Tuesday, November 09, 2010

Cancer in Canada's North:: Issues of Inuit Health & Intervention Strategies

image:: map of the Territory of  Nunavut

This is the first instalment of an occasional series on the North and circumpolar issues

A week and a half ago, I was fortunate enough to attended an Inuit studies conference [version française] at the UQAT campus in Val d'Or, Québec [programme]. {Special thanks to Louis McComber of Serpentine Communications and Mélissa Girard of UQAT.} Much of my interest focused on media and culture, but I was drawn into sessions and conversations on health, civic engagement, sustainable economic  development, and food security, all topics for future blogs.

One presentation by George Wenzel of McGill on food security was particularly fascinating, as he was discussing the complex economic sociology of food security issues for the Inuit. I'm oversimplifying on this blog, but he is finding with his data that traditional diets, with their nutritional and food security benefits, are being displaced by pressures towards engaging in a monetary economy with wage earning. The food is out there, but the financial and temporal resource constraints mean less hunting/harvesting of traditional "country" foods, which typically are not bought due to cultural praxis. I hope to talk to George more on this topic in the future. This issue of food security and nutrition got me thinking about my work in the early 2000s on epidemiology and health risk assessments in special populations in California. 

I started examining latest statistics {2005/6} on cancer  [français] on the Canadian Cancer Society website and was shocked to see the high per 100,000 incidence of lung and colorectal cancers in Nunavut {with a 2006 population of 29,474}, which has about 85% of the population identifying as Inuit and 13.5% as non-aboriginal, the remainder identifying as First Nations or Métis.

The incidence rates for lung cancer were 248 and 267 per 100,000, for men and women respectively, in stark contrast to the Canada-wide numbers of 68 and 47 per 100,000, for men and women respectively. The high incidence of lung cancer is not surprising given the very high smoking rates. The demographics of the region show that the Inuit population is heavily skewed younger and the numbers of young smokers is alarmingly high. Smoking in Inuit populations is a problem not just in Nunavut but in other circumpolar areas, including {but not limited to} Greenland [see data visualization] and Nunavik, Québec [1] and most likely in the Inuvialuit region in the western Arctic {Yukon and Northwest Territories} and Nunatsiavut in Labrador.

The mortality rates are also alarming in Nunavut. Overall, the cancer mortality rates are 359 and 386 per 100,000, for men and women respectively, while the Canada-wide numbers are 208 and 144 per 100,000, for men and women respectively.

The Nunavut Department of Health and Social Services has compiled cancer mortality statistics {among others} from 1991-2000 [2], showing how lung cancer was declining until 1996, only to increase steadily until 2000. These mortality rates depict the specific problems of the North in addressing cultural, economic, and geographic barriers to care, which interact with each other.

Another area I'm exploring are carcinogens being found in the traditional food supply and what the true risks are. I'm concerned that POP {persistent organic pollutants} and other carcinogens found in traditional foods would result in kneejerk reactions and policies emphasizing the increased adoption of "Western" diets, which I feel would result in a much worse health status prognosis. See Donaldson et al. {2010} for an overview of the issues [3].

Culturally appropriate interventions and communications, which are ideally integrated with wider initiatives, and drawing upon knowledge in other circumpolar areas are critical to success [4] {see CBC article describing study}. For example, a programme dealing with preventable cancers such as lung has to incorporate an understanding of the cultural meaning of smoking with the culture and effectively communicate {ideally, by visual means} why Inuit should adopt health maintenance behaviours without seeming paternalistic or "Qallunaat", i.e., non-Inuit. This Inuit Cancer fact sheet [pdf] provides a good overview of the issues of cancer in the North. I'm compiling information on circumpolar health and how it can be linked to culturally appropriate strategies targeting issues of youth outreach, the use of social media, and community health. If you are interested in any of this, please feel free to contact me.

Nunavut health spending is high in comparison to Canada and other circumpolar regions, but with poorer health outcomes [5]. Below is a Health Canada chart from the Healthy Canadians 2008 report::

Initiatives are in place to address these issues, but successful programmes will have to be specifically targeted towards the Inuit populations, as opposed to being part of aboriginal programmes, and address how behaviours are manifested within culture and hegemonic resistance. Since women are often the gatekeepers in the household when it comes to health and the large proportion of the Inuit population are youth, strategies should incorporate women and youth. Recent efforts have attempted to curb smoking and to create smoke free households, where homes with blue lights signal a commitment to quitting smoking or at least smoking outside the house. [6]

[1] "Health survey of Nunavik produces troubling data", Siku News {11 September 2010}. [link]
[2] "Comparable Health Indicators for Nunavut and Canada" {2004}, NUNAVUT DEPARTMENT OF HEALTH AND SOCIAL SERVICES. [link]
[3] Donaldson, SG {2010} "Environmental contaminants and human health in the Canadian Arctic", Sci Total Environ. Oct 15; 408(22): 5165-234. [link]
[4] Young, T. Kue  and Susan Chatwood {2010} "Health care in the North: What Canada can learn from its circumpolar neighbours", CMAJ.2010; 0: cmaj.100948v1. [link to abstract]
[5] "Nunavut spends more on health, but gets less, say circumpolar health experts, 'Nunavut’s per capita expenditures are the highest in the world'", Nunatsiaq Online {2 November 2010}. [link]
[6] "Ain’t no smokin’ at the house of blue lights ITK launches blue light campaign to combat tobacco", Nunatsiaq Online {31 May 2010}. [link]

Twitterversion:: [blog] Issues of cancer & the Inuit North of Canada. @Prof_K

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