**5. Final remarks**

Institutions such as the World Health Organization (WHO) and the Pan American Health Organization (PAHO) [36, 37], ministries and health departments are responsible for planning, monitoring, inspecting, and promoting actions to promote health in the world. In the last five decades, several important global events have been held in relation to global public policies, especially those that reinforce health promotion.

Intersectoral dialog has become increasingly necessary between institutions and countries. Advances in technology and science allow a better analysis and understanding of environmental interventions in order to mitigate damages caused to exposed populations. Globalization causes strong impact on economic, social, political and cultural areas, and, at the same time, on spatial organization that reflects on health conditions. The scales of the impact caused by globalization are differentiated around the world and very particular in realities like the municipality of Ponta de Pedras.

Ponta de Pedras is one of the largest açaí producers in Brazil, but the fruit trade has brought only few benefits to the population, particularly to small and medium producers and traders of the fruit, even with the overall projection of açaí consumption. This study, although lacking comparative temporal data, points to the direction that the global açaí market might have interfered in the health conditions of the residents. Both perception of inhabitants and some available official data point that noncommunicable chronic diseases are becoming more important health issues among the residents. On the other hand, infectious diseases and high infant mortality persist, very much related to the poor sanitary infrastructure and public services, low educational level, and poverty.

In spite of efforts of the federal government in providing electricity, public internet access, and minimum allowance for underprivileged population, local governments find it difficult to implement health policies and sanitation systems, and to receive and use resources for a number of reasons of administrative, technological, educational nature, and distance from regional centers that make important decisions. Thus, although some economic resources and consumer goods are more accessible to a portion of the population, most of the residents remain vulnerable to social and environmental health determinants.

Deficiencies in the form of poverty exist at all territorial scales—regional, national, and global—and increasingly affect remote municipalities, such as Ponta de Pedras, and directly influence health, a scenario that is commonly seen in many other Brazilian municipalities. Public policies must consider this ongoing process in order to extend the social benefits to the vast Amazon region. Health policies could also act to balance the effects of globalization on health.
