Saúde ambiental e ações públicas de controlo: uma avaliação na Amazónia Legal
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2015-04-01
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A saúde ambiental deriva da relação entre o homem e o ambiente, que se manifesta de forma
adversa em aspetos da saúde e qualidade de vida. No Brasil, a exemplo de outros países, os
governantes públicos têm a função de diagnosticar as condições de saúde ambiental da
população, planear programas e ações e proceder à sua monitorização, para prevenir e mitigar
os efeitos negativos na saúde. Trata-se de uma missão complexa porque envolve vários
fatores de risco, tais como socioeconómicos, estruturais e culturais, os quais devem ser
considerados e articulados pela Vigilância em Saúde Ambiental (VISAMB).
Este trabalho pretende avaliar se as ações de vigilância em saúde ambiental, planeadas e
monitorizadas para os estados da Amazónia brasileira, se encontram direcionadas para as suas
prioridades e condições desfavoráveis. Pretende-se, ainda, apresentar um contributo
importante para o desenvolvimento da região, através da melhoria da eficiência e eficácia da
gestão pública no setor da saúde ambiental, com vista à sua replicação para outros contextos
brasileiros.
Para o efeito foi selecionado o modelo de sistematização de indicadores Força Motriz-
Pressão-Exposição-Estado-Efeito-Ação (FPEEEA), que incorpora os fatores de risco para a
saúde ambiental, e procura mensurar as suas consequências na saúde de uma população, de
forma concisa, através de indicadores. A utilização do método permitiu identificar o
saneamento como o fator de risco de saúde ambiental prioritário, seguido pela agricultura.
Recorreu-se ainda à técnica da Análise Fatorial para a agregação das informações sobre as
condições de saúde ambiental dos estados amazónicos em três índices de classificação -
Índice de Condições Básicas de Saúde Ambiental (ICBSA); Índice de Suscetibilidade de
Saúde Ambiental (ISSA) e Índice de Efeito na Saúde Ambiental (IESA) - que permitiram
identificar o Maranhão como o estado Amazónico com maior necessidade de investimento em
ações socioeconómicas (demonstrado pelo ICBSA); o Mato Grosso como o mais deficiente
em infraestruturas de saúde ambiental (apontado pelo ISSA); e o Pará como o estado com
mais doenças provocadas por condições precárias de saúde ambiental (através do IESA).
Após o diagnóstico das necessidades em saúde ambiental da população Amazónica, realizouse
um estudo de caso em Vila da Barca, para ratificar os resultados obtidos para a região, através da comparação da população com e sem saneamento. Naquela área geográfica
confirmou-se a relação direta entre a ausência de saneamento e o surgimento de doenças e,
ainda, a insatisfação da população quanto ao funcionamento do esgotamento sanitário e
drenagem urbana.
Na última etapa de estudo confrontaram-se as necessidades da população amazónica,
identificadas no trabalho, com os programas e ações de VISAMB propostos pelo governo
público e divulgados oficialmente. Identificaram-se oito programas de vigilância de fatores de
risco para a saúde ambiental, sendo apenas um relativo ao saneamento (VIGIÁGUA), cujas
metas estabelecidas não foram alcançadas pelos Estados Amazónicos. Concluiu-se que,
apesar dos esforços que o setor público tem realizado para o avanço das condições de saúde
ambiental no país e na Amazónia, a VISAMB não tem ainda uma prática eficaz de
reconhecimento das necessidades locais e, consequentemente, não consegue desenvolver um
planeamento regionalmente adaptado, pois estabelece ações e metas que são muitas vezes
inviáveis para a capacidade operativa dos estados estudados.
Environmental health is derived from the relation between humans and the environment, which are manifested negatively on aspects of health and quality of life. In Brazil, as in other countries, public authorities have the role of diagnosing environmental health conditions for the population, planning programs and actions and monitor them, in order to prevent and mitigate negative effects on health. This is a complex mission because it involves several risk factors, such as socioeconomic, structural and culture ones, which must be considered by Environmental Health Surveillance (EHS, VISAMB in Portuguese). This work intends to evaluate if environmental surveillance actions planned and monitored for the states of the Brazilian Amazon are directed towards its priorities and unfavorable conditions. The intention is also to present an important contribution to the region’s development through improving efficiency and efficacy in public management in the environmental health sector, with a view to replicating it for other contexts in Brazil. To that end the model for systematizing indicators, known as Driving Force – Pressure – State – Exposure – Effect - Action (DPSEEA, FPEEEA in Portuguese) was selected, which incorporates risk factors for environmental health, and seeks to concisely measure their consequences for the health of a population using indicators. The use of the method made it possible to identify the environmental health risk as a priority, followed by agriculture. Factor Analysis was also employed to aggregate information on environmental health conditions of the Amazon states with three classification indices – Basic Environmental Health Condition Index (ICBSA in Portuguese); Index for Susceptibility to Environmental Health (ISSA in Portuguese) and Index of Effects on Environmental Health (IESA in Portuguese) – which made it possible to identify Maranhão as the Amazon state with the greatest need for investment in socioeconomic actions (demonstrated by the ICBSA); Mato Grosso as the state most deficient in environmental health infrastructure (as indicated by ISSA); and Pará as the state with the most diseases provoked by precarious environmental health conditions (through IESA). After the diagnosis of the environmental health needs of the Amazon population, a case study was carried out in Vila da Barca, to ratify the results obtained for the region, through comparing the population with and without sanitation. In that geographic area a direct relation was confirmed between the lack of sanitation and the emergence of diseases, and even more, the dissatisfaction of the population regarding the working of sanitary sewerage and urban drainage. In the final stage of the study the needs of the Amazon population identified in the research are confronted with the VISAMB programs and actions proposed by the government and officially divulged. Eight surveillance programs of risk factors for environmental health were identified, only one being related to sanitation (VIGIÁGUA), and whose goals established were not achieved by the Amazon States. It is concluded that despite the efforts that the public sector has made for advancing environmental health conditions in the country and in the Amazon, VISAMB has yet to become an effective practice for recognizing local needs, and consequently, is not able to develop regionally adapted planning, because it establishes actions and goals that are often unworkable for the operative capacity of the states studied.
Environmental health is derived from the relation between humans and the environment, which are manifested negatively on aspects of health and quality of life. In Brazil, as in other countries, public authorities have the role of diagnosing environmental health conditions for the population, planning programs and actions and monitor them, in order to prevent and mitigate negative effects on health. This is a complex mission because it involves several risk factors, such as socioeconomic, structural and culture ones, which must be considered by Environmental Health Surveillance (EHS, VISAMB in Portuguese). This work intends to evaluate if environmental surveillance actions planned and monitored for the states of the Brazilian Amazon are directed towards its priorities and unfavorable conditions. The intention is also to present an important contribution to the region’s development through improving efficiency and efficacy in public management in the environmental health sector, with a view to replicating it for other contexts in Brazil. To that end the model for systematizing indicators, known as Driving Force – Pressure – State – Exposure – Effect - Action (DPSEEA, FPEEEA in Portuguese) was selected, which incorporates risk factors for environmental health, and seeks to concisely measure their consequences for the health of a population using indicators. The use of the method made it possible to identify the environmental health risk as a priority, followed by agriculture. Factor Analysis was also employed to aggregate information on environmental health conditions of the Amazon states with three classification indices – Basic Environmental Health Condition Index (ICBSA in Portuguese); Index for Susceptibility to Environmental Health (ISSA in Portuguese) and Index of Effects on Environmental Health (IESA in Portuguese) – which made it possible to identify Maranhão as the Amazon state with the greatest need for investment in socioeconomic actions (demonstrated by the ICBSA); Mato Grosso as the state most deficient in environmental health infrastructure (as indicated by ISSA); and Pará as the state with the most diseases provoked by precarious environmental health conditions (through IESA). After the diagnosis of the environmental health needs of the Amazon population, a case study was carried out in Vila da Barca, to ratify the results obtained for the region, through comparing the population with and without sanitation. In that geographic area a direct relation was confirmed between the lack of sanitation and the emergence of diseases, and even more, the dissatisfaction of the population regarding the working of sanitary sewerage and urban drainage. In the final stage of the study the needs of the Amazon population identified in the research are confronted with the VISAMB programs and actions proposed by the government and officially divulged. Eight surveillance programs of risk factors for environmental health were identified, only one being related to sanitation (VIGIÁGUA), and whose goals established were not achieved by the Amazon States. It is concluded that despite the efforts that the public sector has made for advancing environmental health conditions in the country and in the Amazon, VISAMB has yet to become an effective practice for recognizing local needs, and consequently, is not able to develop regionally adapted planning, because it establishes actions and goals that are often unworkable for the operative capacity of the states studied.
Descrição
Tese de Doutoramento em Gestão
Palavras-chave
Gestão pública , Região da Amazónia (Brasil) , Indicadores ambientais