Challenges and Prospects for Integrating the Assessment of Health Impacts in the Licensing Process of Large Capital Project in Brazil

Document Type : Perspective


1 Escola Nacional de Saúde Pública Sérgio Arouca (Ensp), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil

2 Institute of Global Health, University of Geneva, Genève, Switzerland

3 Swiss Tropical and Public Health Institute, Basel, Switzerland

4 University of Basel, Basel, Switzerland


Brazil was one of the first countries in Latin America to institutionalize a National Environmental Policy in 1981, including the environmental impact assessment (EIA) process of economic activities with anticipated impacts on the environment. Today, EIA practice in Brazil comes with a number of limitations: it is constrained by its environmental advocacy role; application is strongly oriented towards large capital projects; and social responsibility considerations are only partially included. Consequently, EIA studies mainly address issues connected to localised and direct environmental impacts, largely ignoring any socio-economic and health impacts. This perspective paper highlights limitations of current EIA practice in Brazil with a focus on health considerations in impact assessment. While recognizing the positive impact to municipalities where large capital projects are being developed and operated, adverse impacts on health are a reality with measurable evidence in Brazil. Therefore, we argue that specificities on how to systematically assess and monitor potential health impacts cannot remain invisible in the Brazilian legislation, as currently seen in the reformulation of the licensing process in the country. The process of better integrating the assessment of health impacts in the licensing process of large capital project in Brazil must, however, not be based on the imposition of an external model but should be promoted by internal stakeholders from the environmental and health sector, incorporating the experiences gained in various case studies from all over the country


Main Subjects

  1. da Cruz AIG, Ambrozio AMH, Puga FP, de Sousa FL, Nascimento MM. A economia brasileira: conquistas dos últimos 10 anos e perspectivas para o futuro. Brasilia: Ministério do Desenvolvimento, Indústria e Comércio Exterior; 2015.
  2. Programa de Aceleração do Crescimento (PAC) website.   Accessed February 24, 2018.
  3. Winkler MS, Krieger GR, Divall MJ, Singer BH, Utzinger J. Health impact assessment of industrial development projects: a spatio-temporal visualization. Geospat Health. 2012;6(2):299-301. doi:10.4081/gh.2012.148
  4. Franco T, Druck G. Padrões de industrialização, riscos e meio ambiente (Patterns of industrialization risks and environment). Cien Saude Colet. 1998;3(2):61-72. doi:10.1590/S1413-81231998000200006
  5. Katsuragawa TH, Gil LHS, Tada MS, da Silva LH. Endemias e epidemias na Amazônia: malária e doenças emergentes em áreas ribeirinhas do Rio Madeira. Um caso de escola. Estudos Avançados. 2008;22(64):111-141. doi:10.1590/S0103-40142008000300008
  6. Conselho National do Meio Ambiente (CONAMA) website.  Accessed February 24, 2018.
  7. Sanchez LE. Development of Environmental Impact Assessment in Brazil. UVP-Report. 2013;27:193-200.
  8. Bainton N, Vivoda V, Kemp D, Owen J, Keenan J. Project-Induced In-Migration and Large-Scale Mining: A Scoping Study. Brisbane: University of Queensland, Centre for Social Responsibility in Mining (CSRM); 2017.
  9. Hwang SS, Cao Y, Xi J. Project-induced migration and depression: a panel analysis. Soc Sci Med. 2010;70(11):1765-1772. doi:10.1016/j.socscimed.2010.02.005
  10. Vanclay F. Project-induced displacement and resettlement: from impoverishment risks to an opportunity for development? Impact Assessment and Project Appraisal. 2017;35(1):3-21. doi:10.1080/14615517.2017.1278671
  11. Anushrita, Nagpal BN, Kapoor N, et al. Health impact assessment of indira sagar project: a paramount to studies on water development projects. Malar J. 2017;16(1):47. doi:10.1186/s12936-017-1688-0
  12. Knoblauch AM, Divall MJ, Owuor M, et al. Experience and lessons from health impact assessment guiding prevention and control of HIV/AIDS in a copper mine project, northwestern Zambia. Infect Dis Poverty. 2017;6(1):114. doi:10.1186/s40249-017-0320-4
  13. Winkler MS, Divall MJ, Krieger GR, et al. Assessing health impacts in complex eco-epidemiological settings in the humid tropics: Modular baseline health surveys. Environ Impact Assess Rev. 2012;33(1):15-22. doi:10.1016/J.EIAR.2011.10.003
  14. Barbosa EM, Barata MM, Hacon Sde S. Health and environmental licensing: a methodological proposal for assessment of the impact of the oil and gas industry (Portuguese). Cien Saude Colet. 2012;17(2):299-310.
  15. WHO. Health impact assessment: promoting health across all sectors of activity. WHO 2017;  Accessed February 24, 2018.
  16. Linzalone N, Assennato G, Ballarini A, et al. Health Impact Assessment practice and potential for integration within Environmental Impact and Strategic Environmental Assessments in Italy. Int J Environ Res Public Health. 2014;11(12):12683-12699. doi:10.3390/ijerph111212683
  17. Steinemann A. Rethinking human health impact assessment. Environ Impact Assess Rev. 2000;20(6):627-645. doi:10.1016/S0195-9255(00)00068-8
  18. Winkler MS, Krieger GR, Divall MJ, et al. Untapped potential of health impact assessment. Bull World Health Organ. 2013;91(4):298-305. doi:10.2471/blt.12.112318
  19. Padilha JBD, Schneider M. Avaliação de impacto à saúde (AIS): metodologia adaptada para aplicação no Brasil. Brasília: Ministério da Saúde; 2014.
  20. Porto MFS. A tragédia da mineração e do desenvolvimento no Brasil: desafios para a saúde coletiva (The tragedy of mining and development in Brazil: public health challenges). Cad Saude Publica. 2016;32(2):e00211015. doi:10.1590/0102-311X00211015
  21. Pereira CAR, Perisse ARS, Knoblauch AM, Utzinger J, Hacon SdS, Winkler MS. Health impact assessment in Latin American countries: Current practice and prospects. Environ Impact Assess Rev. 2017;65:175-185. doi:10.1016/j.eiar.2016.09.005
  22. Silveira M, Fenner ALD. Health Impact Assessment (HIA): analyses and challenges to Brazilian Health Surveillance. Cienc Saude Coletiva. 2017;22(10):3205-3214. doi:10.1590/1413-812320172210.18272017
  23. Abe KC, Miraglia SGEK. Avaliação de Impacto à Saúde (AIS) no Brasil e América Latina: uma ferramenta essencial a projetos, planos e políticas (Health Impact Assessment (HIA) in Brazil and Latin America: an essential tool for projects, plans and policies). Interface. 2018;22(65):349-358. doi:10.1590/1807-57622016.0802
  24. Simos J. Environnement et santé en période de crise : l’exemple grec. Actualité et Dossier en Santé Publique. 2017;99:40-41.
  25. Simos J, Arrizabalaga P. Utiliser les synergies entre évaluation environnementale stratégique (EES) et évaluation d’impact sur la santé (EIS) pour promouvoir la prise en compte de l’environnement et de la santé dans les processus décisionnels publics. Sozial- und Präaventivmedizin SPM. 2006;51(3):133-136. doi:10.1007/s00038-006-0030-3
  26. Fonseca A, Sanchez LE, Ribeiro JCJ. Reforming EIA systems: A critical review of proposals in Brazil. Environ Impact Assess Rev. 2017;62:90-97. doi:10.1016/j.eiar.2016.10.002