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15/10/2019

Amazon fires have great impact on the Brazilian Public Health System


Icict/Fiocruz

In a study coordinated by the Institute of Scientific and Technological Communication and Information in Health (Icict), Fiocruz has mapped the impact of fires on children’s health in the Amazon region. The survey concluded that in the areas most affected by the fire, the number of children hospitalized with respiratory problems doubled. There were about 2.5 thousand extra hospital admissions each month, in May and June 2019, in approximately 100 municipalities of the Legal Amazon, in particular in the states of Pará, Rondônia, Maranhão and Mato Grosso. This resulted in an additional expense of more than R$ 1.5 million faced by the Brazilian Public Health System (SUS). According to research, living in a town near fire areas results in a 36% increase in the risk of needing hospitalization for respiratory problems. 

The survey also showed that in five of the nine states in the region there has been an increase in the number of deaths among children hospitalized due to respiratory problems. Such was the case in Rondônia. Between January and July 2018, the rate was 287 deaths in every 100,000 children below 10. In the same period in 2019, this number rose to 393. In the state of Roraima, 1,427/100,000 children died while hospitalized for respiratory problems in the first semester of 2018. In the same period in 2019, that number reached 2,398.

These figures are part of a technical report by the Observatory of Climate and Health, a project coordinated by Icict/Fiocruz. The study also included the work of scientists of the National School of Public Health (Ensp/Fiocruz), of the University of São Paulo (USP) and of the University of the State of Mato Grosso (Unemat). The goal of the work is to warn SUS managers and professionals so they can prepare themselves to take care of the health of vulnerable populations. In addition, the survey highlights the importance of strengthening basic healthcare and active search in areas with higher concentration of fires and higher levels of atmospheric pollution, as some populations may not have access to hospitals.

Hospitalizations increased five times in some towns

The figures draw attention to the towns of Santo Antônio do Tauá, Ourilândia do Norte and Bannach, in the state of Pará; Santa Luzia d'Oeste, in Rondônia; and Comodoro, in Mato Grosso, where the number of hospitalizations was more than five times higher than the expected. But the so-called “particulated matter” - toxic residues generated by fires - can also reach large cities hundred of kilometers away from the fires themselves, as wind can blow pollutants across large distances. 

Since its foundation, in 2010, The Observatory of Climate nd Health has been following the evolution of forest fires and their effects on the health of populations in the Amazon and Cerrado areas. This is the first time that a study collects, almost in real time, information with this level of coverage on the correlation of fires and their health effects in the region of the Legal Amazon. 

Researchers collected figures from the System of Hospital Information (SIH), of DataSUS, between the months of May and June - the latest period available - and processed them with a “special scan” technique called Satscan. The goal was to detect groups of municipalities with hospitalization rates for respiratory diseases higher than the expected values. The study also used data from the National Institute of Meteorology (Inmet) and of the BDQueimadas and Prodes Desmatamento monitoring systems, both produced by the National Institute of Space Research (Inpe). The figures obtained are preliminary, however, as not all hospitalizations of the period under study are already registered in the system. It is therefore possible that the rates are even higher.

The satellite images used in the study also show how the fires begin at the edges of indigenous lands, which still seem to play a role of protection against fires and deforestation. Researchers draw attention to the fact that indigenous populations are also likely affected by air pollution, but it is not yet possible to assess the rate of disease in these areas.

Children are more susceptible

The Observatory took into account the fact that the fires take place in what is called the Deforestation Belt, including the states of Acre, Amapá, Amazonas, part of Maranhão, Mato Grosso, Pará, Rondônia and Tocantins, usually between May and October. During the dry season in the region, which coincides with a reduction in regional rains, a droop in humidity rates and the period of fires, an increase in the number of respiratory diseases is a regular occurrance, due to the increase in emission of pollutants and to the higher concentration of toxic gases in the atmosphere, putting the health of the population at risk. However, the situation has worsened significantly with the recent fires.

In the cities under study, the total number of hospitalizations per month reached 5,091, while the expected number was 2,589. These results suggest an excess of 2,500 children hospitalized in the municipalities most affected by the fires. 

Considering the average profile of children hospitalizations due to respiratory problems at the SUS, these cases have generated an exceeding cost of R$ 1.5 million, and 9,750 beds/day occupied in public hospitals and in those with a convention with the SUS.

Burning wood may generate a wide range of gases and aerosols, many of which are harmful for human health, especially due to their small diameter and therefore high capacity of penetration on the lower respiratory tract. “Children are more susceptible to external factors such as pollution”, explains researcher Christovam Barcellos, from Icict/Fiocruz. “Their immune system is still under development and their respiratory tract is still being formed. They are more susceptible to allergies”. “Children also spend more time outdoors than adults, therefore inhaling more pollutants. During physical activities, the deposition of particles in the lungs increases five times”, states Sandra Hacon, a researcher from Ensp/Fiocruz.

Just one part of the problem

Barcellos warns that the study used the rate of hospitalized children as indicators of risk. However, adults, especially those with chronic diseases and the elderly, can be affected by the pollution caused by fires. “As we only used the hospitalizations paid by the SUS, without taking into account the data of the private health system, we have only assessed one part of the problem. There is also the fact that many children may not have been able to reach a hospital at all. In the Amazon region, distances are huge. Many people may have experienced episodes of asthma and bronchities, among others, and not have received medical care”, the researcher added.

“The Amazon fires are a big risk to the health of the population”, states the text of the tecnical report. “The pollutants emitted by these fires can be blown across great distances, reaching cities far from the fires themselves. Among the pollutants, we have fine particular matter (PM2.5), CO (carbon monoxide), NO2 (nitrogen dioxide) and volatile organic compounds (VOCs) that may worsen conditions such as heart problems, airway inflammation, systemic inflammation and neuro-inflammation, endothelial dysfunction, coagulation, atherosclerosis, alterations in the autonomous nervous system, and DNA damages, with carcinogenic potential”.

Deaths and hospitalizations are the most serious and evident aspects of the health problems caused by the fires, but they are not the only ones: “Other adverse health events, such as emergency cases and functional limitations of the respiratory system, are more frequent phenomena that are not easily detected by the health information systems”, the study warns.

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