A multidisciplinary team of Brazilian researchers argues in an article published in the British Medical Journal that health systems in the Brazilian Amazon must be redesigned in light of climate change, extreme weather events, and food insecurity. The researchers propose that this redesign take into account traditional knowledge and the specific needs of local communities.
With COP30 taking place in the Amazon and the recent development of a national health and climate plan by the Brazilian Ministry of Health, the article discusses the future of the SUS (the Sistema Único de Saúde, Brazil's national public health network) in the region. This includes creating indicators sensitive to the region's specific needs and valuing care practices adapted to the territory.
"The health sector was late to join the debate on the climate emergency and, in particular, on the issue of adaptation. However, it should be playing a leading role, given that extreme events such as heat waves, floods, and tornadoes have been intensifying and affecting more and more people," says Gabriela Di Giulio , a professor at the University of São Paulo's School of Public Health (FSP-USP) and one of the authors of the opinion piece published in the BMJ. Di Giulio is also a member of the Scientific Coordination of the FAPESP Research Program on Biodiversity Characterization, Conservation, Restoration, and Sustainable Use ( BIOTA-FAPESP ).
According to the researchers, reimagining health from a critical perspective of sustainability in the Amazon requires strengthening strategies that integrate traditional, scientific, and political knowledge. One suggestion is to include community-based health surveillance based on indigenous epistemologies.
"It's essential to value traditional knowledge about food and dietary practices to curb the spread of ultra-processed foods. In some regions, the public health system already adopts this hybrid approach. An important example is the work of midwives, who combine biomedical and ancestral practices to provide care in vast and hard-to-reach territories," the article states.
The group of authors consists of researchers from FSP-USP, the University of Brasília, the Federal University of Amazonas, FIOCRUZ Amazônia (a local unit of the Oswaldo Cruz Foundation – FIOCRUZ, the Ministry of Health's research and development branch specializing in biological sciences), and the Sérgio Arouca National School of Public Health, which is affiliated with FIOCRUZ.
The researchers advocate for an organic adaptation model that recognizes rivers and forests as active participants in these processes, as well as traditional peoples as holders of crucial knowledge for survival and climate resilience.
To this end, they employ the concept of "fluid territories," a term that has been widely used in the work of FIOCRUZ Amazônia. "The river is the main means of transportation that allows access to healthcare, but there's an unpredictability in this that defies conventional understanding. During the last two droughts, in 2023 and 2024, for example, entire communities were isolated. The river dried up. Therefore, they had no access to healthcare, no health clinics, and healthcare teams were unable to reach the affected areas," explains Leandro Giatti , a professor at FSP-USP and also an author of the article. "In addition, living conditions worsened with the drought, with an increase in communicable diseases, contamination, and hunger. It's necessary to recognize this constraint and that healthcare must be molded to this reality."
From a broader perspective, Di Giulio points out that if the current development model is insisted upon and climate agreements are not fulfilled, there is a risk of endangering socio-biodiversity itself, which is fundamental to minimizing social suffering and damage related to the climate emergency.
The authors emphasize that indigenous peoples have a holistic view of health that integrates spiritual, social, and environmental aspects. They argue that diseases such as malaria and COVID-19 should be understood not only as biological issues, but also as manifestations of imbalances caused by human actions and disrespect for nature and sacred places.
The article emphasizes that the Amazon, which has historically been treated as a territory to be exploited economically and occupied, has suffered from public policies that disregarded the presence and rights of indigenous and traditional peoples. This approach has resulted in biodiversity loss, the destruction of sacred territories, and a profound impact on the physical and mental health of local populations.
Dossier
In addition to the opinion piece on health systems in the Amazon, the group of researchers published three other articles, forming a dossier on climate change and health.
One article analyzes how the experience of indigenous women leaders in addressing the pandemic in the Negro River region can provide insights for responding to climate emergencies. The third article discusses the need to consider alternative forms of socio-environmental governance in the Amazon and their impact on addressing the effects of climate change. The fourth article discusses Brazil's efforts to host the COP and restore multilateralism despite internal contradictions, such as oil exploration and the passage of anti-environmental legislation.
"In this dossier, we aim to offer a decolonial perspective based on our research, experiences, and analyses, to give greater priority to issues arising from the specificities and complexities of the Global South, also highlighting the editorial spaces of journals, which often reflect the vision of the Global North," says Di Giulio.
About São Paulo Research Foundation (FAPESP)
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