Impact of the regulation of the New Brazilian Forest Code on Health: evidence based on respiratory diseases and deforestation in the Legal Amazon

Impact of the regulation of the New Brazilian Forest Code on Health: evidence based on respiratory diseases and deforestation in the Legal Amazon | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of the regulation of the New Brazilian Forest Code on Health: evidence based on respiratory diseases and deforestation in the Legal Amazon Edward Martins Costa, José Alex Bento do Nascimento, Ahmad Saeed Khan, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3523348/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract In 2012, the Brazilian government implemented the New Forest Code, an update to the previous code, aiming to contain deforestation and promote the sustainable use of forest resources. However, regarding the Legal Amazon region, more rigorous requirements and instruments are needed. In this context, this study measured the impact of this policy on respiratory disease hospitalizations caused by deforestation. From the estimates found with the difference-in-differences method, based on panel data between 2000 and 2019, increases in respiratory disease hospitalizations and in deforestation occurred after the enactment of this policy, possibly due to rural private properties not complying with the code, but also to deforestation on public lands. The results also suggest that the underlying mechanism of these effects was the fragile compliance with the restrictions and regulations established by the current forest code, which is the main instrument to combat deforestation in Brazil. JEL Code: C1, I1, Q12, Q23, Q50, Q56. Respiratory diseases impact assessment deforestation New Forest Code Legal Amazon conservation policy Figures Figure 1 Figure 2 1. INTRODUCTION Forest fires and the burning of forests for agriculture 1 are responsible for affecting the balance of ecosystems, and consequently human health. In Brazil, the burning of vegetable biomass is a traditional management practice used for various crops, to create and maintain livestock pastures and as a soil preparation technique for agriculture (Piromal et al ., 2010). It is generally associated with deforestation, regarded as the last stage of the process when, after the vegetation is cut, farmers burn their lands to convert forests into farmlands or pastures. According to the Global Forest Resources Assessment (FAO, 2010), Brazil was the country with the highest incidence of deforestation in the 1990s and 2010s. In addition to the damage to biodiversity (fragmentation of forests, extinction of species etc.), to the soils, and to water resources, deforestation also contributes to the greenhouse gas effect, particularly when associated with fires. The destruction of forests and other forms of native vegetation is responsible for over 75% of net carbon dioxide ( \({\text{C}\text{O}}_{2}\) ) emissions to the atmosphere in Brazil, placing the country among the top ten greenhouse gas – GHG emitting countries globally (IBGE, 2012). More precisely, ranking 7th (2.9% of total global emissions) in 2018, with China, the US, and Russia being the first, second, and third largest emitters, respectively (SEEG, 2019). Fires increase the emission of fine particulate matter, known as PM, which may concentrate in the atmosphere mainly in dry periods (Pöschl et al., 2010 ; Artaxo et al., 2013 ), and are externalities resulting from deforestation. The inhalation of PM from fires has an adverse impact on human health, leading to a higher number of hospitalizations and premature deaths (Johnston et al., 2012 ; Marlier et al., 2013 ; Jacobson et al., 2014 ; Smith et al., 2014 ; HRW et al. , 2020). Between August and September 2019, exposure to toxic smoke increased from nearly three million people residing in 90 municipalities in the Amazon region (corresponding to approximately 12% of the region’s municipalities) to 4.5 million people in 168 municipalities (approximately 22%) over the limit recommended by the World Health Organization (WHO) (HRW et al. , 2020). Furthermore, globally, air pollution from the burning of forests and other vegetation may cause 435,000 premature deaths each year (Jacobson, 2014 ). In summary, the influence of human activity on climate change has a significant effect on the economy, social well-being, and the environment (Laurance, 1999 ; Stern et. al. , 2007; IPCC, 2019). Deforestation in the Amazon is a complex phenomenon and may be associated with economic activity, such as variations in the prices of agricultural commodities, regarded as causes of deforestation both by theoretical studies (Angelsen and Kaimowitz, 1999 ; Angelsen, 1999 ; Geist and Lambin, 2002 ) as well as by empirical research on the Legal Amazon (Pfaff, 1999 ; Arima et al., 2007 , 2011 ; SILVA, 2009 ). Governmental policies implemented as of 2004 have helped reduce deforestation in the Legal Amazon (Barreto and Silva, 2010; Souza et al., 2013 ; Defries et al., 2013 ; Nepstad et al., 2014 ; Jennifer, et al., 2018 ; Assunção et al., 2015 , 2020 ). In this context, an analysis of the relation between deforestation and diseases may highlight costs which have frequently been neglected in efforts to value natural capital, i.e., estimations of the economic value or the pricing of the goods and services provided by nature. The incidence of various diseases may increase due to deforestation, and certain authors even suggest a relation with increases in diseases in general (Saccaro Junior et al., 2015 ). In this scenario, the aim of this study was to estimate the causal relation between deforestation in the Legal Amazon region and public health based on the incidence of respiratory disease hospitalizations. Analyzing this relation may contribute to better manage health services in the North region, where social vulnerability is the highest in the country – and where the impact of environmental imbalances on health may worsen. To this end, the impact of deforestation on respiratory diseases was measured in the 282 municipalities located within 100 km of the borders of the Legal Amazon between 2000 and 2019. The use of longitudinal data allowed the non-observable effect to be controlled on the municipal level. In addition, the impact of the change in the environmental conservation policy was also studied, since it is the main forest protection instrument, establishing the overall regulation of all forms of exploitation of the native vegetation on national territory, and thus an important environmental policy. However, certain limitations were observed in the empirical approach. First, the policy under study is national in scope and, in this context, the more appropriate control group would be the regions of the country that have forests, except for the Legal Amazon. Thus, the sectioning of the border areas in the region under study was adopted given the availability of data by the National Space Research Institute (INPE) 2 . Second, in order to obtain municipal data on the Permanent Preservation Areas (APPs) 3 and the Legal Reserves (RLs) 4 for rural properties it was necessary to cross-check the deforestation shapefiles in the INPE database with the National Rural Environmental Registry System (SICAR), which would require a very complex computational effort, given the characteristics of the database 5 . Therefore, the results obtained in this study considered the total forest areas in the municipalities provided by the INPE. In addition to this introduction, the second section reviews the relevant literature. The area studied, the database, and the econometric methods used are described in the third section; the main results are presented in the fourth section; and, lastly, our concluding remarks are presented in the fifth section. 2. LITERATURE REVIEW 2.1 Institutional Context The first Forest Code, enacted in 1934 during the Getúlio Vargas administration, introduced characteristics aimed at preserving the environment within the rural properties (Brazil, 1934 ). Furthermore, the code addressed the concept of protection forests on a given property. Although the terminology and concepts were not clearly defined, it nevertheless revealed the intention of creating a set of specific rules for the environment. In 1961, a new forest law was enacted, aiming to protect forests and water resources, which was based on the legislation of other countries. This process led to the enactment of the second Brazilian Forest Code on 15 September 1965, through Law n° 4,771/1965 (Viana, 2001 ). This code was an important regulator of forest activities, protecting the existing forest on national territory as goods of common interest to society, upholding the right to property, in addition to establishing rules for the use, preservation, and conservation of the forests and other forms of vegetation on rural properties, namely the APPs and the RLs (Brazil, 1965 ). The guidelines of this law remained in effect until 2012, and the Brazilian forest legislation has been profoundly modified over time, influenced by the connection between international and domestic law, private property, and the preservation of the environment. As result of this debate, the New Forest Code went into effect on 25 May, 2012 through Law Nº 12,651 which established general norms for the Protection of Native Vegetation in general, including APPs, RLs and areas of Restricted Use (UR); the use of the forest, the supply of forest raw materials, the control of the origin of forest products, the control and prevention of forest fires, and the establishment of economic and financial instruments to attain its objectives (Brazil, 2012 ). In summary, it may be said that the New Forest Code introduced changes in relation to its predecessor, mainly with regard to the RL and the creation of the Rural Environmental Registry 6 (CAR). Concerning the RL, the current Code did not change the rural area that property owners must maintain the native vegetation cover. In this respect, the RL regards a fraction of the land of the rural property in which the original native vegetation must be maintained to protect the biodiversity of the area, the fauna and the flora so as to allow its sustainable use. The minimum percentages for RLs in relation to the rural property vary according to biome and location. If the property is located in the Legal Amazon, the percentage is 80%; 35% if the property is located in the Cerrado biome in the Legal Amazon; and 20% in all other regions of the country. In the Legal Reserves, direct use of resources is allowed, provided they are managed sustainably (Brazil, 1965 ; Brazil, 2012 ). The CAR may be considered an important soil use and occupation management tool with regard to environmental aspects. Registry is mandatory for all rural property owners, including their respective perimeters, duly identified and delimited by geographic coordinates, all the property’s protected areas, particularly APPs and RLs, as well topographic surveys identifying waterways, springs, olhos d’água, veredas , tops of hills, slopes and areas used for agrosilvipastoral, ecotourism and rural tourism activities (Brazil, 2012 ). Registry in the CAR is the first step to obtain environmental compliance for the property which is issued by the Environmental Compliance Programs – PRA 7 . However, it is also necessary to understand the effective implementation of the new forest code and its instruments, as well as to what extent its efficacy altered the reality of Brazilian rural properties, ensuring the upholding of the constitutional principles of sustainable development and the social role of properties. RLs must be duly registered in the public property record and, as set forth by Federal Decree n° 6.686/2008, non-registry of the RL is considered a violation. However, the waiver of the registry requirement is set forth in Art. 18: “The Legal Reserve area must be duly registered at the competent environmental agency with the CAR registry set forth in Art. 29, and its disposition may not be altered in cases of transmission, of any type, or of dismemberment, with the exceptions established by this Law” (Brazil, 2012 ). Therefore, the CAR waived the mandatory registry of the RL in the Brazilian public property registries. In addition, the Code currently in effect establishes cases for which the RL is not required, such as public water supply and sewage treatment utilities, for areas acquired or expropriated for the building or expansion of highways and railways, and cases in which the public authority can reduce the percentage of the RL by up to 50%, if over 50% of the area of the municipality is occupied by nature conservation units or by legally recognized indigenous lands, the same applying to States that have approved ecological economic zoning, for which the percentage is 65% (Brazil, 2012 , Art. 12, §§ 4 and 5). The alterations regarding the elimination of the requirement that RLs be registered at a notary public have in fact reduced the bureaucracy of this process making it more accessible to rural property owners. Also, the possibility of compensating the RL in the biome allows states to regulate their areas (Stephanes, 2012 ). In addition, the new Code also created incentives for the environmental regularization of rural properties. Property owners who were penalized may have the fines suspended if they restore the APPs and the RL area (Brazil, 2012 ). With the RLs and APPs no longer required, as previously, the code made environmental protection less enforceable. In addition, the possibility of reducing the RL and the elimination of the registration requirement may be considered a social setback in light of the significantly lower environmental protection requirements in comparison to those established previously, which were more adequate for the preservation of the environment (Coutinho and Carneiro, 2017 ; Lima, 2018 ). 2.2 The relation between fires and respiratory diseases Air quality (smoke from any source) may be harmful to human health, particularly in the case of respiratory diseases. Environmental imbalances, mainly those related to deforestation, have adverse effects on human health due to pollution in the atmosphere (Schimmel, 1978 ; Böhm et al., 1983 ; Böhm et al., 1989 ; Saldiva et al., 1994 ; Saldiva et al., 1995 ; Massad et al., 1995 ). In the United States, the state of California registered more than half of forest fires in the country in recent decades (Fried et al., 2004 ). (Jacobs et al., 1997 ) found that the burning of waste from rice plantations in the region of Butte, between 1983 and 1992, was associated with asthma hospitalizations. Using a time series regression, the authors showed that a one-acre increase in the total area burned increased asthma hospitalizations by 23%. Another study conducted in San Diego, California, with time series data, for a period of one month between September and October, 2003, showed that forest fires significantly increased emergency health assistance for asthma and other respiratory ailments (Viswanathan et. al., 2006 ). Several episodes of large fires over extended periods have also been registered in Asia, mainly in the Southeast region. More recently, the more severe fires occurred in 1997/98 and were related to the El Niño , destroying 11.7 million hectares of forest, properties and other types of vegetation (Tacconi et al., 2007 ; Field and Shen, 2008 ). The impacts on human health associated with this vast forest fire was documented by (Emmanuel, 2000 ) with time series data, over a 4-month period, between August and November 1997, in Singapore, showing that the increase in PM from 50 ug/m³ to 150 ug/m³ was associated with a 37% increase in cases of asthma and 26% in rhinitis. (Sastry, 2002 ) observed that the increase in PM between January 1996 and December, 1997 was related to an increase in mortality among the elderly in Malaysia. (Mott et. al., 2005 ) observed an increase in hospitalizations for asthma and respiratory and cardiovascular ailments during the forest fire period between January, 1995 and December, 1998, in Malaysia. In the case of Brazil, studies have revealed the impacts on human health by different typologies of emission sources: burning of fossil fuels to generate power in transportation (Andrade et al., 2017 ; Vormittag et al., 2018 ; ISS, 2019); industrial processes (Spektor et al., 1991 ; Braga et al., 2007 ); agrosilvopastoral activities associated with burnings, forest fires and soil movement (Cançado et al., 2006 ; Arbex et al., 2014 ), as well as burnings in the North and Midwest regions (Reddington et al., 2015 ; Silva et al., 2016 ; Alves, 2019 ), contributing to the production of additional knowledge on this subject and evidence upon which pollution control and air quality management actions may be based. Specifically in subequatorial Amazon, studies on air pollution provoked by fires were initiated in 1998 by the Experimental Atmosphere Pollution Laboratory (LBA) of the School of Medicine of the University of São Paulo, but it was only in 2007 that the first discoveries were published suggesting an association between respiratory diseases and the surrounding air (Ignotti et al., 2007 ; Mascarenhas et al., 2008 ; Rosa et. al., 2008 ). (Mascarenhas et al., 2008 ), in a study conducted in the state of Acre in September 2005, found that burnings were associated with out-patient assistance for respiratory diseases. (Carmo et al., 2010 ) with monthly time series data between January, 2004 and December, 2005 in Alta Floresta, a municipality in the state of Mato Grosso, revealed that increases of 10 ug/m³ in PM levels were associated with increases of 2.9% and 2.6% in respiratory disease assistance in children respectively 6 to 7 days after exposure. (Ignotti et al., 2010 ), with monthly time series data between January and December 2005 for Alta Floresta and Tangará da Serra, municipalities in the state of Mato Grosso, observed that an increase of 10 ug/m³ in PM levels was associated with increases of up to 6% in hospitalizations for respiratory diseases of children, and 6.8% of the elderly. Fires and the burning of biomass are also important sources of atmospheric pollution with relevant effects on public health (Oliveira et al., 2007 ; Barcellos et al., 2009 ; Carmo et al., 2010 ; Ignotti et al., 2010 ; Machin et al., 2019 ; Sant’anna and Rocha, 2020 ), particularly children (Jacobson et al., 2014 ). In the report “O Ar é Insuportável” (the Air is Unbearable), conclusions show that burnings associated with deforestation in the Amazon had a significant negative impact on public health in the region in 2019. This includes 2,195 hospitalizations due to respiratory diseases attributable to burnings. Of these hospitalizations, 467 (21%) were infants between 0 and 12 months of age, and 1,080 (49%) were elderly persons, aged 60 or over. The study revealed that patients spent a total of 6,698 days in the hospital in 2019 due to exposure to air pollution produced by burnings (HRW et al. , 2020). Regarding the difference-in-differences method, there are several studies that have focused on investigating air pollution, generally in urban areas, associated with industrial production ( Tu, et al. 2019 ; Yang et al., 2020 , Zhang et al., 2020 ). In summary, these are studies on governmental policies aimed at reducing pollutant emissions, consequently improving air quality and public health. Concerning deforestation, few studies have been published in the area of human health, focusing on evaluating policies, combating malaria, for example (Pattanayak et al., 2006 ; Yasuoka and Levins, 2007; Silva and Marshall, 2012 ; Laporta et al., 2013 ; Myers et al., 2013 ; Garg, 2014 ; Bauch et al., 2015 ). 3. METHODOLOGY 3.1 Area of study and identification strategy The Legal Amazon is an area that encompasses 59% of the Brazilian territory including the total area of eight states (Acre, Amapá, Amazonas, Mato Grosso, Pará, Rondônia, Roraima and Tocantins) and part of the state of Maranhão (44ºW), spanning a total of 5.0 million km². However, the borders of the Legal Amazon were altered because of changes in the country`s political division. The Sustainable Amazon Plan (PAS), launched in 2008 by the federal government, considered the totality of the state of Maranhão as part of the Brazilian Amazon (IPEA, 2008). The concept of Legal Amazon was established in 1953, and the territorial borders resulted from the need to plan the region’s economic development, and its territorial borders resulted from the need to plan the region’s economic development, and for this reason it is not limited to the rainforest ecosystem, which occupies 49% of the national territory . This region is recognized for the importance of its biomes, the Cerrado (Rezende et al., 2020 ) and the Amazon (Assunção et. al., 2020 ). The changes introduced by the New Forest Code apply primarily to properties within the administratively defined Legal Amazon. In this regard, the present study analyzed this characteristic and adopted an identification strategy which considered the municipalities on the border of the Legal Amazon to evaluate the impact of this conservation policy in that region. Furthermore, in light of the potential heterogeneity of the Amazon region, we only considered municipalities located near the border. Thus, the reference sample was comprised of municipalities located in the Legal Amazon within 100km of the border and which were considered the treatment municipalities, while the control group is comprised municipalities located outside the Legal Amazon within distances of 100 km between the municipality and the border. This strategy was also adopted by (Assunção et. al., 2020 ). Figure 1 shows the border of the Legal Amazon and the borders of the municipalities for the states of Acre, Amazonas, Amapá, Maranhão, Mato Grosso, Pará, Rondônia, Roraima and Tocantins (all partially or totally located in the region). It must be pointed out that border municipalities, i.e., those crossed by the region’s borders, were not included in either sample. Thus, the empirical strategy was to compare the municipalities affected by the environmental policy (in blue). Since the municipalities are located within the Cerrado biome of the Legal Amazon, they are required to set aside a minimum of 35% of the area of the property for the RL. Of the 142 municipalities in the treatment group, 30 are located in the states of Mato Grosso and Mato Grosso do Sul, 34 in Tocantins, and 78 in Maranhão. The control group was comprised of municipalities that are outside the borders of the Legal Amazon (in green) which must set aside 20% of the area of the property for the RL, being an important region according to New Forest Code. Thus, 140 municipalities were considered, 11 of which in Mato Grosso do Sul, 69 in Goiás, 27 in Maranhão, 27 in Piauí, and 6 in the state of Bahia. Given that the Amazon regions is vast and potentially heterogeneous, considering municipalities located close to the border allowed controlling for similar socio-economic, environmental and social characteristics. 3.2 Empirical strategy Given the availability of municipal data in Brazil, the data were placed in a panel structure, with annual information on the municipalities for the period between 2000 and 2019. In order to analyze the effect of the new forest code on deforestation, the geographic and temporal division of the municipalities in 2012 was adopted as the empirical strategy. In this regard, the difference-in-differences approach was used to test the hypothesis that the Code generates environmental protection. To this end, the following equation was estimated: $${DOENCA}_{it}={\alpha }_{i}+{\varphi }_{i}+{\beta }_{1}\left({Tratado}_{i}Pos2012\right)+{X}_{it}{\prime }{\beta }_{i}+{\epsilon }_{it}$$ 1 where \({Doença}_{it}\) , in municipality i in year t , considers hospitalizations related to all respiratory diseases (codes J00-J99), obtained from the platform of the Information Technology Department of the Unified Health System (SUS) which provides online public health data (DATASUS, 2021). The causes of hospitalizations are registered according to the ICD 10 International Classification of Diseases, 10th review. The variable of interest is the interaction of a dummy, \({Tratado}_{i}\) , indicating that the municipality is located within the Legal Amazon, with the variable that represents the period after the enactment of the new forest code, \(Pos2012\) . In this regard, the year of 2012 was considered post-policy because the conservation policy went into effect in May 2012. The term \({\alpha }_{i}\) represents the fixed effects of the municipalities that describe the initial conditions and the characteristics of the municipalities, such as geographic and infrastructure characteristics. The term \({\varphi }_{i}\) represents the fixed effects for the years, to control for time trends, as well as for seasonal changes in agricultural activity, macroeconomic conditions, rural policies in common. The component \({X}_{it}\) are the control covariables or variables used. The term \({\epsilon }_{it}\) are robust standard errors on the municipal level. Lastly, the parameter of interest β1 captures the causal effect of the new forest code on respiratory disease hospitalizations. All the variables were transformed into logarithm, except for DPOP, IND, URBAN which are percentages, and TEMP an index, which reduces the degree of asymmetry of all the variables considered and tends to stabilize sample variance and kurtosis. Table 1 presents the variables, their descriptions, units of measurement, and sources. Lastly, entropy balancing was adopted in this study, which is a pre-processing technique used to balance covariables in observational studies with binary treatment. Entropy balancing involves a reweighting scheme that directly incorporates the covariable balance in the weight equation which is then applied to the units in the sample. This allowed determining a set of weights that satisfied the balancing restrictions, but that remains as close as possible (in an entropy sense) to a set of basic uniform weights to retain information. By recalibrating the unit weights, it was possible to efficiently adjust the systemic and random imbalances in the representation (Hainmueller, 2012 ). Table 1 Variables of the Study Variable Description Unit Source Respiratory diseases Annual respiratory disease hospitalizations, except those related to tobacco. Number of hospitalizations DATASUS (2021) FLO Forest area Km² PRODES/INPE (2021) GDPpc Real per capita GDP R $ IBGE (2021) Deforested (t-1) Annual increment in deforested area in (t-1) Km² PRODES/INPE (2021) POPG Population estimates Number of inhabitants IBGE (2021) DPOP Populational density Number of inhabitants /areas of municipality (km²) IBGE (2021) URBAN Urban population (% ) IBGE (2021) IND Industrial structure (added value) (% of GDP) IBGE (2021) K/L Capital-labor ratio R $ IPEA (2021) and RAIS (2021) EMISSION Burning of industrial, residential and transportation fuel Tons SEEG (2021) TEMP Temperature (minimum) º C NASA (2021) RAINFALL Rainfall Mm NASA (2021) TOBACCO Tobacco hospitalizations Number of hospitalizations DATASUS (2021) Source: Prepared by the authors, 2021. 4. Impact of the policy on respiratory disease hospitalizations 4.1. Main results Table 2 summarizes the statistics of the means, standard deviations, and the minimum and maximum values of each variable of the study. Here, it must be pointed out that DOENÇA is the result variable to be evaluated by the enactment of the “New Forest Code”. Subsequently, the covariables (control variables) used are listed. The covariables represent a wide range of economic, social and environmental variables that adequately meet the requirements of control variables for the model tested. Table 2 – Statistics of the dependent variables and covariables studied -Legal Amazon- 2021 Variable Mean Standard deviation Min. Max. Respiratory diseases 161 223.99 0 2,352 Deforested 23.05 36.64 0.005 653.96 FLO 1,410.25 1,881,7 0.7 16,782.1 DPOP 0.33 0.53 0.001 15.16 IND 10.01 11.26 0.77 86.99 GDPpc 18,887.15 22,054.99 526.83 289,391.5 POPG 19,343 28,447 897 309,905 URBAN 60.60 19.49 8.9 98.91 K/L 2,844.07 3,037.2 2,000.52 32,946.7 Emission 24,390.81 98,363.6 4,707.84 2,126,336 TEMP 21.93 1.79 17.81 25.84 Rainfall 1,151.46 279.19 454.98 1.713.02 Tobacco 13 23.38 0 303 Source: Prepared based on study data, 2021. Note The series comprised 282 municipalities, over a period of 20 years (2000–2019), for a total of 5,640 observations. The mean was 161 hospitalizations, DOENÇAS, with minimum and maximum values equal to 0 and 2,352 respectively. Regarding data on deforestation, the mean found for the annual increment of deforested areas was 23.05 km², with minimum and maximum values reaching 0.005 and 653.96 respectively. For the forest area, the mean observed was 1,410.25 km², with minimum and maximum values equal to 0.7 and 16,782.1, respectively. For populational density, the mean was 0.33; the higher the rate, the higher the number inhabitants km², with the minimum and maximum values equal to 0.001 and 15.16, respectively. Regarding population estimates, the mean registered was 19,343 inhabitants, with minimum and maximum values equal to 897 and 309,905, respectively. In relation to the urban population percentage, the mean observed was 60.6% of total residents, with minimum and maximum values equal to 8.9% and 98.91%, respectively. Regarding the share of industry in GDP, the mean was 10.01%, with minimum and maximum values equal to 0.77 and 86.99%, respectively. For real per capita GDP, the mean registered was R $ 18,887.68 with minimum and maximum values equal to R $ 526.83 and R $ 289,391.5, respectively. For the K/L ratio, the mean registered was R $ 2,844.07, with minimum and maximum values equal to R $ 2,000.52 and R $ 32,946.7, respectively. Concerning energy, the mean GHG emissions was 24,390.81 tons, with minimum and maximum values equal to 4,707.84 and 2,126,336.00, respectively. Regarding minimum temperature, the mean observed was 21.93ºC, with minimum and maximum values equal to 17.81ºC and 25.84ºC, respectively. The mean for rainfall was 1,152.46 mm, with minimum and maximum values equal to 454.98 and 1,713.02, respectively. Lastly, the mean for tobacco hospitalizations was 13, with minimum and maximum values equal to 0 and 303, respectively. More specifically, a comparison is made in Fig. 2 between the treated and controlled groups of municipalities, considering the mean deforestation increments and respiratory disease hospitalizations, for the entire period of the study (2000–2019). It may also be seen in Fig. 2 that there was a predominance in the reduction of deforestation and in the number of respiratory diseases hospitalizations during the 2000–2019 period. The treated municipalities (in blue) were prioritized by deforestation combating policies, which were surpassed in 2015 by deforestation, three years after the enactment of the new forest code, and 2010 for respiratory diseases hospitalizations. When comparing the means between 2000–2011 (pre-treatment) and 2012–2019 (treatment), it may be observed that the higher means of the treated municipalities in relation to the non-treated ones dropped for both variables, indicating that the differences that existed in the pre-treatment period increased unfavorably for treated municipalities for the entire period, indicating a possible negative effect of the updated version of the previous forest code. Table 3 presents the coefficients estimated for the effect of the new forest code on hospitalizations according to Eq. ( 1 ). Column 1 only includes the fixed effects for municipality and year. Column 2 lists the socio-economic and environmental covariates. The coefficients were positive and robust in all specifications. Thus, a point estimate of 0.45 was found for the model without covariates. The coefficient dropped after the inclusion of the socio-economic and environmental controls (0.28). Thus, there was an increase in deforestation and an increment in hospitalizations. With this result, it must be highlighted that forests are important to maintain a healthy environment. Tropical and temperate forests improve the quality of the soil, contribute to the fauna and flora, and prevent erosion and flooding (Rudel et al., 2005 ; Benhin, 2006 ). Table 3 – Effect of the New Forest Code on respiratory disease hospitalizations - Legal Amazon- 2021 Dependent variable: LNDOENÇA (1) (2) New Forest Code 0.449 (0.022) 0.284 (0.008) Fixed effect for municipalities and years YES YES Covariables NO YES Source: Prepared based on study data, 2021. Note The series comprised 282 municipalities, over a period of 20 years (2000–2019), for a total of 5,640 observations. The standard errors are robust on the municipal level. 4.2 Pre tendency and the validation of the empirical approach It was important to verify whether the results were consistent. As discussed in Section 4.1 , the validity of the estimates found depend on confirming whether the treatment and control groups followed parallel trends before the policy was enacted. Presented below are the post-estimation tests (or result validation tests). Initially, a test was conducted to verify the validity of the equal trend assumption for the DiD model. Although the validity of the equal trend assumption in DiD may be assessed, it may not be proven. A good way of verifying validity is to compare changes in the results for the treatment and control groups before the law went into effect. If the results moved in the same direction (parallel trends) before the law started, we are confident that the results would continue to move together in parallel in the subsequent period. In order to verify the existence of equal trends after enactment, at least two observations of the series for the treatment and control groups would be needed before the law was enacted. This means that the verification would require three observations of the series: two for the period prior to enactment to determine the pre-program trends, and at least one observation after the enactment to determine the pre-impact. If the result of the DiD estimate is systematically different than 0, the trends are not parallel, and the initial DiD is susceptible to deviation naturally (not being attributable to the program) during the treatment (Khandker et al. , 2010; Gertler et al. , 2011). Table 4 – Result of the parallel trend test Dependent variable: LNDOENÇA (1) (2) \({\text{T}\text{e}\text{n}\text{d}\text{P}\text{a}\text{r}}_{it}\) -0.235 (0.311) -0.171 (0.105) Fixed effect for municipalities and years YES YES Covariables NO YES R² 0.01 0.79 Source: Study data, 2021. Note The series comprised 282 municipalities, over a period of 20 years (2000–2019), for a total of 5,640 observations. The standard errors are robust on the municipal level. A test was conducted to verify the parallel trend assumption for the pre-treatment period (2010 to 2012), presented in Table 4 above. The years 2010 and 2011 are pre-enactment, and 2012 is post-enactment so that the impact may be evaluated. In order to capture this trend, the model was estimated again (Eq. 1 ) where the main variable of interest was a dummy variable TendParit which is the interaction with the dummy \({Tratado}_{i}\) , indicating that the municipality is located in the Legal Amazon, with the variable representing the test period (pre-treatment 2010–2012). Given the insignificance of the results, it may be inferred that the trends are parallel, and thus the hypothesis of the DiD model is valid (Khandker et al. , 2010; Gertler et al. , 2011). With the additional robustness test, a placebo test (a falsification test) was conducted in which the estimation was made with a placebo outcome variable which, in principle, was not directly influenced by the effects of the enactment of the new forest code, presented in Table 5 . The use of annual rainfall as a placebo allowed inferring that the enactment of the new law did not affect the annual volume of rainfall in millimeters. This denotes that the empirical strategy is adequate and therefore the results provide evidence that the contemporary effects of the control group were not guiding the results. In summary, since the model’s parallel trend test validated the method, and the empirical strategy was validated by the placebo test, it may be inferred that the assumptions of the DiD regression model are valid. Therefore, the results capture the causal impact of the enactment of the new forest code on the increment conditions in the number of respiratory disease hospitalizations. Table 5 – Robustness test of the DiD model for the placebo result variable ‘precipitação anual’ (LNPRECIPITAÇÃO) Dependent variable: LNPRECIPITAÇÃO (1) (2) New Forest Code 0.006 (0.783) 0.034 (0.126) Fixed effect for municipalities and years YES YES Covariables NO YES R² 0.24 0.33 Source: Study data, 2021. Note The series comprised 282 municipalities, over a period of 20 years (2000–2019), for a total of 5,640 observations. The standard errors are robust on the municipal level. 4.3 Transmission mechanisms In light of the results obtained in the present study, there is empirical evidence that, in spite of the CAR requirement and possibility of complying with the PRA, the effect of the new forest code is still being felt, and consequently the increase in the number of respiratory disease hospitalizations in the region under study. This corroborates the study conducted by (Sant’Anna and Rocha 2020 ), where the authors indicate the existence of a positive relation between particulate emissions and respiratory disease hospitalization rates. This result is probably due to the difficulty in monitoring deforestation in public lands, the lack of institutional support in a wider sense and which varies from state to state and within the federal government, which would allow evaluating the information contained in the CAR. In addition to this, there are technological limitations (infrastructure) and difficulties in integrating databases, insufficient technical staff at the Brazilian Forest Service (SFB) mainly in the states (which rely on temporary consultants and professionals), lack of public interest, among other factors. The Native Vegetation Protection Law (Law Nº 12,651/2012), or simply the Forest Code, is currently the main forest policy tool in Brazil for private lands, and is fundamental to reconcile agricultural and livestock raising growth and the protection of natural resources, since the legal protection devices that limit expansion in terms of production area, namely the APPs and the RL, create incentives for rural producers to invest in technology to modernize agriculture, and in practices that increase productivity. It must be highlighted that forest code is a federal law, but it is enforced on the state level. Therefore, the participation of states in the regulation and enforcement of the regulation and instruments is fundamental for its success. However, the enforcement of the law in fact remains a big challenge. Close to completing ten years of enactment and albeit the advances it has promoted, the Forest Code is still far from being fully enforced in all Brazilian states. Even with the progress in certain states, the registry analysis and validation process continue to be a great challenge for practically all those involved. The main difficulties identified were the following: (a) reference cartographic databases are insufficient to support the analyses; (b) lack of robust hydrographic data; (c) poor quality of the registries; (d) poor communication with landowners and holders when corrections and additional registry information are requested; (e) lack of dedicated assessment and validation teams or insufficient number of staff for this role; and (f) large number of registries. Lastly, there is also the lack of interest by producers to obtain environmental compliance and not enough priority given to this initiative by the state governments. For example, in states whose main activity is livestock ranching, resistance appears to be greater, since the recovery of the APP and Legal Reserve areas depends on the fencing of the areas and producers are not interested in recovering vegetation in a productive manner, with the use of agroforestry systems (Chiavari et al., 2021 ). Between 2013 and 2020, on average, 42% of the hotspots registered annually in the Brazilian Amazon were located in areas that had never been deforested. Also, on average, only 11% of these went from deforested areas to clear-cut areas in up to 3 years. In other words, the rate of burnings used in initial stages of vegetation removal was low. The phenomenon is more frequent in rural settlements and in public land holdings. More particularly, the trend observed in public land holdings suggests that fires may play an important role in illegal land occupation and sale, possibly to rapidly and cheaply occupy a given area (Meneses et al. , 2021). This is important since the new code only applies to private areas. And the increment in the deforested area used in this study considered municipal deforestation as a whole, which was not broken down by category of deforestation actor, which could shed more light on deforestation in private areas. However, this breakdown into categories would only be possible with the conclusion of the CAR process. Furthermore, nearly 60% of land in the Amazon is classified as public and has been intensely targeted for deforestation in recent years. After private property, public lands have the highest rates, 31% and 30% respectively, in 2019. While in the first category fire is used to clear land for pastures, on public lands fire is used to deforest areas for illegal possession by grileiros (land grabbers) for property speculation (Alencar et al. 2020 ). Part of this area has already been illegally registered as “private property” in the CAR, making it clear that these lands are vulnerable to land grabbing and speculation Furthermore, authors shows that deforestation in the Legal Amazon between 2019–2021 surpassed 10 mil km² a year, approximately 56.6% higher that the yearly average for 2016–2018, 51% on public lands, 83% of these federal (Alencar et al. 2020 ; Chiavari et al., 2021 ). In this context, the importance of forests must be highlighted, both in terms of biodiversity and in animal and plant species. Forests also contribute to a healthier ecosystem given the existence of products that have pharmaceutical purposes as well as other uses (Mendelsohn and Balick, 1995). Furthermore, without these forests the soil deteriorates, to the extent where important plants would not be able to develop due to chemical changes and the loss of nutrients (Kahn and Mcdonald, 1995 ; Barbier, 1997 ). Forests regulate the carbon cycle in the atmosphere, absorbing GHGs, such as \({CO}_{2}\) , methane ( \({CH}_{4}\) ), nitrous oxide ( \({N}_{2}O\) ), and perfluorocarbons (PFC’s), storing considerable quantities of carbon in the process (Rudel et al., 2002 ; López and Galinato, 2005 ). The loss of forest cover may provoke environmental imbalances in the long term, and setbacks to economic growth may caused by lower availability of forest resources (Joshi and Beck, 2017 ). Forest fires release large quantities of carbon dioxide into the atmosphere, and this type of deforestation, only considering the tropics, was responsible for approximately 17% of GHG emissions on the entire planet (Barker et al., 2007 ). In this regard, Brazil must prevent deforestation to avoid causing a public health crisis in the region. To this end, an efficient air quality monitoring system is needed to comply with the quality standards needed to protect public health through preventive and reactive actions. Public policies must focus more on the increasing deforestation rates so as to reconcile the interests of economic development with the sustainable use of forest resources and public health. In this regard, the new code may play a central role as an inducer of green growth, attracting financial resources aligned with forest conservation and recovery|. It is important to mention the relevance of the findings of this study regarding the causality between deforestation and respiratory diseases, which focused on municipalities with intense conversion rates, on both sides of the border, particularly where half the world’s tropical deforestation occurs and where forest fires are concentrated (Araújo et al., 2012 ). Thus, the results highlight a particularly important scenario where economic activity and deforestation are more intense, which may help inform the formulation of policies and the enforcement of their instruments, in contexts where deforestation is a pressing subject. 5. CONCLUSIONS Deforestation impacts economic indicators and the well-being of agents, as well as the health of the communities. In this context, this study analyzed deforestation in the Brazilian Amazon and its impacts on respiratory diseases as of the enactment of the new forest code in 2012. The results point towards two implications for policies. First, there is evidence that environmental regulation aimed at controlling deforestation is not being sufficiently enforced. Also, the reach and efficacy of the enforcement of the new forest code depend on land ownership conditions, i.e., the land agents. In this case, if ownership conditions are not clearly defined, the environmental liability will not be clearly defined either. Therefore, states must become more involved in conservation efforts, namely in surveillance, in enforcing the law, and in environmental service payment schemes. These initiatives are important to formulate policies and to hold agents accountable. Secondly, the present study does not suggest that the new forest code increased deforestation, since it considers the nature of the current environmental restrictions, in an institutional context. Thus, it is believed that the enforcement of the CAR and the settlement of the environmental liability by land agents, as well as other policies related to forest conservation, may help reconcile development in the region and environmental conservation. In summary, the approach allowed verifying the fragility of the Legal Amazon with regard to environmental regulations. In light of this, it may be inferred that the policy is not containing deforestation in the region, and this is indirectly related with the increase in respiratory diseases. The empirical and theoretical evidence produced will allow further research, particularly with regard to the key effect manifestation mechanisms (or determinants) on how deforestation impacts the economic and social conditions of a region, in this specific case, human health. Therefore, as new empirical research corroborates and validates the results obtained, these results may serve as a reference to be considered by the agents involved towards the formulation and funding of policies aimed at combating deforestation and preserving the environment; either in defining public policies and strategies aimed at leveraging sustainable regional development, or for the strategies of NGOs, where both may configure their actions to promote social and economic development in the region – towards development with conservation. The adoption of political and strategic stances by public and private agents, in an efficient manner, may lead to a better understand of the key mechanisms. Declarations Ethical Approval For this study, ethical approval is not required. Consent to Participate This all authors have agreed with the content and have provided explicit consent for submission. Consent to Publish This all authors approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Authors Contributions All authors whose names appear in the submission: Edward Martins Costa, José Alex Bento do Nascimento, Ahmad Saeed Khan, Guilherme Irffi e Jair Andrade de Araújo: Made substantial contributions to the conception or design of the work; analysis and interpretation of data; Drafted the work or critically revised it for important intellectual content; Approved the version to be published; and Agreed to be accountable for all aspects of the work to ensure that issues related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. 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Journal of Environmental Economics and Management , 37 (1), 26-43. Pöschl U , Martin S T, Sinha B, Chen Q, Gunthe S S, Huffman J A, Borrmann S, Farmer D K, Garland R M, Helas G, Jimenez J L, King S M, Manzi A, Mikhailov E, Pauliquevis T, Petters M D, Prenni A J, Roldin P, Rose D, Schneider J, Su H, Zorn S R, Artaxo P and Andreae M O (2010) Rainforest aerosols as biogenic nuclei of clouds and precipitation in the Amazon. Science , 329 (5998),1513-1516. Reddington C L, Butt E W, Ridley D A, Artaxo P, Morgan W T, Coe H and Spracklen D V (2015) Air quality and human health improvements from reductions in deforestation-related fire in Brazil. Nature Geoscience , 8 (10), 768-771. RAIS - Relação Anual de Informações Sociais (2021) Cadastro Geral de Empregados e Desempregados. Ministério da Economia, Brasília. Available at http://www.rais.gov.br, (in Portuguese). Rezende V L, Pontara V, Bueno M L, Berg E V D and Oliveira-Filho A T (2020) Climate and evolutionary history define the phylogenetic diversity of vegetation types in the central region of South America. Oecologia , 192 (1), 191-200. Rocha C (2015) Alternativas ao uso do fogo na agricultura e as etapas para planejamento de uma queimada controlada. Empresa Brasileira de Pesquisa Agropecuária – EMBRAPA. Ministério da Agricultura, Pecuária e Abastecimento. Available at https://www.embrapa.br/busca-de-noticias/-/noticia/2471085/alternativas-ao-usodo-fogo-na-agricultura-e-as-etapas-para-planejamento-de-uma-queimada-controlada, (in Portuguese). Rosa A M, Ignotti E, Hacon S S and Castro H A (2008) Analysis of hospitalizations for respiratory diseases in Tangará da Serra, Brazil. Jornal Brasoleiro de Pneumologia , 34 (1), 575-582. Rudel T, Bates D and Machinguiashi R (2002) A tropical forest transition? Agricultural change, outmigration, and secondary forests in the Ecuadorian Amazon. Annals of the Association of American Geographers , 92 (1), 87-102. Rudel T K, Coomes O T, Moran E, Achard F, Angelson A, Xu J and Lambin E (2005) Forest transitions: Towards a global understanding of land use change. Global Environmental Change , 15 (1), 23-31. Saldiva P H N, Lichtenfels A J F C, Paiva P S O, Barone I A, Martins M A, Massad E, Pereira, J C R, Xavier V P, Singer J M and Bohm G M (1994) Association between Air Pollution and Mortality Due to Respiratory Diseases in Children in São Paulo, Brazil: a preliminary report . Environmental Research, 65 (2), 218-225. Saldiva P H N, Pope C A, Schwartz J, Dockery D W, Lichtenfels A J, Salge J M, Barone I and Bohm G M (1995) Air Pollution and Mortality in Elderly People: a time-series study in Sao Paulo, Brazil. Archives of Environmental Health: An International Journal , 50 (2), 159-163. Sant’anna A A and Rocha R (2020) Impactos dos Incêndios Relacionados ao Desmatamento na Amazônia Brasileira Sobre Saúde. Nota Técnica No 11. Instituto de Estudos para Políticas de Saúde-IEPS, (in Portuguese). Sastry N (2002) Forest fires, air pollution, and mortality, in Southeast Asia. Demography , 39 (1), 1-23. Schimmel H (1978) Evidence for possible acute health effects of ambient air pollution from time series analysis: methodological questions and some new results based on new york city daily mortality, 1963-1976. Bulletin of the New York Academy of Medicine , 54 (11), 1052-1108 . SEEG-Sistema de Estimativas de Emissões e Remoções de Gases de Efeito Estufa (2021) Plataforma SEEG . Available athttp://seeg.eco.br, (in Portuguese). SEEG-Sistema de Estimativas de Emissões e Remoções de Gases de Efeito Estufa (2019) Análise das emissões brasileiras de gases de efeito estufa e suas implicações para as metas do Brasil . Observatório do Clima, (in Portuguese). Silva J H G (2009) Economic causes of deforestation in the Brazilian Amazon: an empirical analysis of the 2000s. Paper presented at the XXXVII Encontro Nacional de Economia. Anpec: Foz do Iguaçu. Available at http://www.anpec.org.br/encontro_2009.htm. Silva P M de and Marshall J M (2012) Factors contributing to urban malaria transmission in sub-Saharan Africa: a systematic review. Journal of Tropical Medicine , 11 (1), 479-482. Silva P R de S, Ignotti E, Oliveira B F A de, Junger W L, Morais F, Artaxo P and Hacon S (2016) High risk of respiratory diseases in children in the fire period in Western Amazon. Revista de Saúde Pública , 50 (29), 1-11. Smith L T, Aragão L E O C, Sabel, C E and Nakaya T (2014) Drought impacts on children's respiratory health in the Brazilian Amazon. Scientific Reports , 4 (3726), 1-8. Souza, R A de, Miziara F and Marco Junior P (2013) Spatial variation of deforestation rates in the Brazilian Amazon: A complex theater for agrarian technology, agrarian structure and governance by surveillance. Land Use Policy , 30 (1), 915-924. Spektor D M, Hofmeister V A, Artaxo P, Brague J A P, Echelar F, Nogueira D P, Hayes C, Thurston G D and Lippmann M (1991) Efects of Heavy Industrial Pollution on Respiratory Function in the Children of Cubatãoao, Brazil: a preliminary report. Environmental Health Perspectives , 94 (1), 51-54. Stephanes R (2012) Código Florestal:a lei e considerações . Brasília: Editora Brasília. Brasil, (in Portuguese). Stern N S, Peters V, Bakhshi A, Bowen C, Cameron S, Catovsky D, Crane S, Cruickshank S, Dietz N, Edmonson S-L, Garbett L, Hamid G, Hoffman D, Ingram B, Jones N, Patmore H, Radcliffe R, Sathiyarajah M, Stock C, Taylor T, Vernon H, Wanjie D and Zenghelis (2006) Stern Review : The Economics of Climate Change, H M Treasury, London. Tacconi L, Moore P F and Kaimowitz D (2007) Fires in tropical forests: what is really the problem? Lessons from Indonesia. Mitigation and Adaptation Strategies for Global Change , 12 (1), 55-66. Viana E M (2001) Reserva legal e área de preservação permanente na zona rural:um estudo de negociação entre atores em municípios do Vale do Taquari – RS. Master thesis. Centro Universitário Univates. Brasil, (in Portuguese). Viswanathan S, Eris L, Diunugala N, Johnson J and Mcclean C (2006) An analysis of effects of San Diego wildfire on ambiente air quality. Journal of Air Waste Management Association , 56 (1), 56-67. Vormittag E M P A, Rodrigues C G, André P A de and Saldiva P H N (2018) Assessment and Valuation of Public Health Impacts from Gradual Biodiesel Implementation in the Transport Energy Matrix in Brazil. Aerosol and Air Quality Research , 18 (9), 2375-2382. Yang X, Jiang P and Pan Y (2020) Does China’s carbon emission trading policy have an employment double dividend and a Porter effect? Energy Policy , 142 (1), 111492. Yasuoka J and Richard L (2007) Impact of deforestation and agricultural development on anopheline ecology and malaria epidemiology. American Journal of Tropical Medicine and Hygiene , 76 (3), 450-460. Zhang M, Shan C, Wang W, Pang J and Guo S (2020) Do driving restrictions improve air quality: Take Beijing-Tianjin for example? Science of the Total Environment , 712 (1), 136408. Footnotes Fire is used by farmers and livestock ranchers to clean an area, to renew the pasture or to prepare the land for planting, always through human action. However, forest fires may be provoked by farmer/rancher-set fires which got of control (accidental) or by forest fires set directly by human action or, in rare cases, by natural factors (Nepstad et al. 1999 ; Cochrane, 2010 ; Rocha, 2015 ). In this study, the terms burnings or fires will be used in a broad sense, considering both burnings and forest fires, disregarding the conceptual differences. Information on the remaining areas, on the municipal level, is quite limited. “APPs are areas covered or not by native vegetation whose function is to preserve water resources, the landscape, geologic stability, biodiversity, genic fauna and flora flows, the soil, and ensure the well-being of human populations” (Brazil, 2012 , Art. 3, paragraph II). “Areas located within a rural property or possessions, except for areas of permanent preservation, needed for the sustainable use of natural resources, the conservation and recovery of ecological processes, conservation of biodiversity, and to provide shelter and protection to native flora and fauna (Brazil, 1965 , Art. 1, § 2, paragraph III). It is believed that the use of this disaggregate data may provide important information on the heterogeneous effect of the results obtained in this study. However, it was decided that this would be done in future research. “A national self declaratory, electronic, public registry, mandatory for all rural properties, aiming to integrate the environmental information of rural property ownership or holdings, to constitute a database for environmental and economic control, monitoring and planning, and to combat deforestation (Brazil, 2012 , Art. 29). Environmental compliance may be requested by rural landowners and/or holders who seek to conform to and comply with environmental regulations in the rural properties. The Legal Amazon also includes the territories of 8 neighboring countries, namely Bolivia, Colombia, Ecuador, Guyana, French Guyana, Peru, Surinam, and Venezuela. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3523348","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":266289577,"identity":"d9473cf6-e026-4ef1-86c2-78bfb01c57ea","order_by":0,"name":"Edward Martins Costa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYFCCBCBmA7MYHzDYMDAYEK+FjYHZgCGNRC1sEkRp4WfPMfxcUWYnJz+/+Vk1T4Idg7n0AfxaJHveGEueOZdsbHCMzew2T0Iyg2VfAn4tBjdyN0g2th1I3MDGYHab98cBBoMzBBxmfyN380+Qlvlt7N+KeRKI0GIgkbsNbEvDMR4zZqK0SJx5/82yAeyXnGLJOQnJPJY9BLTwt6cl32wAhVjz8Y0f3iTYyZnzENCCAUjWMApGwSgYBaMACwAA09c/WMogj/kAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-9187-8534","institution":"Universidade Federal do Ceara - Campus do Pici","correspondingAuthor":true,"prefix":"","firstName":"Edward","middleName":"Martins","lastName":"Costa","suffix":""},{"id":266289578,"identity":"0034b9c7-1879-4172-a686-90d70526d88c","order_by":1,"name":"José Alex Bento do Nascimento","email":"","orcid":"","institution":"Universidade Federal do Ceara - Campus do Pici","correspondingAuthor":false,"prefix":"","firstName":"José","middleName":"Alex Bento do","lastName":"Nascimento","suffix":""},{"id":266289579,"identity":"0d21a5a1-a8f1-439b-b3a6-5ed2bcf03681","order_by":2,"name":"Ahmad Saeed Khan","email":"","orcid":"","institution":"Universidade Federal do Ceara - Campus do Pici","correspondingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"Saeed","lastName":"Khan","suffix":""},{"id":266289580,"identity":"a4a2a208-7cb7-4795-bdc3-30ff02ea252c","order_by":3,"name":"Guilherme Irffi","email":"","orcid":"","institution":"Universidade Federal do Ceara","correspondingAuthor":false,"prefix":"","firstName":"Guilherme","middleName":"","lastName":"Irffi","suffix":""},{"id":266289581,"identity":"04fd2689-934d-4884-a76c-de60d7880357","order_by":4,"name":"Jair Andrade de Araujo","email":"","orcid":"","institution":"Universidade Federal do Ceara - Campus do Pici","correspondingAuthor":false,"prefix":"","firstName":"Jair","middleName":"Andrade","lastName":"de Araujo","suffix":""}],"badges":[],"createdAt":"2023-10-31 10:40:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3523348/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3523348/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49511214,"identity":"8c6f9f6e-7bbb-4d2b-a603-17b8fd5d40b3","added_by":"auto","created_at":"2024-01-12 06:21:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":165635,"visible":true,"origin":"","legend":"\u003cp\u003eThe Brazilian Legal Amazon and the reference sample\u003c/p\u003e\n\u003cp\u003eSource: Prepared by the authors, 2021.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3523348/v1/b174d7ed3152d09be3205e51.png"},{"id":49511215,"identity":"90736e20-c2d1-40e3-9138-0ac4e3bbbfc5","added_by":"auto","created_at":"2024-01-12 06:21:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":66787,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the mean increments in deforestation and respiratory disease hospitalizations between the treated and controlled groups of municipalities, in the pre-treatment period (2000-11) and treatment period (2012-19) for the Brazilian Legal Amazon.\u003c/p\u003e\n\u003cp\u003eSource: Prepared by the authors, 2021.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3523348/v1/98b420b8d2e3893db97677f6.png"},{"id":73503832,"identity":"371e9ed3-b082-41a0-a8b4-bca913250e5a","added_by":"auto","created_at":"2025-01-10 15:28:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3331394,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3523348/v1/2acf5edd-b910-4969-ad19-fca06f6d6c95.pdf"}],"financialInterests":"","formattedTitle":"Impact of the regulation of the New Brazilian Forest Code on Health: evidence based on respiratory diseases and deforestation in the Legal Amazon","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eForest fires and the burning of forests for agriculture\u003csup\u003e1\u003c/sup\u003e are responsible for affecting the balance of ecosystems, and consequently human health. In Brazil, the burning of vegetable biomass is a traditional management practice used for various crops, to create and maintain livestock pastures and as a soil preparation technique for agriculture (Piromal \u003cem\u003eet al\u003c/em\u003e., 2010). It is generally associated with deforestation, regarded as the last stage of the process when, after the vegetation is cut, farmers burn their lands to convert forests into farmlands or pastures.\u003c/p\u003e \u003cp\u003eAccording to the Global Forest Resources Assessment (FAO, 2010), Brazil was the country with the highest incidence of deforestation in the 1990s and 2010s. In addition to the damage to biodiversity (fragmentation of forests, extinction of species etc.), to the soils, and to water resources, deforestation also contributes to the greenhouse gas effect, particularly when associated with fires. The destruction of forests and other forms of native vegetation is responsible for over 75% of net carbon dioxide (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({\\text{C}\\text{O}}_{2}\\)\u003c/span\u003e\u003c/span\u003e) emissions to the atmosphere in Brazil, placing the country among the top ten greenhouse gas \u0026ndash; GHG emitting countries globally (IBGE, 2012). More precisely, ranking 7th (2.9% of total global emissions) in 2018, with China, the US, and Russia being the first, second, and third largest emitters, respectively (SEEG, 2019).\u003c/p\u003e \u003cp\u003eFires increase the emission of fine particulate matter, known as PM, which may concentrate in the atmosphere mainly in dry periods (P\u0026ouml;schl et al., \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Artaxo et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), and are externalities resulting from deforestation. The inhalation of PM from fires has an adverse impact on human health, leading to a higher number of hospitalizations and premature deaths (Johnston et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Marlier et al., \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Jacobson et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Smith et al., \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; HRW \u003cem\u003eet al.\u003c/em\u003e, 2020).\u003c/p\u003e \u003cp\u003eBetween August and September 2019, exposure to toxic smoke increased from nearly three million people residing in 90 municipalities in the Amazon region (corresponding to approximately 12% of the region\u0026rsquo;s municipalities) to 4.5\u0026nbsp;million people in 168 municipalities (approximately 22%) over the limit recommended by the World Health Organization (WHO) (HRW \u003cem\u003eet al.\u003c/em\u003e, 2020). Furthermore, globally, air pollution from the burning of forests and other vegetation may cause 435,000 premature deaths each year (Jacobson, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). In summary, the influence of human activity on climate change has a significant effect on the economy, social well-being, and the environment (Laurance, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e1999\u003c/span\u003e; Stern \u003cem\u003eet. al.\u003c/em\u003e, 2007; IPCC, 2019).\u003c/p\u003e \u003cp\u003eDeforestation in the Amazon is a complex phenomenon and may be associated with economic activity, such as variations in the prices of agricultural commodities, regarded as causes of deforestation both by theoretical studies (Angelsen and Kaimowitz, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e1999\u003c/span\u003e; Angelsen, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e1999\u003c/span\u003e; Geist and Lambin, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) as well as by empirical research on the Legal Amazon (Pfaff, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e1999\u003c/span\u003e; Arima et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2007\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; SILVA, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Governmental policies implemented as of 2004 have helped reduce deforestation in the Legal Amazon (Barreto and Silva, 2010; Souza et al., \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Defries et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Nepstad et al., \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Jennifer, et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Assun\u0026ccedil;\u0026atilde;o et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2015\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this context, an analysis of the relation between deforestation and diseases may highlight costs which have frequently been neglected in efforts to value natural capital, i.e., estimations of the economic value or the pricing of the goods and services provided by nature. The incidence of various diseases may increase due to deforestation, and certain authors even suggest a relation with increases in diseases in general (Saccaro Junior et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this scenario, the aim of this study was to estimate the causal relation between deforestation in the Legal Amazon region and public health based on the incidence of respiratory disease hospitalizations. Analyzing this relation may contribute to better manage health services in the North region, where social vulnerability is the highest in the country \u0026ndash; and where the impact of environmental imbalances on health may worsen.\u003c/p\u003e \u003cp\u003eTo this end, the impact of deforestation on respiratory diseases was measured in the 282 municipalities located within 100 km of the borders of the Legal Amazon between 2000 and 2019. The use of longitudinal data allowed the non-observable effect to be controlled on the municipal level. In addition, the impact of the change in the environmental conservation policy was also studied, since it is the main forest protection instrument, establishing the overall regulation of all forms of exploitation of the native vegetation on national territory, and thus an important environmental policy.\u003c/p\u003e \u003cp\u003eHowever, certain limitations were observed in the empirical approach. First, the policy under study is national in scope and, in this context, the more appropriate control group would be the regions of the country that have forests, except for the Legal Amazon. Thus, the sectioning of the border areas in the region under study was adopted given the availability of data by the National Space Research Institute (INPE)\u003csup\u003e2\u003c/sup\u003e. Second, in order to obtain municipal data on the Permanent Preservation Areas (APPs)\u003csup\u003e3\u003c/sup\u003e and the Legal Reserves (RLs)\u003csup\u003e4\u003c/sup\u003e for rural properties it was necessary to cross-check the deforestation shapefiles in the INPE database with the National Rural Environmental Registry System (SICAR), which would require a very complex computational effort, given the characteristics of the database\u003csup\u003e5\u003c/sup\u003e. Therefore, the results obtained in this study considered the total forest areas in the municipalities provided by the INPE.\u003c/p\u003e \u003cp\u003eIn addition to this introduction, the second section reviews the relevant literature. The area studied, the database, and the econometric methods used are described in the third section; the main results are presented in the fourth section; and, lastly, our concluding remarks are presented in the fifth section.\u003c/p\u003e"},{"header":"2. LITERATURE REVIEW","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Institutional Context\u003c/h2\u003e \u003cp\u003eThe first Forest Code, enacted in 1934 during the Get\u0026uacute;lio Vargas administration, introduced characteristics aimed at preserving the environment within the rural properties (Brazil, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e1934\u003c/span\u003e). Furthermore, the code addressed the concept of protection forests on a given property. Although the terminology and concepts were not clearly defined, it nevertheless revealed the intention of creating a set of specific rules for the environment.\u003c/p\u003e \u003cp\u003eIn 1961, a new forest law was enacted, aiming to protect forests and water resources, which was based on the legislation of other countries. This process led to the enactment of the second Brazilian Forest Code on 15 September 1965, through Law n\u0026deg; 4,771/1965 (Viana, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). This code was an important regulator of forest activities, protecting the existing forest on national territory as goods of common interest to society, upholding the right to property, in addition to establishing rules for the use, preservation, and conservation of the forests and other forms of vegetation on rural properties, namely the APPs and the RLs (Brazil, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1965\u003c/span\u003e). The guidelines of this law remained in effect until 2012, and the Brazilian forest legislation has been profoundly modified over time, influenced by the connection between international and domestic law, private property, and the preservation of the environment.\u003c/p\u003e \u003cp\u003eAs result of this debate, the New Forest Code went into effect on 25 May, 2012 through Law N\u0026ordm; 12,651 which established general norms for the Protection of Native Vegetation in general, including APPs, RLs and areas of Restricted Use (UR); the use of the forest, the supply of forest raw materials, the control of the origin of forest products, the control and prevention of forest fires, and the establishment of economic and financial instruments to attain its objectives (Brazil, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn summary, it may be said that the New Forest Code introduced changes in relation to its predecessor, mainly with regard to the RL and the creation of the Rural Environmental Registry\u003csup\u003e6\u003c/sup\u003e (CAR). Concerning the RL, the current Code did not change the rural area that property owners must maintain the native vegetation cover. In this respect, the RL regards a fraction of the land of the rural property in which the original native vegetation must be maintained to protect the biodiversity of the area, the fauna and the flora so as to allow its sustainable use. The minimum percentages for RLs in relation to the rural property vary according to biome and location. If the property is located in the Legal Amazon, the percentage is 80%; 35% if the property is located in the \u003cem\u003eCerrado\u003c/em\u003e biome in the Legal Amazon; and 20% in all other regions of the country. In the Legal Reserves, direct use of resources is allowed, provided they are managed sustainably (Brazil, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1965\u003c/span\u003e; Brazil, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe CAR may be considered an important soil use and occupation management tool with regard to environmental aspects. Registry is mandatory for all rural property owners, including their respective perimeters, duly identified and delimited by geographic coordinates, all the property\u0026rsquo;s protected areas, particularly APPs and RLs, as well topographic surveys identifying waterways, springs, \u003cem\u003eolhos d\u0026rsquo;\u0026aacute;gua, veredas\u003c/em\u003e, tops of hills, slopes and areas used for agrosilvipastoral, ecotourism and rural tourism activities (Brazil, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Registry in the CAR is the first step to obtain environmental compliance for the property which is issued by the Environmental Compliance Programs \u0026ndash; PRA\u003csup\u003e7\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHowever, it is also necessary to understand the effective implementation of the new forest code and its instruments, as well as to what extent its efficacy altered the reality of Brazilian rural properties, ensuring the upholding of the constitutional principles of sustainable development and the social role of properties. RLs must be duly registered in the public property record and, as set forth by Federal Decree n\u0026deg; 6.686/2008, non-registry of the RL is considered a violation. However, the waiver of the registry requirement is set forth in Art. 18: \u0026ldquo;The Legal Reserve area must be duly registered at the competent environmental agency with the CAR registry set forth in Art. 29, and its disposition may not be altered in cases of transmission, of any type, or of dismemberment, with the exceptions established by this Law\u0026rdquo; (Brazil, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Therefore, the CAR waived the mandatory registry of the RL in the Brazilian public property registries.\u003c/p\u003e \u003cp\u003eIn addition, the Code currently in effect establishes cases for which the RL is not required, such as public water supply and sewage treatment utilities, for areas acquired or expropriated for the building or expansion of highways and railways, and cases in which the public authority can reduce the percentage of the RL by up to 50%, if over 50% of the area of the municipality is occupied by nature conservation units or by legally recognized indigenous lands, the same applying to States that have approved ecological economic zoning, for which the percentage is 65% (Brazil, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2012\u003c/span\u003e, Art. 12, \u0026sect;\u0026sect;\u0026nbsp;4 and 5).\u003c/p\u003e \u003cp\u003eThe alterations regarding the elimination of the requirement that RLs be registered at a notary public have in fact reduced the bureaucracy of this process making it more accessible to rural property owners. Also, the possibility of compensating the RL in the biome allows states to regulate their areas (Stephanes, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). In addition, the new Code also created incentives for the environmental regularization of rural properties. Property owners who were penalized may have the fines suspended if they restore the APPs and the RL area (Brazil, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWith the RLs and APPs no longer required, as previously, the code made environmental protection less enforceable. In addition, the possibility of reducing the RL and the elimination of the registration requirement may be considered a social setback in light of the significantly lower environmental protection requirements in comparison to those established previously, which were more adequate for the preservation of the environment (Coutinho and Carneiro, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Lima, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 The relation between fires and respiratory diseases\u003c/h2\u003e \u003cp\u003eAir quality (smoke from any source) may be harmful to human health, particularly in the case of respiratory diseases. Environmental imbalances, mainly those related to deforestation, have adverse effects on human health due to pollution in the atmosphere (Schimmel, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e1978\u003c/span\u003e; B\u0026ouml;hm et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e1983\u003c/span\u003e; B\u0026ouml;hm et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e1989\u003c/span\u003e; Saldiva et al., \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e1994\u003c/span\u003e; Saldiva et al., \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e1995\u003c/span\u003e; Massad et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e1995\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the United States, the state of California registered more than half of forest fires in the country in recent decades (Fried et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). (Jacobs et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e1997\u003c/span\u003e) found that the burning of waste from rice plantations in the region of Butte, between 1983 and 1992, was associated with asthma hospitalizations. Using a time series regression, the authors showed that a one-acre increase in the total area burned increased asthma hospitalizations by 23%. Another study conducted in San Diego, California, with time series data, for a period of one month between September and October, 2003, showed that forest fires significantly increased emergency health assistance for asthma and other respiratory ailments (Viswanathan et. al., \u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral episodes of large fires over extended periods have also been registered in Asia, mainly in the Southeast region. More recently, the more severe fires occurred in 1997/98 and were related to the \u003cem\u003eEl Ni\u0026ntilde;o\u003c/em\u003e, destroying 11.7\u0026nbsp;million hectares of forest, properties and other types of vegetation (Tacconi et al., \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Field and Shen, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). The impacts on human health associated with this vast forest fire was documented by (Emmanuel, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2000\u003c/span\u003e) with time series data, over a 4-month period, between August and November 1997, in Singapore, showing that the increase in PM from 50 ug/m\u0026sup3; to 150 ug/m\u0026sup3; was associated with a 37% increase in cases of asthma and 26% in rhinitis. (Sastry, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) observed that the increase in PM between January 1996 and December, 1997 was related to an increase in mortality among the elderly in Malaysia. (Mott et. al., \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2005\u003c/span\u003e) observed an increase in hospitalizations for asthma and respiratory and cardiovascular ailments during the forest fire period between January, 1995 and December, 1998, in Malaysia.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIn the case of Brazil, studies have revealed the impacts on human health by different typologies of emission sources: burning of fossil fuels to generate power in transportation (Andrade et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Vormittag et al., \u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; ISS, 2019); industrial processes (Spektor et al., \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e1991\u003c/span\u003e; Braga et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2007\u003c/span\u003e); agrosilvopastoral activities associated with burnings, forest fires and soil movement (Can\u0026ccedil;ado et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Arbex et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), as well as burnings in the North and Midwest regions (Reddington et al., \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Silva et al., \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Alves, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), contributing to the production of additional knowledge on this subject and evidence upon which pollution control and air quality management actions may be based.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSpecifically in subequatorial Amazon, studies on air pollution provoked by fires were initiated in 1998 by the Experimental Atmosphere Pollution Laboratory (LBA) of the School of Medicine of the University of S\u0026atilde;o Paulo, but it was only in 2007 that the first discoveries were published suggesting an association between respiratory diseases and the surrounding air (Ignotti et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Mascarenhas et al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Rosa et. al., \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e(Mascarenhas et al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), in a study conducted in the state of Acre in September 2005, found that burnings were associated with out-patient assistance for respiratory diseases. (Carmo et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) with monthly time series data between January, 2004 and December, 2005 in Alta Floresta, a municipality in the state of Mato Grosso, revealed that increases of 10 ug/m\u0026sup3; in PM levels were associated with increases of 2.9% and 2.6% in respiratory disease assistance in children respectively 6 to 7 days after exposure. (Ignotti et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2010\u003c/span\u003e), with monthly time series data between January and December 2005 for Alta Floresta and Tangar\u0026aacute; da Serra, municipalities in the state of Mato Grosso, observed that an increase of 10 ug/m\u0026sup3; in PM levels was associated with increases of up to 6% in hospitalizations for respiratory diseases of children, and 6.8% of the elderly.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eFires and the burning of biomass are also important sources of atmospheric pollution with relevant effects on public health (Oliveira et al., \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Barcellos et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Carmo et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Ignotti et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Machin et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Sant\u0026rsquo;anna and Rocha, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), particularly children (Jacobson et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn the report \u0026ldquo;O Ar \u0026eacute; Insuport\u0026aacute;vel\u0026rdquo; (the Air is Unbearable), conclusions show that burnings associated with deforestation in the Amazon had a significant negative impact on public health in the region in 2019. This includes 2,195 hospitalizations due to respiratory diseases attributable to burnings. Of these hospitalizations, 467 (21%) were infants between 0 and 12 months of age, and 1,080 (49%) were elderly persons, aged 60 or over. The study revealed that patients spent a total of 6,698 days in the hospital in 2019 due to exposure to air pollution produced by burnings (HRW \u003cem\u003eet al.\u003c/em\u003e, 2020).\u003c/p\u003e \u003cp\u003eRegarding the difference-in-differences method, there are several studies that have focused on investigating air pollution, generally in urban areas, associated with industrial production (\u003cem\u003eTu, et al. 2019\u003c/em\u003e; Yang et al., \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Zhang et al., \u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In summary, these are studies on governmental policies aimed at reducing pollutant emissions, consequently improving air quality and public health.\u003c/p\u003e \u003cp\u003eConcerning deforestation, few studies have been published in the area of human health, focusing on evaluating policies, combating malaria, for example (Pattanayak et al., \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Yasuoka and Levins, 2007; Silva and Marshall, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Laporta et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Myers et al., \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Garg, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Bauch et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. METHODOLOGY","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Area of study and identification strategy\u003c/h2\u003e \u003cp\u003eThe Legal Amazon is an area that encompasses 59% of the Brazilian territory including the total area of eight states (Acre, Amap\u0026aacute;, Amazonas, Mato Grosso, Par\u0026aacute;, Rond\u0026ocirc;nia, Roraima and Tocantins) and part of the state of Maranh\u0026atilde;o (44\u0026ordm;W), spanning a total of 5.0\u0026nbsp;million km\u0026sup2;. However, the borders of the Legal Amazon were altered because of changes in the country`s political division. The Sustainable Amazon Plan (PAS), launched in 2008 by the federal government, considered the totality of the state of Maranh\u0026atilde;o as part of the Brazilian Amazon (IPEA, 2008).\u003c/p\u003e \u003cp\u003eThe concept of Legal Amazon was established in 1953, and the territorial borders resulted from the need to plan the region\u0026rsquo;s economic development, and its territorial borders resulted from the need to plan the region\u0026rsquo;s economic development, and for this reason it is not limited to the rainforest ecosystem, which occupies 49% of the national territory\u003ca class=\"FNLink\" href=\"#Fn8\" id=\"#FNLinkFn8\"\u003e\u003c/a\u003e. This region is recognized for the importance of its biomes, the \u003cem\u003eCerrado\u003c/em\u003e (Rezende et al., \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and the Amazon (Assun\u0026ccedil;\u0026atilde;o et. al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe changes introduced by the New Forest Code apply primarily to properties within the administratively defined Legal Amazon. In this regard, the present study analyzed this characteristic and adopted an identification strategy which considered the municipalities on the border of the Legal Amazon to evaluate the impact of this conservation policy in that region. Furthermore, in light of the potential heterogeneity of the Amazon region, we only considered municipalities located near the border.\u003c/p\u003e \u003cp\u003eThus, the reference sample was comprised of municipalities located in the Legal Amazon within 100km of the border and which were considered the treatment municipalities, while the control group is comprised municipalities located outside the Legal Amazon within distances of 100 km between the municipality and the border. This strategy was also adopted by (Assun\u0026ccedil;\u0026atilde;o et. al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the border of the Legal Amazon and the borders of the municipalities for the states of Acre, Amazonas, Amap\u0026aacute;, Maranh\u0026atilde;o, Mato Grosso, Par\u0026aacute;, Rond\u0026ocirc;nia, Roraima and Tocantins (all partially or totally located in the region). It must be pointed out that border municipalities, i.e., those crossed by the region\u0026rsquo;s borders, were not included in either sample. Thus, the empirical strategy was to compare the municipalities affected by the environmental policy (in blue). Since the municipalities are located within the \u003cem\u003eCerrado\u003c/em\u003e biome of the Legal Amazon, they are required to set aside a minimum of 35% of the area of the property for the RL. Of the 142 municipalities in the treatment group, 30 are located in the states of Mato Grosso and Mato Grosso do Sul, 34 in Tocantins, and 78 in Maranh\u0026atilde;o.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe control group was comprised of municipalities that are outside the borders of the Legal Amazon (in green) which must set aside 20% of the area of the property for the RL, being an important region according to New Forest Code. Thus, 140 municipalities were considered, 11 of which in Mato Grosso do Sul, 69 in Goi\u0026aacute;s, 27 in Maranh\u0026atilde;o, 27 in Piau\u0026iacute;, and 6 in the state of Bahia.\u003c/p\u003e\u003cp\u003eGiven that the Amazon regions is vast and potentially heterogeneous, considering municipalities located close to the border allowed controlling for similar socio-economic, environmental and social characteristics.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Empirical strategy\u003c/h2\u003e \u003cp\u003eGiven the availability of municipal data in Brazil, the data were placed in a panel structure, with annual information on the municipalities for the period between 2000 and 2019. In order to analyze the effect of the new forest code on deforestation, the geographic and temporal division of the municipalities in 2012 was adopted as the empirical strategy.\u003c/p\u003e \u003cp\u003eIn this regard, the difference-in-differences approach was used to test the hypothesis that the Code generates environmental protection. To this end, the following equation was estimated:\u003cdiv id=\"Equ1\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equ1\" name=\"EquationSource\"\u003e\n$${DOENCA}_{it}={\\alpha }_{i}+{\\varphi }_{i}+{\\beta }_{1}\\left({Tratado}_{i}Pos2012\\right)+{X}_{it}{\\prime }{\\beta }_{i}+{\\epsilon }_{it}$$\u003c/div\u003e\u003cdiv class=\"EquationNumber\"\u003e1\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ewhere \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({Doen\u0026ccedil;a}_{it}\\)\u003c/span\u003e\u003c/span\u003e, in municipality \u003cem\u003ei\u003c/em\u003e in year \u003cem\u003et\u003c/em\u003e, considers hospitalizations related to all respiratory diseases (codes J00-J99), obtained from the platform of the Information Technology Department of the Unified Health System (SUS) which provides online public health data (DATASUS, 2021). The causes of hospitalizations are registered according to the ICD 10 International Classification of Diseases, 10th review. The variable of interest is the interaction of a dummy, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({Tratado}_{i}\\)\u003c/span\u003e\u003c/span\u003e, indicating that the municipality is located within the Legal Amazon, with the variable that represents the period after the enactment of the new forest code, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(Pos2012\\)\u003c/span\u003e\u003c/span\u003e. In this regard, the year of 2012 was considered post-policy because the conservation policy went into effect in May 2012. The term \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({\\alpha }_{i}\\)\u003c/span\u003e\u003c/span\u003e represents the fixed effects of the municipalities that describe the initial conditions and the characteristics of the municipalities, such as geographic and infrastructure characteristics. The term \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({\\varphi }_{i}\\)\u003c/span\u003e\u003c/span\u003e represents the fixed effects for the years, to control for time trends, as well as for seasonal changes in agricultural activity, macroeconomic conditions, rural policies in common. The component \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({X}_{it}\\)\u003c/span\u003e\u003c/span\u003e are the control covariables or variables used. The term \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({\\epsilon }_{it}\\)\u003c/span\u003e\u003c/span\u003e are robust standard errors on the municipal level. Lastly, the parameter of interest β1 captures the causal effect of the new forest code on respiratory disease hospitalizations.\u003c/p\u003e \u003cp\u003eAll the variables were transformed into logarithm, except for DPOP, IND, URBAN which are percentages, and TEMP an index, which reduces the degree of asymmetry of all the variables considered and tends to stabilize sample variance and kurtosis. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the variables, their descriptions, units of measurement, and sources.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eLastly, entropy balancing was adopted in this study, which is a pre-processing technique used to balance covariables in observational studies with binary treatment. Entropy balancing involves a reweighting scheme that directly incorporates the covariable balance in the weight equation which is then applied to the units in the sample. This allowed determining a set of weights that satisfied the balancing restrictions, but that remains as close as possible (in an entropy sense) to a set of basic uniform weights to retain information. By recalibrating the unit weights, it was possible to efficiently adjust the systemic and random imbalances in the representation (Hainmueller, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVariables of the Study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSource\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnnual respiratory disease hospitalizations, except those related to tobacco.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of hospitalizations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDATASUS (2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFLO\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eForest area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKm\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePRODES/INPE (2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGDPpc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReal \u003cem\u003eper capita\u003c/em\u003e GDP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eR\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIBGE (2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeforested\u003cem\u003e(t-1)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnnual increment in deforested area in (t-1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKm\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePRODES/INPE (2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePOPG\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePopulation estimates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of inhabitants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIBGE (2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDPOP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePopulational density\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of inhabitants /areas of municipality (km\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIBGE (2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eURBAN\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(% )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIBGE (2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eIND\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndustrial structure (added value)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(% of GDP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIBGE (2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eK/L\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCapital-labor ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eR\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIPEA (2021) and RAIS (2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eEMISSION\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBurning of industrial, residential and transportation fuel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSEEG (2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTEMP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTemperature (minimum)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ordm; C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNASA (2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRAINFALL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRainfall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNASA (2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTOBACCO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTobacco hospitalizations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of hospitalizations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDATASUS (2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSource: Prepared by the authors, 2021.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Impact of the policy on respiratory disease hospitalizations","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Main results\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the statistics of the means, standard deviations, and the minimum and maximum values of each variable of the study. Here, it must be pointed out that DOEN\u0026Ccedil;A is the result variable to be evaluated by the enactment of the \u0026ldquo;New Forest Code\u0026rdquo;. Subsequently, the covariables (control variables) used are listed. The covariables represent a wide range of economic, social and environmental variables that adequately meet the requirements of control variables for the model tested.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003e\u0026ndash;\u003c/b\u003e Statistics of the dependent variables and covariables studied -Legal Amazon- 2021\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMin.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMax.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e223.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,352\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeforested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e653.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFLO\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,410.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,881,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16,782.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDPOP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eIND\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGDPpc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18,887.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22,054.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e526.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e289,391.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePOPG\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19,343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28,447\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e897\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e309,905\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eURBAN\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eK/L\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,844.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,037.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,000.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32,946.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eEmission\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24,390.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98,363.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,707.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,126,336\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTEMP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRainfall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,151.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e279.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e454.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.713.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTobacco\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSource: Prepared based on study data, 2021.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eNote\u003c/strong\u003e \u003cp\u003eThe series comprised 282 municipalities, over a period of 20 years (2000\u0026ndash;2019), for a total of 5,640 observations.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe mean was 161 hospitalizations, DOEN\u0026Ccedil;AS, with minimum and maximum values equal to 0 and 2,352 respectively. Regarding data on deforestation, the mean found for the annual increment of deforested areas was 23.05 km\u0026sup2;, with minimum and maximum values reaching 0.005 and 653.96 respectively. For the forest area, the mean observed was 1,410.25 km\u0026sup2;, with minimum and maximum values equal to 0.7 and 16,782.1, respectively.\u003c/p\u003e \u003cp\u003eFor populational density, the mean was 0.33; the higher the rate, the higher the number inhabitants km\u0026sup2;, with the minimum and maximum values equal to 0.001 and 15.16, respectively. Regarding population estimates, the mean registered was 19,343 inhabitants, with minimum and maximum values equal to 897 and 309,905, respectively. In relation to the urban population percentage, the mean observed was 60.6% of total residents, with minimum and maximum values equal to 8.9% and 98.91%, respectively.\u003c/p\u003e \u003cp\u003eRegarding the share of industry in GDP, the mean was 10.01%, with minimum and maximum values equal to 0.77 and 86.99%, respectively. For real per capita GDP, the mean registered was R\u003cspan\u003e$\u003c/span\u003e 18,887.68 with minimum and maximum values equal to R\u003cspan\u003e$\u003c/span\u003e 526.83 and R\u003cspan\u003e$\u003c/span\u003e 289,391.5, respectively. For the K/L ratio, the mean registered was R\u003cspan\u003e$\u003c/span\u003e 2,844.07, with minimum and maximum values equal to R\u003cspan\u003e$\u003c/span\u003e 2,000.52 and R\u003cspan\u003e$\u003c/span\u003e 32,946.7, respectively.\u003c/p\u003e \u003cp\u003eConcerning energy, the mean GHG emissions was 24,390.81 tons, with minimum and maximum values equal to 4,707.84 and 2,126,336.00, respectively. Regarding minimum temperature, the mean observed was 21.93\u0026ordm;C, with minimum and maximum values equal to 17.81\u0026ordm;C and 25.84\u0026ordm;C, respectively. The mean for rainfall was 1,152.46 mm, with minimum and maximum values equal to 454.98 and 1,713.02, respectively. Lastly, the mean for tobacco hospitalizations was 13, with minimum and maximum values equal to 0 and 303, respectively.\u003c/p\u003e \u003cp\u003eMore specifically, a comparison is made in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e between the treated and controlled groups of municipalities, considering the mean deforestation increments and respiratory disease hospitalizations, for the entire period of the study (2000\u0026ndash;2019).\u003c/p\u003e\u003cp\u003eIt may also be seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e that there was a predominance in the reduction of deforestation and in the number of respiratory diseases hospitalizations during the 2000\u0026ndash;2019 period. The treated municipalities (in blue) were prioritized by deforestation combating policies, which were surpassed in 2015 by deforestation, three years after the enactment of the new forest code, and 2010 for respiratory diseases hospitalizations. When comparing the means between 2000\u0026ndash;2011 (pre-treatment) and 2012\u0026ndash;2019 (treatment), it may be observed that the higher means of the treated municipalities in relation to the non-treated ones dropped for both variables, indicating that the differences that existed in the pre-treatment period increased unfavorably for treated municipalities for the entire period, indicating a possible negative effect of the updated version of the previous forest code.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the coefficients estimated for the effect of the new forest code on hospitalizations according to Eq.\u0026nbsp;(\u003cspan refid=\"Equ1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Column 1 only includes the fixed effects for municipality and year. Column 2 lists the socio-economic and environmental covariates. The coefficients were positive and robust in all specifications. Thus, a point estimate of 0.45 was found for the model without covariates. The coefficient dropped after the inclusion of the socio-economic and environmental controls (0.28). Thus, there was an increase in deforestation and an increment in hospitalizations. With this result, it must be highlighted that forests are important to maintain a healthy environment. Tropical and temperate forests improve the quality of the soil, contribute to the fauna and flora, and prevent erosion and flooding (Rudel et al., \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Benhin, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003e\u0026ndash;\u003c/b\u003e Effect of the New Forest Code on respiratory disease hospitalizations - Legal Amazon- 2021\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDependent variable: LNDOEN\u0026Ccedil;A\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNew Forest Code\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.449\u003c/p\u003e \u003cp\u003e(0.022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.284\u003c/p\u003e \u003cp\u003e(0.008)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFixed effect for municipalities and years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSource: Prepared based on study data, 2021.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eNote\u003c/strong\u003e \u003cp\u003eThe series comprised 282 municipalities, over a period of 20 years (2000\u0026ndash;2019), for a total of 5,640 observations. The standard errors are robust on the municipal level.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Pre tendency and the validation of the empirical approach\u003c/h2\u003e \u003cp\u003eIt was important to verify whether the results were consistent. As discussed in Section \u003cspan refid=\"Sec9\" class=\"InternalRef\"\u003e4.1\u003c/span\u003e, the validity of the estimates found depend on confirming whether the treatment and control groups followed parallel trends before the policy was enacted. Presented below are the post-estimation tests (or result validation tests).\u003c/p\u003e \u003cp\u003eInitially, a test was conducted to verify the validity of the equal trend assumption for the DiD model. Although the validity of the equal trend assumption in DiD may be assessed, it may not be proven. A good way of verifying validity is to compare changes in the results for the treatment and control groups before the law went into effect. If the results moved in the same direction (parallel trends) before the law started, we are confident that the results would continue to move together in parallel in the subsequent period. In order to verify the existence of equal trends after enactment, at least two observations of the series for the treatment and control groups would be needed before the law was enacted. This means that the verification would require three observations of the series: two for the period prior to enactment to determine the pre-program trends, and at least one observation after the enactment to determine the pre-impact. If the result of the DiD estimate is systematically different than 0, the trends are not parallel, and the initial DiD is susceptible to deviation naturally (not being attributable to the program) during the treatment (Khandker \u003cem\u003eet al.\u003c/em\u003e, 2010; Gertler \u003cem\u003eet al.\u003c/em\u003e, 2011).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003e\u0026ndash;\u003c/b\u003e Result of the parallel trend test\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDependent variable: LNDOEN\u0026Ccedil;A\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({\\text{T}\\text{e}\\text{n}\\text{d}\\text{P}\\text{a}\\text{r}}_{it}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.235\u003c/p\u003e \u003cp\u003e(0.311)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.171\u003c/p\u003e \u003cp\u003e(0.105)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFixed effect for municipalities and years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSource: Study data, 2021.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eNote\u003c/strong\u003e \u003cp\u003eThe series comprised 282 municipalities, over a period of 20 years (2000\u0026ndash;2019), for a total of 5,640 observations. The standard errors are robust on the municipal level.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eA test was conducted to verify the parallel trend assumption for the pre-treatment period (2010 to 2012), presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e above. The years 2010 and 2011 are pre-enactment, and 2012 is post-enactment so that the impact may be evaluated. In order to capture this trend, the model was estimated again (Eq.\u0026nbsp;\u003cspan refid=\"Equ1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) where the main variable of interest was a \u003cem\u003edummy\u003c/em\u003e variable TendParit which is the interaction with the dummy \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({Tratado}_{i}\\)\u003c/span\u003e\u003c/span\u003e, indicating that the municipality is located in the Legal Amazon, with the variable representing the test period (pre-treatment 2010\u0026ndash;2012). Given the insignificance of the results, it may be inferred that the trends are parallel, and thus the hypothesis of the DiD model is valid (Khandker \u003cem\u003eet al.\u003c/em\u003e, 2010; Gertler \u003cem\u003eet al.\u003c/em\u003e, 2011).\u003c/p\u003e \u003cp\u003eWith the additional robustness test, a placebo test (a falsification test) was conducted in which the estimation was made with a placebo outcome variable which, in principle, was not directly influenced by the effects of the enactment of the new forest code, presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe use of annual rainfall as a placebo allowed inferring that the enactment of the new law did not affect the annual volume of rainfall in millimeters. This denotes that the empirical strategy is adequate and therefore the results provide evidence that the contemporary effects of the control group were not guiding the results.\u003c/p\u003e \u003cp\u003eIn summary, since the model\u0026rsquo;s parallel trend test validated the method, and the empirical strategy was validated by the placebo test, it may be inferred that the assumptions of the DiD regression model are valid. Therefore, the results capture the causal impact of the enactment of the new forest code on the increment conditions in the number of respiratory disease hospitalizations.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003e\u0026ndash;\u003c/b\u003e Robustness test of the DiD model for the placebo result variable \u0026lsquo;precipita\u0026ccedil;\u0026atilde;o anual\u0026rsquo; (LNPRECIPITA\u0026Ccedil;\u0026Atilde;O)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDependent variable: LNPRECIPITA\u0026Ccedil;\u0026Atilde;O\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNew Forest Code\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003cp\u003e(0.783)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003cp\u003e(0.126)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFixed effect for municipalities and years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSource: Study data, 2021.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eNote\u003c/strong\u003e \u003cp\u003eThe series comprised 282 municipalities, over a period of 20 years (2000\u0026ndash;2019), for a total of 5,640 observations. The standard errors are robust on the municipal level.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Transmission mechanisms\u003c/h2\u003e \u003cp\u003eIn light of the results obtained in the present study, there is empirical evidence that, in spite of the CAR requirement and possibility of complying with the PRA, the effect of the new forest code is still being felt, and consequently the increase in the number of respiratory disease hospitalizations in the region under study. This corroborates the study conducted by (Sant\u0026rsquo;Anna and Rocha \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), where the authors indicate the existence of a positive relation between particulate emissions and respiratory disease hospitalization rates.\u003c/p\u003e \u003cp\u003eThis result is probably due to the difficulty in monitoring deforestation in public lands, the lack of institutional support in a wider sense and which varies from state to state and within the federal government, which would allow evaluating the information contained in the CAR. In addition to this, there are technological limitations (infrastructure) and difficulties in integrating databases, insufficient technical staff at the Brazilian Forest Service (SFB) mainly in the states (which rely on temporary consultants and professionals), lack of public interest, among other factors.\u003c/p\u003e \u003cp\u003eThe Native Vegetation Protection Law (Law N\u0026ordm; 12,651/2012), or simply the Forest Code, is currently the main forest policy tool in Brazil for private lands, and is fundamental to reconcile agricultural and livestock raising growth and the protection of natural resources, since the legal protection devices that limit expansion in terms of production area, namely the APPs and the RL, create incentives for rural producers to invest in technology to modernize agriculture, and in practices that increase productivity.\u003c/p\u003e \u003cp\u003eIt must be highlighted that forest code is a federal law, but it is enforced on the state level. Therefore, the participation of states in the regulation and enforcement of the regulation and instruments is fundamental for its success. However, the enforcement of the law in fact remains a big challenge. Close to completing ten years of enactment and albeit the advances it has promoted, the Forest Code is still far from being fully enforced in all Brazilian states.\u003c/p\u003e \u003cp\u003eEven with the progress in certain states, the registry analysis and validation process continue to be a great challenge for practically all those involved. The main difficulties identified were the following: (a) reference cartographic databases are insufficient to support the analyses; (b) lack of robust hydrographic data; (c) poor quality of the registries; (d) poor communication with landowners and holders when corrections and additional registry information are requested; (e) lack of dedicated assessment and validation teams or insufficient number of staff for this role; and (f) large number of registries. Lastly, there is also the lack of interest by producers to obtain environmental compliance and not enough priority given to this initiative by the state governments. For example, in states whose main activity is livestock ranching, resistance appears to be greater, since the recovery of the APP and Legal Reserve areas depends on the fencing of the areas and producers are not interested in recovering vegetation in a productive manner, with the use of agroforestry systems (Chiavari et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBetween 2013 and 2020, on average, 42% of the hotspots registered annually in the Brazilian Amazon were located in areas that had never been deforested. Also, on average, only 11% of these went from deforested areas to clear-cut areas in up to 3 years. In other words, the rate of burnings used in initial stages of vegetation removal was low. The phenomenon is more frequent in rural settlements and in public land holdings. More particularly, the trend observed in public land holdings suggests that fires may play an important role in illegal land occupation and sale, possibly to rapidly and cheaply occupy a given area (Meneses \u003cem\u003eet al.\u003c/em\u003e, 2021). This is important since the new code only applies to private areas. And the increment in the deforested area used in this study considered municipal deforestation as a whole, which was not broken down by category of deforestation actor, which could shed more light on deforestation in private areas. However, this breakdown into categories would only be possible with the conclusion of the CAR process.\u003c/p\u003e \u003cp\u003eFurthermore, nearly 60% of land in the Amazon is classified as public and has been intensely targeted for deforestation in recent years. After private property, public lands have the highest rates, 31% and 30% respectively, in 2019. While in the first category fire is used to clear land for pastures, on public lands fire is used to deforest areas for illegal possession by \u003cem\u003egrileiros\u003c/em\u003e (land grabbers) for property speculation (Alencar et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Part of this area has already been illegally registered as \u0026ldquo;private property\u0026rdquo; in the CAR, making it clear that these lands are vulnerable to land grabbing and speculation Furthermore, authors shows that deforestation in the Legal Amazon between 2019\u0026ndash;2021 surpassed 10 mil km\u0026sup2; a year, approximately 56.6% higher that the yearly average for 2016\u0026ndash;2018, 51% on public lands, 83% of these federal (Alencar et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Chiavari et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this context, the importance of forests must be highlighted, both in terms of biodiversity and in animal and plant species. Forests also contribute to a healthier ecosystem given the existence of products that have pharmaceutical purposes as well as other uses (Mendelsohn and Balick, 1995). Furthermore, without these forests the soil deteriorates, to the extent where important plants would not be able to develop due to chemical changes and the loss of nutrients (Kahn and Mcdonald, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e1995\u003c/span\u003e; Barbier, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e1997\u003c/span\u003e). Forests regulate the carbon cycle in the atmosphere, absorbing GHGs, such as \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({CO}_{2}\\)\u003c/span\u003e\u003c/span\u003e, methane (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({CH}_{4}\\)\u003c/span\u003e\u003c/span\u003e), nitrous oxide (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({N}_{2}O\\)\u003c/span\u003e\u003c/span\u003e), and perfluorocarbons (PFC\u0026rsquo;s), storing considerable quantities of carbon in the process (Rudel et al., \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; L\u0026oacute;pez and Galinato, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe loss of forest cover may provoke environmental imbalances in the long term, and setbacks to economic growth may caused by lower availability of forest resources (Joshi and Beck, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Forest fires release large quantities of carbon dioxide into the atmosphere, and this type of deforestation, only considering the tropics, was responsible for approximately 17% of GHG emissions on the entire planet (Barker et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this regard, Brazil must prevent deforestation to avoid causing a public health crisis in the region. To this end, an efficient air quality monitoring system is needed to comply with the quality standards needed to protect public health through preventive and reactive actions. Public policies must focus more on the increasing deforestation rates so as to reconcile the interests of economic development with the sustainable use of forest resources and public health. In this regard, the new code may play a central role as an inducer of green growth, attracting financial resources aligned with forest conservation and recovery|.\u003c/p\u003e \u003cp\u003eIt is important to mention the relevance of the findings of this study regarding the causality between deforestation and respiratory diseases, which focused on municipalities with intense conversion rates, on both sides of the border, particularly where half the world\u0026rsquo;s tropical deforestation occurs and where forest fires are concentrated (Ara\u0026uacute;jo et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Thus, the results highlight a particularly important scenario where economic activity and deforestation are more intense, which may help inform the formulation of policies and the enforcement of their instruments, in contexts where deforestation is a pressing subject.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. CONCLUSIONS","content":"\u003cp\u003eDeforestation impacts economic indicators and the well-being of agents, as well as the health of the communities. In this context, this study analyzed deforestation in the Brazilian Amazon and its impacts on respiratory diseases as of the enactment of the new forest code in 2012.\u003c/p\u003e \u003cp\u003eThe results point towards two implications for policies. First, there is evidence that environmental regulation aimed at controlling deforestation is not being sufficiently enforced. Also, the reach and efficacy of the enforcement of the new forest code depend on land ownership conditions, i.e., the land agents. In this case, if ownership conditions are not clearly defined, the environmental liability will not be clearly defined either. Therefore, states must become more involved in conservation efforts, namely in surveillance, in enforcing the law, and in environmental service payment schemes. These initiatives are important to formulate policies and to hold agents accountable.\u003c/p\u003e \u003cp\u003eSecondly, the present study does not suggest that the new forest code increased deforestation, since it considers the nature of the current environmental restrictions, in an institutional context. Thus, it is believed that the enforcement of the CAR and the settlement of the environmental liability by land agents, as well as other policies related to forest conservation, may help reconcile development in the region and environmental conservation.\u003c/p\u003e \u003cp\u003eIn summary, the approach allowed verifying the fragility of the Legal Amazon with regard to environmental regulations. In light of this, it may be inferred that the policy is not containing deforestation in the region, and this is indirectly related with the increase in respiratory diseases. The empirical and theoretical evidence produced will allow further research, particularly with regard to the key effect manifestation mechanisms (or determinants) on how deforestation impacts the economic and social conditions of a region, in this specific case, human health.\u003c/p\u003e \u003cp\u003eTherefore, as new empirical research corroborates and validates the results obtained, these results may serve as a reference to be considered by the agents involved towards the formulation and funding of policies aimed at combating deforestation and preserving the environment; either in defining public policies and strategies aimed at leveraging sustainable regional development, or for the strategies of NGOs, where both may configure their actions to promote social and economic development in the region \u0026ndash; towards development with conservation. The adoption of political and strategic stances by public and private agents, in an efficient manner, may lead to a better understand of the key mechanisms.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor this study, ethical approval is not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis all authors have agreed with the content and have provided explicit consent for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis all authors approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors whose names appear in the submission: Edward Martins Costa, Jos\u0026eacute; Alex Bento do Nascimento, Ahmad Saeed Khan, Guilherme Irffi e Jair Andrade de Ara\u0026uacute;jo:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eMade substantial contributions to the conception or design of the work; analysis and interpretation of data;\u003c/li\u003e\n \u003cli\u003eDrafted the work or critically revised it for important intellectual content;\u003c/li\u003e\n \u003cli\u003eApproved the version to be published; and\u003c/li\u003e\n \u003cli\u003eAgreed to be accountable for all aspects of the work to ensure that issues related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cstrong\u003eAlencar A, Moutinho P, Arruda V and Silv\u0026eacute;rio D\u003c/strong\u003e (2020) Amaz\u0026ocirc;nia em chamas: o fogo e o desmatamento em 2019 e o que vem em 2020. 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However, forest fires may be provoked by farmer/rancher-set fires which got of control (accidental) or by forest fires set directly by human action or, in rare cases, by natural factors (Nepstad et al. \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e1999\u003c/span\u003e; Cochrane, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Rocha, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). In this study, the terms burnings or fires will be used in a broad sense, considering both burnings and forest fires, disregarding the conceptual differences.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Information on the remaining areas, on the municipal level, is quite limited.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e \u0026ldquo;APPs are areas covered or not by native vegetation whose function is to preserve water resources, the landscape, geologic stability, biodiversity, genic fauna and flora flows, the soil, and ensure the well-being of human populations\u0026rdquo; (Brazil, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2012\u003c/span\u003e, Art. 3, paragraph II).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e \u0026ldquo;Areas located within a rural property or possessions, except for areas of permanent preservation, needed for the sustainable use of natural resources, the conservation and recovery of ecological processes, conservation of biodiversity, and to provide shelter and protection to native flora and fauna (Brazil, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1965\u003c/span\u003e, Art. 1, \u0026sect;\u0026nbsp;2, paragraph III).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e It is believed that the use of this disaggregate data may provide important information on the heterogeneous effect of the results obtained in this study. However, it was decided that this would be done in future research.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e \u0026ldquo;A national self declaratory, electronic, public registry, mandatory for all rural properties, aiming to integrate the environmental information of rural property ownership or holdings, to constitute a database for environmental and economic control, monitoring and planning, and to combat deforestation (Brazil, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2012\u003c/span\u003e, Art. 29).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Environmental compliance may be requested by rural landowners and/or holders who seek to conform to and comply with environmental regulations in the rural properties.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e The Legal Amazon also includes the territories of 8 neighboring countries, namely Bolivia, Colombia, Ecuador, Guyana, French Guyana, Peru, Surinam, and Venezuela.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Respiratory diseases, impact assessment, deforestation, New Forest Code, Legal Amazon, conservation policy","lastPublishedDoi":"10.21203/rs.3.rs-3523348/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3523348/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn 2012, the Brazilian government implemented the New Forest Code, an update to the previous code, aiming to contain deforestation and promote the sustainable use of forest resources. However, regarding the Legal Amazon region, more rigorous requirements and instruments are needed. In this context, this study measured the impact of this policy on respiratory disease hospitalizations caused by deforestation. From the estimates found with the difference-in-differences method, based on panel data between 2000 and 2019, increases in respiratory disease hospitalizations and in deforestation occurred after the enactment of this policy, possibly due to rural private properties not complying with the code, but also to deforestation on public lands. The results also suggest that the underlying mechanism of these effects was the fragile compliance with the restrictions and regulations established by the current forest code, which is the main instrument to combat deforestation in Brazil.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJEL Code:\u003c/strong\u003e C1, I1, Q12, Q23, Q50, Q56.\u003c/p\u003e","manuscriptTitle":"Impact of the regulation of the New Brazilian Forest Code on Health: evidence based on respiratory diseases and deforestation in the Legal Amazon","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-12 06:21:08","doi":"10.21203/rs.3.rs-3523348/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3cd99de3-d9a7-48f7-9e3f-4cf201cdac66","owner":[],"postedDate":"January 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-10T15:20:47+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-12 06:21:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3523348","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3523348","identity":"rs-3523348","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}