health and environment in circumpolar populations · health and environment in circumpolar...
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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
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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
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Northern sky,
lands, and seas
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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
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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
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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%)
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Cities and Villages
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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
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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
)
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Tuberculosis incidence
Injury mortality
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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
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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
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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
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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
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Diet and nutrition in transition
Greenland Yamalo-Nenets
Magadan
Nunavut
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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
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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
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• Sanitation and water
• Solid waste disposal
• Housing
• Gross pollution of air, water
and land
Old Problems - not gone away
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Radioactivity
Humans reindeers
lichens
Chernobyl fallout
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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
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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
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Resource development
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Economic benefits vs environmental costs
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Contaminants
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• 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
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BENEFITS
•Nutrition
•Taste
•Social/cultural
values
•Physical activity
•Children’s
education
•Saves $
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Risk communication
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Poor risk communication has led to decline in traditional food
consumption and breastfeeding in N. Canada in the past
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Climate change – “right to be cold?”
Climate types
Mean winter temperature
[Kottek (2006)]
[EarthSystemAtlas]
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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]
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Reduction in sea ice
Retreating glaciers[NASA]
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Impact on infrastructure
Melting of permafrost, coastal flooding, storm surges affect
• Water delivery and sanitation systems
• Housing, food storage
• Transportation
• Health care facilities
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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
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Impact on human activities – travel, hunting, herding
• Weather more
unpredictable – more
injuries
• Reduced access –
impact on daily life,
food and fuel costs
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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
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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)
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• 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
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Taking advantage of climate change?
• farming Greenland
government aims
to develop
agriculture, sheep
ranching, and diary
farming
New economic
opportunities?
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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
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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
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A Healthy Environment for the Next Generation