Health Climate Justice and Deforestation in the Amazon

Health is a dimension of tropical deforestation that deserves greater attention in light of current trends of climate change, environmental degradation and national and subnational development policies. Forest fires are becoming more frequent and larger in scale globally (Baccini et al., 2017). Deforestation fuels global warming, and reducing forest fires is essential to meet the Paris Agreement targets (UNEP, 2018).


Amazon Tipping Point
A suite of general circulation model projections generally agrees, showing robust cross-model drying in the Amazon and other regions (Cook et al., 2014). This can generate feedback loops given the fact that the Amazon generates approximately half of its own rainfall by recycling moisture five to six times as air masses move from the Atlantic across the basin to the west (Salati et al., 1979).
Negative synergies between deforestation, climate change, and widespread use of fire indicate a tipping point for the Amazon system to flip to non-forest ecosystems in eastern, southern, and central Amazonia at 20-25% deforestation (Lovejoy & Nobre, 2018). However, with the combined stress of rising temperature, deforestation, and increased forest fires, the tipping point may be reached significantly earlier. To date, almost 18% of the Amazonian basin has been deforested (Gaffney et al., 2018). While there is scientific uncertainty about the tipping point ( Fig. 13.1), the precautionary principle recommends setting a goal for zero net deforestation no later than 2025-preferably earlier.
There are already signs of a transition to a disturbance-dominated regime in the Amazon, driven by interactions between deforestation, fire, and drought, potentially leading to losses of carbon storage and changes in regional precipitation patterns and river discharge (Davidson et al., 2012).
The Amazon biodiversity is highly vulnerable to climate change. The Amazon contains one of Earth's richest assortments of biodiversity with recent compilations indicating at least 40,000 plant species, 427 mammals, 1294 birds, 378 reptiles, 427 amphibians, 3000 fishes, and likely over a million insect species (Case, 2006). Even a 2 °C rise would make the new average temperature hotter than previous extremes, and would threaten more than one-third of species in all groups in the absence of

Forest Fires and Health
Forest fires increase air pollution, and this results in health problems. Evidence on the nexus between forest fires, air pollution and health is not new. Human health impacts of forest fires include biophysical effects, psychosocial impacts, occupational exposure issues among fire crew members, and visibility impairment (Fowler, 2003). A recent literature review of public health issues caused by forest fires between 1990 and 2018 presented evidence on mortality, respiratory and cardiovascular morbidity as well as other possible impacts on human health (Cancedo-González & Viqueira, 2018). A study of 13.5 years of data including 48 days affected by wildfire smoke in Sydney, Australia, demonstrated a significant increase in mortality associated with smoke-affected days (Johnston et al., 2011). An earlier study of mortality in Sydney, using 8 years of data, found an increase in mortality associated with wildfire-related PM10 (Morgan et al., 2010). An analysis of forest fires that blanketed the Indonesian islands of Kalimantan and Sumatra in late 1997 found that individuals who were exposed to haze experienced greater increases in difficulty with activities of daily living and that haze had a negative impact on respiratory and general health (Frankenberg et al., 2005). A meta-analysis of data from 2003 to 2010 in 10 cities in southern Europe found increases in cardiovascular mortality associated with PM10 that were stronger on smoke-affected days than on non-affected days (Faustini et al., 2015).
Large-scale intentional forest fires in Indonesia cause haze in neighboring countries. The causal impact of these fires on Singaporean health outcomes had estimated partial health and avoidance costs of US$184 million from September 2012 to August 2017 (Sankaran & Sheldon, 2018). A study on prenatal exposure to the 1997 Indonesian forest fires based on child nutritional outcomes found that mean exposure to air pollution during the prenatal stage was associated with a 0.5 standard deviation decrease in height-for-age z score at age 17. Because adult height is associated with income, this implies a loss of 4% of average monthly wages for approximately one million Indonesian workers born during this period (Tan-Soo & Pattanayak, 2019).
An analysis of hospitalizations due to respiratory diseases in people over 60 years of age who were residents of Cuiabá in the Brazilian Amazon during 2012 found significant correlations between exposure to these contaminants and hospitalizations. There was a hospitalization risk increase of 31.8%, with an increase of 3.5 μg/m 3 of PM2.5 concentrations and an increase of 188 in the total number of hospitalizations (Machin et al., 2019).
The spatial variability of aerosols over Amazon Basin shows that large areas of three to five million km 2 are affected by high aerosol concentrations. The concentration of trace gases and aerosols from forest fires in the dry season increase by factor of 2-8 in large areas (Artaxo et al., 2006).
A 10 μg/m 3 increase in the level of exposure to particulate matter in the Amazon was associated with increases of 2.9% and 2.6% in outpatient consultations due to respiratory diseases in children on the sixth and seventh days following exposure, respectively. Levels of particulate matter from biomass burning in the Amazon were associated with adverse effects on the respiratory health of children (Carmo et al., 2010). A cross-sectional analysis of cardiovascular mortality among people over 65 years in the Brazilian Amazon, where the predominant source of air pollution is from wildfires, found a significant association between the percentage of hours of PM2.5 over 25 μg/m 3 and cardiovascular mortality (Nunes et al., 2013).

Implications for Public Policies and Research
Considering the fact that there is clear evidence that forest fires are directly correlated to health problems, and that climate change is likely to increase the magnitude of this problem, there is urgency for action.
Deforestation is a result of a complex sum of factors, which vary both in space and time. Therefore, it is necessary to take into account this complexity to understand the dynamics of deforestation. Drivers of deforestation can be grouped into (1) economic factors (market structure, conditions and access to credit, incentives, prize of commodities, international demand, etc.), (2) governance factors (budget and structure of environmental institutions, efficiency of command and control instruments, management efficacy of protected areas and indigenous lands); (3) political factors (power of the lobby of the agricultural sector; changes in legislation at the federal, state and municipal levels), (4) infrastructure development (road construction, hydroelectric dams, etc.) and development of extractive industries (mining, oil, and gas), and (5) structural factors (population growth and migration, poverty and inequality, etc.). Reducing deforestation and forests fires, therefore, is no simple task (Viana, 2017).
A roadmap for action should include a mix of policy instruments to: (1) strengthen governance in the frontier, (2) increase funding mechanisms for sustainable development in the Amazon, (3) change the paradigm of financing for infrastructure, (4) reduce corruption and increase transparency, (5) improve corporate behavior, (6) strengthen civil society organizations, (7) education and communication, (8) ecosystem services and poverty, (9) promote community-based sustainable development pathways, especially in protected areas and indigenous lands, and (10) build political support (Viana, 2017).
Environmental policies have had a setback in recent elections in Brazil, both at the national and subnational levels. There is a general perception that environmental policies are slowing economic growth and thus need to be weakened (Viana, 2019).
The connection between deforestation, forest fires and health can be an important tool to change environmental policies in the Amazon. Health relates directly to the interests of all citizens and their family members. High air pollution is seen and easily understood by the general public. Health problems are publicized in the media, and this creates an opportunity to drive policy change.
Institutions engaged in the design and implementation of environmental public policies should give greater emphasis to the health dimension of deforestation. The same applies to those engaged in public health public policies: they should emphasize the forest fire-health nexus. There is a need for a massive communication strategy to create greater public awareness and thus influence policy-making on the forest fire-health nexus.
There are some questions that require attention in the design and implementation of sound public policies: How can we communicate effectively and promote dialogue on public policies associated with the forest fires, air pollution, and health? How can we disseminate research results on the nexus between forest fires, air pollution, and health?
Although the body of evidence is quite sufficient for practical action, there are several research questions that deserve further work: How can we address the ethical components of climate injustice towards indigenous peoples and isolated communities and their linkages to health and forest fires? How can we improve public health systems to deliver health care to problems associated with air pollution in the Amazon, especially for indigenous peoples and isolated communities? How can we improve the understanding of the consequences of air pollution to public health in the Amazon? What are the scenarios for forest fires, air pollution, and health in their short term and long term in light of climate change?

Conclusions and Call to Action
Public policies in the Amazon aimed at reducing deforestation and forest fires are traditionally driven by an environmental rationale, without appropriate consideration to the human health dimension. Public health policies do not give due consideration to air pollution derived from forest fires. Climate policies do not give the necessary attention to forest fires. This needs to change if the Amazon is to succeed in meeting the Sustainable Development Goals by 2030.
A better understanding of the nexus between forest fires and health can change societal perceptions and become drivers of necessary change in public policies. This is key to strengthen policies aimed at reducing forest fires in the Amazon.
There is a need for urgent action to avoid the tipping point of the Amazon forest, which would have profound consequences for Brazil, South America, and the planet. The following actions are recommended: 1. Policy dialogue, design, and implementation of cross-sectoral policies aiming at zero deforestation in all nine Amazon countries by 2025. The process should be informed by science and supported by massive communication about the health-deforestation nexus, in all Amazon regions. Other regions of South America should be informed about the importance of the Amazon to maintain rainfall regimes. Zero net deforestation policies should include reforestation, such as agroforestry systems to boost resilience and compensate for residual deforestation. Research on the efficacy and efficiency of different policy instruments should be supported. 2. New financial mechanisms to support implementation of zero net deforestation policies. These mechanisms should include a carbon tax and payments for ecosystem services to compensate Amazon populations, especially indigenous peoples, for the benefits (carbon, biodiversity, water, others) provided by their forests. Research on the importance and value of the Amazon for rainfall regimes and climate stability in the region and globally should be supported. 3. Health policies to improve care for air pollution-related diseases. These policies should have a special focus on indigenous peoples, who suffer from one of the world's greatest climate injustices, because they have not been part of the problem of greenhouse gas emissions. Research on the health impacts and appropriate care for deforestation-borne air pollution should be supported. 4. Develop new partnerships engaging the business and civil society organizations in the design and implementation of practical solutions for sustainable development of the Amazon. These solutions should support national and subnational governments to increase efficiency, efficacy and transparency. These partnerships should be broad, including local, national and global actors. The Amazon is too big to fail.
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