INTRA-STATE INEQUALITIES IN BASIC SANITATION AND THEIR IMPACTS ON HEALTH: A COMPARATIVE STUDY IN MUNICIPALITIES OF THE EASTERN AMAZON

Abstract

Access to basic sanitation is a determinant of public health, yet profound regional inequalities persist in Brazil, especially in the Amazon. This descriptive, exploratory, and documentary study adopts a quantitative approach, using 2024 secondary data from SNIS/SINISA, DATASUS, and IBGE to compare sanitation, health, and income indicators in Castanhal and Marabá against the Pará state average. The results revealed that both municipalities present critical structural deficits, with 99.3% of the population lacking sewage collection and treatment rates reaching only 3.5% in Castanhal and 2.0% in Marabá. Despite this poor coverage, local water tariffs (R$ 7.11/m³ and R$ 7.59/m³, respectively) exceed the state average (R$ 5.21/m³), constituting tariff injustice. Regarding health, Castanhal recorded 123.5 hospitalizations per 100,000 inhabitants and Marabá 29.0, both lower than the state average (220.4). This suggests a non-linear relationship between sanitation and illness, likely influenced by underreporting. Furthermore, state income data showed that the population without sanitation has a slightly higher average income (R$ 2,346.02) than those with access (R$ 2,259.99), pointing to a chronic failure in public service provision that affects even higher-income classes. It is concluded that sanitation infrastructure in Castanhal and Marabá is an issue of social justice and State inefficiency, requiring emergency investments, tariff revisions, and the strengthening of health information systems.