Challenges and perspectives in analyzing health in the Brazilian Amazon: a look at population-based studies

Abstract

The Brazilian Amazon has great environmental and social heterogeneity, and is home to several ecosystems vital for production and maintenance of biodiversity, of the water cycle, and of other ecosystem services 1. The population occupation and dispersion pattern throughout the Amazon resulted in a myriad of human settlements interconnected by rivers and land, which was modified by the incorporation of intervention processes in the territory. From 1970 to 2020 1, the region saw its population increase from 8 to 28 million with profound changes in the socio-spatial distribution and urbanization pattern, forming the so-called urbanized forest 2. In this environment, ways of life and productive systems persist and resist for which the forest is a resource and a means of reproduction of life, in a complex space of relations and interactions with the new employer production systems, in which the forest is only an input 3. The socio-environmental diversity and specificity in the Amazon poses challenges for scientific knowledge production 3. Observations of health and disease processes and their determinants is heterogeneous in their quality and representativeness of the populations studied, both human and nonhuman 4. This is evident in biodiversity studies that show a concentration of surveys in areas of easier access and close to research institutions 5. Among epidemiological studies, clinical studies with patients recruited in care services, usually residents of state capitals that house academic institutions, predominate. Population-based studies in the form of local surveys are less frequent 6,7,8. Apart from urban centers, there are few examples of research along a gradient of urban-rural or riverine landscapes 9. Based on the authors’ experience in field research in the region, this study analyzes the specificities of health and disease research in the Amazon, with emphasis on population-based studies, addressing methodological aspects to be considered when designing surveys and cohorts in the area.