Health sector involvement in federal environmental licensing and malaria control in the Brazilian Amazon: a retrospective observational study

Malaria, a disease with a long history in the Brazilian Amazon region, continues to be a significant public health challenge, particularly for those populations considered most vulnerable. Large-scale infrastructure developments in the region have the potential to heighten the risk of transmission by modifying environmental conditions and drawing migratory labour flows. Since 2001, Brazilian legislation has mandated the involvement of the health sector in environmental licensing processes in areas endemic or at risk of malaria, yet this integration remains limited. An analysis was conducted of federal licensing processes registered with Ibama between 2008 and 2024, with the objective of identifying those that occurred in Amazonian states and verifying which of these were monitored by the Ministry of Health (MoH). Of the 3,335 processes analysed, 897 (26.9%) involved the Amazon region. Of these, a total of 140 cases (representing 15.6% of the total number of cases) had a process initiated at the MoH. The mining (20.3%) and power generation (19.1%) sectors had the highest proportions of cases that resulted in a process being opened. The follow-up period exhibited variability over time, reaching a peak of 28.9% in 2014 and subsequently declining, with a figure of 6.7% recorded in 2018. While 70.0% of the projects under scrutiny resulted in a case being initiated at the MoH within a year, 8.6% required a period of up to three years, and a case was documented that exhibited a 16-year interval between the initiation of proceedings at Ibama and at the MoH. The findings suggest that most projects on Amazon region are progressing without the necessary involvement of the health sector, thereby increasing the risk of adverse impacts on malaria control measures. It is imperative to enhance the systematic and timely involvement of the MoH in environmental licensing processes to ensure that development is aligned with the overarching objective of eliminating malaria in Brazil.

疟疾（Malaria）是巴西亚马逊地区历史悠久的疾病，至今仍是严峻的公共卫生挑战，对当地最易感人群的威胁尤为突出。该地区大规模基础设施开发可能通过改变环境条件、吸引流动劳动力流入，加剧疟疾传播风险。自2001年起，巴西立法要求在疟疾流行或存在疟疾风险的地区开展环境许可流程时，必须纳入卫生部门参与，但这一跨部门融合机制至今仍存在局限。本研究对2008年至2024年间在Ibama登记的联邦环境许可流程开展分析，旨在识别其中涉及亚马逊各州的项目，并验证这些项目中有多少得到了卫生部（Ministry of Health, MoH）的监管。在分析的3335项流程中，有897项（占比26.9%）涉及亚马逊地区。其中共有140项案例（占总案例数的15.6%）启动了MoH相关流程。采矿业（20.3%）与发电业（19.1%）的流程启动案例占比最高。监管周期随时间呈现波动变化：2014年达到28.9%的峰值，随后逐步下降，2018年这一比例降至6.7%。70.0%的纳入审查的项目在一年内启动了MoH相关流程，8.6%的项目耗时长达三年，另有案例记录显示，Ibama流程启动与MoH流程启动之间的间隔长达16年。研究结果表明，亚马逊地区的多数项目在推进过程中未纳入必要的卫生部门参与，由此加剧了疟疾防控措施受到负面影响的风险。必须强化MoH在环境许可流程中的系统性、及时性参与，以确保开发活动符合巴西消除疟疾的总体目标。