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presentations Environmental variables and the risk of disease/symptoms

Torbjörn Messner

Main conclusion

Be cautious when extrapolating results from another population

1 Reasons

Different genetic setup Different adaptation Population responses vary by Latitude Altitude

Other causes for caution

Ecologic fallacy Negative publication bias

2 Static weather variables and AMI

Running mean smoother 15 8 6 10 4 5 Definite Definite MI 2 Total number of AMI/Fitted values AMI/Fitted of number Total 0 0 -40 -20 0 20 40 60 80 100 Mean temperature, ¡C Mean humidity, % bandwidth = .8 Total number of AMI Fitted v alues 15 10 5 Total number of AMI/Fitted values AMI/Fitted of number Total 0

960 980 1000 1020 1040 Mean barometric pressure, mbar Total number of AMI Fitted v alues

3 Dynamic weather variables and AMI

Running mean smoother Running mean smoother 5 15 4 10 3 2 All surviving MI All surviving All deceased MI All deceased 5 1 0 0

-40 - 20 0 20 40 -40 -20 0 20 40 Humidity change Humidity change bandwidth = .8 bandwidth = .8

Running mean smoother 8 6 4 Surviving MI Surviving 2 0

-20 - 10 0 10 20 Temperature change bandwidth = .8

NAO and weather Positive NAO

4 NAO and weather Negative NAO

NAO variations and AMI 1.5

TotalAMI

1 Surviving AMI Fitted Fitted values .5 Fatal AMI

SCD 0

-4 -2 0 2 4 Third lag arctic oscillation

5 AMI and geomagnetic activity

Lowess smoother Lowess smoother 5 15 4 10 3 2 All surviving MI All surviving All deceased MI All deceased 5 1 0 0

0 20 40 60 0 20 40 60 Sum magnetic activity Sum magnetic activity bandwidth = .8 bandwidth = .8

Lowess smoother 6 4 Sudden death Sudden 2 0

0 20 40 60 Sum magnetic activity bandwidth = .8

Other diseases

”Weather sensitivity” Stroke Blood pressure Rheumatic diseases Migraine/headache Miscellaneous

Climate Change and Contaminants in the Arctic

Alaska Forum on the Environment Symposium on Climate Change and Human Health in the Arctic

13-15 February 2008 Anchorage, Alaska

James E. Berner, MD Alaska Native Tribal Health Consortium

Climate Change and Contaminants in the Arctic

• Atmospheric and Ocean Processes • ACIA Climate Model Projections • Impact of Climate on Contaminants • Conclusions

1 Climate Change and Contaminants in the Arctic Atmospheric Processes

Polar Vortex (PV) A cyclonic wind pattern around the North Pole strongest in the troposphere above 15,000 ft., and strongest in winter. The PV profoundly influences temperature, barometric pressure, Arctic ice and surface water circulation as well as Arctic and Northern hemisphere weather.

Climate Change and Contaminants in the Arctic Atmospheric Processes

Semi permanent surface high and low pressure fields • Icelandic low – strongest in winter. • Aleutian low – strongest in winter. • East Siberian high – strongest in winter. • Chukchi-Beufort Sea high – strongest in winter. • Arctic high (Baffin Island) – strongest in winter.

2 Circumpolar Ocean Currents

Climate Change and Contaminants in the Arctic

Atmospheric Processes

Arctic Oscillation (AO) Index A measurement of difference in sea level pressure (SLP) between the Arctic high pressure field, and the northern hemisphere mid-latitude (37-45°N) low pressure field.

3 Climate Change and Contaminants in the Arctic

A positive AO increases wind currents into the Arctic, and raises the mean Arctic temperature, decreases sea ice, increases precipitation. A negative AO increases sea ice decreases mean temperature, increases cold air movement into northern latitudes.

Effects of the Positive Phase of Effects of the Negative Phase of the Arctic Oscillation the Arctic Oscillation

(Figures courtesy of J. Wallace, University of Washington)

Website: http://nsidc.org/arcticmet/patterns/arctic_oscillation.html 8

4 •.

The Arctic Oscillation in Winter (November to March). Data from NCEP.

Website: http://www.arctic.noaa.gov/detect/climate-ao.shtml 9

Climate Change and Contamints in the Arctic

Ocean Processes

Thermohaline Circulation A global ocean current that delivers warm surface water from the tropics to the Arctic and Antarctic.

5 Climate Change and Contaminants in the Arctic Bering Sea Inflow

Pacific and Bering Sea water passes through the Bering Strait at 800,000m3/sec. The flow is forced by an 18 cm difference in sea level from the Atlantic, and flows east through the Canadian Archipelago to the Atlantic. It circulates at a few meters depth, and is the major heat delivery mechanism to the Beaufort Sea.

Arctic Influence on Ocean Circulation The Arctic plays a fundamental role in circulation of water in the oceans of the world. When warm, salty North Atlantic water reaches the cold Arctic around Greenland and Iceland and in the Labrador Sea, it becomes denser as it cools, and therefore sinks to deeper layers of the ocean. This process of forming deep water is slow, but takes place over a huge area. Every winter, several million cubic kilometers of water sink to deeper layers, which move water slowly south along the bottom of the Atlantic The polar front influences global ocean currents Ocean. 12

6 Climate Change and Contaminants in the Arctic

Ocean Processes

Southern Oscillation Index Cyclic changes in equatorial Pacific Ocean surface temperatures, as expressed by the gradient between Darwin, Australia and Tahiti result in El Niño events. Warm surface water in the western Pacific, and cold surface water in the eastern Pacific, result in La Niña events.

El Niño Southern Oscillation (ENSO)

http://www.srh.weather.gov/srh/jetstream/tropics/enso.htm Website: 14

7 El Niño Southern Oscillation (ENSO)

From December 1997, this image shows the change of sea surface temperature from normal. The bright red colors (water temperatures warmer than normal) in the Eastern Pacific indicates the presence of El Niño Website: http://www.srh.weather.gov/srh/jetstream/tropics/enso.htm 15

EL Niño Conditions

16 Website: http://www.srh.weather.gov/srh/jetstream/tropics/enso_patterns.htm

8 La Niña Conditions

Website: http://www.srh.weather.gov/srh/jetstream/tropics/enso_patterns.htm 17

Climate Change and Contaminants in the Arctic ACIA Climate Model Projections

• Increase mean temperature of 1.6–5.8C by 2100. • Increase precipitation, mostly as rain. • Decreased sea ice, decreased snow cover and albedo. • Increase in sea level § 20cm. • Possible increase river output in some, not all, Arctic rivers. • Decrease in permafrost in some regions.

9 Climate Change and Contaminants in the Arctic

ACIA Climate Model Limitations

• No ability to model ocean processes. • No ability to model AO, SO, PV. • No ability to model clouds.

Climate Change and Contaminants in the Arctic

Climate and Contaminant Transport (Atmospheric)

• Siberian high is responsible for about 15%. • Aleutian low contributes about 25%. • Icelandic low contributes about 40%.

10 Fig. 6·1. The major sources of contaminant lead transported to the Arctic are indicated by the stable lead isotope composition of sediment cores as being either Western Europe (indicated by a 206 Pb: 21 207Pb ratio of 1.14) or Eurasia (indicated by a 206Pb:207 Pb ratio of 1.18) adapted from Gobeil et al., 2001a). AMAP Assessment 2002: The influence of Global Change on Contaminant Pathways.

Climate Change and Contaminants in the Arctic

Climate and Contaminant Transport (Oceanic)

• Strong positive AO causes increased cyclonic movement of surface water and ice in the Arctic Ocean. • Strong positive AO diverts Russian Arctic river inflow (1000 Km3/yr.) into the Canada Basin, and the Canadian Archipelago. • Strong negative AO causes Russian River water to be diverted to eastern Greenland. 22

11 Fig. 6·10. Oil/gas-bearing regions and locations of oil/gas production together with the ice- drift field under a ) AO-conditions and b) AO+conditions (ice motion based on Rigor et al. (2002) and oil data from Bakke et al. (1998)). AMAP Assessment 2002: The Influence of Global Change on Contaminant Pathways. 23

Climate Change and Contaminants in the Arctic

Climate and Contaminant Transport (Atmospheric)

• Strong ENSO events increase atmospheric transport of lower latitudes contaminants to Eastern Arctic Canada.

12 Climate Change and Contaminants in the Arctic

Climate – Contaminant – Ecosystem Interaction

• Increased temperature increases volatilization. • Increased temperature speeds bacterial uptake and chemical reaction with contaminants. • Increased solar radiation on open Arctic Ocean water speeds gaseous evasion of volatile contaminants. • Increased precipitation increases atmospheric scavenging of contaminants, and decreases rate of transport to the Arctic. 25

Climate Change and Contaminants in the Arctic Conclusions

• Climate-contaminant interaction is complex, and poorly understood. • Impact of climate is not uniform. • Some contaminants (HCH) appear to be decreasing in Arctic environmental samples. • Only serial measurements, over time, in the environment, biota, and human residents, will eventually allow understanding of mechanisms and impacts.

Climate & Pathogens: Consequences for Human Health & Subsistence Food Chains Across High Latitudes of the North

Eric P. Hoberg, US National Parasite Collection, USDA Lydden Polley, Veterinary Microbiology, Univ. Saskatchewan Susan Kutz, Ecosystem and Public Health, Univ. Calgary Emily Jenkins, Veterinary Microbiology, Univ. Saskatchewan Brett Elkin, Government of Northwest Territories Alasdair Veitch, Government of Northwest Territories

Climate Change in the North

Climate change will modify the interface for people & the environment. Exposure to pathogens through water-borne & food-borne pathways will be altered. Pathogens & diseases in key mammalian, avian & fish species can influence availability, sustainability & suitability of food resources. Pathogens & emergence of diseases can disrupt structure for terrestrial, aquatic & marine ecosystems.

1 Climate Change Predictions

Climate change will eliminate ecological barriers & constraints on development & distribution for pathogen transmission; creates new conditions. Maps for distributions of hosts, pathogens & diseases will be redrawn. Emergence of diseases & unanticipated “cascades” can influence terrestrial, aquatic and marine ecosystems.

Defining Pathogens

Microparasites (prions, viruses, bacteria, protozoans) Macroparasites (worms, arthropods- ticks, fleas) Widespread among all vertebrates & invertebrates Potential to cause disease- impaired function or responses; reproductive success; survival Interactive (multifactoral) processes for disease Weather, habitat, long term climate change Contaminants, Other stressors on host individuals/ populations

2 Circulation of Pathogens

ARTHROPOD IH VECTOR

Indirect Vector Transmission DH Transmission

Direct Transmission

Pathogens & Environment

Zoonoses (animals to humans) Subsistence food chains & “country foods” Wildlife & Fish Pathogens Circulate in natural populations Ecological mechanisms/ characteristic ranges Shape ecosystem structure & function Food-web interactions & cascades Influence on subsistence food chains, animal or resource distribution & availability

3 Pathogens & Climate Change

Long term/ Cumulative “in situ” processes Responses to trends in warming Decadal and longer Extension of growth season; tolerance, development & generation time; amplification; emerging disease Tipping points for changing dynamics of transmission Latitudinal & altitudinal range shifts Host-switching? Sympatry, “Ecotone” or Border effects

Short-term/ Ephemeral “external” processes Responses to extreme weather events Temperature anomalies/ humidity Explosive emergence of disease

Climate & Pathogens

Ecology of Parasitic Disease in Wildlife- Prevalence, intensity, dynamics of transmission Interactions among pathogens New ecological associations (wild/domestic hosts) Pathogen evolution (viruses) in new hosts Altered vector ecology, distribution, abundance Synergy w/ environmental stressors, habitat Extreme weather, anthropogenic disturbance

Ecology of Zoonoses (transmissible from animals to people) Food chains in terrestrial, aquatic & marine environments Water resources Interface for people, wildlife & environment

4 Things We Know?

Climate change is accelerating Increasing abundance of pathogens Climate has direct influence on distribution for pathogens/ diseases Host-Species distributions change Change drives host-switching Switching to new hosts drives disease

Things We Need to Know?

Pathogen diversity Distribution- hosts & geography Effects on hosts Potential for interaction with climate development, thresholds, tipping points, Resilience, tolerances

5 Things We Don’t Know?

Challenge to predict dynamic change Specific biological parameters Detailed data for pathogen distribution Unanticipated cascades Consequences for perturbation of key vertebrates/invertebrates

Process for Understanding

Evidence based to demonstrate links Baselines for distribution, epidemiology Effects of temperature on transmission Regional evidence of climate change Forecast temporal & spatial effects Detect consequences of climate change

6 Collaboration is Critical

Local knowledge- communication Integrated field sampling- hosts/pathogens Opportunistic (hunting activities) Targeted Survey and inventory (standards) Monitoring (following specific systems) Development of baselines/ museum archives (tissues, specimens, informatics) Research networks/ training

Why We Need Archives?

“The Past is the Key to the Present” Environments in rapid transition Permanent change & loss New ecological associations Permanent record of faunal structure Documenting Stability & Change

7 Influence of Climate

Spatial/ Temporal distributions of wildlife/ migration, habitat use Wildlife numbers, population structure Access to wildlife resources Pathogens are part of equation Reduced reliance on wildlife resources? Cascading effects on a subsistence culture in northern communities?

Climate change in the Arctic: Potential emergence or re-emergence of infectious diseases

Alan J. Parkinson Ph.D. Arctic Investigations Program Centers for Disease Control & Prevention Anchorage, Alaska.

Where are we going?

• Climate Change and infectious Diseases Diseases – Increase in existing diseases? – New diseases? • Planning Ahead-Public Health Actions – Tracking – Outbreak investigation – Partnerships – Education – Research • Conclusions

1 www.cdc.gov/eid

Existing Infectious Diseases of Concern In Arctic Regions • Invasive bacterial diseases (pneumonia; meningitis) – Streptococcus pneumoniae – Haemophilus influenzae • Tuberculosis • Influenza and other respiratory viruses – RSV • Methicillin resistant staph aureus (MRSA) – Antimicrobial resistance • Sexually transmitted infections – Chlamydia, gonorrhea, HIV • Botulism • Parasitic diseases – Echinococcus multilocularis; Echinococcus granulosis

2 Hospitalization Rates for “High” and “Low” Water Service Regions, Alaska, 2000-2004

300 *P < 0.05 250 200 Low Service 150 ** High Service 100 *

Rate per 10,000 50 * 0

a e V s A h nia S rr o R a ction MRS Di fe n Pneum in I Sk

Hennessy etal AJPH 2008 in press

Infectious diseases may increase due to damage to the sanitation infrastructure

• “Water-washed” diseases – Bacterial Skin infections • Methicillin Resistant Staphylococcus aureus – Respiratory diseases • RSV • Pneumonia, influenza • “Waterborne” diseases – Giardia sp – Cryptosporidium – Hepatitis A

3 Existing infectious diseases that may increase in prevalence • Clostridium botulinum – Caused by eating food contaminated with botulinium neurotoxin – Common in US, Canadian Arctic and Greenland – Associated with fermented foods made in sealed (anaerobic) containers at temperatures above 4C (41F) – Incidence may increase as ambient temperatures increase

Existing infectious diseases that may increase in prevalence

• Paralytic Shellfish poisoning (PSP) – Shellfish concentrate neurotoxin from algal blooms (red-tides) – Follows eating raw shellfish • gastroenteritis, paralysis – Alaska has one of the highest rates in US – Potentially increase by climate-related sea water warming, precipitation, nutrient-laden run-off

4 Existing infectious diseases that may increase in prevalence

• Giardia lamblia – Protozoan infection of the GI tract – Diarrhea following consumption of contaminated untreated water – Beaver common host • Range expanding northward in Alaska and Canada – Expansion of habitat may result in appearance of disease in new regions.

Existing infectious diseases that may increase in prevalence

Endemic regions where Echinococcus sp life cycle has been established

• Echinococcus multilocularis – Northern Hemisphere only – Parasitic tape worm disease – Human accidental host – Cyst-like lesions in liver – Vectors are foxes, rodents (voles) – Dogs and man accidental hosts – Climate-favoring expansion of habitat may result in appearance of disease in new regions.

5 Infectious diseases that may emerge West Nile Virus Surveillance-Dead Birds 2004

• West Nile virus – Emerged in US 1999- outbreak of encephalitis – Infects mosquitoes, birds, – Humans, horses dead-end hosts – Mosquito vectors in Alaska and Canada West Nile Virus Surveillance-Dead Birds 2007 • A. vexans • C.pipiens • C.resuans – Dead bird surveillance conducted 2000-2006 – Furthest north 57o L North 2004

Infectious diseases that may emerge

• Vibro parahemolyticus – Ubiquitous in marine environments – Associated with fish/shellfish – Causes gastroenteritis – Outbreaks associated with farm seawater mean temperatures of >15C – Outbreaks increasing since 1997 • California • Washington • British Columbia

6 Mean Daily Farm “A” Water Temperature by Date, and Number of Farm “A”-associated Case-patients by Harvest Date of Consumed Oysters-2004 8 21

6 17

4 13 Temp. Temp.

# of Cases of # 11

2 9

0 5 1 6 11 16 21 26 1 6 11 16 21 26 31

June July Date

From McLaughlin et al NEJM 2005 353: 1463-70

Environmental Investigation Results Farm A July-August Water Temperatures by Year

19 (no data 1999) 18 17 16 15 14 13 Temperature (ºC)Temperature 12 0.21 degree C yearly increase 11 (r²=0.14, P<0.001) 10 1997 1998 2000 2001 2002 2003 2004 Year From McLaughlin et al NEJM 2005 353: 1463-70

7 Planning Ahead-Public Health Actions

• Track infectious diseases & trends – Surveillance • Climate sensitive diseases – Respiratory infections – Aseptic meningitis (WNV) • Circumpolar – International Circumpolar Surveillance (ICS)

International Circumpolar Surveillance Network

Russian# Federation # # #

# # # ### # # ## # # # # # # # # # # # # ## # Finland # # #### # # ## ## # # # ### Sweden ## # # Latitude 60o North Norway

# # # # ## ##### Iceland

# # # # United States # Greenland # # ## Arctic (Alaska)# # # # # # # # # ### # # # ##

# Reference labs # Northern Canada • # # # # # # # • Clinical labs # # # Participants shown # # in dark grey # # # ## #

Parkinson, AJ., Butler, JC. Emerging Infectious Disease January 2008

8 Planning Ahead-Public Health Actions

• Investigate outbreaks – Gastroenteritis, aseptic meningitis, botulism – Related to climate? • Develop partnerships – Local, state, federal govts, universities, NGO’s, industry – Community based networks • Develop policies and plans – Early warning systems – Public health advisories

Planning Ahead-Public Health Actions

• Ensure continuity of health care – Extreme events- village evacuation • Inform and educate – Specific groups at risk – General public – Health care providers • Public health workforce – Policy makers

9 Planning Ahead- Public Health Actions

• Conduct research – Understand the associations between weather, weather extremes, climate and infectious disease emergence • Investigate outbreaks-role of climate • Need for baseline data on climate sensitive infectious disease prevalence • Role of temperature and food and water borne diseases – Community Based Research – Circumpolar Health Research Networks

Conclusions (1) • Arctic communities uniquely vulnerable to climate change – Small isolated communities – Existing health disparities – Traditional lifestyle and culture important to health and wellbeing – Fragile economic support, dependence on subsistence hunting and fishing – Public health response and acute care may be marginal, or non-existent in some regions

10 Conclusions (2)

• Infectious diseases may emerge or reemerge, there may be: – Increase in infectious diseases already present – Emergence of new infectious diseases

Conclusions (3)

• Planning Head-Public Health Actions – Track infectious diseases & trends – Investigate outbreaks – Develop partnerships – Develop policies and plans – Ensure continuity of health care – Inform and educate – Conduct research

Community Relocation and Health - Case Greenland

Rasmus Ole Rasmussen

Professor Roskilde University, Denmark

Senior Research Fellow Nordregio, Nordic Council of Ministers, Sweden

Conclusions

• Four elements are presently decisive in structuring the settlements and the relocation processes – Politics – Food access / the formal and the informal economy – Gender differences in aspirations and mobility – Generation differences in aspirations and mobility • The relocation processes have marked influence on lifestyles and physical and social healt • Perception of lifestyles and physical and social health have marked influence on the relocation processes • The ongoing climate changes are generally enhancing these processes

1 The presentation

• Introduce to changes in the settlement structure • Focus on contemporary location/relocation mechanisms • Look into consequences on both physical and social health • Conclude on the most important challenges

1. Changes in the settlement structure

2 Settlement Structure

60.000

50.000

40.000

30.000 Totalpopulation

20.000

10.000

- 1781 1801 1821 1841 1861 1881 1901 1921 1941 1961 1981 2001 Villages Towns

Political processes of change

• Sedentarization • Intentional dispersion • Modernization phase 1 – privatization, concentration • Modernization phase 2 – state intervention, concentration • Preparation for Home Rule – centralization • Home Rule – intentional dispersion • Home Rule – unintentional concentration

3 Settlement structure – the village of Alluitsup Paa

• Picture from Alluitsup Paa

Settlement structure - the village of Alluitsup Paa

• Picture from Alluitsup Paa

4 Characteristics of village life

• Size: from few to 500 inhabitants • Services available – A single shop – School, 1st to 6th or 8th grade – Service houses • Economic background – Hunting and fishing – Simple processing facilities – Limited 3rd sector jobs – Informal economic activities

Settlement structure - the town of Nanortalik

• Picture from Nanortalik

5 Settlement structure - the town of Ilulissat

• Picture from Ilulissat

Settlement structure - the capital of Nuuk

• Picture from Nuuk

6 Characteristics of town life

• Municipal centres • Size: 500 – 14.000 inhabitants • Full services available – Several shops – School 1-10th grade – Services available at individual level • Economic background – Hunting and fishing – Processing facilities – 3rd sector jobs – Informal economic activities

Gendered migration patterns

7 Circumpolar gender imbalance

Nordic countries gender imbalance

• Map of gendered differences in the Nordic Countries

8 Greenland gender imbalance

Gender characteristics of out-migration

Summarized gender out-migration 1980-2005

5000

4000

3000

2000

1000

0 1980 1985 1990 1995 2000 2005

-1000

Accumulated net out migration males Accumulated net out migration females

9 Gender characteristics of out-migration

Greenlanders in Denmark

16000 14000 12000 10000 8000 6000 4000 2000 0 1980 1985 1990 1995 2000 2005

Males Females

Gender characteristics of inter-settlement migration

Mobility - Males, South Greenland Mobility - Females, South Greenland

100% 100%

80% 80% Dead Dead 60% Leaving region 60% Leaving region Sheep farm Sheep farm 40% Village in region 40% Village in region Town in region Town in region 20% 20%

0% 0% 1977 1982 1987 1992 1997 2002 2007 1977 1982 1987 1992 1997 2002 2007

10 Gender structure of education

Persons finished education

350

300

250

200

150 Persons

100 Females 50 Males

- 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003

Household incomes

• 24% of hunters with full time license had incomes from other activities • In more than 70% of the households the wives contributed to the income – Typically incomes from the service sector, i.e. Schools, Kindergartens, Offices, Cleaning etc. – Very seldom in connection with processing of hunting and fishing products • In more than 50% the major income source is generated by the wife • In many villages the informal economy provides more than 30% of all incomes

11 Renewable Resources

16000 14000 12000 10000 8000 6000 4000 Numberpersonsof 2000 0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

No license Full time, formal sale Leisure, formal sale Full time, no formal sale Leisure, without formal sale

Renewable Resources

Types of hunting activity 2003

100% 90% 80% 70% 60% Full time 50% Leisure time 40% 30% 20% 10% 0% Nuuk Narsaq Aasiaat Ilulissat Qaanaq Sisimiut Paamiut Qaqortoq Maniitsoq Upernavik Nanortalik Ammassalik Kangaatsiaq Uummannaq Qeqertarsuaq Qasigiannguit Illoqqortoormiit Outside municipalities Outside

12 Gender structure of education

• Picture from Alluitsup Paa

Gender structure of education

• Picture from Nanortalik

13 The demographic challenge

• Picture from South Greenland

The demographic challenge

• Picture from South Greenland

14 The demographic challenge

• Picture from South Greenland

The demographic challenge

• Picture from South Greenland

15 Food supply and food security

Food-security

Greenland import of food

1.000.000

900.000

800.000

700.000

600.000 *1.000 dkr. *1.000

500.000

400.000

300.000

200.000

100.000

Living animals Meat and meat products Dairy products and eggs Fish and fish products Cereals Fruit and vegetables Sugar, sugar products and honey Coffee, tea etc. Feedstuff Other products Beverages Tobacco and tobacco products

16 Informal economy - case Nanortalik

• Picture from Nanortalik

Informal economy – case Alluitsup Paa

• Picture from Alluitsup Paa

17 Informal economy - case Nanortalik

• Picture from Nanortalik

Informal economy – case Ilulissat

• Picture from Ilulissat

18 Informal economy – case Ilulissat

• Picture from Ilulissat

Informal economy – case Ilulissat

• Picture from Ilulissat

19 Rationales

• Maintaining a link to the formal economy • (Re)distribution of formal economies • Indirect and direct social support • Maintaining local production • Provides local products available for a larger audience • Providing basic existence of otherwise condemmed settlements

Economic base

Income structure Subsistence

250000 Informal sale 200000 Formal sale fish 150000 100000 Formal sale Hunting 50000 Direct transfers 0 Sisimiut Paamiut Tasiilaq Income

20 Informal economy in towns and villages

Informal income in main groups

80.000.000

70.000.000 Sale on local market

60.000.000 Sale to institutions

50.000.000 Sale to restaurants

40.000.000 Sale to families, friends 30.000.000 etc. Gifts 20.000.000 Own consumption 10.000.000

0 Towns Villages

From informal to formal economy

• Picture from supermarket

21 From informal to formal economy

• Picture from supermarket

Health characteristics

22 Town/village smoking characteristics

• Graph to be included showing: – Level of smoking high – Differences in the type of smoking between towns and villages – Faster reaction to rejection of smoking habits in the towns – Report of diseases directly caused by smoking between towns and villages not significant – Respiratory diseases, however, reported higher in villages compared to towns

Town/village drinking characteristics

Alcohol consumption

70 60 50 40 30 Percent 20 10 0 Men, Tow ns Men, Villages Women, Tow ns Women, Villages Denmark, Men Denmark, Women

Intake over sensible drinking limit Occasional heavy drinkers Abstainers

Mean alcohol intakes

14 12 10 8 6 4 2 Drinks per week per Drinks 0 Men, Tow ns Men, Villages Women, Tow ns Women, Villages Denmark, Men Denmark, Women

Mean alcohol intakes, drinks/w eek

23 Town/village obesity characteristics

• Graphic to be included showing – Reported obesity and obesity related health problems higher in villages compared to towns – Higher consumption of local food, but also higher consumption of low quality food in villages

Town/village health differences

• Graphic to be included showing: – The general pattern of health related problems in towns and villages show a marked over-representation of most health problems in the villages

24 Social health

Town/village violence and abuse characteristics

• Graphic to be included showing – Violence is a crucial factor in both towns and villages. The level of unreported violence is substantial higher in villages, and the level of violence has huge impact on the gendered migration pattern.

25 Youth risk perception

Social reaction

60 51 50

40 33 30 19,8 Percent 20 10,1 10 0,48 0,11 0 Boys Girls Boys Girls Boys Girls

Suicide thoughts Suicide attempts Sucides

Suicide

Suicide by region 1999-2003

300

250 239

200 181

150 120 98 100

100.000 inhab. 100.000 61 42 39 50 12 23 0 Av. annual rates of deaths by suicide per per suicide by deaths of rates annual Av. Inuit Inuit Finland Canada Inuit Nunavik Nunavut Denmark Inuvialuit Greenland Alaska Inuit Alaska Nunatsiavut

26 Suicide

Suicide in Greenland and Nunavut e

140 120

100 80 60 40

per 100.000 inhab. 100.000 per Nunavut Inuit 20 Greenland 0 Av. annual rates of deaths by suicid by deaths of rates annual Av. 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002

Perspectives

27 Gendered perspectives

- Perceptions of changes • The role of relations to community • The role of relations to the world outside the community • The role of qualification to the world outside the community • Gender based differences in discourses and actions

Youth perspective

– Perceptions of their future • Possibilities / options • Local and global constraints – The relations to community – The relations to the world outside the community – Youth gender based differences

28 Generation reflections

• Parents: Would like to see their children follow them in the activity • BUT • They would not like to recomment it due to – It is VERY hard – It pays VERY little – It is too risky

Generation reflections

• Many sees their future in other settings • Many, however, would like to pursue a future in hunting and fishing, • BUT would require – Professionalization – Better equipment – Better working environment – Better economy • A prerequisite, therefore, is a more modern, advanced, skilled AND RESPECTED trade

29 Generation reflections

• THEY HAVE A CULTURAL IDENTITY • But it differs from their parents.. • And it differs from what outsiders would like it to be.. • And it worries them that THEIR culture is not accepted by the ones who are supposed to represent them in international settings!

Conclusions

30 Thank you for your attention

• Picture from Nanortalik