health, environment and socioeconomic thematic dimensions deriving from the participating subgroups and based on the Collective Subject Discourse; - Rapid Participatory Diagnosis: based on workshops and focus groups, a work flowchart was constructed to describe the small-scale fishing work process stages based on a semi-structured roadmap with questions related to stages of the work process; best time for fishing; travel means; resting time; meals; fish processing; work positive aspects; income; autonomy and dignity; and life-promoting aspects. Afterwards, the team experienced the work of the fisherwomen through ethnography, recording the information in a field diary and using audiovisual resources. Data were organized in the Critical Process Matrix based on critical epidemiology, characterizing the protective and destructive health processes, which are expressed in the dialectical movement in the general, particular, and singular domains. The results were systematized seeking to disseminate them with broad access, such as the booklet ‘Water women’s health’ and the documentary ‘The sea that lives in me’.
Objective 5 - Analyze and develop action research to structure the comprehensive community repair of health and living conditions in the territories of affected communities	- Participatory Action Research (PAR) through culture circles, a methodology that includes investigative methods, educational techniques and political action. It was conducted in Cabo de Santo Agostinho, in a community identified based on context analysis, documents with notifications about the oil disaster, the health-disease process and considering the listening of organizations and social movements. It involved two processes: a socio-environmental diagnosis and the matrix of demands for reparation, which were performed grounded on documentary analysis; epidemiological survey, field diary records, systematization of data on vulnerability to environmental risks and health conditions.
Objective 6 - Understand socio-technical vulnerabilities related to the care production process for those exposed during beach cleaning and strengthen PHC care lines in the territories	- Scoping Review on oil disaster-crimes - Conducted in Bireme, LILACS, SciELO, PubMed, Cochrane Library and Embase, articles published from 1973 to 2021. The search resulted in 22 articles on 10 oil disasters around the world on three continents (Asia, America, and Europe), whose causes were grounding (3), shipwreck (1), collision (2), spill (3), and explosion (1). The actions developed were intersectoral, economic, environmental and health-related; - Investigation of the guidelines and actions developed by health management in addressing the 2019 oil disaster: an exploratory case study. Semi-structured interviews were conducted with 16 managers from the municipal and state health secretariats of Pernambuco. The analysis of the collective subject discourse revealed five thematic axes: managers’ perception of the impacts of the oil disaster-crime in the territory, actions developed to mitigate the disaster’s impacts, hardships endured by managers in the disaster mitigation process, evaluation of health management actions in the disaster’s context, and preparation for future disasters; - Descriptive case study with a qualitative approach in a municipality. Content Analysis was performed using the IRaMuTeQ software of interviews with health managers, whose results revealed four categories: municipal management in attention to the sea; disaster risk governance and its absence; COVID-19 syndemic and impacts on the rehabilitation and recovery of communities affected by the oil disaster; and what to do if a disaster happens again.
Objective 7 - Building strategies for the production of social technologies from an intersectoral perspective for Popular Health Surveillance	- Analysis of the media discourse on the oil spill in the state based on documentary research with data from the Brazilian Institute of the Environment (IBAMA) and articles published by Jornal do Comércio (JC); - Formation of a communications, education, culture and health committee with representatives of social movements in the territories and a research team to methodologically conduct this objective; - Conducting training processes with different stakeholders such as health managers, social movements, community leaders and postgraduate students. - The conflicts raised in the characterization of Objective 2 were systematized and published in the EJAtlas, whose objective is to support populations and groups affected by unsustainable and health-damaging projects and policies. The EJAtlas maps environmental conflicts in locations around the world and allows collaboration in the identification and characterization of conflicts; - In conjunction with the research and the other objectives, different communication and training strategies were developed for participatory and community surveillance. Printed and digital information materials were produced, including health and environmental protocols, collaboration in the development of case reporting strategies, photos, booklets, posters, cards, press releases, and maps. Training processes such as courses, workshops, discussion groups and seminars were performed to promote the debate on access to information. The production of scientific articles, book chapters, dissertations, theses, and participation in congresses, round tables and conferences were also relevant constructions of these moments; - To create the photographic exhibition, a photography competition was staged with the production of digital photos taken by the community itself on themes that promote visibility of the realities of water peoples during the disaster-crime; - A website is being developed to systematize all of these materials. It will function as a project portfolio and will disseminate all the results. It is a way of sharing data and information on the productions of the water peoples and the project members.

Obj.	Main results	Popular-institutional dialogue	Emancipatory experiences
1	Epidemiological study: socioeconomic characteristics: mean of 46 years, mostly female, self-declared Black or brown; married/common-law marriage; low schooling level and insufficient monthly income for family survival; work: began working in fishing, on average, at 14, mean fishing working time of 32 years, no fixed working hours, some worked in other activities to supplement their income and although they reported using Personal Protective Equipment (PPE), this equipment was often improvised; health: just over half reported worse or much worse health, compared to a year earlier, with cardiovascular, respiratory, endocrine, and arbovirus diseases. Most reported not having had COVID-19, but some had not been tested; impacts of the oil disaster-crime: it impacted the lives, income, and harmed the environment, with mobilization for support being done by volunteers or community organizations. They reported that their fishing equipment became dirty with oil and that they had to stop fishing, some for more than 30 days. They did not receive government financial support or staple food baskets and had to consume what they caught. In healthcare, around 70% of the workers found oil while working and some of these workers had contact with their skin but did not seek medical care. Around a third of them participated in the cleanup of oil residues even without any training. Some parts of the body were exposed and displayed symptoms such as severe headaches and joint pain, insomnia, and burning eyes. Around half of the workers met the diagnostic criteria for Post-Traumatic Stress Disorder (PTSD).	- Social movements: Fishermen’s colonies and associations, Pastoral Fisheries Council (CPP), National Coordination of Small-scale Fisherwomen (ANP), Suape Forum - Education institutions: Federal University of Bahia (UFBA), University of North Carolina (UNC), Federal University of Pernambuco (UFPE) - Municipal Health Secretariats (SMS) (RAS): Health Surveillance, Primary Care, and Family Health teams (eSF)	- Health cards for small-scale fishing workers delivered to traditional fishermen/fisherwomen; - International course on the impacts of the oil spill in Brazil: intersectoral coping strategies in the community context; - Health actions conducted with health teams.
2	Review: substandard working conditions involving inhospitable and polluted fishing sites, physical overload, inadequate postures and strenuous work rhythms. High prevalence of Musculoskeletal Disorders, Repetitive Strain Injuries, and Work-Related Musculoskeletal Diseases. Mapping: characterization of the oil spill and identification of the socioeconomic, health and environmental impacts that were published in the EJAtlas. Social reproduction matrix - biocommunal: improvised or inadequate PPE used in oil clean-up; possibility of physical illness; cases of PTSD; food insecurity and COVID-19 syndemic; self-awareness and conduct: organizations and solidarity networks affected, with cultural and symbolic territorial transformations and ruptures; technical-economic: impact on tourism; fishing ban, unemployment, and livelihood insecurity. Ecological: several damages to the ecosystems of the affected territories; political: weak government mitigation response, lack of plans to address tragedies and policies to support small-scale fishing. As a result, increased vulnerability of water people was evidenced, influencing the social determination of the health-disease process; the unsustainability of the current development model, and the need for remedial measures in oil spill disasters.	- Social movements: Fishermen’s colonies and associations, CPP, ANP, Suape Forum - Education institutions: UFBA, UNC, UFPE, Institute of Environmental Science and Technology of the Autonomous University of Barcelona (ICTA-UAB) - SMS (RAS): Health Surveillance, PHC, and eSF	- Description of socioenvironmental conflicts in the northeastern macro context; - Structuring research based on ecosystem approaches in health; - Support the development of a pilot project for intervention in municipal health management; - Promote training processes on the health issues of water peoples.
3	Metabolic alterations: mean concentrations of malondialdehyde (MDA) (in μM) by municipality: Tamandaré=8.7; Cabo de Santo Agostinho=20.2; Porto de Galinhas=9.3; Barra de Sirinhaém=11.6. These results are well above the reference values of 3.31 μM. Despite this, this phenomenon cannot be attributed solely to exposure to oil, since this same population is exposed to other conditions that can alter enzymes such as MDA.	- Social movements: Fishermen’s colonies and associations - Education institutions: UFBA, UFPE, UNC, Catholic University of Pernambuco (UNICAP) - SMS: Health Surveillance, PHC	- Feedback on exams for ESF and participants; - Strengthening of laboratory surveillance; - ESF training; - Basis for studies and creation of protocols for care and monitoring of fishermen’s health.
4	Participatory Mapping: health: symptoms of poisoning, mental distress, lack of knowledge of the impacts and late use of PPE, mostly inadequate, for cleaning the beaches, and lack of a monitoring plan for those exposed; environment: pollution throughout the region, impact on fish sales and consumption by the population, government’s inertia; socioeconomic: government’s negligence towards more impoverished areas, environmental racism, lack of media coverage of discussions on socioenvironmental and health vulnerabilities, impacts on income, with a severe reduction in sales and low coverage of state financial aid. Rapid Participatory Diagnosis: destructive processes in the General domain, socioenvironmental injustice and vulnerabilities such as the economic development model, the Suape Port Industrial Complex, the 2019 oil disaster-crime, the COVID-19 syndemic, difficulty in accessing public policies, loss of local biodiversity and real estate speculation in the region; in particular, exhausting working hours and work overload, use of rudimentary equipment and tools for work and storage, low-cost product marketing, generating the need for supplementary income, and unequal gender, class, and race relationships; in the singular, physical and mental illnesses and deaths. The study highlighted central issues, giving visibility to the reality of water women.	- Social movements: Fishermen’s colonies and associations, CPP, ANP, CPP, Suape Forum, Center for Comprehensive Care and Development (CADI), Anglican Church of Gaibu, ‘All to the Sea’ women’s group (TPM).	- Collective construction of social maps about the impacts; - Appreciation of the work and way of life of water women; - Promotion of health care moments (medical care and integrative and complementary practices); - ‘Water Women’s Health’ booklet; - Documentary about the work process of shellfish gatherers on the southern coast of PE; - Film debates in the territory, education institutions, and festivals.
5	Structuring processes for comprehensive community reparation of health and living conditions in the territories: the measures taken have been incipient since the incident in 2019, and urgent actions are needed to restore the dignity of these populations. Rehabilitation: declare a state of emergency; adopt urgent health measures (assistance and monitoring); investigate and monitor people affected by the spill; provide specialized and equitable care for fishermen; promote mental health care. Restitution: develop research and ongoing monitoring to restore the territory’s biodiversity and fishing territory. Compensation: emergency benefit for the spill; guarantee of social assistance benefits; government incentives for income generation. Satisfaction measures: create and guarantee the functioning of the Permanent Monitoring and Action Committee to address spills with the participation of small-scale fishermen; media visibility. Non-repetition guarantee: ensure compliance with environmental laws and hold those responsible for the spill accountable.	- Social movements: Fishermen’s colonies and associations, CPP, ANP, CPP, Suape Forum, CADI, Anglican Church of Gaibu, and TPM.	- Culture circles; - Promotion of a moment to receive and listen to participants; - Matrix of Critical Processes of the social determination of health; - Care with integrative and popular practices in health.
6	Review studies: criticisms of the control, mitigation, or prevention of immediate and future damage resulting from disasters, which is an open agenda for social movements in the fight to guarantee a healthy and sustainable environment. Actions to address oil disasters in different countries appear to have been incipient, revealing government incapacity in the face of these situations. Interviews: health management weaknesses (at the state and municipal levels) in disaster mitigating actions, resulting from the lack of preparation of health services and professionals. The lack of instruments and the lack of coordination between federated entities escalated the difficulties, generating disastrous situations in the territory. There is a need to build instruments that guide more efficient and effective actions in these situations. The municipality analyzed had advance organization of the actions to confront the disaster, but the lack of governance in the disaster-crime and the focus of health management on the COVID-19 syndemic were highlighted as difficulties and vulnerabilities in the actions. Continuing education and coordination with fishermen and shellfish gatherers were some of the lessons learned.	- Social movements: Fishermen’s colonies and associations - Education institutions: UFBA, UFPE, CEPEDES/ENSP Fiocruz-RJ - State and Municipal Health Secretariats: Health Surveillance, PHC, and health teams - State Workers’ Health Network: State and regional worker health center - Ministry of Fisheries	- ‘Waters’ Health’ Intervention Project: pilot project for a health program for water people in partnership with a SMS and small-scale social movements; - Continuing education plan built from health needs; - Technical cooperation agreement between Fiocruz and the Ministry of Fisheries.
7	A timeline was created linking the arrival of oil on the newspaper articles, analyzing the narratives considering the environmental, socioeconomic and health impacts, where health topic had low visibility of the damage, making it necessary to think about communication practices. Training and popular strengthening processes: Free course on community communication for healthy and sustainable territories; international course on the oil spill impacts in Brazil: intersectoral coping strategies in the community context; course for popular water health workers; workshop on partial results with the small-scale fishing social movement; workshops on the Rural, Forest, and Water Health Policy with health workers; continuing education workshop on water people’s health; creation of ‘Among Us: Network of Popular Communicators’; health cards for small-scale fishing workers; rapid participatory diagnosis/work flowchart; ‘Seminar on the Oil Disaster-Crime on the Coast of Pernambuco and the Water People’s Health’. Academic and scientific dissemination materials: recording and publishing of conflicts in EJAtlas; production of the documentary ‘The Sea that lives in me’; poetry - ‘Nameless stain that doesn’t go away’; photography contest ‘I who inhabit the sea’; ‘ ‘Water Women’s Health’ booklet; production of four published scientific articles, three book chapters in press, three course completion monographs, 10 master’s dissertations, and four doctoral theses in public health, eight submitted articles,	Social movements: Fishermen’s colonies and associations, CPP, ANP, Suape Forum, Community Communicators Network, Cabo de Santo Agostinho Women’s Center, Anglican Church of Gaibu, CADI, TPM - Education institutions (UFBA, UNC, UFPE, and ICTA-UAB) - Municipal Health Secretariats (RAS): Health Surveillance, Primary Care - Regional and State CERESTS - National and international education institutions - Ministry of Fisheries	- Conducting training processes in the communities - Publishing conflicts on the EJAtlas platform; - Creating a network of popular communicators; - Conducting courses organized collaboratively with social movements; - Conducting workshops and seminars to disseminate results and developing strategies to improve the health of water peoples; - Producing materials collaboratively with different social stakeholders.
	one book in preparation with results of the project; technical report ‘Analysis of the inclusion of health in the Environmental Impact Study of ExxonMobil - Offshore Drilling of Oil Wells in the Sergipe/Alagoas Basin’; technical document ‘General recommendations for the health sector in risk management in crude oil spill contexts’; continuing health education plan for health professionals and managers focusing on Water People; ‘The Pernambuco Charter’ and virtual platform for publishing the products and results of the project on the institutional website.

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[1] Conflict of interests:

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