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Cited by 120Conservation, Biodiversity, and Resource ManagementLand Use and Ecosystem ServicesPublic Health and Environmental Issues

Public health impacts of ecosystem change in the Brazilian Amazon

Open access
Bauch, Simone C., Birkenbach, Anna M., Pattanayak, Subhrendu K., Sills, Erin O.·2015·Proceedings of the National Academy of Sciences
DOI 10.1073/pnas.1406495111PMC PMC4475939
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Abstract

Significance: Nature threads the very fabric of human lives in remote forest areas of developing countries. Unfortunately, we do not fully understand how ecosystem services (such as human health benefits) could be secured by conserving natural capital. Thus, we analyze a rich dataset on disease, climate, demography, land uses, and conservation policies in the Brazilian Amazon. Unsurprisingly, we find that the health dividends vary across conservation policies and are small relative to the overall burden of these diseases. However, interventions targeted specifically at preserving biodiversity (strict protected areas) generate health cobenefits. Thus, given a chance, nature does its part for human (health) capital, especially for the poor and politically voiceless.

AI snapshot

Written from the paper’s full text.

TL;DR

Combining municipal panel data from about 700 Brazilian Amazon municipalities (2003–2006), this paper finds strict protected areas are negatively correlated with malaria, acute respiratory infection (ARI), and diarrhea, while roads and sustainable-use protected areas have mixed associations. Scenario estimates suggest that expanding strict protected areas between 1990 and 2010 by 63% reduced malaria, diarrhea, and ARI by 6%, 2%, and 1.5%, respectively, in an average municipality.

Key findings

  • Strict protected areas are negatively correlated with malaria, diarrhea, and ARI; as expected for negative controls, strict protected areas are not correlated with AIDS, dengue, arthritis, or leukemia.
  • Sustainable-use protected areas are not associated with diarrhea and ARI and are positively correlated with malaria; indigenous reserves are negatively correlated only with diarrhea.
  • Roads are associated with higher malaria but lower diarrhea and ARI, consistent with dual effects on ecosystem disturbance and healthcare access.
  • Quantile regressions show relationships vary by disease level: strict protected areas are negatively correlated with malaria at the 75th and 90th quantiles but with ARI only at the 90th, and with diarrhea at all points except the 90th; roads are positively correlated with malaria only at the upper end, but with diarrhea and ARI at all levels.

Methods

  • Municipal-level panel dataset for the Brazilian Amazon covering 4 years (2003–2006) and about 700 municipalities, with 25 variables including malaria, dengue, AIDS, arthritis, and leukemia cases in the population and diarrhea and ARI cases in children under 2 years of age; health program coverage; weather; demographics; socioeconomic factors; and land-use drivers (strict, sustainable-use, and indigenous protected areas, roads, and mining).
  • Random-effects/error-components panel models and quantile regressions (10th, 25th, 50th, 75th, and 90th quantiles), with standardized coefficients presented for key land-use drivers and negative-control diseases used as falsification tests for protected-area effects.
  • Data sources include DATASUS, the Brazilian Institute of Geography and Statistics, the Ministry of the Environment, and IMAZON for road length.

Limitations

  • The paper states that regression results may be biased by omitted confounders, observed or unobserved; that more rigorous causal impact analysis would require longer time-series data; that negative controls may not be valid for all land-use drivers because those drivers have multiple impact channels (e.g., roads could increase AIDS); and that the analysis does not consider the full range of benefits or costs of protected areas, mining, or roads.
  • Evident from the text: the analysis is observational and reports correlations rather than causal estimates; the panel covers only 4 years; diarrhea and ARI are measured in children under 2 years of age, not the whole population; and municipal aggregation may mask individual-level behaviors and exposure.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1073/pnas.1406495111

Cites

57 of 57 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 32 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Strict PAs are negatively correlated with ARI only in the 90th quantile of the disease distribution.

    “strict PAs are negatively correlated with malaria in the 75th and 90th quantiles but with ARI only in the 90th quantile.”
    Quote in the paperSubstantial claim
  • Findingown data

    Municipalities with more roads have higher rates of malaria in the Brazilian Amazon.

    “Fig. 1 also shows that municipalities with more roads have higher rates of malaria but lower rates of diarrhea and ARI.”
    • Also stated in: § Discussion · hedged
      “First, we find mixed evidence on the influence of roads: They are associated with increases in malaria and decreases in diarrhea and ARI cases.”
    Quote in the paperSubstantial claim
  • Findingcitation

    In summer, higher temperature and rainfall are negatively correlated with all three diseases in the Brazilian Amazon.

    “natural water bodies are positively correlated with all three diseases, altitude is negatively correlated with malaria, and in the summer higher temperature and rainfall (which could, for example, flush pathogens down river) are negatively correlated with all three diseases (23,42,43).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [23]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [42]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [43]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Findingown data

    Strict PAs are negatively correlated with diarrhea at all points of the disease distribution, except at the 90th quantile.

    “strict PAs are negatively correlated with diarrhea at all points of the distribution, except at the 90th quantile.”
    Quote in the paperSubstantial claim
  • Findingcitation

    Natural water bodies are positively correlated with all three diseases in the Brazilian Amazon.

    “natural water bodies are positively correlated with all three diseases, altitude is negatively correlated with malaria, and in the summer higher temperature and rainfall (which could, for example, flush pathogens down river) are negatively correlated with all three diseases (23,42,43).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [23]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [42]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [43]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims. 17
  • Classified as probably not a substantial claim. 10

  • May combine two claims.

    Findingown data

    Strict PAs are not correlated with AIDS, dengue, arthritis, or leukemia in the Brazilian Amazon.

    “Turning to our negative controls, we find that as expected, strict PAs are not correlated with AIDS, dengue, arthritis, or leukemia.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Public health impacts of ecosystem change in the Brazilian Amazon

    The health dividends vary across conservation policies and are small relative to the overall burden of these diseases.

    “Unsurprisingly, we find that the health dividends vary across conservation policies and are small relative to the overall burden of these diseases.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    When models are reestimated by dropping the most urban municipios, the population coefficient is either statistically insignificant or positive and significant.

    “If we reestimate all models by dropping the most urban municipios, we find the population coefficient to be either statistically insignificant or positive and significant.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The study did not identify spurious relationships between protected areas and dengue, arthritis, leukemia, and AIDS, confirming that the strategy is reasonable.

    “As reported in Results, we do not identify spurious relationships between PAs and these health outcomes, confirming that our strategy is reasonable.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Arthritis and leukemia have no known conceptual or empirical links to conservation actions.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given
    § Public health impacts of ecosystem change in the Brazilian Amazon

    Roads increase mobility and hence both the spread of disease and access to medical services.

    “Roads increase mobility and hence both the spread of disease and access to medical services.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    These negative controls are best viewed as falsification tests only for the health impacts of protected areas.

    “Thus, these negative controls are best viewed as falsification tests only for the health impacts of PAs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given
    § Public health impacts of ecosystem change in the Brazilian Amazon

    Informal mining is associated with water pollution as well as working and living conditions that increase exposure to mosquitos.

    “Informal mining is associated with water pollution as well as working and living conditions that increase exposure to mosquitos.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given
    § Public health impacts of ecosystem change in the Brazilian Amazon

    All of these policies can be manipulated to reduce deforestation, which in turn reduces air and water pollution from forest fires, erosion, and agriculture.

    “All of these policies can be manipulated to reduce deforestation, which in turn reduces air and water pollution from forest fires, erosion, and agriculture.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Expansion of strict PAs between 1990 and 2010 by 63% reduced ARI, diarrhea, and malaria by 1.5%, 2%, and 6%, respectively, in an average municipality.

    “Our estimates suggest that this expansion reduced ARI, diarrhea, and malaria by 1.5%, 2%, and 6%, respectively, in an average municipality.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Dengue is transmitted primarily in urban areas, where it has expanded rapidly in Brazil.

    “Dengue is transmitted primarily in urban areas, where it has expanded rapidly in Brazil (49).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Underlying drivers of deforestation and land use more generally include mining, roads, and protected areas.

    “Underlying drivers of deforestation and land use more generally include mining (36), roads (53), and PAs (54).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [36]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [53]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [54]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation
    § Public health impacts of ecosystem change in the Brazilian Amazon

    The Brazilian Amazon is an appropriate setting to explore the health impacts of ecosystem changes because it has undergone rapid land-use change and significant conservation efforts, including PAs covering 44% of the region.

    “The Brazilian Amazon is an appropriate setting to explore the health impacts of ecosystem changes because it has undergone both rapid land-use change, including conversion of nearly a fifth of the original forest cover to other land uses, and significant conservation efforts, including establishment of PAs covering 44% of the region (39).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Public health impacts of ecosystem change in the Brazilian Amazon

    Recent approximations attribute as much as 24% of the global burden of disease to poor environmental quality, including land-use patterns.

    “Recent approximations attribute as much as 24% of the global burden of disease (GBD) to poor environmental quality, including land-use patterns (9,10).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [9]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [10]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Study design and conductreasoning

    The study estimated models of dengue, AIDS, arthritis, and leukemia as negative controls because theory suggests they are not related to landscape-level ecosystem change, in order to check whether estimated coefficients could reflect underlying correlations or omitted variables.

    “To check whether the estimated coefficients in models of malaria, ARI, and diarrhea could reflect underlying correlations between public health and placement of PAs, we also estimate models of dengue, AIDS, arthritis, and leukemia as negative controls that theory suggests are not related to landscape-level ecosystem change.”
    • Also stated in: § Statistical Methods. · plain
      “To assess whether our results could be due to some omitted variables that influence both land-use policies and public health, we estimate models of negative controls that have no theoretical relationship with rural ecosystems: dengue, arthritis, leukemia, and AIDS.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Arthritis and leukemia have no known conceptual or empirical links to conservation actions.

  • May combine two claims.

    Premisecitation
    § Public health impacts of ecosystem change in the Brazilian Amazon

    Reduced deforestation can prevent the proliferation of mosquito breeding sites and microclimates conducive to anopheline development and growth, and conserve biodiversity including mosquito predators and species that dilute the transmission of malaria.

    “Reduced deforestation can also prevent the proliferation of mosquito breeding sites and microclimates conducive to anopheline development and growth, and conserve biodiversity including mosquito predators and species that dilute the transmission of malaria itself (13,40).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [40]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data
    § Public health impacts of ecosystem change in the Brazilian Amazon

    Conservation scenarios based on estimated regression results suggest that malaria, ARI, and diarrhea incidence would be reduced by expanding strict PAs, and malaria could be further reduced by restricting roads and mining.

    “Conservation scenarios based on estimated regression results suggest that malaria, ARI, and diarrhea incidence would be reduced by expanding strict PAs, and malaria could be further reduced by restricting roads and mining.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Public health impacts of ecosystem change in the Brazilian Amazon

    Health is a universal development concern and very likely to be directly affected by land use and land-use policy.

    “Health is a universal development concern (one of three components of human development indices) and very likely to be directly affected by land use and land-use policy (3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    Roads can plausibly both damage ecosystems and improve access to formal health services.

    “This supports the contention that roads can plausibly both damage ecosystems and improve access to formal health services.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior research has found the PSF to be effective at decreasing mortality rates among infants and children.

    “Prior research has found the PSF to be effective at decreasing mortality rates among infants and children (50)(51)(52).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [50]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [51]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [52]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Standardized coefficients have been more widely used in other social sciences and recommended for use in ecology.

    “Standardized coefficients have been more widely used in other social sciences (55) and recommended for use in ecology (56).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [55]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [56]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisereasoning

    The PSF could also be positively correlated with disease outcomes, as it might reflect the government's response to high disease rates in some regions.

    “The PSF could also be positively correlated with disease outcomes, as it might reflect the government's response to high disease rates in some regions.”
    Quote in the paperNot a substantial claim
21 of 21

  • The authors state this as an assumption.

    The four negative control diseases (AIDS, dengue, arthritis, and leukemia) are not theoretically related to landscape-level ecological changes.

    “we model four diseases that serve as negative controls for the link between PAs and disease because they are not theoretically related to landscape level ecological changes: AIDS, dengue, arthritis, and leukemia (Materials and Methods).”

  • The paper relies on this without support.

    Even less evidence exists on how specific conservation policies affect multiple health outcomes.

    “Even less evidence exists on how specific conservation policies affect multiple health outcomes.”

  • The authors state this as an assumption.

    The unexplained residual variation in the health outcome (the error) is unrelated to the land-use drivers.

    “We assume that the unexplained residual variation in the health outcome (the error) is unrelated to the landuse drivers, which largely reflect federal government decisions (about placement of roads and PAs) and the distribution of mineral resources.”

  • The paper relies on this without support.

    Arthritis and leukemia have no known conceptual or empirical links to conservation actions.

    “Arthritis and leukemia have no known conceptual or empirical links to conservation actions.”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Strict protected areas are said to reduce all diseases, but not the negative controls

    Minor

    The paper says expansion of strict protected areas reduced the incidence of all diseases considered. Elsewhere, it says strict protected areas were not correlated with four diseases included as negative controls, so the claim cannot apply to all diseases considered.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. SK Pattanayak, , Evaluating the health impacts of climate change and conservation policies using applied CGE. BE J Econ Anal Poli 9, 6 (2009).

Cited by

Sorted by citations

Related

Authors
Bauch, S. C., Birkenbach, A. M., Pattanayak, S. K., & Sills, E. O.
Affiliations
  • Inter-American Development Bank (US)
  • Duke University (US)
  • North Carolina State University (US)
ORCID
Venue
Proceedings of the National Academy of Sciences
Publisher
National Academy of Sciences
Published
2015-06-15
Volume
112
Issue
24
Pages
7414-7419
ISSN
  • 0027-8424 (ISSN-L)
  • 1091-6490
DOI
10.1073/pnas.1406495111
PMC
PMC4475939
OpenAlex
W2125132456
Cited by
120
References
56
Citations by year
2026: 4 · 2025: 7 · 2024: 10 · 2023: 10 · 2022: 14 · 2021: 16 · 2020: 15 · 2019: 9 · 2018: 13 · 2017: 12 · 2016: 5 · 2015: 4 · 2014: 1
FWCI
9.28
Type
journal article
Language
en
Open access
Locations
  • Proceedings of the National Academy of Sciences (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Physical Sciences › Environmental Science › Global and Planetary Change › Conservation, Biodiversity, and Resource Management
  • Physical Sciences › Environmental Science › Global and Planetary Change › Land Use and Ecosystem Services
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Public Health and Environmental Issues
Keywords
ecosystem change, public health, protected areas, conservation policy, land use change, malaria, acute respiratory infections, diarrhea, environmental protection, roads, mining, natural capital, health co-benefits, Brazilian Amazon
MeSH terms
Brazil, Conservation of Natural Resources, Diarrhea, Humans, Malaria, Public Health, Regression, Psychology, Respiratory Tract Infections, Incidence, Infection Control, Ecosystem

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