Environmental pollution challenges public health surveillance: the case of mercury exposure and intoxication in Brazil

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Lancet Regional Health-Americas Pub Date : 2024-08-30 DOI:10.1016/j.lana.2024.100880
Maria Elena Crespo-Lopez , Amanda Lopes-Araújo , Paulo Cesar Basta , Isabela Soares-Silva , Carlos B.A. de Souza , Caio Gustavo Leal-Nazaré , Letícia Santos-Sacramento , Jean Ludger Barthelemy , Gabriela P. Arrifano , Marcus Augusto-Oliveira
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Abstract

Pollution, causing millions of deaths annually, disproportionally affects low- and middle-income countries (LMICs). Mercury ranks among the three main chemicals of major public health concern, and even low levels can cause cardiovascular and nervous outcomes, with children and indigenous populations being especially vulnerable. Nearly 80% of all emissions in South America originate from the Amazon. Brazil, the fifth-largest contributor to global mercury emissions, exemplifies the challenges faced by LMICs in effectively monitoring and addressing mercury exposure/intoxication. Despite having powerful tools such as SINAN (a digital platform for compulsory disease reporting), and Community Health Agents, data reveals significant underreporting, especially in the Amazon. Furthermore, SINAN has important delays in its update: for instance, 196 cases of Munduruku Indigenous people in 2019 have only been included in 2023. In this Personal View, we outline insightful recommendations to enhance public health surveillance and implement enduring, effective strategies to monitor, report and address mercury exposure/intoxication, focusing on the Brazilian Amazon. Although these recommendations are tailored to the challenges of this country, they hold potential for adaptation by other Amazonian countries facing similar issues (high mercury emissions and the presence of vulnerable populations, among others).

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环境污染对公共卫生监测的挑战:巴西的汞暴露和汞中毒案例
污染每年造成数百万人死亡,对中低收入国家的影响尤为严重。汞是引起重大公共卫生问题的三大主要化学品之一,即使含量很低,也会导致心血管和神经系统疾病,儿童和土著居民尤其容易受到影响。南美洲近 80% 的汞排放源于亚马逊地区。巴西是全球第五大汞排放国,它充分体现了低收入和中等收入国家在有效监测和处理汞暴露/汞中毒方面所面临的挑战。尽管拥有 SINAN(强制报告疾病的数字平台)和社区健康代理等强大工具,但数据显示报告严重不足,尤其是在亚马逊地区。此外,SINAN 的更新也存在重大延误:例如,2019 年 Munduruku 土著居民的 196 例病例直到 2023 年才被纳入。在这篇《个人观点》中,我们概述了一些有见地的建议,以加强公共卫生监测,实施持久、有效的战略来监测、报告和解决汞暴露/汞中毒问题,重点关注巴西亚马逊地区。尽管这些建议是针对巴西所面临的挑战而提出的,但对于面临类似问题(汞排放量高、存在弱势人群等)的其他亚马逊国家来说,这些建议也具有适应潜力。
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期刊介绍: The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.
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