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Recent increases in the price of oil have generated much interest in biofuel development but the social and environmental impacts of large scale adoption of biofuels at both regional and national scales remain understudied, especially in developing economies. Although the recent swings in prices for oil may slow down these surges in supply and demand, production of biofuels from food remain profitable above $50/barrel making the biofuel market viable. Here we use municipality-level data for the state of São Paulo in Brazil to explore the effects of fires associated with sugarcane cultivation on respiratory health of elderly and children. We examined the effects of fires occurring in the same year in which respiratory cases were reported as well as chronic effects associated with long-term cultivation of sugarcane. Across the state, respiratory morbidity attributable to fires accounted for 113 elderly and 317 child cases, approximately 1.8% of total cases in each group. Although no chronic effects of fire were detected for the elderly group, an additional 650 child cases can be ascribed to the long-term cultivation of sugar cane increasing to 5.4% the percent of children cases that can be attributed to fire. For municipalities with greater than 50% of the land in sugarcane the percentage increased to 15% and 12%, respectively, for elderly and children. An additional 209 child cases could also be attributed to past exposure to fires associated with sugarcane, suggesting that in total 38% of children respiratory cases could be attributed to current or chronic exposure to fires in these municipalities. The harmful effects of cane-associated fires on health are not only a burden for the public health system but also for household economies. This type of information should be incorporated into land use decisions and discussions of biofuel sustainability.
