Ecosyndemics: The potential synergistic health impacts of highways and dams in the Amazon
Introduction
Development projects such as highways and dams can produce national economic benefits. However, these benefits often come at a cost as development projects can have destructive impacts on food, water, and socio-cultural systems (Barber et al., 2014; World Commission on Dams, 2000). While both the positive and negative repercussions of mega-development projects are well-documented (USCOLD, 1997; Altinbilek, 2002; Vittor et al., 2006; Perz et al., 2008), the possibility that rapid infrastructure change in highly biodiverse ecosystems ignites a common cascade of synergistically interconnected health problems, or ecosyndemic interactions, is underexplored.
Ecosyndemics refer to disease interactions that result from environmental changes commonly caused by humans (Singer, 2013). In this paper, we push scholarship on ecosyndemics into new territory by using the ecosyndemic framework to compare two case studies conducted by the authors. The first documents the impacts of the Interoceanic highway, which was completed in the Peruvian Amazon in 2011, examining the health and wellbeing of communities around the highway. The second investigates the health risks associated with the Belo Monte dam, which was completed in the Brazilian Amazon in 2016. Based on a secondary appraisal of the two case studies, we find preliminary evidence for the hypothesis that dams and highways can ignite or amplify ecosyndemic interactions between increased psychological stress, vector-borne, and sexually-transmitted infections.
Section snippets
Background
The term ecosyndemic is an extension of the original syndemic concept, which refers to a set of enmeshed health problems that synergistically interact within the context of noxious biosocial conditions to amplify the overall disease burden on a particular population (Singer, 2009). However, ecosyndemics are distinctly focused on how conditions for poor health are more likely to occur under unstable environmental conditions coupled with economic inequalities. While the syndemic concept has had
Background
The Interoceanic highway (IOH) was completed in 2011 and passes through Peru, Bolivia, and Brazil. In the region of Madre de Dios in Peru, the newly paved highway improved connections between previously isolated rural areas to the region's capital city, Puerto Maldonado, as well as to other major transit centers in Peru, Bolivia, and Brazil. The economic and environmental effects of the IOH have been charted (Delgado, 2008; Southworth et al., 2011), and there is increasing interest in
Methods
The original research study was conducted in two phases. In the first phase, focus groups (FG: n = 12) and key informant interviews (KI: n = 34) were conducted in 2014 in eight communities along the IOH to assess issues related to community structure, health, wellbeing, and perceived risks. FGs were conducted exclusively with long-term residents, categorized as participants who had lived there before the IOH was paved in 2006 and focused on the history of the community, times of migration into
Results
FG discussions were conducted with 83 community members, 34 KIs participated in interviews, and 522 households completed the survey. The average age of survey respondents was 36 years old, with more females (70.7%) responding than males. Results from both the qualitative and quantitative data revealed evidence of perceived increases in disease and the emergence of new disease risks. In survey data, dengue was identified as the main cause of illness (48%), which was supported by KIs who worked
Background
The Belo Monte Dam, located on the lower Xingu River in the Brazilian Amazon in the state of Pará, became operational in 2016 and is the third largest dam in the world (Diamond and Poirier, 2010). Urban and rural populations living below and above the dam have been greatly impacted (Castro-Diaz et al., 2018; Irigaray, 2014) through a combination of accompanying socio-ecological changes. For example, dam construction began in 2011 and led to an influx of more than 40,000 workers into the city of
Methods
Pace's (2018) doctoral study explored the potential health impacts of the Belo Monte Dam on the community of Gurupá using a syndemic framework, the results of which have not been published in a peer-reviewed journal. This study was conducted in two phases. The first phase was qualitative and consisted of informal and structured interviews in Portuguese with local and regional public health personnel (n = 11) in addition to participant observation and community member interviews (n = 50), to
Results
In Pace (2018) study in Gurupá, the sampled population for the health survey included 100 community members, aged 17–74 years old, and consisted of 41 male and 59 female heads of households. In terms of health status, 82% of respondents reported feeling good, very good, or excellent, with only 18% of respondents reporting that they felt that their health was bad or very bad. In line with this, the majority of participants (72%) responded that they were not ill or did not recall any recent
Discussion
Despite a number of significant differences, using an ecosyndemic framework to examine the potential public health impacts of the Belo Monte dam in Brazil and the Interoceanic highway in Peru suggests that each project initiates a similar pattern of changes in population, ecosystem, and social health. While there are many factors interacting in these fluid and locally-grounded processes, we conclude that there is the possibility for syndemic interactions to occur between the “unhappy triad” (
Conclusion
In conclusion, comparing the studies of the health effects of the Interoceanic Highway in Peru and the Belo Monte dam in Brazil led us to develop a conceptual model (Fig. 3) outlining how mega-development projects in tropical ecosystems lead to a common cascade of ecological, social, and population level changes that may create the conditions for ecosyndemic interactions to occur. As previously detailed, we see substantial possibility for interactions between psychological stress, vector-borne,
CRediT authorship contribution statement
Paula Skye Tallman: Conceptualization, Data curation, Writing - original draft, Writing - review & editing. Amy R. Riley-Powell: Conceptualization, Data curation, Writing - original draft, Writing - review & editing. Lara Schwarz: Conceptualization, Data curation, Investigation, Writing - review & editing. Gabriela Salmón-Mulanovich: Conceptualization, Writing - review & editing. Todd Southgate: Funding acquisition, Investigation, Methodology, Project administration, Writing - review & editing.
Acknowledgements
This project was completed with funding from the Inter- American Institute for Global Change Research (IAI) CRN3076, supported by the US National Science Foundation (Grant GEO-1128040). The Inter-American Training for Innovations in Emerging Infectious Diseases Fellowship Program (5D43TW009349-03), via the Fogarty International Center, supported GL. ARP was supported by the Wellcome Trust (#212712/Z/18/Z).
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