ABSTRACT
This chapter examines the major challenges to public health in the state's population of Indigenous people and migrants who have chronic health issues going back hundreds of years. It highlights the importance of the high incidence of malaria, and measures and services required to control it, as well as the proportion and attendance of representatives of rural communities at meetings of municipal health councils, and their operational autonomy, as some of the more specific indicators to assess the impact of public policies on the health of rural workers in the Amazon region states. The state of Maranhao, in the Amazon region, has the worst social indicators in Brazil. Maranhao has played, since the beginning of colonization, the role of gateway to several expanding fronts over the Amazon. The long period of Maranhao's colonization and the migration movements to the region, the disrespect of Indigenous and local communities values, has spread foreign culture and also foreign disease.
