In Brazil, some initiatives focusing on sustainable rural development are being implemented in rural settlements. This study aimed to investigate environmental health issues faced in traditional rural settlements in comparison to sustainable development settlements. Qualitative research approaching four "Sustainable Development Projects" and two traditional projects in rural settlements of central and northeastern Sao Paulo State based on workshops with participants of the settlement projects, discussing environmental health problems faced by community. Procedures were developed after the Ethics Research Committee approval. Settlers in both types of settlements reported similar environmental health problems, related mainly to lack of basic sanitation, inadequate waste management, difficulties in pest control, and workers' health problems. There is a large gap between the proposed discourse of some polities concerned with sustainable development, as in the case of the sustainable development projects in rural settlements in the State of Sao Paulo, particularly in the incorporation of issues related with public health. However, this dissociation does not manifest itself in the perception of the settlers involved in such projects. For them the construction of a sustainable lifestyle cannot waive attention from the central role of primary attention on aspects of public health as a fundamental factor for human development.
