Arctic Healthcare: How is Healthcare Delivered to the Most Remote Regions of the World?

Hope Watson, College of Public Health, Kinesiology

The Arctic and Its Peoples

Telemedicine and eHealth

Infant Mortality and Maternal Health

Pipaluk

Challenges in Arctic Healthcare Delivery:

• Geography • Population Density• Transportation Infrastructure

• Language Barrier • Medical Staff Turnover • Health Stigmas and Cultural Differences• Low Budget for Preventative Healthcare • Food Security

Solutions for Equal Access and Quality

In the case of any complicated pregnancy in Greenland, the expecting mother must be flown from her home to the Southern Capital, Nuuk, to receive care from a physician able to oversee the complications. This process involves Mothers likely have to stay until the baby is delivered, which may mean being away from their home settlement and family. This protocol was implemented to reduce infant mortality gap between Greenland and Denmark. The protocol initiative is due to the legal obligation under Self Rule, where Denmark must provide equal access and quality of care to Greenlandic people.

Health Inequalities

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Centralizing Care Facilities

Applications for Non-remote Geographies

The Arctic faces many similar clinical issues that are prevalent in other regions of the world, but are magnified due to infrastructural and social challenges. Arctic regions have begun utilizing creative approaches to reducing these problems; the solutions have potential to replicated elsewhere. Particularly, mental health issues have become the largest epidemic in the past decade without enough healthcare personnel to meet demands. Effective telemedicine and technology based phone application approaches that allow a professional to oversee multiple patients real time.

Mental Health

A Pipaluk, literally translating to “sweet little thing” in Greenlandic , is a multifunctional medical equipment machine. The Pipaluk machine is in every location in Greenland and many other Arctic areas with more than 50 citizens. The machine serves as: otoscope, tooth camera, EKG, scope (pulse, BP, saturation), digital and video camera, stethoscope, spirometer, and scanner. Many health care facilities in the Arctic do not have X-Rays or MRIs, so procedures must be regularly outsourced to other facilities.

Currently in many Arctic regions receiving proper care entails either the patient or the doctor travelling once or twice per year. Lack of specialist care is marked by health inequalities in very high rates of chronic Otis media (causing deafness), tuberculosis, and suicide. The main goal of telemedicine is to have specialists available at all times. One of the next steps Greenland is looking to make is the ability to for Danish surgeons to perform surgeries in Nuuk utilizing surgical robots. All Arctic regions current require vast distances of travel when medical issues need to be outsourced. For nationalized healthcare systems the transportation cost is absorbed by the state and be up to 15% of healthcare expenditures in remote regions.

Chukotka (Russia) and Greenland have the highest rates of suicide anywhere else in the world. Rapid infrastructure and lifestyle changes occurred in the Arctic following WWII, where in many areas roads had not previously existed. Societies transitioned from a hunting and bartering society to a wage earning society

One of the major barriers for equal access to care is disproportionate amounts of money spent on Northern and Southern populations, where underfunding is prevalent in both Denmark/Greenland and Russia/Chukotka (exact measures unknown). The other geographical areas see the inflating costs due to travel cost and health care personnel dispersion required for care. Reallocating nationalized health care budgets and special funding for indigenous populations and reducing transportation costs creates potential to close both the underfunding and inflation gap while providing equal access and quality of care.

Health Expenditures ’05-’09

There are 11 main groups of indigenous peoples in Arctic regions, comprising approximately 1.73 million people. The Arctic is home to the lowest population densities in the world, even as low as 0.36/sq. mi in ice free areas.

Russia is home to about 80% of indigenous people (1.4 million), but this is likely an unreported value due to lack of census and health surveillance.

Among youth aged 15-17: • Among 32% a family member had

committed suicide. • Among 18% a boy/girlfriend or good

friend had committed suicide. • Among 18% a friend from school

had committed suicide. • 42% knew ‘someone else’ who had

committed suicideInternational Journal of Circumpolar Health, 2015

Most of the housing in Arctic areas, particularly Greenland, was government built as part of modernization in a post WWII society. This has forced centralization on many of the I on many of the indigenous Inuit people there. Although this trend continues to make healthcare delivery easier, it comes at a cultural cost of displacing people from their homes and the land they are originally from.

A typical government built house in Greenland.

Indigenous Arctic peoples have long been affected disproportionately by disease. The early 1700s marked the first large smallpox waves on the virgin soil populations. Modernly, Arctic people suffer the highest global rates of Tuberculosis and large STI rates. They also suffer greater rates of smoking and drinking addiction. Artic peoples usually suffer higher rates of cancer, but research also shows special protective genetics for certain cancers.

Average cost of one-way flight from Quaannaq to Nuuk: $2,300.Alaska Canada Greenland Norway, Sweden,

FinlandRussia

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Percent Indigenous Persons by Region