Large hydropower projects and the epidemiologic transition path: insights from Belo Monte dam construction in middle sized municipalities in the Brazilian amazon

The construction of large hydropower dams in the Amazon region affects social and environmental characteristics, directly impacting local population health. On the other hand, conditionalities that are mandatory by law and enforced by regulatory agencies, are ought to increase investments in local health infrastructures, improving population health. This paper aims to assess how the Belo Monte dam, the second largest hydropower plant in Brazil, built between 2011 and 2016, affected health in municipalities within the direct influence area of construction. We collected all notifications of deaths and diseases in the study area for the period of 4 years before (2007-2010), 5 years during (2011-2016) and 4 years after (2017-2020) the dam construction. Then, we selected the top-10 causes of death and sickness to analyze changes in pattern of distribution over time. We also analyzed the notifications of suicides during the study period. The data were retrieved from the Mortality Information System (SIM), Malaria Epidemiological Surveillance Information System (SIVEP-Malária), and the Notifiable Diseases Information System (SINAN). These datasets cover all compulsory notifications of diseases and deaths in Brazil. Results showed that despite some improvements in population health, as was the case of malaria, other diseases including dengue, tuberculosis and syphilis increased over time. The number of suicides also increased over time, especially among the young population (0-25 years old), and continued increasing even after the dam construction. We conclude that the vast investments in social _x0093_development_x0094_ do not fulfill the promises made before the dam construction and that new policies should be developed to properly allocate financial resources for health improvement in the context of large hydropower dams. Importantly, assessments, mitigation, and compensation plans of impacts caused by constructions of large hydropower dams in the Amazon should be more responsible regarding damaging impacts on the local population health.