Indicator of environmental health: formula modifications and indicator applications in Brazil

ABSTRACT The Environmental Health Indicator (Indicador de Salubridade Ambiental - ISA) was established in 1999 by the São Paulo’s State Council of Sanitation (Conesan). Although this indicator was created to measure the level of environmental health of the municipalities in São Paulo state, Brazil, ISA has been applied in several other regions of Brazil. Moreover, throughout these 17 years, the original ISA formulation has been altered according with local characteristics, as suggested by the manual that originated it. Thus, this study aimed to evaluate ISA application state of the art in Brazil, by the identification of the progress, gaps, and challenges of its use. An extensive literature investigation was performed in order to find studies available in electronic media that used ISA. We identified and analyzed 60 cases. The Northeast and South regions are those with the greatest number of studies, and the majority of them (41.6%) are result of master’s dissertations. Each study uses an average of six first order indicators, and the literature review is the predominant method for choosing and evaluating them. Finally, we showed that the differences between the ISAs are actually a drawback for this indicator use. Since each study has peculiarities in terms of indicators, weights, and criteria calculation, it is only possible to compare the results from the same study over time, but these differences preclude the comparison between the values obtained in different studies.