WHEN THE TERRITORY BECOMES ILL: ENVIRONMENTAL CHANGES, SOCIAL VULNERABILITY AND PRIMARY HEALTH CARE RESPONSES

Abstract

This chapter discusses how environmental changes and extreme climate events become health problems when they affect territories marked by social inequalities. It is a narrative literature review based on recent Brazilian studies on heat, floods, droughts, wildfires, mortality, mental health, maternal and child outcomes, and damage to the infrastructure of the Brazilian Unified Health System. The aim is to analyze how territory shapes exposure, protection, and recovery capacity and to discuss possible Primary Health Care responses. The literature shows that age, race/skin color, income, education, housing, mobility, and service availability modify the intensity of health impacts. Environmental events may also increase demand while simultaneously compromising facilities, transportation, supply chains, and continuity of care. The chapter argues for Primary Health Care capable of integrating environmental surveillance, epidemiological information, and territorial knowledge to anticipate risks and organize responses proportional to local vulnerability. Climate resilience within SUS therefore depends less on isolated emergency actions and more on continuous territorial planning, risk communication, active outreach, and intersectoral coordination.