Public health policies in traditional communities of the Tapajós-Arapiuns Extractive Reserve, Brazilian Amazon

Abstract

Health policies aimed at specific populations have contributed to advancing equity within Brazil’s Unified Health System (SUS), but their implementation still faces critical challenges. In the Amazon, the climate crisis disproportionately affects traditional communities whose social reproduction depends directly on the territory and whose access to rights is constrained by territorial inequalities. Based on a partial analysis of a doctoral thesis in Public Policy at the Federal University of ABC (UFABC), defended in February 2026, this article analyzes the impacts of climate change on living conditions and access to health among traditional communities in the Tapajós-Arapiuns Extractive Reserve (RESEX), in Santarém, Pará. The study adopts a qualitative, exploratory and descriptive approach, combining bibliographic and documentary research with participant observation and semi-structured interviews. Nine local community leaders were interviewed, with emphasis on their narratives about environmental changes and everyday life. The findings indicate that extreme drought intensifies pre-existing logistical and territorial vulnerabilities, affecting mobility, food production, water availability and access to health services. The study argues that climate change acts as a catalyst of historical vulnerabilities and that health policies in Amazonian territories need to incorporate local knowledge, social participation and territorial specificities into planning and implementation.