How distinct stakeholders deal with health impacts secondary to changes in production? the case of a federal paving highway in the Brazilian Amazon

The BR 163 is a highway that crosses vast region of Amazon forest. In the context of its paving the Ministry of Health stimulated researches aimed at assessing health impacts and formulating strategies with the participation of the local community, who is strongly polarized by different conceptions of local development and fears about the deforestation and changing of the traditional ways of living.

Objectives: To analyze and identify opinions and strategies of different stakeholders with regard to the health impacts of the BR 163paving.
Methodology - 21 semi-structured interviews were conducted during the period of February and March 2007, in 2 municipalities of the Para state. The questioned themes were the: health impacts of the current operation conditions of the road, positive and negative issues, preparation, difficulties and taken actions. The interviews were recorded and transcribed and subjected to content analysis on their modality of thematic analysis.

Results. Speeches on the road and its impacts were much more frequent than actions planned by the subjects. Demerits of pavement were cited more than positive issues such as the displacement of people and supplies and varied economic opportunities. Demerits referred to the introduction and growth of certain infectious diseases, accidents and violence and increased demand for already insufficient health services. Few public administrators considered themselves prepared to cope with problems and opportunities, but some private producers had already made investments in the light of the opportunities previewed.

Discussion - Notwithstanding the identification of opportunities and problems, for most stakeholders, they seemed as not directing their strategies as users, managers or health professionals. The private sector seemed more attentive to opportunities. Despite the environmental legislation in Brazil and the official discourse of health promotion, the impacts of changes in modes of production aren’t conveniently considered for the formulation of public health policies.