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Ecosystem approaches emerge as alternative to integrate multiple aspects of health problems arising from precarious socio-sanitary conditions to understand and search for solutions. The vulnerability to leptospirosis is associated to areas where there is a tendency to occur natural flooding disasters associated with precarious socio-sanitary conditions. This manuscript present the identification of leptospirosis risk areas in the Itaboraí municipality, considering environmental and socio - sanitary characteristics related to the disease production. The spatial analysis was performed by overlapping the themes of interest: flood risk areas (28% of the territory), critical areas (0.9% of the territory and 9.3% of the population of the municipality) and reported cases of leptospirosis through visual analysis. Of the 89 reported cases of leptospirosis, 71% were located within the flood areas and 34% in locations with poor socio-sanitary conditions. The integration of socioenvironmental data and analysis of the leptospirose spatial distribution demonstrate the unfair, disproportionate and avoidable occurrence of the disease in those localities, highlighting a situation of social inequity in health in which populations with lower economic conditions are impelled to occupy portions of the territory environmentally degraded and with less availability of services. This shows a promising surveillance approach. [ABSTRACT FROM AUTHOR]