Análise dos impactos sociais e à saúde de grandes empreendimentos hidrelétricos: lições para uma gestão energética sustentável Analysis of the social and health impacts of large hydroelectric plants: lessons for a sustainable energy managementResumo O objetivo deste estudo foi analisar os impactos à saúde e sociais resultantes da construção dos complexos de Usinas Hidrelétricas de Tucuruí (Pará, Brasil) e de James Bay (Quebec, Canadá). O método comparativo empregado na aná-lise da revisão bibliográfica visou apontar lições, a partir da experiência nacional e internacional, para uma gestão sustentável de futuros grandes empreendimentos energéticos no Brasil. No estudo, foi observado um desencadeamento sucessivo de impactos sociais nas categorias de trabalho e renda, educação, saneamento, ambiente físico e cultura, associados aos agravos à saúde como estresse, distúrbios nutricionais, distúrbios psicossociais, cardiopatias, doenças respiratórias e digestivas. As ações mitigadoras e compensatórias foram tardiamente implementadas e visavam remediar os efeitos dos impactos negativos. Contudo, mesmo decorridos três décadas, essas ações se mostraram ineficientes para a resolução de todos os problemas ocasionados à saúde e socioambientais. Palavras-chave Hidrelétrica, Gestão ambiental, Impacto social, Saúde ambiental Abstract The main objective of this study was to analyze the social and health impacts resulting from the construction of the Tucuruí (Pará, Brazil) and James Bay (Quebec, Canada) Hydroelectric Plants. The comparative method study used in analysis of the literature review revealed lessons to be learned from the national and international experience in order to ensure sustainable management of future major energy projects in Brazil. In this study, a successive negative domino effect was observed in terms of social impacts on jobs, income, sanitation, and culture, all with associated health problems. These included stress, nutritional and psychosocial disturbances, cardiopathies, as well as respiratory and digestive problems. The actions seeking to mitigate the effects of these negative impacts were slow to be implemented. Moreover, even though three decades have elapsed, these actions proved inefficient to resolve all the health and socio-environmental problems caused.

Water and sanitation service access is a global problem, impacting disproportionally poor communities of low-income countries. Failed universalization initiatives highlighted historical negligence, social inequality, and bad governance. Infrastructure developments require large investments, which most local governments cannot afford. Alternative funding might come from private investors through cost-effective project finance arrangements. Public services should be sustainable, conciliating users' willingness to pay with providers' willingness to supply. Governments have implemented profit-driven strategies over taxing outsourced public services to increase budget inflow. Inefficient tax schemes on essential public services have damaged universalization initiatives in developing countries. These negative taxing practices have damaged tariff structure, service sustainability, and project attractiveness. The public sector should not profit from unsustainable outsourced services that are required but they cannot supply. Water and sanitation expansions on low-income communities in developing countries should not take place as tariff-free schemes, but within a tax-exempt policy.