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State of the Knowledge: Public Health , 2011

Emilie Cameron, PhD

NATIONAL COLLABORATING CENTRE CENTRE DE COLLABORATION NATIONALE FOR ABORIGINAL HEALTH DE LA SANTÉ AUTOCHTONE Acknowledgements © 2011 National Collaborating Centre TheNCCAH would like to acknowledge our for Aboriginal Health, (NCCAH). The reviewers for the generous contributions of The author wishes to thank the numerous National Collaborating Centre for their time and expertise to this manuscript. people who shared their time and resources Aboriginal Health supports a renewed in the development of this report. public health system in Canada that This publication is available for download is inclusive and respectful of diverse First at: www.nccah.ca Special thanks to Gail Turner, Isaac Sobol, Nations, Inuit and Métis peoples. The Catherine Carry, Anna Fowler, NCCAH is funded through the Public This document is printed onFSC certified Lynda Brown, Catherine Dallas, and Health Agency of Canada and hosted at 100% post-consumer waste recycled paper. Shannon O’Hara. the University of Northern British Columbia, in Prince George, BC. The content of this report, its conclusions Production of this report has been made and recommendations, and any errors it possible through a financial contribution may contain are the sole responsibility of from the Public Health Agency of Canada. the author. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada or of the NCCAH. CONTENTS

Acknowledgements 2 Executive Summary 5 Introduction and Background 9 Guiding Principles 9 Research Questions and Methodology 9 Overview of the Population 9 Social Determinants of Health 11 Current State of the Knowledge 13 Maternal, Fetal, and Infant Health 14 Birthing and Midwifery 14 Breastfeeding and Infant Nutrition 15 Fetal Alcohol Spectrum Disorder (FASD) 15 A Note on Women and Girls 16 Child Health 16 Otitis Media 16 Dental Health 17 Respiratory Infections 17 Communicable Diseases 17 Sexually Transmitted Infections (STIs) 18 Gastroenteritis And Other Food- Borne Infections 18 Tuberculosis 19 Other Communicable Diseases 19 Pandemic Planning 20 Cancer 20 Diabetes 21 Respiratory Disease 22 Cardiovascular Disease 22 Injury 23 Abuse 23 Mental Health and Wellness 25 Suicide 25 Substance Use 26 Disability 27 Environmental Health 27 Environmental Contamination 27 Climate Change 27 Food Security and Nutrition 28 Urban Inuit 29 Summary: Trends, Needs, and Gaps 30 Bibliography 33 Appendices 39 Appendix A: 40 Appendix B: Overview of National Inuit Organizations 41 Appendix C: Public Health Surveillance in the Four Northern Regions 42

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EXECUTIVE SUMMARY

Introduction Public Health Issues Identified

The purpose of this report is to synthesize The report discusses the following public current knowledge to 2011 relating to health issues: Inuit public health issues and to identify potential trends and gaps in that · Maternal, fetal, and infant health, knowledge. The report discusses a range including issues relating to birthing and of public health issues identified in each midwifery, breastfeeding and infant of the four northern Inuit regions nutrition, and Fetal Alcohol Spectrum (Inuvialuit, Nunavut, , and Disorder (FASD) Nunatsiavut; see Appendix A for map, · Child health, including ear infection Inuit Nunangat) and in southern (otitis media), dental health, and Canadian cities. It summarizes current respiratory infections understandings of each public health · Communicable diseases, including issue, identifies emerging health trends, sexually transmitted infections, and describes needs and gaps in gastroenteritis and other food-borne knowledge that might be the focus for diseases, and other communicable future initiatives. diseases like meningitis and tuberculosis · Cancer Methodology · Diabetes · Respiratory disease The report was developed through a · Cardiovascular disease comprehensive review of reports, studies, · Injury, including physical and sexual and other literature relating to Inuit public abuse health, as well as through interviews with · Mental health and wellness, including key informants working across the four suicide and substance use northern regions and in southern cities. · Disability Health issues are approached from a social · Environmental health, including determinants perspective. environmental contaminants and the effects of climate change on Inuit health · Food security and nutrition · Urban Inuit health.

Current knowledge relating to each issue is discussed, including statistical data and regional patterns when available.

5 Emerging Health Trends Climate change is already contributing Kanatami and Nunavut Research negatively to Inuit health and future Institute 2006; see also fact sheets There is a serious shortage of impacts are not well understood. prepared by Nipingit, the National Inuit comprehensive, current, Inuit-specific · Socioeconomic problems such as Committee on Ethics and Research, at public health data available in Canada to poverty, unemployment, violence, www.naho.ca/inuit/e/ethics). assist in tracking public health concerns substance abuse, neglect, and over time and identifying emerging health overcrowding impact significantly upon Needs and Gaps trends. However, interviews and anecdotal the health and well-being of Inuit. evidence from communities suggest that Public health planners, policy-makers, The health care systems serving Inuit the following health issues are an emerging and service providers in all regions note are faced with numerous challenges. A concern and priority: the importance of taking these broad number of needs and gaps were identified factors into account and approaching throughout the development of this · Diabetes is a rising concern in Inuit Inuit health from a holistic, report: communities. Emerging research and community-based perspective. Research anecdotal evidence suggest that Inuit and policy addressing Inuit public · There is a shortage of comprehensive are highly vulnerable to a significant health issues from a social determinants and reliable data documenting Inuit increase in diabetes incidence rates in perspective are needed. public health issues, although the the coming years. · Inuit knowledge and values are health surveys conducted in Nunavik · As Inuit shift away from a more increasingly being incorporated in 2004 and Nunavut, Nunatsiavut, and traditional diet, become more into public health planning and Inuvialuit in 2007/2008 are expected to sedentary, and obesity rates increase, programming, although there is still make a significant contribution to this cardiovascular disease is also expected much to be done in this regard. body of knowledge. to become an increasing public health · Inuit are increasingly controlling · There is a need to compile and concern. research agendas in their regions. coordinate existing data into a · Sexually transmitted infection rates are There is a need, however, to develop a comprehensive, centralized database. high and rising in Inuit communities. comprehensive discussion document · This lack of reliable and accessible data Chlamydia and gonorrhea are already outlining an Inuit-specific set of frustrates efforts to secure funding to highly prevalent, but public health research guiding principles in order address emerging health concerns at experts are increasingly concerned to ensure that research is culturally the community level. In many cases, about the vulnerability of Inuit and community appropriate. Inuit communities are aware of pressing needs communities to HIV and Hepatitis C Tuttarvingat at NAHO (formerly the but are unable to implement much infection. Ajunnginiq Centre), Inuit Tapiriit needed services and programs. · Youth suicide is a major concern in all Kanatami, and the Nunavut Research · Health data analysts are needed in Inuit regions. Institute have produced guides, fact every region to assist in the analysis · Inuit are increasingly noting the effects sheets, and reports that are very helpful and dissemination of available health of climate change on their environment. in this regard (e.g., Inuit Tapiriit information.

6 · Informants in every region stressed often intergenerational public health · There is a need for research the importance of networking, problems. There is a related need to documenting public health successes coordination, and cooperation across increase research examining Inuit health and protective factors that promote jurisdictional levels and even within from a social determinants perspective. health and well-being in Inuit government departments or agencies. A · National pandemic plans are communities. mechanism for this kind of interaction inappropriate for remote, fly-in is needed. communities with low capacity to react While the gaps and shortages are · Similarly, coordination of health to crises. The northern regions are significant, public health experts identify services is important to ensure that vulnerable to pandemics in this regard, the following broad goals as potentially federal, provincial and territorial, although planning for and responding significant contributions to improving the regional, and other organizational to the H1N1 influenza pandemic in overall health and well-being of Inuit: services are integrated, accessible, and 2009/2010 is expected to improve · Set specific, national goals for Inuit effective. pandemic planning processes currently health outcomes, with associated targets · The need for increased capacity at all underway. and measurable indicators, and commit levels is also a pressing concern in every · Although there are knowledge gaps sufficient long-term funding to support region. It takes generations to build in relation to all of the public health these goals; capacity among Inuit in the area of issues discussed in this report, gaps are · Develop Inuit-specific health indicators public health and a holistic strategy to particularly glaring in terms of injury, that account for the importance of encourage more Inuit to consider public disability, obesity, health determinants culture in health outcomes; health careers is needed. such as literacy, informal caregiving and · Ensure that Inuit have access to · Although more data and research caretaking, and the particular health appropriate and timely health services, are required to understand the concerns relating to urban Inuit. including screening, diagnostic, public health concerns facing Inuit · There is a need for an Inuit definition treatment, and long-term care services; communities, it is also important that of health and wellness that would guide · Interventions aimed at specific health action be taken to address identified public health service provision, policy, issues are ultimately ineffective problems and that program evaluation surveillance, and resource development. if the underlying social, cultural, and promising practices be circulated · Inuit concerns and needs tend not to and economic determinants of more widely between regions, public be addressed by federal, provincial, or health are not addressed. In this health organizations, agencies, and territorial public health planning or by regard, meaningful commitments individual workers. initiatives aimed at a general Aboriginal to address housing, employment, · No single public health issue facing population. It is crucial that the and intergenerational trauma are as Inuit can be addressed in isolation. distinct cultural, historical, geographic, significant a contribution to health Holistic, culturally-sensitive initiatives environmental, and socioeconomic outcomes as improvements in health that involve Elders, youth, and other factors impacting Inuit health be service provision. community leaders at the community accounted for and incorporated into all level are essential to address complex, public health activities.

State of the Knowledge: Inuit Public Health 2011 7

INTRODUCTION

Introduction and Background Research Questions and 3. Review and Feedback: Circulation Methodology of preliminary report to community The purpose of this project is to summarize stakeholders and reviewers and synthesize the state of current Several research questions guided the 4. Final Reporting: Development of final knowledge on Inuit public health issues. development of this report: report and dissemination. The report is intended to enhance · What public health issues are of understanding of existing knowledge This project has received ethics approval relating to Inuit public health, to particular concern in Inuit communities in each of the four northern regions? through the University of Northern determine gaps in that knowledge, and to British Columbia’s Research Ethics Board. facilitate collaboration in the public health · What public health issues are of community. particular concern for groups within Inuit communities, such as women, Overview of the Population Drawing on governmental and children, or Elders? organizational grey literature, academic · What is the state of current knowledge Inuit share a common cultural heritage research, and interviews with public regarding these health issues? and tradition that covers a vast health experts, the report synthesizes · What concerns exist in terms of geographical area; over three-quarters knowledge across varying spheres and planning for and delivering public of the 50,485 Inuit in Canada live in 53 seeks to identify and interpret trends. It health services in remote northern communities scattered across 40% of includes information pertaining primarily regions? What kind of knowledge is Canada’s landmass (Statistics Canada to Inuit communities in the four northern required to facilitate any challenges 2008). They live primarily in four northern regions: Nunavut, Inuvialuit, Nunavik, identified? regions of Inuvialuit, Nunavut, Nunavik, and Nunatsiavut, although information · What sorts of trends exist in terms of and Nunatsiavut (see Appendix A, Inuit regarding the specific health concerns of these knowledges? What gaps? Nunangat), although a significant and Inuit living in southern Canadian cities is · To what extent does an Inuit view of growing number of Inuit (17%) also live included where it is available. health and wellness inform public in cities in the south (primarily Ottawa- health research, practice, and planning? Gatineau, Yellowknife, Edmonton, Guiding Principles Montreal, and Winnipeg, and to a lesser The project was carried out in four phases: extent, Vancouver and Toronto; see Statistics Canada 2008). This project is fundamentally guided 1. Project Design: identification of goals, by principles of knowledge sharing and principles, and questions guiding the Though there are regional differences, collaboration. The National Collaborating research project there is much that Inuit share. Today, Centre for Aboriginal Health (NCCAH) 2. Data Collection: Key informant Inuit share a common interest in is committed to “KSTE” principles interviews with representatives from advocating for health and wellness (Knowledge, Synthesis, Translation, and government, non-governmental services, programs, policies, and research Exchange) with a view to ensuring that organizations, universities, and other that are Inuit-specific and Inuit-led, knowledge is shared across geographical stakeholders; review of literatures and that take into account the unique and institutional levels, making it relating to Inuit public health geographical, cultural, and socio- meaningful and useful to communities. economic factors affecting their health.

9 The planning and delivery of health services in Inuit regions has evolved from “We must seek our own solutions to improve our situation. a pre-government era in which Inuit controlled their own health and welfare Our ability to make our own decisions was taken away to increasing influence by non-Inuit, beginning with the arrival of whalers, from us; we must now take it back. We must take back traders, and missionaries to the Arctic. Federal government intervention into our ways of healing. Although healing wasn’t part of our health services began most intensively vocabulary, we had means of ensuring we lead healthy in the 1950s when Inuit were often taken away from their communities to lives. Men and women had roles, there were certain ages tuberculosis sanitaria. Gradually, health services were also delivered by provincial those teachings were taught. We had ways of resolving and territorial agencies. More recently, comprehensive land claim settlements issues.” (Inungni Sapujjijiit: Task Force on Suicide Prevention and Community Healing 2003, 10) have introduced Inuit jurisdiction over matters like health, and Inuit-led agencies are instrumental in advocating for health Most communities have nursing stations 2008). The rate of Inuit adults stating services, disseminating health information, staffed by a nurse or community health that their health is excellent to very good and representing the particular needs representative, with physicians and other has declined over the years, and is lower of Inuit women, Elders, and youth. See specialists flying in periodically. Advanced than for the general Canadian population Appendix B for an overview of the major medical care requires transfer to southern (Tait 2008, 10). In almost every indicator Inuit-led agencies involved in health. Canadian cities, “a recurring problem in of health, Inuit score lower than the the provision of culturally appropriate Canadian population. Some particularly Government interventions into Inuit health services in the North” (Jenkins alarming statistics include: communities often marginalized and et al. 2003, 19). Indeed, most Inuit · Cancer, the second leading cause of eroded the rich tradition of healing and must fly out of their home communities death among Inuit, is increasing among wellness that has always informed Inuit for diagnostic and screening services, Inuit in all regions. Lung cancer rates health. After many decades of exclusion medical treatments, palliative services, among Inuit in Canada are the highest from health planning, research, and and other forms of health care, resulting in the world (Circumpolar Inuit Cancer service provision, Inuit are increasingly in significant social and emotional costs, Review Working Group 2008; Inuit incorporating these traditions and values as well as financial burdens for families Tapiriit Kanatami 2009). In 2000, lung into the health care system. However, and for the health care system. It seems cancer rates in some Inuit regions were current health delivery systems continue that “geography and population density 60% higher than the national average to be “based on western medical models have so far dictated that Inuit do not have (Inuit Tapiriit Kanatami 2004a). and dominated by non-Inuit” (Inuit access to services equal to their southern · Accidental death rates in the two largest Tapiriit Kanatami 2004a, 8). counterparts” (National Aboriginal Inuit regions are nearly three times Health Organization 2004, 1). the Canadian average (Inuit Tapiriit There are many challenges associated with Kanatami 2004a). health care in remote, fly-in communities. The Inuit population is young and · Suicide in Inuit communities is There are high turnover rates among staff growing at twice the rate of the general reported at more than eleven times and a lack of training and professional Canadian population. Over 50,000 the national average (Pauktuutit development available for those who do people identified as Inuit in the2006 Inuit Women of Canada 2007a). One remain in communities (Turner 2010). Census (Statistics Canada 2008). The researcher reports that among young Inuit health is delivered from multiple, population is expected to rise to 60,000 men in Nunavut, the rate is nearly forty overlapping governments and agencies by 2016 (Inuit Tapiriit Kanatami 2004a). times the national average (Hicks 2006). (including federal, provincial/territorial, In 2006, the median age of Inuit was 22 · Tuberculosis rates in Inuit communities regional, and Inuit-led organizations), years compared to 40 years among the have doubled since 2006 and are often resulting in a lack of coordination general Canadian population, and the currently 185 times higher than the and communication between jurisdictions average Inuit life expectancy is about 15 rates for non-Aboriginal Canadians (Canada-Aboriginal Peoples’ Roundtable years shorter than the average Canadian (Inuit Tapiriit Kanatami 2010; Public 2004; Inuit Tapiriit Kanatami 2004a). life expectancy (Inuit Tapiriit Kanatami

10 Health Agency of Canada 2009b). Social Determinants of Health would diagnose and treat tuberculosis Tuberculosis rates are directly related to in a timely and effective manner, thus inadequate and overcrowded housing, Researchers and policy-makers are exacerbating infection rates. In a social food insecurity, and access to health increasingly employing a social determinants of health framework, the services (Turner 2010). determinants perspective in their efforts to impact of the physical environment (such · Environmental contaminants and understand and address Aboriginal health as inadequate and overcrowded housing) climate change are negatively affecting concerns. The World Health Organization on physical, emotional, mental or spiritual the health and safety of Inuit (Furgal defines the social determinants of health health is accounted for, as are factors such and Seguin 2006). as “the conditions in which people are as employment and income, education, · In a study of food security in born, grow, live, work and age, including and food security. Kugaaruk, Nunavut, five out of six the health system. These circumstances Inuit homes were classified as food are shaped by the distribution of Key social determinants identified insecure (National Aboriginal Health money, power and resources at global, by residents of Nunavut include: Organization 2004). More than two- national and local levels, which are acculturation, self-determination, thirds of Inuit preschoolers live in food- themselves influenced by policy choices” education, quality of early life, insecure homes (Egeland et al. 2010). (World Health Organization 2010). productivity, income and its distribution, Understanding people’s health through a food security, health care services, social In response to these challenges, “Inuit of social determinants lens means thinking safety net, housing, and environment Canada want to restore wellness in their about the systems and structures in which (Nunavut Department of Health and lives” (Inuit Tapirisat of Canada 2001, 2), people live as opposed to separating Social Services 2005). Other studies and not just in terms of disease rates or individual health outcomes from their additionally identify health behaviours, other statistical indicators. To be healthy social contexts (Marmot et al. 2008). systemic issues in the health and education in a holistic sense, Inuit require healthy Gleeson and Alperstein (2006, 266) sectors, community infrastructure, environments, education and employment argue that there is now “robust evidence and cultural continuity as factors opportunities, safe and adequate housing, demonstrating that social determinants determining health, as well as issues such social supports, and hope among their have far greater influence upon health and as colonialism, racism, and social inclusion youth (Inuit Tapiriit Kanatami 2004a). the incidence of illness than conventional (de Leeuw, Greenwood, and Cameron Inuit have many strengths that assist in biomedical and behavioural risk factors” 2009; Loppie Reading and Wien 2009). this regard: (see also Baum and Harris 2006; Lantz Inuit Tuttarvingat recently compiled an annotated bibliography of research · Much of Inuit language and culture has et al. 1998; Raphael 2002). Social examining housing as a determinant of been maintained determinants research is still in its infancy health (Knotsch and Akalehiywot 2008). · A land-based economy continues to in the Inuit public health sector, but it allow many Inuit to maintain access offers a compelling means of accounting All of the public health issues discussed to traditional country foods and for the diverse social and political pressures in this report can be understood from a lead sustainable lives in their home shaping Inuit health (Richmond 2009). social determinants perspective. Exploring communities the social determinants of Inuit public · Inuit have high breastfeeding rates A social determinants of health health concerns is an important focus for · The average educational attainment of framework highlights how “individuals, future research. Inuit is increasing over time communities and nations that experience · Most Inuit have access to primary, inequalities in the social determinants secondary and tertiary health services of health not only carry an additional when needed (Elliott and burden of health problems, but they are Macauley 2004). often restricted from access to resources that might ameliorate problems” (Loppie Some of the strengths, challenges, and Reading and Wien 2009, 2). For example, gaps in knowledge related to restoring Inuit have vastly unequal access to wellness in Inuit communities are appropriate and affordable housing, discussed in this report. leading to overcrowding, and thus making Inuit more vulnerable to communicable diseases such as tuberculosis. They also lack access to the health services that

State of the Knowledge: Inuit Public Health 2011 11

Current State of the Knowledge

‘Knowledge’ can mean many different is a tremendously useful resource for things. For the purposes of this report, governments, organizations, and public knowledge refers to sources as diverse health service providers. Some of this as statistical information recording the report is reproduced in Appendix C. prevalence and severity of various public health concerns in Inuit communities, In recent years, comprehensive regional to the kinds of knowledges involved health surveys have been undertaken in delivering coordinated, consistent in each of the four northern regions. In public health programs and services, 2004, a study involving 1,058 residents to the more holistic, culturally-based in 14 communities in Nunavik was kinds of knowledges stemming from the carried out. Entitled Qanuippitaa? wisdom of Inuit. To be most effective in (or How Are We?), the study gathered addressing public health concerns all these broad population health and health knowledges need to be marshaled. determinant data and represents the most recent and comprehensive health Although knowledge varies regarding data for the Nunavik region. A similar each of the public health issues discussed survey (Qanuippitali?) was carried out in in this report, some general comments 2007/2008 for the Inuvialuit Settlement can be made. There is quite simply a Region, Nunavut, and Nunatsiavut and lack of comprehensive, Inuit-specific preliminary reports are anticipated soon. public health data available in Canada. The survey included questionnaires Although health data exists regarding investigating household crowding, particular issues in particular regional food security, nutrition, country food, contexts, more comprehensive, pan-Inuit eating habits, mental health, community health data is required. Informants also wellness, and medical history. Individual emphasize the importance of coordinating clinical tests included: blood pressure, existing information, making information pulse and carotid artery testing; blood accessible, and ensuring that health data glucose and diabetes testing; height, collection is guided by Inuit. weight, body composition and waist circumference testing; exposure to Some progress has been made in infections (e.g., H. pylori); bone health; this regard. ITK has developed a nutrient status testing; and exposure to comprehensive Inuit Public Health environmental contaminants (see www. Surveillance Report (Elliott and Macauley inuithealthsurvey.ca). 2004) outlining the surveillance programs and sources of data available for each of The2006 Aboriginal Peoples Survey (APS) the four northern Inuit regions and for includes health-related data, as well as each public health issue. This document social and economic data that is useful

13 weeks before birthing and remain away from their homes for a period of time following the birth. Pauktuutit and the Aboriginal Women and Girls’ Health Roundtable emphasize the need for action on developing a medical evacuation policy that strengthens fathers’ roles in birthing and enhances support to women by allowing a family member to accompany the mother (Aboriginal Women and Girls’ Health Roundtable 2005). They are also active in encouraging midwifery, alongside Irnisuksiiniq, the Inuit Midwifery Network developed by Inuit Tuttarvingat at NAHO. Various participants in the from a social determinants of health youth, and other leaders to inform the Irnisuksiiniq-Inuit Midwifery Network perspective (for an overview of Inuit design and delivery of public health are active in establishing midwives and health and social conditions documented programs and services. This is particularly birthing centres in northern communities. in the 2006 APS, see Tait 2008). the case in relation to youth suicide, To date there are five birthing centres in climate change and environmental the northern regions, three in Nunavik Both the Government of Nunavut and contamination, and birthing and (in Puvurnituq, Inukjuak, and Salluit) the Government of Northwest Territories midwifery, where Inuit have played an and two in Nunavut (Rankin Inlet and have released comparable indicator reports active role in researching and designing Cambridge Bay). Women living in these summarizing comprehensive health appropriate and effective initiatives. communities can opt to give birth at the data for their regions. Unfortunately, Organizations like ITK, Pauktuutit, birthing centres if they have low-risk Inuit-specific data is not identified in and the Inuit Tuttarvingat continue pregnancies. Recent research also indicates these reports. While the population of to advocate for more comprehensive, excellent outcomes for higher-risk births Nunavut is approximately 85% Inuit, Inuit consistent, and meaningful participation attended by midwives along Nunavik’s comprise only 10-12% of the population of Inuit in all areas of health. Hudson Coast (Van Wagner 2010). of NWT, making the NWT data less useful for Inuit-specific inquiry. The Maternal, Fetal, and Infant Health Needs and goals in relation to birthing Nunatsiavut region has not yet published and midwifery include: a comparable indicators report, owing This section addresses public health · Establishment of Inuit midwifery as a to their recent transition to regional concerns related to birthing and viable, cost-effective option for birthing self-governance. Some population health midwifery, breastfeeding and infant in Inuit communities. This requires the information is available in newsletters nutrition, and FASD. Although not coordination of regional, provincial/ published throughout the 1990s and early discussed in detail in this report, other territorial, and federal agencies and 2000s; these can be accessed through the related public health concerns include the elimination of jurisdictional and Nunatsiavut Government. high rates of teenage pregnancy, the need administrative barriers that prevent for sex education and family planning in the practice of Inuit midwifery at the Inuit health statistics from across the elementary and secondary schools in the community-level (Pauktuutit Inuit four northern regions will also be North (see also the section on Sexually Women of Canada 2006b). available shortly through an online portal Transmitted Infections in this report), · Development and dissemination of (Naasautit: Inuit Health Statistics, www. and the importance of including Elders health promotion information about naasautit.ca). The Naasautit project aims as visible and vocal participants in child Inuit pregnancy, childbirth, and to make better use of existing statistics and bearing and child rearing activities. midwifery. enable Inuit regional organizations and · Ongoing development and communities to access health information. Birthing and Midwifery dissemination of midwife training Currently, almost all pregnant Inuit modules that promote culturally- Increasingly, public health agencies and women are flown out of their home appropriate Inuit birthing and organizations are turning to Inuit Elders, communities to urban centres several midwife techniques (modules have

14 Although federal funding for FASD “Isolation, teen pregnancies, housing shortages, domestic prevention, awareness, resources, and community supports in Aboriginal violence, poor nutrition, the high cost of living, persistent communities has increased over the last several years, Inuit communities receive organic pollutants in country foods, the lack of knowledge a disproportionately low portion of this funding, and identify a general lack of about available services, and the general insensitivity of Inuit-specific planning, programming, the medical system to Inuit culture are all factors that and resources available. Many note, however, that Pauktuutit has produced complicate the delivery of maternity care programs and very useful, Inuit-specific resources and delivered training workshops in services [in the North].” (Ajunnginiq Centre 2006b, 2) northern communities specific to FASD. Several years ago Pauktuutit and Inuit Tuttarvingat developed a training manual been developed in Nunavik and are in about the concentration of pollutants in for public health workers who work development in Nunavut). breast milk and the link between fetal with women at risk of giving birth to · Recruitment and training of Inuit and infant health, breastfeeding, and the children with FASD (Working Together to midwives to staff birthing centres consumption of country foods. Much Understand FASD). (Gafvels 2010). fear, misinformation, and confusion exists in Inuit communities regarding best NAHO’s Inuit Tuttarvingat (formerly Breastfeeding and Infant Nutrition practices related to breastfeeding and the the Ajunnginiq Centre) has undertaken Based on a cohort study of all births consumption of country foods. These several studies and produced reports in Canada during 1990-2000, Inuit- concerns are discussed more fully in the summarizing the main challenges inhabited areas have much higher rates Environmental Health section of this identified by Inuit communities regarding of preterm birth, stillbirth and infant report. Note, however, that organizations awareness and prevention activities, mortality compared with the rest of like ITK encourage expectant mothers to helping those affected by FASD, and Inuit- Canada and with other rural and northern continue their consumption of country specific FASD issues (e.g., Ajunnginiq areas (Luo et al. 2010). Infant mortality foods, particularly arctic char, because Centre 2003, 2006a). Issues identified rates in Nunavik and Nunavut are over of the nutritional, social, cultural, and as prominent and cutting across all the three times higher than the overall economic benefits of eating traditional regions include: Canadian rate, and Inuit infants suffer foods, and because foods like char · Lack of diagnosis. This is directly tied to disproportionately from bacterial and and caribou are known to carry lower a lack of specialists residing in or visiting viral infections (Jenkins et al. 2003; Tait contamination loads than foods like Inuit communities. 2008). Breastfeeding and good infant beluga, seal, and polar bear (Inuit Tapiriit · Lack of follow-up and coordination nutrition are important factors preventing Kanatami 2004b). following diagnosis. Communities infant mortality. Surveys have shown high require FASD co-coordinators to ensure breastfeeding rates among Inuit women; Fetal Alcohol Spectrum Disorder (FASD) long term, coordinated services are rates are particularly high in Nunavik. A FASD has been identified as a pressing provided for affected individuals and report prepared by ITK notes, however, health issue facing Inuit communities. their families. that adopted infants tend not to be breast Interviews with representatives from · Lack of services. Even if FASD is fed, and up to 30% of Inuit aged 15-24 each of the northern regions identified diagnosed, there is a severe lack of report having been adopted (Elliott FASD as one of the major issues they were services in Inuit communities to assist and Macauley 2004). The promotion of concerned about in their region. As with affected individuals and their families. breastfeeding is an ongoing priority for many public health issues discussed in · Lack of alcohol counseling and harm organizations like Pauktuutit. this report, actual incidence rates among reduction services. Prevention efforts Inuit are unknown. Anecdotal evidence aimed at pregnant women are frustrated Starting in the late 1970s, concerns were suggests, however, that the incidence by a lack of effective services and raised about environmental contamination of FASD is many times higher in Inuit programs in communities to assist and the presence of persistent organic communities than the national average women in reducing or stopping their pollutants (POPs) in the Arctic food (Ajunnginiq Centre 2006a). alcohol consumption. chain. Scientists raised particular concerns

State of the Knowledge: Inuit Public Health 2011 15 · Lack of staff and staff training. There A Note on Women and Girls knowledge of particular health issues, is a general lack of trained, long-term The Aboriginal Women and Girls’ Health Healey and Meadows argue that there public health staff in almost all Inuit Roundtable met in 2005 involving NAHO is a need to “examine the underlying communities. Community Health and Health Canada (FNIHB and the factors in communities that contribute to, Representatives and other community Bureau of Women’s Health and Gender for example, food insecurity, economic members identify the need for Analysis, BWHGA). The Roundtable insecurity, suicide, abuse and addictions” ongoing training and networking to brought together over 70 people, including (211), as these factors significantly assist them in implementing FASD- First Nations, Inuit, and Métis Elders. contribute to women’s health outcomes. related programs and services, but The Roundtable found that the main fundamentally also require more staff to concerns facing Aboriginal women and Child Health do so. girls are family and social breakdown, · Lack of staff training and services violence against Aboriginal women and This section provides an overview of for FASD-affected offenders in the girls, poverty, and a lack of accessible, child health concerns, particularly otitis Corrections system, as well as a lack holistic, and appropriate health services, media and ear health, dental health, and of diagnosis for adults suspected to be particularly in the areas of addiction, respiratory infections. Nutritional issues living with FASD. circulatory and respiratory problems, are discussed in the Food Security and diabetes, hypertension, cancer, and Nutrition section of this report. Given these challenges and concerns, the prenatal care. In addition, the Roundtable main recommendations identified in the found that there is a lack of Inuit-specific Otitis Media literature include: policies that reflect Inuit priorities in Chronic otitis media is a persistent health research, policy, and planning · Coordinated development of a national infection of the middle ear, linked to (Aboriginal Women and Girls’ Health Inuit-specific strategy to address inadequate housing, a smoke-filled Roundtable 2005). These gaps are key areas prevention, promotion and awareness, environment, poor nutrition (First of concern in women’s and girls’ health. and to help individuals affected with Nations and Inuit Health Branch FASD 1999), and possibly to prenatal exposure Overall there is a paucity of research · Increased funding for training and to environmental contaminants on Canadian Inuit women’s health capacity building at the community level (Government of Canada 2005). Inuit and a need, in particular, for research · Increased focus on counseling and have been found to have the highest accounting for the complex relationships services available to women at reported rates of chronic otitis media between determinants of health and the risk, which will require significant worldwide, with reported prevalence rates well-being of Inuit women (Healey and investments in human resources, varying from 7 to 31%, depending on the Meadows 2007). In addition to increasing funding, and training. community studied (Elliott and Macauley

16 2004). Baxter (1999) reports prevalences Early intervention is a priority, requiring dental health among Inuit requires of over 50% in certain communities over better screening, referral, and treatment an understanding of the political and certain periods. for children with ear infections. This is economic factors affecting the structure particularly challenging in remote, isolated and availability of dental services, and Chronic ear infections often result in communities without audiological sensitivity to concerns around non- hearing loss. A recent study in Nunavik specialists. insurable health benefits in the North. found that 23% of school-aged children had significant hearing loss (Ayukawa et Dental Health Respiratory Infections al. 2003), and similar statistics have been Tooth and gum disease are common in Inuit infants and children experience recorded in the other northern regions Inuit children (as well as adults). Very some of the highest rates of respiratory (Elliott and Macauley 2004). Hearing loss high rates of decayed and missing teeth infection in the world (Kovesi et al. 2007). has been linked to poor performance in are reported across the northern regions, Infections caused by respiratory syncitial school and delayed speech and language with some regions noting 95-100% virus (RSV), adenovirus, influenza A, and development, as well as to suicide in youth. prevalence (Elliott and Macauley 2004). parainfluenza virus contribute to rates Tooth decay in infants and toddlers such as a 48% incidence of hospitalization In 2005, Nunavik’s Kativik School often results from prolonged exposure to for respiratory infection among infants Board equipped most classrooms with sugar-containing drinks (including milk), less than six months of age in the Baffin acoustic soundfield systems to assist especially when the child is put to bed Region of Nunavut (Banerji et al. 2001). the learning of children with hearing with a bottle. Lack of tooth brushing and The Government of Nunavut is increasing impairments (George 2005). Others snacking on candy in older children also surveillance of RSV due to high rates are considering similar initiatives. In contributes to tooth decay. of hospitalization for bronchitis and the area of prevention, Bowd (2003, pneumonia among Inuit, particularly 7) argues that “community-based, A report prepared for ITK lists among children under the age of two culturally sensitive public health and fluoridation of community drinking (Sobol 2010). Environmental factors educational programs are the keys to water, promotion of dental hygiene and such as household crowding, poor prevention of middle ear disease and healthy eating, and adequate dental care ventilation, and exposure to tobacco hearing loss in northern communities,” as important preventive strategies (Elliott smoke may contribute to respiratory including particular focus on encouraging and Macauley 2004). Dental therapists infection in infants and children (Elliott breastfeeding and reducing exposure to have been employed in some communities and Macauley 2004; Kovesi et al. 2007), smoke. Adequate nutrition, improved as key players in the implementation while adoption, lack of breastfeeding, housing, and access to clean water are of these various community strategies. prematurity, and congenital heart disease also cited as important preventive factors. Quinonez (2003) notes that addressing have been identified as possible individual risk factors. Elliott and Macauley (2004) suggest that expansion of passive RSV immunization might be considered in order to reduce respiratory infection.

Widespread outbreaks of viral and bacterial respiratory infections among children and adults are frequently reported in the four northern regions, including tuberculosis (TB), which remains “a serious public health problem in Canada’s Inuit regions” (Elliott and Macauley 2004, 15). Please see section on tuberculosis for more details.

Communicable Diseases

Historically, Inuit did not experience high rates of communicable disease. As

State of the Knowledge: Inuit Public Health 2011 17 a result of contact with Europeans in the infections, but public health workers Other important areas of focus include: sixteenth and seventeenth centuries, Inuit know that there are Inuit currently living · Inclusion of Inuit and community- were exposed to a range of communicable in northern communities with HIV and based organizations in the development, diseases to which they had no immunity, Hepatitis C. implementation and evaluation of such as smallpox, typhoid, and influenza. STI strategies in each of the northern In the early and mid twentieth century, Widespead vaccination against Human regions epidemic rates of tuberculosis were a Papillomavirus (HPV), a central causal · Implementation of regional sexual major cause of death, and outbreaks of agent of cervical cancer, was carried out health coordinators measles and polio also occurred. The across the northern regions over the past · More resources (including Internet incidence of these diseases has been several years. Although data do not exist materials), training, and capacity greatly reduced over the past several documenting the incidence of HPV in building for communities decades, although tuberculosis and other Nunatsiavut (Turner 2010), a 1999 study · Involvement of mining companies respiratory diseases are still significant of 19 communities representing 80% in funding sexual health programs in concerns in the four northern regions. of the population of Nunavut showed mining communities Today, sexually transmitted infections are a 26% prevalence rate for oncogenic · More consistent sexual health education a pressing concern, alongside tuberculosis, HPV (Totten et al. 2010). A more recent in schools and communities meningitis, gastroenteritis and other food- surveillance initiative initially found a · More opportunities to network and borne infections. prevalence rate of 34% for HPV and 24% coordinate across community and for oncogenic HPV in a sample of 1116 regional levels (e.g., at a proposed Sexually Transmitted Infections (STIs) women, 90% of whom were Inuit (Totten northern sexual health conference) Sexually transmitted infections are a et al. 2010). A study in Nunavik found as (Pauktuutit Inuit Women of Canada growing concern in Inuit communities. much as a two-fold higher burden of HPV 2006a). Chlamydia and gonorrhea are particularly infection among women in Nunavik than prevalent; some report incidences of up in the general Canadian population, and Gastroenteritis and Other to ten times the national average in Inuit close to a three-fold higher prevalence Food-Borne Infections communities (Steenbeek et al. 2006). among women under the age of 20 Gastroenteritis is a common infectious Chlamydia infection rates have risen (Hamlin-Douglas et al. 2008). disease among Inuit infants and children, dramatically over the past decade, and although there is a lack of statistics on public health experts are concerned that Several organizations have identified Inuit incidence rates. Dehydration is one of the HIV and Hepatitis C are also on the rise, reluctance to talk about sex as a challenge main risk factors leading to gastroenteritis, although current statistics are not available in addressing sexual health issues (e.g., and it can be fatal if untreated. E.coli in this regard (Pauktuutit Inuit Women of Pauktuutit Inuit Women of Canada infection has been reported in the northern Canada 2006a). 2008). This is compounded by a lack of regions (Elliott and Macauley 2004). anonymity and confidentiality in small There are currently no AIDS/HIV service communities. As with most other health A number of food-borne illnesses are organizations in the North. People who issues discussed in this report, geography, reported in Inuit populations. Botulism, are HIV-positive must travel south to isolation, and a lack of staff limit the produced by bacteria in fermented receive care and treatment. Pauktuutit feasibility and effectiveness of sexual health meat, is potentially deadly if ingested. has been active for many years in raising campaigns and programs. Organizations There were 62 outbreaks and 132 awareness about HIV/AIDS in Inuit like Pauktuutit identify a need to involve cases of botulism reported in Nunavik communities, through AIDS walks, Elders and other community leaders in between 1971 and 1999 (Elliott and fairs, and the dissemination of resource any strategy to address sexual health issues, Macauley 2004). Cases are also reported materials. High rates of unprotected even if they may not have formal training in the other regions. Trichinellosis, a sex, teenage pregnancy, STI infection, in sexual health. parasitic infection transmitted through and the increase in travel between eating the raw meat of infected animals northern communities and the South In 2010 the Government of Nunavut (usually walrus), has also been reported. raise concerns about the vulnerability of launched a sexual health website (www. Both botulism and trichinellosis cause Inuit communities to HIV and Hepatitis irespectmyself.ca) aimed at youth to severe symptoms but can be treated C infection (Pauktuutit Inuit Women raise their awareness of safe sex, sexual successfully with medication. As Elliott of Canada 2006a). Statistics are often health and lower the incidence of sexually and Macauley (2004, 16) note, it is crucial unreliable or unavailable regarding these transmitted diseases. that adequate stores of these medications

18 be maintained in Inuit communities, as (Møller 2010). This is one of the many In 2006 the Government of Nunavut both these diseases are very uncommonly examples where national standards implemented emergency measures in seen in southern Canadian populations. of care for a particular public health response to a possible outbreak of HTLV- Promotion of safer meat fermentation concern are simply not appropriate 1 virus (a virus that can lead to leukemia, practices for botulism prevention and or effective in Inuit regions. There is lymphoma, or neurological consequences early testing of harvested walrus meat for a need for Inuit-specific and Inuit-led in 5% of infected cases). Public education Trichinella is encouraged in many regions. initiatives in this realm. With regard to and an infant ante-natal screening tuberculosis, more effective screening program were successfully implemented Tuberculosis and treatment programs are required. (Sobol 2010). Tuberculosis is “a serious public health Turner (2010) notes that tuberculosis problem in Canada’s Inuit regions” (Elliott rates are exacerbated by broader health Vaccination against various communicable and Macauley 2004, 15). In 2006, rates service issues, particularly access to diseases has been successful in many of tuberculosis were 23 times higher community-based screening, diagnosis, regions. In Nunatsiavut, a pneumococcyl among Inuit than in the total Canadian and continuing care. Although pan-Inuit vaccination program resulted in dramatic population (Inuit Tapiriit Kanatami 2008; statistics suggest extremely high levels reductions in medical evacuation of babies Tait 2008). In 2008, the rate in Nunavut of TB, some communities do not have from remote communities (Turner 2010). (184.4 per 100,000 population) was the significant rates. Studies of how these HPV immunization carried out in 2009 is highest in the country and 38 times communities keep TB infection rates low, also expected to reduce the incidence of that of the general population (Public and other protective factors, would be cervical cancer. Health Agency of Canada 2009b, 1). A immensely valuable for addressing TB in large number of adults and Elders with communities with higher rates. Inuit experienced higher rates of infection, latent infections contribute to periodic hospitalization, and mortality than the reactivation of TB, as well as crowding, Other Communicable Diseases national average during the 2009/2010 socioeconomic conditions, and difficulties A review of factors influencing Inuit infant H1N1 influenza pandemic (Sobol2010 ). in monitoring and treating TB at the health highlights that meningitis has caused Public health officials report that national community level. more infant and child deaths over the pandemic plans are inappropriate for past 20 years in Nunavik than any other remote regions and for Inuit populations. The resources provided by national type of infection (Jenkins et al. 2003, In spite of these challenges, vaccination programs to address TB are simply not 24). Meningitis outbreaks are relatively against H1N1 was quickly and effectively suitable for remote, fly-in communities, frequent across the northern regions carried out in the northern regions and nor are they culturally appropriate (Dewailly et al. 2000; Jenkins et al. 2003). is believed to have made a significant

State of the Knowledge: Inuit Public Health 2011 19 contribution to preventing further communities suffer from higher rates of the Inuvialuit and Nunavut regions. infection (Sobol 2010; Turner 2010). overcrowding, inadequate water quality, Comprehensive cancer data from the food insecurity, pre-existing chronic registry is summarized on ITK’s website, Pandemic Planning health conditions, and lower education and ITK continues to lobby for the Pandemic planning and preparedness and incomes, all of which exacerbate maintenance of an Inuit specific cancer has been a key priority for all levels of vulnerability to H1N1. Public health registry that will include data from all government, particularly in the wake officials insist that an Inuit-specific four northern regions. Currently, each of the 2003 outbreak of Severe Acute appendix to the Canadian Pandemic Plan region collects its own cancer data, but to Respiratory Syndrome (SARS) and is required in order to effectively address varying extents. Comprehensive reports “systemic deficiencies” identified in the unique issues that arise in pandemic summarizing cancer data are available Canada’s public health response to the planning in Inuit regions (Turner 2009). from the Government of the Northwest outbreak (Health Canada 2003). Low Territories (Government of the Northwest population density and geographic Both the Northwest Territories and Territories 2003) and Nunavut (Healey, dispersion make pandemic planning in any Nunavut have developed pandemic Plaza, and Osborne 2003) although Inuit- rural and remote area challenging, but the influenza plans (Government of Nunavut specific data are not available. Detailed challenges of planning for and responding 2006; Government of the Northwest statistics are not yet available for Nunavik to pandemic events in Inuit communities Territories 2005) and territorial plans and Nunatsiavut. Because Nunavut also highlight the broader issues shaping are being revised in Nunavut (Sobol has a population of approximately 85% Inuit public health outcomes, including 2010). Community-level pandemic plans Inuit (compared to 10-12% Inuit in the lack of funding, lack of access to health have been developed in most northern NWT), the data collected by Nunavut is services, jurisdictional issues, and the communities. considered to be most representative of challenges in recruiting and retaining the Inuit population as a whole, although health care workers (Turner 2010). The Cancer experts are cautious about generalizing Public Health Agency of Canada released without more study. a report in late 2009 discussing needs As with most health issues discussed in and strategies for H1N1 response in this report, there is a lack of up to date, The Circumpolar Inuit Cancer Review, rural and remote communities (Public comprehensive, long-term, Inuit-specific which included Canadian data to 2003, Health Agency of Canada 2009a). The data relating to cancer. Between 1988 found cancer rates have risen in the past report notes that remote and isolated and 1997, an Inuit Cancer Registry 30 years among both Inuit men and communities in Canada tend to be was maintained by the Government women, and that lung cancer death rates primarily Aboriginal, and that these of the Northwest Territories covering in particular are the highest in the world and rising (Circumpolar Inuit Cancer Review Working Group 2008). Aside from the impact of tobacco, levels of PCBs and other pollutants may be implicated in these rising rates (Inuit Tapiriit Kanatami 2009). Elliott and Macauley cite a cross- jurisdictional study of circumpolar Inuit from 1969-1988 in their report to ITK (2004), showing that the most frequently diagnosed cancers (in descending order) were those of the lung, colon, stomach and nasopharynx for men, and those of the cervix, lung, breast and colon for women. These incidence patterns are also noted in Nunavut’s more recent cancer report (Healey, Plaza, and Osborne 2003), where lung cancer is identified as the biggest concern in the region, accounting for almost 40% of all cancer cases (compared

20 to 19% in Canada). The high incidence of facilities), the mortality rates for those diabetes in the future is indicated by lung cancer is widely attributed to high diagnosed with cancer are much higher risk factors such as increased inactivity, rates of smoking among Inuit. Colorectal than for other populations. This is a major obesity, and infrequent access to health cancer is the second most common concern for organizations like ITK, as are care (First Nations and Inuit Health invasive cancer and the rates have risen other barriers to treatment including a Branch 2000). Researchers also suggest sharply for both men and women since fragmented health care system and lack of that a combination of high omega-3 1989 (Inuit Tapiriit Kanatami 2009). The aftercare. consumption (as found in fish and incidence of breast cancer, prostate and other country foods) and high simple endometrial cancer is lower than national Research into the links between carbohydrate consumption (particularly averages, but breast cancer remains a northern contaminants and cancer sugars) is an explosive combination concern in Nunavut, particularly as has been underway for several years. for diabetes (Dewailly et al. 2006). screening and diagnostic services are In order to identify the impact of Consuming a combination of country intermittent and often conducted outside environmental contaminants on cancer foods and high carbohydrate store-bought of communities (Inuit Tapiriit Kanatami rates, comprehensive, long term cancer foods is very common among Inuit. 2009). Nasopharyngeal cancer is 24.3 data is required, underscoring the need Results from the Inuit Health Survey times more prevalent in Nunavut than in for an Inuit cancer registry. In the carried out in 2007/2008 are anticipated Canada as a whole. The Government of interim, Inuit need timely, accurate and shortly, and should provide insight into Nunavut’s cancer report suggests a possible culturally appropriate resources to support current rates of diabetes. genetic predisposition among Inuit to education and encourage prevention nasopharyngeal cancer (Healey, Plaza, and (Inuit Tapiriit Kanatami 2009). The Government of Nunavut is hoping Osborne 2003). to head off an epidemic of diabetes Diabetes by directing federal diabetes funding Among men in Nunavut, lung cancer is towards awareness and prevention efforts. the most prevalent (43% of cases), while Diabetes is a growing concern in Inuit Diabetes is also a significant concern among women cervical cancer accounts communities but there is a shortage of for health planners and public health for 30% of all diagnoses (Healey, Plaza, reliable, comprehensive, long term data workers in Inuvialuit, Nunavik, and and Osborne 2003). These cancers are to document this issue. Diabetes is not Nunatsiavut. While researchers point to declining over time in Canada (Inuit yet highly prevalent among Inuit, but the replacement of certain traditional Tapiriit Kanatami 2009). Cervical cancer health researchers predict much higher foods by packaged, canned, and other pre- is associated with sexually transmitted rates of diabetes in the future. Their made foods as a primary cause of diabetes infections, a growing concern in Inuit predictions are based on the growing and advocate a diet comprised of more communities. Approximately 75% of rates of metabolic syndrome, a cluster of fresh, wholesome foods, others note that cervical cancer cases in Nunavut were warning signs clinicians look for in pre- choosing more healthy dietary choices is diagnosed between the ages of 20 and 39 diabetic patients, including abdominal significantly more expensive at local food (Healey, Plaza, and Osborne 2003). obesity, high triglyceride levels, and low stores, and that the provisions required HDL cholesterol levels (Chateau-Degat to secure country foods are not accessible As the Government of Nunavut’s cancer 2006). A 2004 health survey in Nunavik to all community members (Statistics report states, treatment, and often found that 12.6% of the population was Canada 2001). Efforts to address dietary diagnosis, of cancer is generally not pre-diabetic, while 4.8% had diabetes habits in Inuit communities must take undertaken in the territory itself. Most (compared to a national average of 3.1%) into account food security issues and cancer patients are treated in one of (Dewailly et al. 2007). Similarly, the factors mitigating the ability of Inuit to four out-of-territory cities: Yellowknife, 2006 Aboriginal Peoples Survey found pursue more traditional food procurement Ottawa, Winnipeg and Edmonton 4% of Inuit had been diagnosed with activities. The prevention protocols which “can present challenges because diabetes, up from 2% in 2001 (Tait 2008, outlined in the Canadian Aboriginal of the distance between local health 14). Other researchers suggest that rates Diabetes Initiative also emphasize support care providers and emotional support could be much higher in circumpolar for community-based activities that networks” (Healey, Plaza, and Osborne Inuit communities than those diagnosed promote healthy and active lifestyles. 2003, 1). Notably, because cancer is (Young et al. 1992). While diabetes often diagnosed much later in Inuit rates are still much lower among Inuit In addition to research relating to the than in southern populations (due to a than in other Aboriginal populations, four northern regions, the Aboriginal lack of local specialists and diagnostic the potential for much higher rates of Diabetes Initiative specifically targets

State of the Knowledge: Inuit Public Health 2011 21 urban Inuit populations in its prevention 70% of the adult Inuit population Available interventions to reduce and awareness programs. Tungasuvvingat smokes, while 48% of youth in Nunavut tobacco use include increasing cigarette Inuit (an Ottawa-based urban Inuit aged 12-19 report being daily smokers prices through taxation, mandatory organization) hosts a website (www. (Government of Nunavut 2004, 25). The modifications to product packaging, point- inuitdiabetes.ca) providing a range of 2006 Aboriginal Peoples Survey found of-sale regulations, bans on indoor public resources relating to type 2 diabetes. that more than 58% of Inuit adults smoke smoking, community- and school-based daily, a rate over three times that of all education campaigns, improving access to In summary, while rates are not yet as Canadian adults (Tait 2008). The rates smoking cessation programs, and litigation high as in other Aboriginal communities, differ by region, with the most likely to against tobacco companies (Elliott and diabetes is a major concern in the four smoke daily living in Nunavik (73%) and Macauley 2004). Note, too, that the northern regions, and public health the least likely (40%) living outside Inuit national smoking “Quit-Line” now has initiatives are particularly focused on Nunangat. By way of comparison, 21% Inuit language translators available. prevention and monitoring of risk factors of Canadians aged 12 and older reported in the hopes of preventing epidemic levels smoking daily or occasionally in 2008 Cardiovascular Disease in the future. (Statistics Canada 2009). Cardiovascular disease is a rising Respiratory Disease High rates of smoking, combined concern in Inuit communities. For years, with household crowding and passive researchers believed that Inuit were not smoke exposure of infants and others, ITK’s Public Health Surveillance report susceptible to cardiovascular disease, notes that 6-7% of Nunavut and Nunavik “expose the Inuit population to a high but as Bjerregaard, Young and Hegele adults reported chronic respiratory degree of risk from smoking related (2003) note, this view was based on problems in the 2001 Aboriginal Peoples illness” (Elliott and Macauley 2004, weak scientific evidence and uncertain Survey and that in the Kivalliq region 17). Efforts to address smoking among mortality statistics. The traditional marine from 1987-1996, respiratory disease Inuit are complicated by beliefs that diet eaten by older Inuit seems to protect (mostly from chronic obstructive lung smoking is a traditional cultural practice. them from cardiovascular disease, but as disease), was found to be the third Organizations like Pauktuutit and younger Inuit shift their diets away from leading cause of death overall, at a rate 2.7 ITK are working to problematize this these foods, researchers are finding a times the national average (Elliott and belief, noting that tobacco does not corresponding increase in cardiovascular Macauley 2004, 17). Smoking is a known grow in the Arctic. Culturally-sensitive, disease (Dewailly et al. 2001). It is risk factor for respiratory disease, and grassroots, community-based strategies are believed that the high levels of omega-3 cigarette smoking rates are very high in particularly critical in efforts to address fatty acids found in marine foods assist in the four northern regions. Approximately tobacco use. regulating HDL cholesterol levels and thus

22 contribute to low levels of heart disease in accidental poisoning, accidental falls, and are lacking, but there is evidence to suggest older Inuit. fire as leading causes of unintentional that suicide rates in Inuit communities injury, often linked to the consumption are higher than overall Aboriginal rates TheQanuippitaa? health survey in of alcohol. Drowning is a particularly (Government of Canada 2001, 7) and are Nunavik collected information on important concern for Inuit, as nearly 11 times higher than national averages. cardiovascular disease, including the all communities are located along the Among young men the rates are even more monitoring of blood cholesterol and coast. The effect of climate change on alarming. (Please refer to the discussion of glucose levels. Preliminary findings suggest ice conditions has rendered sea ice suicide in the Mental Health and Wellness doubled rates of hypertension among Inuit travel particularly dangerous in recent section of the report). in Nunavik (Picard 2009). Similar data years (Inuit Tapiriit Kanatami, Nasivvik was collected during the 2007/2008 Inuit Centre for Inuit Health and Changing Pauktuutit and ITK have partnered in Health Survey and preliminary results are Environments, and Ajunnginiq Centre the development of an Inuit-specific expected soon. 2005). More specific comments on Injury Prevention Framework which the prevention of unintentional injury recommends the implementation of Factors such as increased obesity, a shift to include: public education initiatives addressing a more sedentary lifestyle, and increased binge drinking, helmet use, and vehicle · Effective prevention requires an consumption of processed foods suggest and water safety (Inuit Tapiriit Kanatami understanding of injury prevention that cardiovascular health will become a 2004c). TheFramework also recommends concepts and a holistic, coordinated more important public health issue in the the development of injury surveillance plan. Community-based surveillance years to come. programs to provide more detailed, and meaningful, relevant data are Inuit-specific injury data. These initiatives crucial. must be culturally-sensitive and take into Injury · A prevention strategy and community- account the fact that prevention requires based action plan also requires a coordinated, systematic, and culturally- Injury is a leading cause of death among information about who is being injured, sensitive approach. Inuit but there is a relative shortage of when, under what conditions, where, research investigating this pressing public and why. Abuse health concern. While some focus their · Education is the foundation of Abuse and family violence are priority public health planning on preventing prevention, but education alone issues for Pauktuutit. Although physical injuries and accidents (sometimes is ineffective without regulations, comprehensive data is unavailable (owing, alcohol-related), organizations like equipment, and concrete interventions in part, to the reluctance of victims to Pauktuutit focus on preventing abuse and (e.g., drunk driving laws, random report violence), Nunavut’s reported battering. Suicide is sometimes included breathalyzer tests, seatbelts, designated violent crime rate was eight times the in injury data, although many choose to driver strategies, etc.) (Korhonen 2004c). address suicide as a mental health issue Canadian average in 2004, and the use of shelters for abused women grew by rather than an injury issue. Suicide, homicide, assault, and 54% between 2001 and 2004, a dramatic family violence are the leading forms increase (Pauktuutit Inuit Women As with many other public health issues, of intentional injury in Aboriginal of Canada 2006c). The rates declined there is a shortage of Inuit-specific data populations. Again, Inuit-specific statistics on injury (Government of Canada 2001). Available studies consider injury among all Aboriginal populations a “I think the intergenerational impact is the main one. major knowledge gap faced by public health agencies aiming to address injury When the [new] system of government came, changes in Inuit communities. Current estimates suggest that unintentional injuries among were made [in how Inuit live and govern themselves]. Inuit are 4-5 times the national average in Nunavut, and 6 times the national A lot of our people are still living in that place where they average in Nunavik (Korhonen 2004c). Pan-Aboriginal injury studies identify had to obey; they had to listen to what was being brought motor vehicle accidents, drowning, to them.” (Inuk counselor/healer, cited in Pauktuutit Inuit Women of Canada 2006c, 4)

State of the Knowledge: Inuit Public Health 2011 23 slightly in 2005 and 2006, but 2007 and Between 2006 and 2008 Pauktuutit of abuse 2008 data show slight increases in violent designed and piloted a national mobile · Invest in training and capacity crime, and the violent crime rate remains training module for frontline workers development eight times higher than the Canadian who work in the 14 women’s safe shelters · Sustain front-line workers and average (Nunavut Statistics Bureau 2008; that serve the 53 Inuit communities across community services Statistics Canada 2007). Sexual abuse is Canada (Pauktuutit Inuit Women of · Deliver services that heal Inuit also a significant concern in the North, Canada 2010). · Expand programs that build on Inuit where appropriate services are lacking strengths and prevent abuse (Pauktuutit and available staff are overburdened and Inuit describe the high rates of abuse Inuit Women of Canada 2006c). often overwhelmed (Pauktuutit Inuit and violence in their communities as an Women of Canada 2003). In 2004 the intergenerational issue, rooted in shame, Specific concerns related to sexual abuse rate of reported sexual assault in Nunavut guilt, and fear, and stemming from the include: was almost 13 times that of Canada as massive changes experienced by Inuit · Lack of Inuit content in programs a whole – 941 reported sexual assaults over the past several decades, including · Lack of training specific to Inuit child per 100,000 people, compared to 74 residential schooling. They insist on sexual abuse for Canada (Pauktuutit Inuit Women the need for community solutions to · Need for ongoing support and of Canada 2006d, 17). Rates in 2007 abuse and active intervention to prevent networking for caregivers decreased slightly to 669 reported assaults victims from repeating the cycle of abuse. · Need for additional staff and reduced per 100,000 people but this still represents Note that an Inuit-specific residential workloads (Pauktuutit Inuit Women of an alarmingly high rate, especially when school healing strategy was developed Canada 2003). compared to national averages that year of by Pauktuutit (2007b) (see Pauktuutit’s 65 per 100,000 (Statistics Canada 2007, 2). website for information on the A lack of meaningful and sustained Sivumuapallianiq project). government funding and commitment Since 2003, Pauktuutit has been working to all abuse issues is a major concern to improve the coordination of abuse In its National Strategy to Prevent for Pauktuutit. Notably, Pauktuutit prevention services and resources in Abuse in Inuit Communities, Pauktuutit incorporates principles derived from Inuit communities, in part through the identifies the following priorities: Inuit Qaujimajanngit (Inuit knowledge maintenance of a database listing over · Make abuse in Inuit communities a and values) in its abuse advocacy, 400 programs and services available in priority issue programming, and analyses. communities across the northern regions. · Raise awareness and reduce tolerance

24 Mental Health and Wellness of suicide and the links between suicide · Nunavut – 120 per 100,000 population and family history, early childhood · Inuvialuit – 61 per 100,000 population According to ITK, mental wellness experiences, mental health, education, is the highest priority health issue employment, substance use, and the There are a variety of suicide-prevention for Inuit. Difficulties with mental availability and accessibility of health care projects and initiatives underway across health stem from factors such as services. A backgrounder on Inuit suicide the four regions and these are surveyed in loss of culture, lack of recognition, released in 2009 also cites high poverty several good reports (Ajunnginiq Centre poverty, housing issues, violence, abuse, rates, housing problems, lack of education, 2006c; Inungni Sapujjijiit: Task Force addictions, and intergenerational trauma lack of employment, intergenerational on Suicide Prevention and Community related to residential schooling and trauma, loss of cultural values and lifestyle, Healing 2003; National Inuit Youth institutionalization for tuberculosis. Youth and the effect of suicide “clusters” as Council, Inuit Tapiriit Kanatami, and suicide is a particular concern for Inuit contributing factors (National Inuit Ajunnginiq Centre 2005; National Inuit and several programs and strategies have Youth Council et al. 2009). Korhonen Youth Council et al. 2009; Stevenson been developed in recent years to address (2004c) suggests that studies aimed at and Ellsworth 2004). The National these concerns. understanding how girls and women cope Inuit Youth Council is active in suicide with stress might assist in identifying prevention, as is ITK, Inuit Tuttarvingat, Providing appropriate and timely the protective factors and appropriate and various levels of government and mental health services is a significant interventions required in terms of male health service providers. A new suicide challenge in the four northern regions. suicide. prevention strategy is being developed There is a shortage of mental health in Nunavut (Uqaqatigiiluk!/Talk about staff in small, remote communities and Based on 2001 Census data, Health It!) that will combine prevention efforts a high turnover among existing staff Canada estimates the national Inuit suicide with an intervention training program for due to burnout, isolation, and lack of rate at more than 11 times the national Nunavut’s front-line workers (Bell 2009). professional development (Zamparo average (National Inuit Youth Council et al. 2005). Culturally-specific mental et al. 2009). Among men aged 15-24 in In spite of these efforts, some major wellness programs are also lacking in Inuit Nunavut, the rate of suicide is reported by challenges remain. Although there is communities, although more and more Hicks (2006; 2007) to be nearly 40 times a national Inuit action plan on mental Inuit-specific and Inuit-driven mental the national average, and this rate appears wellness (Alianait), Canada does not have health initiatives are emerging. to be increasing. Hicks (2006) also reports a national suicide prevention strategy significant disparities in suicide rates (Inuit Tapiriit Kanatami et al. 2009), This report focuses specifically on suicide between regions and within regions (the and funding for the National Aboriginal and substance abuse, as these are the Qikiqtani region of Nunavut, for example, Youth Suicide Prevention Strategy is more prominent mental health concerns has significantly higher suicide rates than currently at risk. The 2004 National identified by communities. It is important the Kitikmeot and Kivalliq regions). Inuit Youth Suicide Prevention report to note, however, that a Canadian Although it is lower than that of men, the (Stevenson and Ellsworth 2004) notes Mental Health Association conference suicide rate among Inuit women is almost that there is no clear, unified vision as to identified schizophrenia as a concern in five times the Canadian average of 4.9 per what needs to be done to address suicide Inuit communities and pointed to the 100,000 (24.6 per 100,000 in Nunavut in Inuit communities, and that there is over-representation of Inuit with mental and 52.4 per 100,000 in Nunavik in 2001; little in the way of evaluation tools for health concerns in the justice system see Pauktuutit Inuit Women of Canada suicide prevention and wellness programs. (Korhonen 2004b). 2007a). Culturally-specific risk factors and models of suicide prevention need to be Suicide A backgrounder on Inuit suicide prepared identified and implemented, and greater Suicide is a major concern in all Inuit by Pauktuutit Inuit Women of Canada collaboration between mental health and communities, particularly among (2007a, 3) reports the following suicide suicide prevention service providers is youth and particularly male youth. The rates for the period 1999 to 2003: needed. The Ajunnginiq Centre released a report on traditional Inuit knowledge higher prevalence of suicide among · Canada – 12 per 100,000 population and practices that encourage resilience young men is not well understood and · Nunavik – 181 per 100,000 population and coping (Ajunnginiq Centre 2006c), several informants suggest that this is an · Nunatsiavut – 239 per 100,000 considering how these practices might important area of future research. Hicks population (2007) emphasizes the social determinants bear upon suicide prevention efforts.

State of the Knowledge: Inuit Public Health 2011 25 This kind of initiative is a direct response An Inuit-specific, comprehensive, many communities experience crisis and to community interest in developing territory-wide follow-back study grief on a regular basis. The long term, culturally-specific, locally driven responses (Qaujivallianiq inuusirijauvalauqtunik) is intergenerational effects of residential to suicide. currently underway in Nunavut. The study schooling and other traumas also will involve the collection and analysis contribute to substance misuse. TheNational Inuit Youth Suicide of 300 Inuit life stories, including 100 Prevention Framework identifies people who have never attempted suicide, The substances most often used are challenges in securing long term 100 who have, and 100 who completed alcohol and marijuana. Marijuana is often funding, training, and support for suicide. The purpose is to better identify cheaper and easier to acquire than alcohol, suicide prevention initiatives, noting risk factors and assist in developing more particularly in ‘dry’ communities (Dolan that such initiatives need not specifically effective prevention approaches (National 2007). Street drugs like cocaine and heroin address suicide in order to contribute to Inuit Youth Council et al. 2009). are reported in Iqaluit and in some mining wellness in communities (e.g., economic communities. Solvent abuse is endemic in development, spiritual renewal, anti- Substance Use some regions, while in others it tends to colonial initiatives, and so on) (Stevenson It is important to note that not all come and go. and Ellsworth 2004). They advocate for a substance use is related to mental health central database or network to coordinate concerns, and that not all use of substances Inuit communities and regional programs and research, but at the same is “abuse.” This section discusses the use governments have identified alcohol time stress community ownership and and abuse of a range of substances. abuse as a priority problem (Korhonen empowerment to heal their own problems. 2004a). Inuit tend to drink less overall Increased education about healthy There are many factors influencing than the national average, but drinking lifestyles and romantic relationships is substance use among Inuit. Inadequate tends to occur in binge events. Korhonen identified as a priority, and the effects of housing and overcrowding is the norm notes that “binge drinking… is a major intergenerational trauma are highlighted. in most communities: Inuit are nearly factor in violence, accidents and injury, Overall, contributors to the Prevention eight times more likely to live in crowded employment and family problems, [and] Framework stress that young people need homes (Inuit Tapiriit Kanatami 2008). unwanted sexual contacts” (ii). There is a people to talk to about their feelings, and Unemployment rates are high, and shortage of alcohol-related information require a sense of hope and viable social, Inuit are struggling with rapid cultural, available to communities, however, as well cultural, and economic futures in their economic, social, and environmental as a severe lack of effective and appropriate communities. This requires efforts on change (Dolan 2007). High suicide treatments and services at the community multiple fronts. rates and loss of community members level (Ajunnginiq Centre 2006a). to injuries and accidents mean that

26 Many people succeed in moderating or Environmental Health agencies like Nunavik’s Regional stopping their drinking altogether without Board of Health and Social Services outside help; others require more help. Environmental health concerns in the four aim to clarify some of this confusion Alcohol counseling is generally done northern regions range from concerns and provide clear, accurate guidelines by Community Health Representatives over contaminants in the water, soil, regarding country foods. (CHRs), wellness workers, or addictions and country foods (due to air and water · The benefits of eating country foods workers. There are numerous challenges, pollution, contaminated DEW line sites, still outweigh the risks, particularly however, in recruitment, training, and other vectors of contamination), when the cultural, economic, and and retention, as well as in building concerns about the impact of climate nutritional value of traditional foods capacity among Inuit to fill these jobs. change on the health and well-being is factored in. Arctic char and caribou These challenges vary by region and by of northern communities, and toxins carry the lowest levels of contaminants, community. The Northwest Territories in the homes and workplaces of Inuit. and pregnant and lactating women are reports a severe lack of capacity and Environmental contamination and climate actively encouraged to consume these knowledge in Inuit regions regarding change are discussed in this report. foods. Foods like beluga, seal, and polar addiction and a shortage of skilled bear, because of their higher fat content, addictions workers (Government of the Environmental Contamination may pose health risks if consumed in Northwest Territories 2002). While there has been substantial research excess, but Inuit are still encouraged into the prevalence of toxins in northern to consume these foods in moderation Cigarettes are the most commonly environments, there is still little evidence (Inuit Tapiriit Kanatami 2004b). used drug in the northern regions; linking exposure to contaminants in approximately 70% of the adult Inuit the food chain with adverse health Climate Change population smokes, while 48% of youth outcomes in Inuit. Nevertheless, Climate change is a growing concern in Nunavut aged 12-19 report being daily environmental contamination remains a throughout Canada, but particularly in the smokers (Government of Nunavut 2004, priority concern for Inuit public health. Arctic regions where the effects of climate 25). (Please see the section on Respiratory Numerous government and academic change are more visible and the impact of Diseases for fuller discussion of the impact studies into contaminants have been climate change on Inuit communities is of smoking on Inuit health). undertaken (largely through the Northern potentially severe. Inuit leaders emphasize Contaminants Program or NCP), and a that climate change represents a significant Disability comprehensive overview of this literature and urgent threat to Inuit health, including is beyond the scope of this report. In There is a lack of comprehensive data general terms, however, the following can related to disability issues in Inuit be stated with some confidence: “The role of hunting, communities, but disability has been · Inuit show elevated levels of numerous fishing and the traditional identified as a concern by organizations environmental contaminants, including like ITK. Hearing loss is a significant mercury, PCBs, and organochlorides. concern, as are disabilities resulting from foods and food-gathering The secondCanadian Arctic accidents and injury, and disabilities Contaminants Report noted that “79% related to FASD. An article in a disabilities practices goes far beyond of mothers from Nunavik and 68% of journal states that there are approximately those from the Baffin region had higher nutrition and is intimately 5,000 people living with disabilities mercury blood levels than those known throughout the eastern and central Arctic, to be safe for the fetus and breastfeeding tied up with Inuit and that the disability rate in the north infant” (Elliott and Macauley 2004, 24). is thought to be twice that of the rest · A great deal of confusion, spirituality and identity as of Canada at 30% (Shain 1998). More misinformation, and fear exists around research is required to understand the environmental contamination and a people; thus the pollution kinds of disabilities most prevalent among higher toxicity levels in Inuit. Much of Inuit and the challenges experienced by the concern relates to the consumption of the arctic ecosystem is of Inuit with disabilities, and more accurate of country foods (Furgal, Powell, and statistics are needed to document the Myers 2005). Recent public health great concern” number of Inuit reporting disabilities. information and interventions by (Elliott and Macauley 2004, 24)

State of the Knowledge: Inuit Public Health 2011 27 not only physical health, but also their In addition to identifying and attempting but also contribute to community cultural, spiritual, and economic well-being to predict the health impacts of climate resilience in the face of other stresses. (Inuit Circumpolar Commission 2009). change, researchers and policy-makers are Relatively straightforward solutions such Already, Inuit are noticing changes to increasingly interested in coping strategies as establishing community freezers to their environment that impact on health and community capacity for adaptation ensure the safe preservation of country and safety (Government of Nunavut to changing environmental conditions foods are also suggested (Furgal and 2003; Inuit Tapiriit Kanatami, Nasivvik (Ford et al. 2010; Government of Nunavut Seguin 2006, 1968). Broader policy- Centre for Inuit Health and Changing 2003; Lemmen et al. 2008). The ability to supported interventions identified Environments, and Ajunnginiq Centre adapt and respond varies by individual, by Ford et al. (2010) include support 2005). Increasingly, researchers are drawing community and region, but several factors for the teaching and transmission of on Inuit knowledge to identify evidence of are identified by researchers as important environmental knowledge and land skills, climate change and better understand the considerations (see especially Furgal and enhancement of emergency management factors that enhance or inhibit the ability Seguin 2006): capacity, protection of infrastructure, and of Inuit to adapt to rapid environmental economic support to facilitate adaptation · The ability to overcome changes in change (e.g., Ford et al. 2008; Furgal, among more vulnerable groups. access to or availability of country food Martin, and Gosselin 2002; Furgal and resources is significantly related to Seguin 2006; Laidler 2006). Inuit leaders also emphasize the access to economic and technological importance of working to prevent further resources (e.g., as the snow travel season The Nasivvik Centre for Inuit Health and climatic change through reductions shortens, the use of all terrain vehicles Changing Environments (based at Laval in greenhouse gas emissions (Inuit (AT Vs) to access hunting grounds will University) is actively researching the links Circumpolar Commission 2009; Watt- increase). between Inuit health and climate change. Cloutier 2009). As with any health · The generation and sharing of local Changes such as increased temperature concern facing Inuit communities, the and traditional knowledge of regional fluctuations, extreme weather events, importance of involving Inuit in research, environments assists in adapting to new and uncharacteristic weather patterns policy, planning, education, and other navigational and hunting conditions. have been linked to injury, psychological initiatives cannot be overstated. · Institutional or other formal support for stress, and even death (due, for example, the pursuit of traditional activities may to travel and hunting in areas with assist in ensuring that local knowledge Food Security and Nutrition increasingly unpredictable ice and storm is maintained and local environmental conditions). Increased UVB exposure changes are monitored. Food security is identified as a significant is linked to higher risks of skin cancers, · Communities with strong public health concern in many regions, as is child and burns, infectious disease, cataracts, and infrastructures (e.g., water treatment adult nutrition. A food security study in immunosuppression (Furgal, Martin, facilities), or with access to resources Nunavut found that half of those surveyed and Gosselin 2002). Researchers also to strengthen these basic services, are reported there was not enough to eat in note challenges related to northern expected to be better equipped to the house in the previous month (Lawn home design: the lack of ventilation respond to new water-borne diseases and Harvey 2001). Recent results of the in homes causes heat stress among the and other infectious disease increases. Nunavut Inuit Child Health Survey elderly on warm days (Furgal and Seguin · Existing health status of Inuit is reported nearly 70% of Inuit preschoolers 2006). Decreased access to country expected to be exacerbated by changes were found to reside in households rated foods, decreased ability to build igloos, in local climate. Environmental change as “food insecure” (Egeland et al. 2010). higher incidences of diarrheal and other is expected to compound difficulties in Boult (2004) suggests that low income, infectious diseases, emergence of new addressing basic health needs, economic changing dietary habits, high cost of diseases, instability of physical structures vulnerability, and rapid social and food, lack of awareness of healthy eating built on permafrost, flooding, and cultural change. habits, and a number of other factors have psychosocial disruption are all considered combined to ensure hunger and poor potential health impacts due to climate Researchers emphasize the importance nutrition continue to impact many Inuit change (Furgal and Seguin 2006). Some of developing coping and adaptation families. communities might even be forced to strategies as soon as possible, noting relocate if rising sea levels flood existing that such strategies not only reduce The Nasivvik Centre for Inuit Health communities. vulnerability to climate-related changes, and Changing Environments published

28 an Inuit Food Guide for Nunavik and populations were Ottawa/Gatineau, to be younger and more skilled, and to Nunatsiavut, outlining healthy food 725; Yellowknife, 640; Edmonton, 590; leave communities to seek employment, choices for Inuit and providing recipes Montréal, 570; and Winnipeg, 355. education, and services that are and nutritional information (Gagné and Toronto (315), St. John’s (280) and unavailable in their home communities. Blanchet 2006). Nutritional deficiency Vancouver (210) also have significant Inuit This can impact upon capacity within is a concern across the Inuit population populations. Inuit public health experts northern communities, insofar as there but particularly for children and pregnant suggest that these numbers are low, and are fewer skilled adults available to occupy and lactating women. Governments and that significantly larger populations of key positions, provide child and Elder health agencies are actively encouraging Inuit reside in southern cities. care, and provide overall leadership in the consumption of country foods among the community. Ensuring that northern Inuit, as current research suggests that the Many of the public health concerns communities offer adequate programs, nutritional value of these foods outweighs identified in the northern regions are services, and opportunities not only the risks of consuming contaminants also concerns in the urban South, but directly affects individual public health (Inuit Tapiriit Kanatami and Government organizations like Tungasuvvingat Inuit, outcomes then, but also indirectly affects of Nunavik 2003). an Inuit service agency based in Ottawa, public health in that it enables Inuit who pay particular attention to diabetes, want to remain in the North to do so, and Urban Inuit mental health and counseling services, to contribute to community well-being. addictions, HIV and other STIs, and child In general, there is a dearth of research The population of Inuit living in urban and family health. Agencies supporting into the specific health needs of urban centres is growing. According to the urban Inuit communities also aim to Inuit. Although not a specifically health- 2006 Census, approximately 11,000 Inuit provide employment and education related study, the Environics Institute live outside of the four northern Inuit services, youth programming, nutrition recently released an Urban Aboriginal land claim settlement regions (8,400 of and Head Start programs, and other Peoples Survey, involving 2,614 Aboriginal which live in cities), and there has been initiatives that help maintain an Inuit peoples living in Vancouver, Edmonton, a 60% increase in the population of Inuit support network. Calgary, Regina, Saskatoon, Winnipeg, living in urban centres outside of Inuit Thunder Bay, Toronto, Montreal, Halifax, Nunangat since 1996 (Statistics Canada It is also worth noting the impact of urban and Ottawa (see www.uaps.ca). 2008). In 2006, the urban centres outside migration upon northern communities. Inuit Nunangat with the largest Inuit Although not well-studied, migrants tend

State of the Knowledge: Inuit Public Health 2011 29 Summary: in the identification of the following years, leading to increased incidences of Trends, Needs, and Gaps emerging health trends: drowning), and future impacts are not well understood. · Diabetes is a rising concern in Inuit · Socioeconomic problems such as Public health programming, policy- communities. Emerging research and poverty, unemployment, violence, making, resource development, and anecdotal evidence suggest that Inuit substance abuse, neglect, and service delivery in the four northern are highly vulnerable to a significant overcrowding impact significantly upon regions are beset by challenges. There increase in diabetes incidence rates in the health and well-being of Inuit. are ‘gaps’ everywhere: a lack of Inuit- the coming years. Public health planners, policy-makers, specific data, lack of staff and resources, · As Inuit shift away from a more and service providers in all regions note lack of funding to address emerging traditional diet, become more sedentary, the importance of taking these broad health concerns, and lack of coordination and obesity rates increase, cardiovascular factors into account and approaching across the multiple jurisdictional levels disease is also expected to become an Inuit health from a holistic, in each region. In many cases, the scope increasing public health concern. community-based perspective. Research and nuances of various public health · Sexually transmitted infection rates are and policy addressing Inuit public issues are not well understood. In large high and rising in Inuit communities. health issues from a social determinants part this is due to a lack of data and Chlamydia and gonorrhea are already perspective is needed. comprehensive surveillance systems, but highly prevalent, but public health · Inuit knowledge and values are it is also attributable to a severe shortage experts are increasingly concerned increasingly being incorporated of qualified, long term public health staff about the vulnerability of Inuit into public health planning and available to analyze data, network and communities to HIV and Hepatitis C programming, although there is still coordinate services, engage in professional infection. much to be done in this regard. development, and implement much · Youth suicide is a major concern in all · Inuit are increasingly controlling needed health services and initiatives. Inuit regions. research agendas in their regions. · Inuit are increasingly noting the effects There is a need, however, to develop a In spite of these challenges, there are of climate change on their environment. comprehensive discussion document a number of very knowledgeable and Climate change is already contributing outlining an Inuit-specific set of committed people working in each of the negatively to Inuit health (e.g., sea ice research guiding principles in order northern regions who were instrumental has become less predictable in recent to ensure that research is culturally

30 and community appropriate. Inuit · The need for increased capacity at all · Inuit concerns and needs tend not to Tuttarvingat at NAHO (formerly the levels is also a pressing concern in every be addressed by federal, provincial, or Ajunnginiq Centre), Inuit Tapiriit region. It takes generations to build territorial public health planning or by Kanatami, and the Nunavut Research capacity among Inuit in the area of initiatives aimed at a general Aboriginal Institute have produced guides, fact public health and a holistic strategy to population. It is crucial that the sheets, and reports that are very helpful encourage more Inuit to consider public distinct cultural, historical, geographic, in this regard (e.g., Inuit Tapiriit health careers is needed. environmental, and socioeconomic Kanatami and Nunavut Research · Although more data and research factors impacting Inuit health be Institute 2006; see also fact sheets are required to understand the accounted for and incorporated into all prepared by Nipingit, the National Inuit public health concerns facing Inuit public health activities. Committee on Ethics and Research, at communities, it is also important that · There is a need for research www.naho.ca/inuit/e/ethics). action be taken to address identified documenting public health successes problems and that program evaluation and protective factors that promote A number of gaps have also been and promising practices be circulated health and well-being in Inuit identified throughout the development of more widely between regions, public communities. this report: health organizations, agencies, and individual workers. While the gaps and shortages are · Every public health issue discussed · No single public health issue facing significant, public health experts identify in this report would benefit from Inuit can be addressed in isolation. the following broad goals as potentially comprehensive, long term, Inuit-specific Holistic, culturally-sensitive initiatives significant contributions to improving the health data. There is a related need to that involve Elders, youth, and other overall health and well-being of Inuit: compile and coordinate existing data community leaders at the community into a comprehensive, centralized · Set specific, national goals for Inuit level are essential to address complex, database. health outcomes, with associated targets often inter-generational public health · This lack of reliable data frustrates and measurable indicators, and commit problems. There is a related need to efforts to secure funding to address sufficient long-term funding to support increase research examining Inuit health emerging health concerns at the these goals. from a social determinants perspective. community level. In many cases, · Develop Inuit-specific health indicators · National pandemic plans are communities are aware of pressing needs that account for the importance of inappropriate for remote, fly-in but are unable to implement much culture in health outcomes. communities with low capacity to react needed services and programs because · Ensure that Inuit have access to to crises. The northern regions are they cannot produce the statistical appropriate and timely health services, vulnerable to pandemics in this regard, evidence required by funding agencies. including screening, diagnostic, although planning for and responding · Health data analysts are needed in treatment, and long-term care services. to the H1N1 influenza pandemic in every region to assist in the analysis · Interventions aimed at specific health 2009/2010 are expected to improve and dissemination of available health issues are ultimately ineffective pandemic planning processes currently information. if the underlying social, cultural, underway. · Informants in every region stressed and economic determinants of · Although there are knowledge gaps the importance of networking, health are not addressed. In this in relation to all of the public health coordination, and cooperation across regard, meaningful commitments issues discussed in this report, gaps jurisdictional levels and even within to address housing, employment, are particularly glaring in terms of government departments or agencies. A and intergenerational trauma are as injury, disability, obesity, literacy as mechanism for this kind of interaction significant a contribution to health a determinant of health, informal is needed. outcomes as improvements in health caregiving and caretaking, and the · Similarly, coordination of health service provision. particular health concerns relating to services is important to ensure that urban Inuit. federal, provincial and territorial, · There is a need for an Inuit definition regional, and other organizational of health and wellness that would guide services are integrated, accessible, and public health service provision, policy, effective. surveillance, and resource development.

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State of the Knowledge: Inuit Public Health 2011 37

Appendices

Appendix A

Inuit Nunangat

Appendix B

Overview of National Inuit Organizations

Appendix C

Public Health Surveillance in the Four Northern Regions

Appendix C1 Public Health Surveillance in Northwest Territories/Inuvialuit

Appendix C2 Public Health Surveillance in Nunavut

Appendix C3 Public Health Surveillance in Nunavik

Appendix C4 Public Health Surveillance in Labrador/ Nunatsiavut

39 Appendix A: Inuit Nunangat

Inuvialuit Nunavut Nunavik Nunatsiavut

Yukon

Northwest Territories Newfoundland and Labrador

Quebec CANADA

Source: Inuit Tapiritt Kanatami, Inuit Regions of Canada, www.itk.ca/publications/maps-inuit-nunaat-inuit-regions-canada

40 Appendix B: Overview of National Inuit Organizations

There are three national Inuit Inuit Tuttarvingat (formerly the Pauktuutit: Inuit Women of Canada organizations engaged in advocacy, Ajunnginiq Centre), National Aboriginal Suite 400, 56 Sparks Street research, consultation, information Health Organization Ottawa, ON, K1P 5A9 dissemination, and program delivery in the 220 Laurier Avenue West, Suite 1200 www.pauktuutit.ca four northern regions. Each organization Ottawa, ON, K1P 5Z9 has a different mandate and set of priorities www.naho.ca/inuit Pauktuutit represents Inuit women at the relating to Inuit public health. national level. Pauktuutit is primarily an Inuit Tuttarvingat is the Inuit-specific advocacy organization, but is also active Inuit Tapiriit Kanatami (ITK) centre of excellence of the National in the development of resources and 170 Laurier Avenue West, Suite 510 Aboriginal Health Organization programs that cater to the specific needs Ottawa ,ON, K1P 5V5 (NAHO). NAHO aims to improve of Inuit women and children. Since its www.itk.ca and promote the health and well-being incorporation in 1984, Pauktuutit has of Aboriginal Peoples by carrying focused in particular on the need for ITK is primarily an advocacy organization, out knowledge-based activities, such gender equality and the representation representing the interests of the Inuit of as publishing reports, facilitating of Inuit women on issues of concern to Canada at the national level since 1972. research, making presentations, holding aboriginal peoples in Canada. Pauktuutit ITK has played a key role in Inuit land conferences, and sharing information. represents the interests of Inuit women claims over the past several decades and Whereas ITK is primarily an advocacy in the development of federal policies continues to be active in a variety of organization, Inuit Tuttarvingat focuses and programs, and has been active in the policy areas, including health. Through primarily on information dissemination. areas of abuse, diabetes, early childhood its Health Committee, ITK works with Inuit Tuttarvingat emphasizes in development, economic development, various government, non-government, particular the validation and promotion of FASD, community care, injury prevention, and Aboriginal organizations towards holistic healing practices that will restore justice, teen pregnancy, tobacco reduction, meeting Inuit health needs, and has been a healthy Inuit lifestyle and improve the sexual health, and youth rights. active in initiatives relating to diabetes, health status of Inuit. It has been active Fetal Alcohol Spectrum Disorder, home in the areas of mental health, suicide care, accident prevention, nutrition, and prevention, substance abuse, midwifery, non-insured health benefits, as well as traditional health, literacy, climate change, the health aspects of climate change. ITK and food security. shares information about Inuit health care needs and priorities with a variety of health committees and jurisdictions, while working with them to develop appropriate policies and programs.

State of the Knowledge: Inuit Public Health 2011 41 Appendix C: Public Health Surveillance in the Four Northern Regions

Rather than duplicate already completed very comprehensive and useful summary sources of data relevant to Inuit public research, this appendix calls attention to a of public health surveillance programs and health compiled by ITK (Source: Elliott and Macauley, 2004). Appendix C1. Public Health Surveillance in Northwest Territories/Inuvialuit Overall Health Indicators

Health Under Active Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Issue Surveillance Surveillance Program for Program Identifier Elements Outputs Program Available Life Yes NWT Dept. of Territorial/ StatsCan Yes Age-specific Life Reported in NWT Health Expectancy Health and National mortality mortality and Expectancy Status Report, not by Social Services database, population ethnicity; Reported in Health Status Census data counts NWT PIRC Report; Data Report/PIRC linkage required for Inuit- specific life expectancy

Self- Yes NWT Dept. of Territorial Canadian Yes Self-rated Self-rated Other data sources: reported Health and Community Health Status: Health Status Aboriginal Peoples Survey health Social Services Health Survey Excellent, Health Status Very Good, Report/PIRC Good, or Fair/ Poor

Maternal Health

Health Issue Under Active Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Surveillance Surveillance Program for Program Identifier Elements Outputs Program Available Anemia in No Pregnancy

Nutrition in No Pregnancy

Smoking in Yes Canadian Territorial Canadian Yes Survey item: Estimate Inuit sample Pregnancy Community Community whether smoked of rates of likely too Health Survey Health Survey during last smoking in small for pregnancy pregnancy generalizability

Alcohol use Yes Canadian Territorial Canadian Yes Survey item: Estimate Inuit sample in pregnancy Community Community whether drank of rates of likely too Health Survey Health Survey alcohol during last alcohol use in small for pregnancy pregnancy generalizability

Drug use in No pregnancy

STIs in No Pregnancy

Ectopic Yes Canadian National CIHI/DAD No Hospital Ectopic Pregnancies Perinatal separations for pregnancy rate Surveillance ectopic pregnancy, system population counts

42 Fetal/Infant/Child Health

Health Issue Under Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Active Surveillance Program for Program Identifier Elements Outputs Surveillance Program Available Infant Yes Canadian National StatsCan No Counts of death Infant mortality Reported in PIRC, Mortality Perinatal Death less than one rate NWT Health Status Surveillance Database year of age Report Program

Prematurity Yes Canadian National StatsCan No Gestational Age Rate of Perinatal Birth and at Birth, Cause of preterm birth, Surveillance Death Death data mortality from Program Databases prematurity

SIDS Yes Canadian National StatsCan No Cause of death Rate of SIDS Perinatal Death data Surveillance Database Program

Congenital Yes Canadian National CIHI/DAD No Hospitalizations Rate of The NWT is Anomalies Perinatal for Congenital Congenital planning to (including Surveillance Anomalies Anomalies institute a territorial Fetal Alcohol Program congenital anomalies Spectrum surveillance system. Disorder)

Breastfeeding Yes NWT Territorial NWT Yes Details of Breastfeeding NWT Breastfeeding Breastfeeding Breastfeeding initiation, initiation surveys done in Surveys surveys maintenance and rates, mean 1983, 1993, and discontinuation duration of 2003 of breastfeeding breastfeeding, reasons for breastfeeding choices

Immunizations Yes Immunization Territorial HealthSuite Yes Demographic Immunization Does not include Registry forms from Information, Date coverage rates influenza community of Immunization, immunizations. and public type of Program evaluation health nurses immunization has demonstrated given undercounting. A national immunization registry has been proposed.

Infant anemia No

Oral health Yes 1996/97 Territorial Survey data Unknown Counts of Average DMF A survey of National decayed/missing/ counts by children in 18 School filled (DMF) teeth age, gender, NWT communities. of Dental ethnicity, Unknown if it will be Therapy community. repeated. Survey Effect of Water fluoridation by community.

Otitis Media/ No Hearing Loss

State of the Knowledge: Inuit Public Health 2011 43 Communicable Diseases

Health Issue Under Active Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Surveillance Surveillance Program for Program Identifier Elements Outputs Program Available Notifiable Yes Communicable Territorial Community Yes Case counts for Infection Territorial System: Diseases Disease physicians, (Health each disease, rates, trends, i-PHIS module. Registry nurses, and Care laboratory outbreak Aggregate data laboratories Number testing done, curves when sent to National [HCN]) Patient applicable Disease reporting Demographics, System (see below). date of illness onset and reporting

National National Provinces and No Counts of cases Infection rates, Provincial and Notifiable Territories of disease, trends Territorial counts of Disease demographics reportable diseases Database (age, gender) reported monthly

Sexually Yes Communicable Territorial Community Yes Counts of cases, Infection Territorial System: Transmitted Disease physicians, (HCN) contacts, and rates, trends, i-PHIS module. Infections Registry, STI nurses, and treatments, treatment Aggregate data (STI) module laboratories demographics completion sent to National rates for cases Disease Reporting and contacts System (see below).

National National Provinces and No Counts of cases Infection rates, Notifiable Territories of disease, trends Disease demographics Database

Tuberculosis Yes Communicable Territorial Community Yes Counts of TB rates, Each case reported Disease physicians, (HCN) TB cases, trends, to National Registry, TB nurses, and demographics, treatment Tuberculosis Module laboratories treatment details completion Registry (see rates below)

National TB National Provinces and Yes Counts of TB rates, Registry Territories TB cases, trends, demographics, treatment treatment details completion rates

HIV/AIDS Yes Communicable Territorial Community Yes Counts of cases HIV/AIDS Each case reported Disease physicians, (HCN) of disease, rates, trends, to the National Registry nurses, and demographics treatment HIV/AIDS registry laboratories (age, gender) completion (see below) rates

National HIV/ National Provinces and Yes Counts of cases, Rates of AIDS registry Territories demographics AIDS and HIV (including infection ethnicity), other details of illness

44 Communicable Diseases

Health Issue Under Active Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Surveillance Surveillance Program for Program Identifier Elements Outputs Program Available Invasive Yes International Circumpolar Participating Yes Counts of Infection rates, All 4 Inuit regions Bacterial Circumpolar laboratories positive serotypes, of Canada Infections Surveillance laboratory vaccine represented. (ICS) specimens, preventability. Diseases demographic Analyzed by monitored: invasive data region and S. pneumonia, ethnicity. meningococcal disease, H. influenza, Group A and B Strep.

RSV/ Yes Communicable Territorial Health Yes Counts of Infection rates Reportable only bronchiolitis Disease professionals affected in outbreaks in an outbreak Registry individuals situation

Influenza Yes FluWatch National Sentinel No Intermittent Indications Health counts of of level of professionals individuals influenza presenting with activity in the influenza-like NWT at any illness given time

Vaccine Yes Vaccine National Community No Patient identifier, Rates of associated Associated and public demographics, serious adverse Adverse Events health nurses date, vaccine adverse effects events Surveillance given, to vaccines System description of (VAAESS) adverse event

Chronic Lung Disease (smoking related)

Health Under Active Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Issue Surveillance Surveillance Program for Program Identifier Elements Outputs Program Available Burden of Yes Chronic National StatsCan No Counts of deaths Mortality and Can access Territorial chronic disease Death and hospitalizations hospitalization data, but with lung Surveillance Database, from COPD, rates for COPD limitations (see report disease Online CIHI/DAD pneumonia and pneumonia, text) trends

Tobacco Yes PIRC and Territorial/ Canadian Yes Counts of smokers Smoking rates Other data sources: Use health National community vs. non-smokers in 1996 and 2002 Drug Status health survey population sample and Alcohol Surveys, Reports (previously NWT Labour Force NPHS) Survey

Youth Yes School Territorial School Not Counts of smokers Smoking rates, Youth Smoking Survey smoking Tobacco Tobacco reported vs. non-smokers attitudes among – done in 1982, 1987, Survey Survey on in population youth 1993, 1999, 2002 sample, details of (now called School smoking history and Tobacco Survey) attitudes

State of the Knowledge: Inuit Public Health 2011 45 Cancer

Health Issue Under Name of Scope of Data Source(s) for Inuit Core Dataset Elements Main System Comments Active Surveillance Program Program Identifier Outputs Surveillance Program Available Cancer Yes NWT Territorial Health providers and Yes Patient demographics, Incidence Potential Cancer hospital pathology (HCN) method of diagnosis, and mortality exists for Registry departments, cancer site, cell type, date rates for calculating reciprocal notifications of diagnosis, patient alive each type of survival from other Canadian or dead, date of death if cancer times cancer registries applicable

Canadian National Provinces and No As above As above Cancer Territories Registry

Cancer No screening participation

Diabetes

Health Under Name of Scope of Data Source(s) for Inuit Core Dataset Main System Comments Issue Active Surveillance Program Program Identifier Elements Outputs Surveillance Program Available Diabetes Yes National Territorial/ CIHI discharge Yes Diagnosis codes, Diabetes Program will be Prevalence Diabetes National Abstract Database (HCN) demographic prevalence modified to include Surveillance (DAD), NWT Medicare information (age, rates, overall, information on co- System database (physician gender, Health by gender, and morbid conditions; (NDSS, shadow billing), Care Number, by 5-year age aggregate data Health NWT health care Community of groups; trends is passed on to Canada) registration database Residence) national system

Cardiovascular Disease and Risk Factors

Health Issue Under Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Active Surveillance Program for Program Identifier Elements Outputs Surveillance Program Available Cardiovascular Yes Cardiovascular National StatsCan No Counts of Mortality and Territorial data can Disease Disease Death deaths and hospitalization be accessed, but morbidity and Surveillance Database, hospitalizations rates for different with limitations mortality Online (Health CIHI/DAD from C.V. cardiovascular (see report text) Canada) diseases diseases, trends

Obesity Yes Canadian National/ Canadian Yes Survey items: Body mass index, Community Territorial Community height and categorized as Health Survey Health Survey weight underweight, acceptable weight or obese

Hypertension Yes Canadian National/ Canadian Yes Survey items: Rate of Underestimates (self-reported) Community Territorial Community diagnosis of self-reported true rates Health Survey Health Survey hypertension hypertension

Physical Yes Canadian National/ Canadian Yes Survey items: Activity level, activity Community Territorial Community frequency, classified Health Survey Health Survey duration and as inactive, intensity of moderately physical activity active, or active

46 Injuries

Health Issue Under Name of Scope of Data Inuit Core Dataset Main System Comments Active Surveillance Program Source(s) for Identifier Elements Outputs Surveillance Program Program Available Injury Yes National National CIHI/DAD No Injury-related Hospital Only includes Hospital Trauma hospital separation rates hospitalizations Morbidity Registry separations for for different types within NWT each province and of injuries territory

Injury Yes Injury National StatsCan No Counts of Mortality and Territorial data morbidity and Surveillance Death deaths and hospitalization can be accessed, mortality Online (Health Database, hospitalizations rates for different but with Canada) CIHI/DAD from injuries types of injuries; limitations (see trends report text)

Contributing Yes CHIRPP/ Territorial/ CHIRPP Yes Injury time Aggregate Sentinel Factors to Yellowknife National Database and place, information on surveillance: Injuries circumstances and causative factors only a fraction of details and outcomes of injuries captured different types of injuries

Occupational Yes Workers’ Territorial WCB Injury No Detailed data on Aggregate Injuries Compensation Database circumstances, type information on Board of the of injury, health outcomes of NWT and care utilization different types of Nunavut injuries, risks of different types of work

Water-related Yes Canadian Red Provincial/ Coroner’s Yes Type of injury, Aggregate Extraction of data fatalities Cross-Western Territorial Reports personal factors, frequency data from Coroner’s (drownings, Zone equipment factors, on data elements reports is done boat and environmental described by Red Cross accidents) factors volunteers

State of the Knowledge: Inuit Public Health 2011 47 Mental Health

Health Under Name of Scope of Data Source(s) Inuit Core Dataset Elements Main System Comments Issue Active Surveillance Program for Program Identifier Outputs Surveillance Program Available Mental Yes Canadian Territorial/ Canadian Yes Survey items: Questions Estimates of Inuit sample well-being Community National Community on stress levels, proportion of may be too Health Survey Health Survey sense of belonging to population small for (formerly community, contacts experiencing stress, generalizability NPHS) with mental health seeing mental professionals health professionals

Suicide No

Alcohol Yes NWT Drug Territorial NWT Drug Not Details of respondents’ Rates and patterns and Drug and Alcohol and Alcohol reported patterns and history of of use of alcohol, abuse Surveys Surveys on use of alcohol, illegal drugs and tobacco drugs and tobacco

Environmental Health

Health Issue Under Name of Scope of Data Inuit Core Dataset Main System Outputs Comments Active Surveillance Program Source(s) for Identifier Elements Surveillance Program Program Available Environmental Yes Northern National Academic Variable Variable Levels, trends of contaminants contaminants research contaminants in Program (NCP) studies environment, food supply, human tissues and fluids; effects on nutrition, human health

E. coli/ Yes NWT Water Territorial Routine No Various Water quality test Available online Coliform Quality water chemical water results for each NWT at Department counts of database quality quality tests; community, updated of Public works water supply testing bacteriological twice yearly website: www. tests for fecal maca.gov.nt.ca/ and total operations/water/ coliforms homepage.asp

Disability

Health Issue Under Name of Scope of Data Source(s) for Inuit Core Dataset Main System Comments Active Surveillance Program Program Identifier Elements Outputs Surveillance Program Available Activity Yes Canadian Territorial/ Canadian Yes Survey items: Estimates of Inuit sample limitation Community National Community Health limitations on disability rates in may be too Health Survey activity, 2-week territory small for Survey disability generalizability

Health Yes PIRC Territorial StatsCan Mortality No expectancy database, census (disability- population counts, free life census data on expectancy) activity limitation

48 Appendix C2. Public Health Surveillance in Nunavut

Overall Health Indicators

Health Under Active Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Issue Surveillance Surveillance Program for Program Identifier Elements Outputs Program Available Life Yes PIRC report Territorial/ StatsCan No Age-specific Life Contained in Nunavut Expectancy National mortality mortality and Expectancy PIRC report database, population Census data counts

Self- Yes PIRC Territorial Canadian Yes Self-rated Self-rated Other data sources: reported Community Health Status: Health Status Aboriginal Peoples health Health Survey Excellent, Very Survey Good, Good, or Fair/Poor

Maternal Health

Health Issue Under Active Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Surveillance Surveillance Program for Program Identifier Elements Outputs Program Available Anemia in No Pregnancy

Nutrition in No Pregnancy

Smoking in Yes Canadian Territorial Canadian Yes Survey item: Estimate Inuit sample likely Pregnancy Community Community whether smoked of rates of too small for Health Survey Health Survey during last smoking in generalizability pregnancy pregnancy

Alcohol use Yes Canadian Territorial Canadian Yes Survey item: Estimate in pregnancy Community Community whether drank of rates of Health Survey Health Survey alcohol during last alcohol use pregnancy in pregnancy

Drug use in No pregnancy

STIs in No Pregnancy

Ectopic Yes Canadian National CIHI/DAD No Hospital Ectopic Pregnancies Perinatal separations for pregnancy Surveillance ectopic pregnancy, rate system population counts

State of the Knowledge: Inuit Public Health 2011 49 Fetal/Infant/Child Health

Health Issue Under Active Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Surveillance Surveillance Program for Program Identifier Elements Outputs Program Available Infant Mortality Yes Canadian National StatsCan No Counts of death Infant mortality Reported in PIRC Perinatal Death less than one rate Surveillance Database year of age Program

Prematurity Yes Canadian National StatsCan No Gestational Age Rate of Perinatal Death at Birth, Cause of preterm birth, Surveillance Database Death data mortality from Program prematurity

SIDS Yes Canadian National StatsCan No Cause of death Rate of SIDS Perinatal Death data Surveillance Database Program

Congenital Yes Canadian National CIHI/DAD No Hospitalizations Rate of Anomalies Perinatal for Congenital Congenital (including Surveillance Anomalies Anomalies Fetal Alcohol Program Spectrum Disorder)

Breastfeeding No Existing data from NWT Breastfeeding surveys done in 1983 and 1993

Immunizations No

Infant anemia No

Oral health Yes 1996/1997 Territorial Survey data Unknown Counts of Average DMF A survey National decayed/missing/ counts by of children School of filled (DMF) teeth age, gender, in 18 NWT Dental Therapy ethnicity, communities. Survey community. Unknown if it Effect of water will be repeated. fluoridation by community.

Otitis Media/ No Hearing Loss

50 Communicable Diseases

Health Issue Under Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Active Surveillance Program for Program Identifier Elements Outputs Surveillance Program Available Notifiable Yes Communicable Territorial Community Yes Case counts for each Infection rates, Territorial System: Diseases Disease physicians, (HCN) disease, laboratory trends, outbreak i-PHIS module. Registry nurses, and testing done, patient curves when Aggregate data sent laboratories demographics, date applicable to National Disease of illness onset and reporting System reporting (see below).

National National Provinces No Counts of cases Infection rates, Provincial and Notifiable and of disease, trends Territorial counts of Disease Territories demographics (age, reportable diseases Database gender) reported monthly

Tuberculosis Yes TB registry Territorial Community Yes Counts of TB cases, TB rates, trends, Each case reported physicians, (HCN) demographics, treatment to National nurses, and treatment details completion rates Tuberculosis Registry laboratories

Yes National TB National Provinces Yes Counts of TB cases, TB rates, trends, Registry and demographics, treatment Territories treatment details completion rates

HIV/AIDS Yes Communicable Territorial Community Yes Counts of cases HIV/AIDS rates, Each case reported Disease physicians, (HCN) of disease, trends, treatment to the National HIV/ Registry nurses, and demographics (age, completion rates AIDS registry (see laboratories gender) below)

National HIV/ National Provinces Yes Counts of cases, Rates of AIDS AIDS registry and demographics and HIV infection Territories (including ethnicity), other details of illness

Invasive Yes International Circumpolar Participating Yes Counts of positive Infection rates, All 4 Inuit regions of Bacterial Circumpolar laboratories laboratory serotypes, Canada represented. Infections Surveillance specimens, vaccine Diseases monitored: (ICS) demographic data preventability. invasive S. pneumonia, Analyzed by meningococcal region and disease, H. influenza, ethnicity. Group A & B Strep.

RSV/ Yes Communicable Territorial Health Yes Counts of affected Infection rates in bronchiolitis Disease professionals individuals outbreaks Registry

Influenza Yes FluWatch National Sentinel No Intermittent counts Indications of Health of individuals level of influenza professionals presenting with activity in the influenza-like illness NWT at any given time

Vaccine Yes Vaccine National Community No Patient identifier, Rates of serious associated Associated and public demographics, adverse effects to adverse Adverse Events health nurses date, vaccine given, vaccines events Surveillance description of System adverse event (VAAESS)

State of the Knowledge: Inuit Public Health 2011 51 Chronic Lung Disease (smoking related)

Health Issue Under Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Active Surveillance Program for Program Identifier Elements Outputs Surveillance Program Available Burden of Yes Chronic National StatsCan No Counts of deaths Mortality and Can access chronic lung disease Death and hospitalizations hospitalization Territorial data, but disease Surveillance Database, from COPD, rates for COPD with limitations (see Online CIHI/DAD pneumonia and pneumonia, text of report) trends

Tobacco Use Yes PIRC and Territorial/ Canadian Yes Counts of smokers Smoking rates Other data sources: health National community vs. non-smokers in 1996 and 2002 Status health survey population sample Drug and Alcohol Reports (previously Surveys, NWT NPHS) Labour Force Survey

Cancer

Health Issue Under Name of Scope of Data Source(s) for Inuit Core Dataset Elements Main System Comments Active Surveillance Program Program Identifier Outputs Surveillance Program Available Cancer Yes NWT Territorial Health providers and Yes Patient demographics, Incidence Potential Cancer hospital pathology (HCN) method of diagnosis, and exists for Registry departments, reciprocal cancer site, cell type, date mortality calculating notifications from of diagnosis, patient alive rates for survival other Canadian cancer or dead, date of death if each type of times registries applicable cancer

Canadian National Provinces and No As above As above Cancer Territories Registry

Cancer No screening participation

Diabetes

Health Under Name of Scope of Data Source(s) for Inuit Core Dataset Main System Comments Issue Active Surveillance Program Program Identifier Elements Outputs Surveillance Program Available Diabetes Yes National Territorial/ CIHI discharge Abstract Yes Diagnosis codes, Diabetes Aggregate data Prevalence Diabetes National Database (DAD), NWT (HCN) demographic prevalence is passed on to Surveillance Medicare database information (age, rates, overall, national system System (physician shadow gender, Health by gender, (NDSS, Health billing), NWT health Care Number, and by 5-year Canada) care registration Community of age groups; database Residence) trends

52 Cardiovascular Disease and Risk Factors

Health Issue Under Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Active Surveillance Program for Program Identifier Elements Outputs Surveillance Program Available Cardiovascular Yes Cardiovascular National StatsCan No Counts of Mortality and Territorial Disease Disease Death deaths and hospitalization data can be morbidity and Surveillance Database, hospitalizations rates for different accessed, but mortality Online (Health CIHI/DAD from C.V. cardiovascular with limitations Canada) diseases diseases, trends (see report text)

Obesity Yes Canadian National/ Canadian Yes Survey items: Body mass index, Community Territorial Community height and categorized as Health Survey Health Survey weight underweight, acceptable weight or obese

Hypertension Yes Canadian National/ Canadian Yes Survey items: Rate of self- Underestimates (self-reported) Community Territorial Community diagnosis of reported true rates Health Survey Health Survey hypertension hypertension

Physical Yes Canadian National/ Canadian Yes Survey items: Activity level, activity Community Territorial Community frequency, classified as Health Survey Health Survey duration and inactive, moderately intensity of active, or active physical activity

Injuries

Health Issue Under Name of Scope of Data Source(s) Inuit Core Dataset Main System Outputs Comments Active Surveillance Program for Program Identifier Elements Surveillance Program Available Injury Yes National National CIHI/DAD No Injury-related Hospital separation Only includes Hospital Trauma hospital rates for different hospitalizations Morbidity Registry separations for types of injuries within Nunavut each province (would be a major and territory underestimate of total injury hospitalizations)

Injury Yes Injury National StatsCan No Counts of Mortality and Territorial data can morbidity and Surveillance Death deaths and hospitalization rates be accessed, but mortality Online (Health Database, hospitalizations for different types of with limitations Canada) CIHI/DAD from injuries injuries; trends (see report text)

Occupational Yes Workers’ Territorial WCB Injury No Detailed Aggregate Injuries Compensation Database data on information on Board of the circumstances, outcomes of different NWT and type of injury, types of injuries, Nunavut health care risks of different utilization types of work

Water-related Yes Canadian Red Provincial/ Coroner’s Yes Type of injury, Aggregate fatalities Cross-Western Territorial Reports personal frequency data (drownings, Zone factors, on data elements boat equipment described accidents) factors, and environmental factors

State of the Knowledge: Inuit Public Health 2011 53 Mental Health

Health Under Name of Scope of Data Inuit Core Dataset Elements Main System Outputs Comments Issue Active Surveillance Program Source(s) for Identifier Surveillance Program Program Available Mental Yes Canadian Territorial/ Canadian Yes Survey items: Questions Estimates of proportion Other data well-being Community National Community on stress levels, sense of of population source: Health Survey Health belonging to community, experiencing stress, Aboriginal (formerly Survey contacts with mental seeing mental health Peoples NPHS) health professionals professionals Survey

Suicide No

Alcohol Yes NWT Drug Territorial NWT Drug Not Details of respondents’ Rates and patterns of and Drug and Alcohol and Alcohol reported patterns and history of use of alcohol, drugs abuse Surveys Surveys on use of alcohol, illegal and tobacco drugs and tobacco

Environmental Health

Health Issue Under Name of Scope of Data Source(s) Inuit Core Dataset Main System Outputs Comments Active Surveillance Program for Program Identifier Elements Surveillance Program Available Environmental Yes Northern National Academic Variable Variable Levels, trends of All four contaminants contaminants research contaminants in environment, Inuit Program studies food supply, human tissues regions of (NCP) and fluids; effects on Canada nutrition, human health covered.

E. coli/ Yes Nunavut Territorial Routine No Bacteriological Water quality test results for Coliform Water Quality water quality tests for fecal each Nunavut community counts of database testing and total water supply coliforms

Disability

Health Issue Under Name of Scope of Data Source(s) for Inuit Core Dataset Main System Comments Active Surveillance Program Program Identifier Elements Outputs Surveillance Program Available Activity Yes Canadian Territorial/ Canadian Yes Survey items: Estimates of Other data limitation Community National Community Health limitations on disability rates in source: Health Survey activity, 2-week territory Aboriginal Survey disability Peoples Survey

Health Yes PIRC Territorial StatsCan Mortality No expectancy database, census (disability- population counts, free life census data on expectancy) activity limitation

54 Appendix C3. Public Health Surveillance in Nunavik

Overall Health Indicators

Health Under Active Name of Scope of Data Inuit Core Dataset Main System Comments Issue Surveillance Surveillance Program Source(s) for Identifier Elements Outputs Program Program Available Life Yes Health Portrait of Provincial MSSS No Age-specific Life Data are consistent in both Expectancy Quebec and its Mortality mortality and Expectancy reports Regions, 2001 Database population Health and What Regional Nunavik No counts Affects it has in Mortality Nunavik, 1997 Database

Self- Yes Sante Quebec Provincial/ Sante Yes Self-rated Self-rated Most recent survey, 1992. reported Regional Surveys Regional Quebec Health Status: Health Other data sources: health Nunavik Excellent, Very Status Aboriginal Peoples Survey Survey Good, Good, (APS). Note: Community or Fair/Poor Health Survey (CCHS) does not include Nunavik.

Maternal Health

Health Under Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Issue Active Surveillance Program for Program Identifier Elements Outputs Surveillance Program Available Anemia in No Special research studies only (see Hodgins, 1997). Sante Quebec Pregnancy survey has data on general population iron intake.

Nutrition in No Sante Quebec survey collects data on nutrient (e.g. folate) Pregnancy intake of general population (non-pregnant). Canadian Prenatal Nutrition Program is program-oriented and does not conduct surveillance on these indicators.

Smoking in Yes Sante Quebec Provincial/ Sante Quebec Yes Survey items: Estimate of rates Most recent survey Pregnancy Regional Regional Nunavik current smoking; of smoking in in 1992 Surveys Survey pregnancy status pregnancy

Alcohol Yes Sante Quebec Provincial/ Sante Quebec Yes Survey items: Estimate of rates use in Regional Regional Nunavik current alcohol of alcohol use in pregnancy Surveys Survey use; pregnancy pregnancy status

Drug use in No Sante Quebec Provincial/ Sante Quebec Yes Survey items: Estimate of rates pregnancy Regional Regional Nunavik current drug use; of drug use in Surveys Survey pregnancy status pregnancy (e.g. hashish; solvent inhalation)

STIs in No MADO (Notifiable Pregnancy Diseases database) does not record pregnancy status

Ectopic Yes MedEcho Provincial/ MedEcho No Hospital Ectopic Pregnancies Hospitalization Regional Hospitalization separations for pregnancy rate Surveillance Database ectopic pregnancy, (MSSS) population counts

State of the Knowledge: Inuit Public Health 2011 55 Fetal/Infant/Child Health

Health Issue Under Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Active Surveillance Program for Program Identifier Elements Outputs Surveillance Program Available Infant Yes “Our Children” Regional MSSS Mortality No Counts of death Infant Mortality Report, NRBHSS Database less than one mortality rate Health Portrait Provincial/ year of age of Quebec and Regional its Regions, 2001

Prematurity Yes “Our Children” Regional MSSS Mortality No Births <37 Rate of Report and Birth weeks; deaths preterm birth, Databases attributed to mortality from prematurity prematurity

SIDS Yes “Our Children” Regional MSSS Mortality No Cause of death Rate of SIDS Report Databases data mortality NRBHSS

Congenital Yes “Our Children” Regional MSSS: MedEcho No ICD-9 codes Prevalence Anomalies Report Hospitalization, for congenital rate of (including NRBHSS Stillbirth and anomaly congenital Fetal Alcohol Mortality hospitalizations, anomalies and Spectrum databases stillbirths and associated Disorder) infant deaths stillbirths and deaths

Breastfeeding No No surveillance: Research studies done in 1988 and 1990

Immunizations Yes “Our Children” Regional Individual Yes Percent of Special Report immunization children aged compilations of NRBHSS records (hard <3 and <2 hard copy data copy only who have were performed available) received MSSS by authors. scheduled Computerized vaccinations database planned.

Infant anemia No Research studies only (Hodgins 1997); hemoglobin routinely tested at 9 months of age, but not captured by surveillance

Oral health Yes “Our Children” Regional Belanger, R., Yes Counts of DMF counts Report Public Health decayed/missing/ by age; Department, proportion NRBHSS cavity-free

Otitis Media/ Yes Otology Regional Annual reports, Unknown Counts of Proportion of Hearing Loss and hearing otology and kindergarten kindergarten programs of hearing children with children Regional Health programs one or more with these Centres perforated ear problems drum; or failing hearing test

56 Communicable Diseases

Health Issue Under Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Active Surveillance Program for Program Identifier Elements Outputs Surveillance Program Available Notifiable Yes Communicable Regional/ Community No Case counts for Infection Diseases Disease Provincial physicians, each disease, rates, trends, (including Registry: nurses, and laboratory outbreak STIs) MADO (MSSS/ laboratories testing done, curves when INSPQ) patient applicable demographics, date of illness onset and reporting

Tuberculosis Yes Communicable Regional/ Community Yes Counts of TB rates, Each case reported to Disease Provincial physicians, (Health TB cases, trends, National Tuberculosis Registry: nurses, and Care demographics, treatment Registry MADO (MSSS/ laboratories Number) treatment completion INSPQ) details rates

AIDS Yes Programme de Provincial Community Yes Demographics AIDS Each case reported to surveillance with physicians, (age, gender, incidence/ the National HIV/AIDS du sida du regional nurses, and ethnicity), geo- registry Quebec (MSSS) breakdowns laboratories locator (3 digit postal code); risk factors

HIV Yes Laboratoire de Provincial/ LSPQ/MSSS Yes As above HIV Only reportable Sante Publique Regional incidence/ to Public Health if du Quebec donated/received blood/tissue

Invasive Yes International Circumpolar Participating Yes Counts of Infection All 4 Inuit regions of Bacterial Circumpolar laboratories positive rates, Canada represented. Infections Surveillance laboratory serotypes, Diseases monitored: (ICS) specimens, vaccine Invasive S. pneumonia, demographic preventability. meningococcal disease, data Analyzed by H. influenza, Group A region and and B Strep. MADO also ethnicity. captures these.

RSV/ No Hospitalizations could be tracked with MedEcho; Deaths are bronchiolitis captured by mortality database

Influenza Yes FluWatch National Sentinel No Intermittent Indications Health counts of of level of professionals individuals influenza presenting with activity in the influenza-like NWT at any illness given time

Vaccine Yes Vaccine National Community No Patient Rates of associated Associated and public Identifier, serious adverse Adverse Events health nurses demographics, adverse events Surveillance date, vaccine effects to System given, vaccines (VAAESS) description of adverse event

State of the Knowledge: Inuit Public Health 2011 57 Chronic Lung Disease (smoking related)

Health Under Active Name of Scope of Data Source(s) Inuit Core Dataset Main Comments Issue Surveillance Surveillance Program for Program Identifier Elements System Program Available Outputs Burden of No National (CIHI) data does not chronic give sub-provincial regional lung breakdowns. Hospitalizations can disease be captured thru MedEcho and deaths from mortality database.

Tobacco Yes Sante Quebec Regional Sante Quebec Yes Current/past Smoking Use Survey; smoking status; rates APS National APS demographics

Cancer

Health Issue Under Name of Scope of Data Source(s) for Inuit Core Dataset Elements Main Comments Active Surveillance Program Program Identifier System Surveillance Program Available Outputs Cancer Yes Nunavik Regional MedEcho No Patient demographics, Incidence Cancer (hospitalizations). method of diagnosis, and Registry Providers, reciprocal cancer site, cell type, mortality Tumor Provincial notifications from date of diagnosis, rates for Registry, MSSS other Canadian patient alive or dead, each type cancer registries date of death if of cancer applicable

Cancer Yes Cervical cancer Provincial/ Sante Quebec Yes PAP smear within Age- New program screening screening Regional survey last 2 years; specific of screening participation coverage: demographics PAP mammography Sante Quebec smear and PAP smears survey coverage for women 50-69 rates years to begin in Nunavik in September 2004

Diabetes

Health Under Name of Scope of Data Inuit Core Dataset Main System Outputs Comments Issue Active Surveillance Program Source(s) Identifier Elements Surveillance Program for Program Available Diabetes Yes Sante Regional/ Sante Yes Fasting blood Diabetes prevalence New Nunavik regional Prevalence Quebec Provincial Quebec sugar levels; rates, overall, by diabetes registry planned Nunavik Surveys demographics gender, and by 5-year for 2004/2005 (INSPQ Survey age groups; trends pilot project)

58 Cardiovascular Disease and Risk Factors

Health Issue Under Name of Scope of Data Inuit Core Dataset Main System Outputs Comments Active Surveillance Program Source(s) for Identifier Elements Surveillance Program Program Available Cardiovascular Yes Sante Quebec Regional/ Sante Yes Diagnosis and Estimates of Last Sante Disease Nunavik Survey Provincial Quebec medication use for prevalence and Quebec Nunavik morbidity and Nunavik Surveys; CVD (self-report); mortality due to Survey in 1992; mortality Mortality Mortality cause-specific CVD next planned for Database database mortality 2004/5

Obesity Yes Sante Quebec Regional/ Sante Yes Clinical Body mass index; Nunavik survey Provincial Quebec anthropometric waist to hip ratio Surveys measurements

Hypertension Yes Sante Quebec Regional/ Sante Yes BP measurement; Prevalence of clinical (self-reported) Nunavik survey Provincial Quebec diagnosis and and self-reported Surveys medication use hypertension for hypertension (self-reported)

Physical Yes Sante Quebec Regional/ Sante Yes Survey items: Activity level, activity Nunavik survey Provincial Quebec physical activity classified as inactive, Surveys both in village and moderately active, or while “on land” active

Injuries

Health Issue Under Name of Scope of Data Source(s) Inuit Core Dataset Elements Main System Comments Active Surveillance Program for Program Identifier Outputs Surveillance Program Available Injury Yes Health Portrait Provincial/ MedEcho No Injury-related Hospital Hospital of Quebec and Regional hospitalization hospital separations separation rates Morbidity its Regions, database for different MSSS types of injuries

Injury Yes Sante Quebec Regional/ Sante Quebec No Self-reported Incidence and morbidity Nunavik Provincial surveys; injuries; counts of mortality rates and mortality Survey; mortality deaths from injuries; for injuries, by Nunavik database external cause type mortality (E-codes) database

Occupational Yes Commission Provincial CSST Injury No Data on type of Incidence of Injuries de la Sante et Database injury, circumstances, occupational de la securite health care injury by type, du travail utilization, location, (CSST) Quebec demographics demographics

Water- No Could be derived related from mortality fatalities database

State of the Knowledge: Inuit Public Health 2011 59 Mental Health

Health Under Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Issue Active Surveillance Program for Program Identifier Elements Outputs Surveillance Program Available Mental Yes Sante Quebec Regional/ Sante Quebec Yes Survey items: self- Estimates of Estimates of well-being Nunavik Survey Provincial Surveys reported levels of general mental psychiatric happiness, stress well-being, disorders available psychological in research reports distress only (e.g. Kirmayer L. 1994)

Suicide Yes Mortality: Regional/ Mortality No Cause of death; Estimates of Youth suicide Nunavik Provincial database; self-reported suicide mortality attempts also Mortality Sante Quebec Yes suicide attempts; rates and suicide recorded by Database survey; Hospitalizations attempt rates; by Youth Protection Attempts: Sante MedEcho No for suicide age, gender and Services, Nunavik Quebec Survey; database attempts community MedEcho Hospitalization database

Alcohol Yes Sante Quebec Regional/ Sante Quebec Yes Self-reported Rates and patterns Use by age <15 and Drug Nunavik Survey Provincial Surveys use of alcohol, of use of alcohol not captured abuse marijuana/ and drugs, eg. hashish, solvents Proportion with and other drugs binge-drinking pattern

Environmental Health

Health Issue Under Name of Scope of Data Inuit Core Dataset Main System Outputs Comments Active Surveillance Program Source(s) Identifier Elements Surveillance Program for Program Available Environmental Yes Northern National Academic Variable Variable Levels, trends of All four Inuit regions contaminants contaminants research contaminants in of Canada covered. Program studies environment, food Sante Quebec (NCP) supply, human tissues Survey (1992) also and fluids; effects on measured exposures nutrition, human health

E. coli/ Yes KRG water Regional Routine No Bacteriological Water quality test Coliform quality water tests for fecal results for each counts of database quality and total Nunavik community water supply testing coliforms

Disability

Health Issue Under Name of Scope of Data Inuit Core Dataset Elements Main System Comments Active Surveillance Program Source(s) for Identifier Outputs Surveillance Program Program Available Activity limitation Yes Sante Regional/ Sante Yes Self-reported disabling Estimates of Other data Quebec Provincial Quebec conditions and disability rates by source: Nunavik Survey limitations on activity; age, gender Aboriginal Survey demographics Peoples Survey

Health expectancy No (disability-free life expectancy) Appendix C4. Public Health Surveillance in Labrador/Nunatsiavut

Overall Health Indicators

Health Under Name of Scope of Data Source(s) Inuit Core Dataset Elements Main System Comments Issue Active Surveillance Program for Program Identifier Outputs Surveillance Program Available Life Yes Mortality Provincial/ MSSS Mortality No Age-specific mortality Life Data are consistent Expectancy Surveillance Database and population counts Expectancy in both reports System, Nunavik NLCHI Mortality No Database

Self- Yes Labrador Regional LIRHS Yes Self-rated Health Status: Self-rated Other data sources: reported Inuit Regional Very Good, Good, Fair or Health Aboriginal Peoples health Health Survey Poor; demographics Status Survey (APS)

Maternal Health

Health Issue Under Name of Scope of Data Inuit Core Dataset Main System Comments Active Surveillance Program Source(s) for Identifier Elements Outputs Surveillance Program Program Available Anemia in No Information on prenatal Pregnancy form but not extracted for surveillance

Nutrition in No Information on prenatal Pregnancy form but not extracted for surveillance

Smoking in Yes Labrador Regional LIRHS Yes Survey items: Estimate of rates Most recent survey in Pregnancy Inuit Regional current smoking; of smoking in 1992 Health Survey pregnancy status pregnancy

Alcohol use Yes Labrador Regional LIRHS Yes Survey items: Estimate of rates in pregnancy Inuit Regional current alcohol of alcohol use in Health Survey use; pregnancy pregnancy status

Drug use in Yes Labrador Regional LIRHS Yes Survey items: Estimate of rates pregnancy Inuit Regional current drug use; of drug use in Health Survey pregnancy status pregnancy

STIs in No Pregnancy

Ectopic No Pregnancies

State of the Knowledge: Inuit Public Health 2011 61 Fetal/Infant/Child Health

Health Issue Under Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Active Surveillance Program for Program Identifier Elements Outputs Surveillance Program Available Infant Yes Mortality Regional/ MSSS No Counts of Infant mortality Mortality Surveillance Mortality death less than rate System, Database one year of age NLCHI

Prematurity No Low birth weight reported in LIHC Community Profiles

SIDS Yes Mortality Regional/ MSSS No Cause of death Rate of SIDS Surveillance Mortality data mortality System, Databases NLCHI

Congenital No Anomalies

Breastfeeding No Breastfeeding initiation on LBNF; public health keeps hard copy record at 2, 4, 6 months of age

Immunizations Yes Regional Regional Individual Yes Percent of Special compilations of Immunization immunization children aged hard copy data were Database records (hard <3 and <2 who performed by authors. copy only have received Computerized database available) MSSS scheduled planned. vaccinations

Infant anemia No

Oral health No

Otitis Media/ No Public Health follows Hearing Loss up individual cases

62 Communicable Diseases

Health Issue Under Name of Scope of Data Inuit Core Dataset Main System Comments Active Surveillance Program Source(s) for Identifier Elements Outputs Surveillance Program Program Available Notifiable Yes Communicable Regional/ Community No Case counts for Infection Computerized CDC Diseases disease control Provincial physicians, each disease, rates, trends, database maintained (including database nurses, and laboratory testing outbreak at both regional and STIs) laboratories done, patient curves when provincial levels demographics, applicable date of illness onset and reporting

Tuberculosis Yes Tuberculosis Regional/ Community Yes Counts of TB rates, Each case reported to Registry Provincial physicians, TB cases, trends, National Tuberculosis (provincial) nurses, labs demographics, treatment Registry and regional treatment details completion TB database rates

HIV/AIDS Yes Communicable Regional/ Community Yes Demographics HIV/AIDS Each case reported to Disease Provincial physicians, (age, gender, incidence/ the National HIV/AIDS Control nurses ethnicity), geo- Prevalence registry Database locator (3 digit rates postal code); risk factors

Invasive Yes International Circumpolar Participating Yes Counts of positive Infection All 4 Inuit regions of Bacterial Circumpolar laboratories laboratory rates, Canada represented. Infections Surveillance specimens, serotypes, Diseases monitored: (ICS) demographic data vaccine Invasive S. pneumonia, preventability. meningococcal Analyzed by disease, H. influenza, region and Group A and B ethnicity. Strep. Provincial/ Regional CDC system also captures these, without Inuit identifier.

RSV/ Yes Communicable Regional/ Community No Aggregate Incidence Useful for epidemic bronchiolitis Disease Provincial physicians, case counts by rates detection Control nurses community, region Database

Influenza Yes Communicable Regional/ Community No Case counts for Infection Lab-confirmed cases Disease Provincial physicians, each disease, rates, trends, of influenza notifiable Control nurses, laboratory testing outbreak individually; aggregate Database laboratories done, patient curves when reporting for demographics, applicable influenza-like-illness, date of illness for outbreak detection onset and reporting

Vaccine Yes Vaccine National Community No Patient identifier, Rates of associated Associated and public demographics, serious adverse Adverse Events health date, vaccine adverse events Surveillance nurses given, description effects to System of adverse event vaccines (VAAESS)

State of the Knowledge: Inuit Public Health 2011 63 Chronic Lung Disease (smoking related)

Health Issue Under Active Name of Surveillance Scope of Data Inuit Core Dataset Elements Main System Comments Surveillance Program Program Source(s) Identifier Outputs for Program Available Burden of Yes Labrador Inuit Regional LIRHS Yes Self-reported Prevalence Self-reported chronic lung Regional Health Survey diagnosed chronic rates data only disease diseases

Tobacco Use Yes Labrador Inuit Regional LIRHS Yes Self-reported tobacco Smoking rates Self-reported Regional Health Survey use; demographics by age and data only gender

Cancer

Health Issue Under Name of Scope of Data Source(s) Inuit Core Dataset Elements Main System Comments Active Surveillance Program for Program Identifier Outputs Surveillance Program Available Cancer Yes Tumor Provincial Providers, death No Patient demographics, Incidence Registry, certificates, labs method of diagnosis, and mortality NFLD Cancer and reciprocal cancer site, cell type, rates for each Treatment/ notifications date of diagnosis, type of cancer Research from other Can. patient alive or dead, Foundation cancer registries date of death if applicable

Cancer Yes Cytology Provincial PAP smear No Dates PAP smears Age-specific No screening Registry forms, Bliss done; results; PAP smear mammography participation NFLD Cancer Murphy Cancer demographics coverage surveillance Treatment/ Centre, St. rates, done Research Johns abnormality Foundation rates

Diabetes

Health Under Active Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Issue Surveillance Surveillance Program for Program Identifier Elements Outputs Program Available Diabetes Yes Labrador Regional LIRHS Yes Self-reported Prevalence Self-reported data only; Prevalence Inuit Regional diagnosed rates other source: APS Survey Health Survey chronic diseases

64 Cardiovascular Disease and Risk Factors

Health Issue Under Active Name of Scope of Data Source(s) Inuit Core Dataset Main System Comments Surveillance Surveillance Program for Program Identifier Elements Outputs Program Available Cardiovascular Yes Morbidity: Regional LIRHS Yes Self-reported Prevalence Self-reported Disease Labrador Inuit diagnosed rates data only; morbidity and Regional Health chronic disease hospitalization mortality Survey data could also Mortality: Provincial Death No Cause of death; Cause-specific be used, but no Mortality certificates demographics mortality Inuit identifier Surveillance System, NLCHI

Obesity Yes Labrador Inuit Regional LIRHS Yes Self-reported Prevalence Self-reported Regional Health height, weight rates data only Survey

Hypertension Yes Labrador Inuit Regional LIRHS Yes Self-reported Prevalence Self-reported (self-reported) Regional Health diagnosed rates data only Survey chronic diseases

Physical activity Yes Labrador Inuit Regional LIRHS Yes Self-reported Prevalence Self-reported Regional Health physical activity rates data only Survey

Injuries

Health Issue Under Name of Surveillance Scope of Data Inuit Core Dataset Main System Comments Active Program Program Source(s) for Identifier Elements Outputs Surveillance Program Available Injury No CHIRPP/Janeway Provincial/ CHIRPP Yes Injury time Incidence Sentinel surveillance: Hospital Child Health Centre National Database and place, and causative Only a fraction of Morbidity circumstances, factors for injuries captured; and details specific injuries only those serious enough to be transferred to St. John’s

Injury Yes Morbidity: Labrador Regional LIRHS Yes Self-reported Prevalence rates Self-reported data morbidity Inuit Regional diagnosed only; hospitalization and mortality Health Survey chronic diseases data could also be Mortality: Mortality Provincial Death No Cause of death; Cause-specific used, but no Inuit Surveillance System, certificates demographics mortality identifier. LIHC also NLCHI keeps database of intentional injuries

Occupational Yes Work Injuries Provincial WHSCC No Data on type Incidence of Injuries Database, forms of injury, occupational Occupational Health completed circumstances, injury by type, and Safety Division, by health care location, Provincial Dept. of workplace utilization, demographics Employment and at time of demographics Labour injury

Water- No Could be derived related from mortality fatalities database

State of the Knowledge: Inuit Public Health 2011 65 Mental Health

Health Under Active Name of Surveillance Scope of Data Source(s) Inuit Core Dataset Elements Main System Comments Issue Surveillance Program Program for Program Identifier Outputs Available Mental Yes Labrador Inuit Regional LIRHS Yes Self-reported health, Estimates Self-reported well- Regional Health wellness, chronic of mental data being Survey mental conditions well-being, Aboriginal Peoples Regional/ APS Yes Same prevalence of Survey National problems LIHC Counseling Regional LIHC Internal Yes LIA number, Services and Crisis Response Mental Health demographics, provided Databases Program incident type, services Databases provided

Suicide No Mortality data available from NLCHI Mortality Surveillance System

Alcohol Yes Clinical Database Provincial CDMS (access Yes MCP number, Acute care and drug Management through demographics, service rates abuse System (captures NLCHI) ethnicity, status of acute care episodes) service LIHC Alcohol Regional Yes Client number, intake/ Substance and Drug Abuse discharge information, abuse Treatment Centre substance abused treatment Database Regional Yes Self-reported drug use rates Labrador Inuit RHS

Environmental Health

Health Issue Under Name of Scope of Data Source(s) Inuit Core Dataset Main System Outputs Comments Active Surveillance Program for Program Identifier Elements Surveillance Program Available Environmental Yes Northern National Academic Variable Variable Levels, trends of All four Inuit contaminants contaminants research contaminants in regions of Program studies environment, food Canada covered (NCP) supply, human tissues & fluids; effects on nutrition, human health

E. coli/ Yes LIHC Regional Routine water No Bacteriological Water quality test Water testing Coliform Community quality testing tests for fecal results for each results also counts of Profiles and total community reported to water supply coliforms provincial ministry

66 Disability

Health Issue Under Active Name of Scope of Data Source(s) for Inuit Core Dataset Main System Comments Surveillance Surveillance Program Program Identifier Elements Outputs Program Available Activity Yes Labrador Regional LIHS Yes Self-reported Estimates of Self-reported limitation Inuit Health disabling disability rates by Survey; National APS conditions and age, gender Aboriginal limitations Peoples on activity; Survey demographics

Health No expectancy (disability- free life expectancy)

State of the Knowledge: Inuit Public Health 2011 67 sharing knowledge · making a difference partager les connaissances · faire une différence ᖃᐅᔨᒃᑲᐃᖃᑎᒌᓃᖅ · ᐱᕚᓪᓕᖅᑎᑦᑎᓂᖅ

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