This study addresses the territorial changes and health conditions of populations living in the area affected by the Porto do Itaqui Thermal Power Plant (TPP), specifically the Vila Maranhão, Cajueiro, Camboa dos Frades, Nova Camboa dos Frades and São Benedito communities located in the municipality of São Luís -MA, Brazil. The data consisted of 191 interviews that were conducted from January to October 2013. The results showed that the individuals from these communities had a low educational level, with most having attended school only up to the elementary level, which contributes to a high rate of unemployment or of individuals surviving on temporary jobs. The communities' environmental awareness indicated that the main difficulties were associated with the lack of public policies, particularly regarding roads, garbage collection, low sanitation coverage, increased violence, unemployment, and informal employment. Regarding air quality, the results showed that the air pollutant concentrations still met the established limits, although the Camboa dos Frades community showed greater health problems due to a direct influence of pollutants. The reconfiguration of land use and land cover caused changes in the organization of the communities and the environment, reflected by the predominance of semi-urbanized areas and changes in the flows of small bodies of water caused by siltation from erosion. The identification of health conditions and the changes occurring in the communities affected by projects such as the TPP is important; therefore, public policies for urban mobility, spatial planning, health, education and urban safety should be proposed for such communities.