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The Social Determinants of Elevated Rates of Suicide Among Inuit Youth

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The Social Determinants of Elevated Rates of Suicide Among Inuit Youth Jack Hicks THE SOCIAL DETERMINANTS OF ELEVATED RATES OF SUICIDE AMONG INUIT YOUTH 30 30 Indigenous Indigenous Affairs Affairs 4/07 4/07 “If the populations of ‘mainland’ Canada, Den- A transition in suicide patterns mark and the United States had suicide rates compa- rable to those of their Inuit populations, national The earliest existing data on suicide among Inuit comes emergencies would be declared.” from Greenland. Writing in 1935, Dr. Alfred Berthelsen calculated an annual suicide rate of just 3.0 per annum Upaluk Poppel, representative of the Inuit Circumpolar per 100,000 population for the period 1900 to 1930.3 (By Youth Council, presentation to the United Nations’ Perma- comparison, the most recent suicide rate for Denmark nent Forum on Indigenous Issues, May 18, 2005 is 13.6 per 100,000, 11.6 for Canada and 11.0 for the USA.) He concluded that the few suicides occurring in Greenland at that time were all the result of serious mental illnesses. As late as 1960 there was still the oc- t has not always been the case that the world’s casional year when there were no recorded suicides by IInuit population has suffered from the tragically Greenlanders. high rates of death by suicide that they experience The transition from the “historical pattern of sui- today. cide by Inuit” to the “present-day pattern of suicide by The 150,000 Inuit alive today are an indigenous Inuit” was first documented in North Alaska by psy- people inhabiting Greenland, the Arctic regions of chiatrist Robert Krauss. In a paper presented at a con- Canada, the north and west coasts of Alaska, and the ference in 1971, he noted: Chukotka peninsula in the Russian Far East. A mari- time people, Inuit traditionally relied on fish, marine In the traditional pattern, middle-aged or older men were mammals and land animals for food, clothing, trans- involved; motivation for suicide involved sickness, old port, shelter, warmth, light and tools. Until fairly re- age, or bereavement; the suicide was undertaken after so- cent times, there was a remarkable cultural homoge- ber reflection and, at times, consultation with family neity across their homelands, but that began to members who might condone or participate in the act; change as the four states in which Inuit now find and suicide was positively sanctioned in the culture. themselves1 consolidated their grips over their Arc- tic regions. In the emergent pattern, the individuals involved are Beginning in the 1950s, governments across the young; the motivation is obscure and often related to in- Arctic subjected Inuit to intense disruptions of the tense and unbearable affective states; the behaviour ap- lifeways they were accustomed to. The details var- pears in an abrupt, fit-like, unexpected manner without ied considerably across the region, but the funda- much warning, often in association with alcohol intoxi- mental economic, political and social processes of cation; and unlike the traditional pattern, the emergent incorporation and sedentarization were similar. pattern is negatively sanctioned in the culture.4 These processes of incorporation and sedentariza- tion also took place at somewhat different times in This suicide transition among Inuit was experienced different parts of the Arctic, and had somewhat di- first in North Alaska in the late 1960s, then in Green- vergent outcomes.2 land in the 1970s and early 1980s, and then again in Canada’s Eastern Arctic5 in the late 1980s and through the 1990s.6 Each time the transition oc- curred, it resulted in a higher overall Rates of death by suicide among Alaska Natives, rate of death by suicide. Greenlanders, and Eastern Arctic Inuit, 1960-2003 The temporal sequence in which the “regional suicide transitions” occurred 180 160 is noteworthy, as it mirrors – roughly 140 one generation later – the processes of 120 Alaska Natives 100 “active colonialism at the community Greenlanders 80 Eastern Arctic Inuit level”. (We need to differentiate be- 60 tween “active” and “passive” colonial- (per 100,000(per pop.) 40 Ratesdeathof by suicide 20 ism as some Inuit populations had been 0 colonized for several generations – but 1960 1963 1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 in those cases the colonial powers had Year not attempted to substantially reorgan- (right) Upernavik (meaning “Springtime Place”), a town of 1,200 in north Greenland. Photo: Jack Hicks Indigenous Affairs 4 /07 31 ize Inuit society as they depended on the persistence of the communal mode Rates of death by suicide among Nunavut Inuit, by sex and age cohort, 1999-2003 of production to ensure a supply of marine mammal products, fox pelts, 900 800 etc.) One of the positive aspects of 700 state intervention in Inuit life was the 600 rapid decline in the incidence of tu- 500 Men 400 Women berculosis. We can therefore use the 300 decline in tuberculosis incidence as a 100,000 (per pop.) 200 historical marker of the early years of Ratesdeathof by suicide 100 0 “active colonialism at the community 10-14 15-19 20-24 25-29 30-39 40-49 50+ level”. The historical sequence in Age cohort which Inuit infectious disease rates fell (as a result of the introduction of West- ern medicine) was the same order in Rates of death by suicide among Inuit men in Nunavut which Inuit rates of death by suicide and all men in Canada later rose across the Arctic. 900 800 700 What the basic statistics tell us 600 500 400 Even though the existing data on sui- 300 200 cide among Inuit is quite limited, the 100 suicide100,000(per pop.) basic statistics we do have can tell us a Avg.annual deathof rate by 0 10-14 15-19 20-29 30-44 45-59 fair amount about what has happened Age cohort and what is happening. Inuit men in Nunavut (1999-2003) Men in Canada (1998) In each jurisdiction for which data is available,7 suicides first increased dramatically among young men. For Greenland, Dr. Peter Bjerregaard has Rates of death by suicide among Nunavut Inuit, shown that suicide began to increase by region and sex, 1999-2003 among men born after 1950 – the very 300 year in which the Danish state initiat- ed an intensive programme to turn 250 Greenland into a “modern welfare so- 200 Men 150 ciety”… a process in which Green- Women landers had very little say. 100 Today, suicide rates among Inuit 50 suicide100,000(per pop.) Avg.annual deathratesof by are several times higher among young 0 men than they are among women of Nunavut (all) Qikiqtani Kivalliq Kitikmeot the same age, older men and women; Region and many times higher than among their peers in “mainland” Denmark Coast has by far the highest rates. In Greenland, the suicide rate among and “southern” Canada and the US. It young Inuit men peaked first in Nuuk in the early 1980s, then along the is difficult to find words that ade- rest of the west coast in the late 1980s, and finally on the east coast in the quately describe the amount of sui- early 1990s. Suicide by young men in East Greenland reached a rate of cide-related pain and trauma that has 1,500 per annum per 100,000 population, surely one of the highest sui- been suffered in Inuit communities in cide rates ever recorded anywhere on earth, before finally beginning to recent years. decline. In Nunavik (the Inuit part of northern Quebec), the Hudson In each Inuit jurisdiction, there are coast has suffered from a much higher suicide rate than the Ungava some subregions that developed and coast, while in Nunavut the Qikiqtani (formerly Baffin) region has a sustained far higher rates of suicide markedly higher suicide rate than the two mainland regions. than others. In Alaska, the Northwest 32 IndigenousIndigenous Affairs Affairs 4/07 4/07 Members of the Kanguit Healing Circle, a group of residents in Cape Dorset, Nu- The community of Clyde River (Kanngiqtugaapik), an Inuit community of 820 on the navut, who offer counselling to other community residents. Photo: Jack Hicks. east coast of Baffin Island, in the Canadian territory of Nunavut. Photo: Jack Hicks. Boys in a boarding home in Tasiilaq, East Greenland. Children from small set- Bent B. Kristiansen, the Vice-Mayor of Ilulissat: ”Suicide prevention is our tlements stay in boarding homes while attending school in the larger towns in Council’s number one priority. … We know that we can’t prevent ALL suicides, Greenland. Photo: Jack Hicks but we believe that intervention can sometimes prevent a difficult time in the life of a troubled person from escalating into a tragedy.” Photo: Jack Hicks. Simultaneously, there are places in the Arctic where medical history; education history; work history; rela- suicide rates are decreasing – those sub-regions of the In- tionship history; substance use/abuse; engagement uit world that have experienced the most “develop- with the justice system; availability of, access to and ment” in recent decades. In Greenland, suicide rates use of health care services; and other factors that may among young men in Nuuk have declined significantly have played a role in the suicidal behaviour of these over the past 25 years while they have remained stable persons. We would also like to know about the pres- on the rest of the west coast and risen considerably in ence or absence of a number of protective factors.9 East Greenland. A similar shift appears to be underway An important body of research exists on mental in Alaska, where the suicide rate among Alaska Natives health in Greenland. In a recent article, the two leading residing in “urban Alaska”8 is now less than a third that figures in health research there in recent decades – Drs.
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