Health and Environment in

Circumpolar Populations

Kue Young

Dean and Professor

Edmonton, Alberta, CANADA

Collaborative Arctic Seminars in Epidemiology

CASE 2015

Blachford Lodge, Yellowknife,

Northwest Territories, CANADA

August 3, 2015

Contents

• The Circumpolar World

• Who Are Circumpolar Indigenous Peoples?

• What Is Their Health Status?

• What Do We Mean by “Environment”?

• Old Problems – Still Here

• New Problems – Increasing Concern

• Health Effects of Arctic Climate Change

• Seeking Solutions

Northern sky,

lands, and seas

Circumpolar countries and regions

[US] United States

[Ak] Alaska

[CA] Canada

[Yk] Yukon

[Nt] Northwest Territories

[Nu] Nunavut

[DK] Denmark

[Gl] Greenland

[Fo] Faroe Islands

[IS] Iceland

[NO] Norway

[Nd] Nordland

[Tr] Troms

[Fm] Finnmark

[SE] Sweden

[Vb] Västerbotten

[Nb] Norrbotten

[FI] Finland

[Ou] Oulu

[La] Lappi

[RU] Russian Federation

[Mu] Murmansk Oblast

[Ka] Kareliya Republic

[Ar] Arkhangelsk Oblast

- [Ne] Nenets AO

[Ko] Komi Republic

[Yn] Yamalo-Nenets AO

[Km] Khanty-Mansi AO

[Tm] Taymyr AO

[Ev] Evenki AO

[Sk] Sakha Republic

[Ma] Magadan Oblast

[Ky] Koryak AO

[Ck] Chukotka AO

Circumpolar Peoples• Diverse

cultures and

languages

• Indigenous,

migrants old

and new

• 10 million

people

inhabiting 27

regions

0

20

40

60

80

100

Fo IS Ou Ko Mu Ar Ka Nd La Km Vb Ma Sk Tr Nb Yn Ev Ak Ne Ta Yk Fm Ck Ky Nt Nu Gl

Proportion of indigenous people

Population size

USA 307 m

Canada 34 m

Denmark 5.5 m

Norway 4.8 m

Sweden 9.3 m

Finland 5.3 m

Russia 142 m

Alaska 698,500 (0.2%)

N. Canada 109,500 (0.3%)

Greenland 56,300 (1%)

Faroe Islands 48,600 (0.9%)

Iceland 319,300 (- -)

N. Norway 464,500 (10 %)

N. Sweden 507,500 (6%)

N. Finland 657,400 (12%)

N. Russia 7,047,500 (5%)

Cities and Villages

Human development index [inequality adjusted]

0,00 0,10 0,20 0,30 0,40 0,50 0,60 0,70 0,80 0,90 1,00

Norway

United States

Canada

Sweden

Finland

Iceland

Denmark

Russia

HDI value

Adjusted Unadjusted

Regional health disparities – life expectancy at birth

20

30

40

50

60

70

80

90

IS Vb SE La Ou Nd CA NO FI Tr Fm Nb Fo Ak Nt DK US Yk Nu Km Ak-

Nat

Yn Ar RU Sk Mu Gl Ne Ko Ka Gl-

born

Ma Tm Ck Ev Ky

LE

at

bir

th (

years

)

Tuberculosis incidence

Injury mortality

0

500

1 000

1 500

2 000

2 500

1955-59 1960-64 1965-69 1970-74 1975-79 1980-84 1985-89 1990-94 1995-99 2000-04 2005-09

TB

in

cid

ence

(p

er 1

00

,00

0)

Greenland

Alaska Native

Canadian Inuit

Canada

Greenland

Canadian Inuit

Alaska

Native

Canada

Trend in tuberculosis incidence among

indigenous populations

Trend in suicide among indigenous populations

0

20

40

60

80

100

120

140

160

1960 1963 1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999

Suic

ides

per

10

0,0

00

GreenlandersCanadian Inuit

Alaska

Natives

y = 1446,8e-0,226x

R² = 0,6206

0

50

100

150

200

250

300

350

400

0 5 10 15 20 25 30

TB

cas

es p

er 1

00

00

0

% attained tertiary education

Koryak AO

Evenki AO

Nunavut

Norrbotten

Association between

education and

tuberculosis

Social determinants of health

0

2

4

6

8

10

12

14

16

18

20

0

2

4

6

8

10

12

14

16

18

20

1955-

59

1960-

64

1965-

69

1970-

74

1975-

79

1980-

84

1985-

89

1990-

94

1995-

99

2000-

04

2005-

09

Lit

res

alco

ho

l/p

erso

n/d

ay

Cig

aret

tes/

per

son/d

ay

Alcohol

Cigarettes

Alcohol and tobacco

Importation into Greenland

Diet and nutrition in transition

Greenland Yamalo-Nenets

Magadan

Nunavut

Trends and Patterns

Circumpolar regions fall into 4 groups:

• Nordic countries – best in every indicator, little

difference between north and south, or indigenous vs

non-indigenous

• Alaska, Yukon, Northwest Territories – comparable

or even better than national average, but substantial

disparities between indigenous and non-indigenous

within the North

• Greenland and Nunavut - >85% indigenous; wide

gap compared to Denmark and Canada

• Russia – health and demographic crisis nationally,

worse in Siberia

Environment, what’s that?

• A non-specialist definition – anything that is not

inside the body; opposite of “biological”

• “Social environment” vs “physical environment”

• In the real world, no such neat distinction exists

• But we are not in the real world, so let’s just stick to

the “physical”, at least for now.

• The “old” vs “new” environmental health issues

• Sanitation and water

• Solid waste disposal

• Housing

• Gross pollution of air, water

and land

Old Problems - not gone away

Radioactivity

Humans reindeers

lichens

Chernobyl fallout

Old environmental

problems such as

water, housing and

sanitation have

known and

substantial health

impacts [eg.

respiratory and

gastrointestinal dx]

and known

remedies – but

they are not sexy

New problems – increasing concern

• Environmental impact of resource development

• Long range transport of contaminants

• Climate change – warming of the Arctic

Compared to the “old” environmental health problems:

Higher profile [for now] but much is still

unknown/guesswork

Health impacts difficult to detect

Resource development

Economic benefits vs environmental costs

Contaminants

• Heavy Metals

– mercury, lead, cadmium…

• Persistent Organic Pollutants (POPS)

– PCBs,

– DDTs,

– toxaphene,

– chlordanes,

– HCHs…

• New Chemicals

– brominated flame retardants,

– fluorinated organic compounds…

– some current use pesticides

Risk vs Benefits of

Country Foods

BENEFITS

•Nutrition

•Taste

•Social/cultural

values

•Physical activity

•Children’s

education

•Saves $

Risk communication

Poor risk communication has led to decline in traditional food

consumption and breastfeeding in N. Canada in the past

Climate change – “right to be cold?”

Climate types

Mean winter temperature

[Kottek (2006)]

[EarthSystemAtlas]

Climate change is not new

Temperature trends

in the Arctic past

2000 years

Glacial-interglacial

cycles during past

600,000 years

[IPPC-4]

[Kaufman (2009]

Reduction in sea ice

Retreating glaciers[NASA]

Impact on infrastructure

Melting of permafrost, coastal flooding, storm surges affect

• Water delivery and sanitation systems

• Housing, food storage

• Transportation

• Health care facilities

Impact on biodiversity

• Advancing treeline ->

new animal hosts and

insect vectors moving

north -> zoonoses [eg.

beaver and giardiasis]

• Thinning of sea ice ->

stresses on marine

mammals -> reduced

harvest -> nutritional

status

• Changes in avian and

mammal migration

patterns -> hunting less

productive

Impact on human activities – travel, hunting, herding

• Weather more

unpredictable – more

injuries

• Reduced access –

impact on daily life,

food and fuel costs

Warming trends affect food storage and

preservation – thawing of underground food

caches – increased

spoilage

risk of botulism with

fermented meats in sealed

containers above 4oC

Any positive effects?

y = 0.5828x + 75.09

R2 = 0.3441

0

10

20

30

40

50

60

70

80

90

-40.0 -30.0 -20.0 -10.0 0.0 10.0

Mean January temperature (degrees Celsius)

Lif

e ex

pec

tan

cy a

t b

irth

(y

ears

)

y = -0.3889x + 3.0865

R2 = 0.5096

0

5

10

15

20

25

-45 -40 -35 -30 -25 -20 -15 -10 -5 0 5 10

Mean January temp (C)

IMR

(p

er 1

00

0 l

iveb

irth

s)

Young and Mäkinen (2010)

• Decrease in mean January temp associated with:

infant and perinatal mortality rate

ASMR from respiratory diseases

life expectancy at birth in both M and F

• Decrease in mean July temp associated with:

infant mortality rate

ASMR from respiratory diseases

• independent of a variety of socioeconomic,

demographic, and health care factors

Cold climate is significantly associated with higher

mortality in Arctic populations and should be

recognised in public health planning

Taking advantage of climate change?

• farming Greenland

government aims

to develop

agriculture, sheep

ranching, and diary

farming

New economic

opportunities?

Health system response: The Arctic can’t wait for the rest

of the world to change [or have more conferences]

• Surveillance: monitor environmental change

and health status; community-based

observation; traditional knowledge

• Preparedness response: government-

community partnerships in planning and

implementation

• Adaptation options: need research and

evaluation, multisectoral approaches –

facilities design, training, service delivery

Northern indigenous peoples are resilient and adaptable, and are not helpless victims. Climate change in historical times had been drivers of culture change:

• Global warming after 7,000 years ago ushered in the Neolithic (Late Stone Age) in Eurasia. The development of a marine-based subsistence promoted the colonization of the Arctic from Norway to the Bering Sea

• The Thule culture, the direct forebears of today’s Inuit, sprang up from the Bering Sea coast 1000 years ago, developed innovations such as hunting large sea mammals in open water using skin boats –took advantage of climate change that enabled them to migrate across the Arctic from Alaska to Greenland

A Healthy Environment for the Next Generation