Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department


Major Professor

David A. Himmelgreen, Ph.D.

Committee Member

Marianne Schmink, Ph.D.

Committee Member

Hilton P. da Silva, Ph.D.

Committee Member

Linda M. Whiteford, Ph.D.

Committee Member

Rebecca K. Zarger, Ph.D.


Amazon, Brazil, Development, Public Health, Ribeirinho Community


This dissertation examines the public health impacts of a large dam project on a downstream community using the framework of Syndemic Theory. The particular focus is the Belo Monte Dam, located in the Brazilian Amazon, and its impact on the community of Gurupá, Pará. At the present time the Belo Monte Dam, which is nearing completion, stands out in scale as being the world’s third largest dam complex. Gurupá is a community well known (and well-studied) in the social science literature as Amazon Town. The aims of this study are to assess the pre-existing public health of Gurupá, as well as the current and future health impacts associated with dam construction by (a) assembling a comparative list of known health impacts created by the construction of hydroelectric dams world-wide, (b) conducting ethnographic research focusing on the public health system in Gurupá, and (c) integrating these data using Syndemic Theory to create a heuristic model of health impacts to be used by public health workers to assist in the mitigation of negative public health impacts.

This research is significant to the advancement of the scholarly literature in that it uses syndemic theory in a new way, thereby broadening the relevance and applicability of the approach. The syndemic framework postulates that the concurrent presence of two or more ill-health conditions in a population can lead to a dynamic interaction in which each of the conditions shapes and worsens the other. The widespread presence of two or more poor health conditions within a population can lead to an aggregate of health issues that collectively and substantially lower the health status of the entire community. By studying communities worldwide that have dealt with the aftermath of dam construction, this dissertation creates a model suggesting the high likelihood of certain diseases and socio-environmental factors combining and leading to ill health in a syndemic fashion. The model can then be tailored to the specifics of this case study.

Gurupá is the focus of the study. The community is unique for the region as it has been the subject of several ethnographies since the 1940s. This dissertation makes use of these decades of research as a base line to evaluate current changes in the public health system as impacted by the dam. With this base-line as a starting point, the study combines a review of epidemiological data, ethnographic observations, interviews with public health professionals and the local population, and a health and food frequency survey to identify what factors are most detrimental to the community’s health in reference to the Belo Monte dam construction.

The results of this study identify risks from increases in intestinal parasites (due to poor water quality and sanitation), increases in rates of malaria and dengue fever, increases in potential stressors (e.g. from increases in violence and drugs associated with migration of new people into the community), and a surge in sexually transmitted infections. As research shows, these factors combine to create a breakdown in community cohesion, which has been a key factor in keeping Gurupá healthier than its surrounding towns. Community cohesion is described as a mutual trust and camaraderie among community members that provide a safety net against common problems. Community cohesion also allows for a sense of social control that is not attainable when community members are strangers or do not trust each other. If there is a lack of trust within the community then it is less likely that individuals will do things based on the greater good.

As seen with previous studies, syndemic theory usually examines one public health issue and postulates about the different factors that go into its proliferation. This research instead takes a known risk factor to population health, dam construction, and uses syndemic theory to hypothesize about all the potential impacts so as to create a model that can be used to mitigate said impacts. Studying the impacts of dams and their syndemic effects on populations tie previous environmental, anthropological, public health, and biological studies together showing how all factors combine and mutually impact each other, which provides the foundation for a nonlinear approach to solving Amazon specific public health issues.