Chris Furgal

Vulnerability of Aboriginal health systems in Canada to climate change.

Abstract Climate change has been identified as potentially the biggest health threat of the 21st century. Canada in general has a well developed public health system and low burden of health which will moderate vulnerability. However, there is significant heterogeneity in health outcomes, and health inequality is particularly pronounced among Aboriginal Canadians. Intervention is needed to prevent, prepare for, and manage climate change effects on Aboriginal health but is constrained by a limited understanding of vulnerability and its determinants. Despite limited research on climate change and Aboriginal health, however, there is a well established literature on Aboriginal health outcomes, determinants, and trends in Canada; characteristics that will determine vulnerability to climate change. In this paper we systematically review this literature, using a vulnerability framework to identify the broad level factors constraining adaptive capacity and increasing sensitivity to climate change. Determinants identified include: poverty, technological capacity constraints, socio-political values and inequality, institutional capacity challenges, and information deficit. The magnitude and nature of these determinants will be distributed unevenly within and between Aboriginal populations necessitating place-based and regional level studies to examine how these broad factors will affect vulnerability at lower levels. The study also supports the need for collaboration across all sectors and levels of government, open and meaningful dialogue between policy makers, scientists, health professionals, and Aboriginal communities, and capacity building at a local level, to plan for climate change. Ultimately, however, efforts to reduce the vulnerability of Aboriginal Canadians to climate change and intervene to prevent, reduce, and manage climate-sensitive health outcomes, will fail unless the broader determinants of socio-economic and health inequality are addressed.

Local observations of climate change and impacts on traditional food security in two northern Aboriginal communities.

Abstract Objectives. Our primary objective was to record participant observations of changes in the localenvironment, harvesting situations and traditional food species and to explore what impact thesemay have on traditional food. Study Design. A participatory study with 2 northern Aboriginal communities in Canada. Methods. Focus groups were conducted in both communities. Both specific and open-endedquestions were asked, to gather information about the traditional food harvest and a qualitativeanalysis was conducted. Results. Members from both communities are witnessing variable changes in climate that areaffecting their traditional food harvest. New species and changes in migration of species beingobserved by community members have the potential to affect the consumption of traditional food.Similarly, changes in water levels in and around harvesting areas are affecting access to harvestareas, which in turn affects the traditional food harvest. Conclusions. Community members have been required to change their harvest mechanisms toadapt to changes in climate and ensure an adequate supply of traditional food. A strong commitmentto programs that will ensure the protection of traditional food systems is necessary. (Int J Circumpolar Health 2006; 65(5) 403–415).

Foreword to the special issue: climate change impacts, adaptation and vulnerability in the Arctic

The Arctic climate is changing, carrying wide-ranging implications for indigenous and non-indigenous inhabitants, businesses, industry and government across the circumpolar region. The latest scientific assessments indicate that change is happening faster than previously thought, and that the Arctic will continue to experience dramatic climate change in the future. This special edition of Polar Research brings together nine papers on climate change impacts, adaptation and vulnerability in the Arctic, providing important insights on the nature of the risks and opportunities posed by climate change in the circumpolar region, highlighting opportunities for policy response and providing insights on how to conduct effective climate change research with Arctic communities.

Knowledge Transfer and Exchange Processes for Environmental Health Issues in Canadian Aboriginal Communities

Within Canadian Aboriginal communities, the process for utilizing environmental health research evidence in the development of policies and programs is not well understood. This fundamental qualitative descriptive study explored the perceptions of 28 environmental health researchers, senior external decision-makers and decision-makers working within Aboriginal communities about factors influencing knowledge transfer and exchange, beliefs about research evidence and Traditional Knowledge and the preferred communication channels for disseminating and receiving evidence. The results indicate that collaborative relationships between researchers and decision-makers, initiated early and maintained throughout a research project, promote both the efficient conduct of a study and increase the likelihood of knowledge transfer and exchange. Participants identified that empirical research findings and Traditional Knowledge are different and distinct types of evidence that should be equally valued and used where possible to provide a holistic understanding of environmental issues and support decisions in Aboriginal communities. To facilitate the dissemination of research findings within Aboriginal communities, participants described the elements required for successfully crafting key messages, locating and using credible messengers to deliver the messages, strategies for using cultural brokers and identifying the communication channels commonly used to disseminate and receive this type of information.

Municipal water quantities and health in Nunavut households: an exploratory case study in Coral Harbour, Nunavut, Canada

Background Access to adequate quantities of water has a protective effect on human health and well-being. Despite this, public health research and interventions are frequently focused solely on water quality, and international standards for domestic water supply minimums are often overlooked or unspecified. This trend is evident in Inuit and other Arctic communities even though numerous transmissible diseases and bacterium infections associated with inadequate domestic water quantities are prevalent. Objectives Our objective was to explore the pathways by which the trucked water distribution systems being used in remote northern communities are impacting health at the household level, with consideration given to the underlying social and environmental determinants shaping health in the region. Methods Using a qualitative case study design, we conducted 37 interviews (28 residents, 9 key informants) and a review of government water documents to investigate water usage practices and perspectives. These data were thematically analysed to understand potential health risks in Arctic communities and households. Results Each resident receives an average of 110 litres of municipal water per day. Fifteen of 28 households reported experiencing water shortages at least once per month. Of those 15, most were larger households (5 people or more) with standard sized water storage tanks. Water shortages and service interruptions limit the ability of some households to adhere to public health advice. The households most resilient, or able to cope with domestic water supply shortages, were those capable of retrieving their own drinking water directly from lake and river sources. Residents with extended family and neighbours, whom they can rely on during shortages, were also less vulnerable to municipal water delays. Conclusions The relatively low in-home water quantities observed in Coral Harbour, Nunavut, appear adequate for some families. Those living in overcrowded households, however, are accessing water in quantities more typically seen in water insecure developing countries. We recommend several practical interventions and revisions to municipal water supply systems.

Trends in the study of Aboriginal health risks in Canada

Objective. To identify trends in the study of health risk in peer-reviewed and grey literature in Canadian Aboriginal populations from 1960 to 2007. Study design. Systematic literature review and analysis. Methods. Peer-reviewed literature was searched using 5 electronic library databases. The grey literature was searched using 3 online search engines, 4 agency websites and 2 online compiled databases. The search terms used were “Canada,” synonyms for Canadian Aboriginal peoples and “risk.” Citations were screened for relevance to Aboriginal populations and risks to aspects of human health. Results. Both literatures show an exponential growth in risk-focused study of Canadian Aboriginal health issues over time. There is a geographic foci in the North with the Prairies and the West under-represented. Risk is most commonly used in relation to general health, environmental, zoonotic infections and chronic diseases in the peer-reviewed literature, and general health or environment in the grey literature. Most publications in both literatures are on generalized Aboriginal populations. When specified, a larger proportion of the publications relate to First Nations people, followed by Inuit. Little literature exists on Mètis health risks in Canada. Conclusions. There has been an increase in publications about Aboriginal health risk in Canada over time. Trends reflect a research focus on the North and an increased interest in environment and health issues. Greater attention to mental health, addictions and Mètis health is required. The increasing use of a risk-based analytical focus has potential implications for understanding the nature of Aboriginal health today and in the future.

Well-being and environmental change in the arctic: a synthesis of selected research from Canada’s International Polar Year program

The social and cultural dimensions of arctic environmental change were explored through Canada’s International Polar Year (IPY) research program. Drawing on concepts of vulnerability, resilience and human security, we discuss preliminary results of 15 IPY research projects (of 52) which dealt with the effects and responses of northern communities to issues of ecological variability, natural resource development and climate change. This paper attempts to determine whether the preliminary results of these projects have contributed to the IPY program goal of building knowledge about well-being in the arctic. The projects were diverse in focus and approach but together offer a valuable pan-northern perspective on many themes including land and resource use, food security, poverty and best practices of northern engagement. Case study research using self-reported measures suggests individual views of their own well-being differ from regional and territorial standardized statistics on quality of life. A large body of work was developed around changes in land and resource use. A decline in land and resource use in some areas and consequent concerns for food security, are directly linked to the effects of climate change, particularly in coastal areas where melting sea ice, erratic weather events and changes in the stability of landscapes (e.g., erosion, slumping) are leading to increased risks for land users. Natural resource development, while creating some new economic opportunities, may be compounding rather than offsetting such stresses of environmental change for vulnerable populations. While the IPY program has contributed to our understanding of some aspects of well-being in the arctic, many other issues of social, economic, cultural and political significance, including those unrelated to environmental change, remain poorly understood.

Community-level risk factors for notifiable gastrointestinal illness in the Northwest Territories, Canada, 1991-2008.

BackgroundEnteric pathogens are an important cause of illness, however, little is known about their community-level risk factors (e.g., socioeconomic, cultural and physical environmental conditions) in the Northwest Territories (NWT) of Canada. The objective of this study was to undertake ecological (group-level) analyses by combining two existing data sources to examine potential community-level risk factors for campylobacteriosis, giardiasis and salmonellosis, which are three notifiable (mandatory reporting to public health authorities at the time of diagnosis) enteric infections.MethodsThe rate of campylobacteriosis was modeled using a Poisson distribution while rates of giardiasis and salmonellosis were modeled using a Negative Binomial distribution. Rate ratios (the ratio of the incidence of disease in the exposed group to the incidence of disease in the non-exposed group) were estimated for infections by the three major pathogens with potential community-level risk factors.ResultsSignificant (p≤0.05) associations varied by etiology. There was increased risk of infection with Salmonella for communities with higher proportions of ‘households in core need’ (unsuitable, inadequate, and/or unaffordable housing) up to 42% after which the rate started to decrease with increasing core need. The risk of giardiasis was significantly higher both with increased ‘internal mobility’ (population moving between communities), and also where the community’s primary health facility was a health center rather than a full-service hospital. Communities with higher health expenditures had a significantly decreased risk of giardiasis. Results of modeling that focused on each of Giardia and Salmonella infections separately supported and expanded upon previous research outcomes that suggested health disparities are often associated with socioeconomic status, geographical and social mobility, as well as access to health care (e.g. facilities, services and professionals). In the campylobacteriosis model, a negative association was found between food prices in communities and risk of infection. There was also a significant interaction between trapping and consumption of traditional foods in communities. Higher rates of community participation in both activities appeared to have a protective effect against campylobacteriosis.ConclusionsThese results raise very interesting questions about the role that traditional activities might play in infectious enteric disease incidence in the NWT, but should be interpreted with caution, recognizing database limitations in collection of case data and risk factor information (e.g. missing data). Given the cultural, socioeconomic, and nutritional benefits associated with traditional food practices, targeted community-based collaborative research is necessary to more fully investigate the statistical correlations identified in this exploratory research. This study demonstrates the value of examining the role of social determinants in the transmission and risk of infectious diseases.

A spatial and temporal analysis of notifiable gastrointestinal illness in the Northwest Territories, Canada, 1991-2008

BackgroundThis is the first study to describe the geographical and temporal distribution of notifiable gastrointestinal illness (NGI) in the Northwest Territories (NWT), Canada. Understanding the distribution of NGI in space and time is important for identifying communities at high risk. Using data derived from the Northwest Territories Communicable Disease Registry (NWT CDR), a number of spatial and temporal techniques were used to explore and analyze NGI incidence from the years 1991 to 2008. Relative risk mapping was used to investigate the variation of disease risk. Scan test statistics were applied to conduct cluster identification in space, time and space-time. Seasonal decomposition of the time series was used to assess seasonal variation and trends in the data.ResultsThere was geographic variability in the rates of NGI with higher notifications in the south compared to the north. Incidence of NGI exhibited seasonality with peaks in the fall months for most years. Two possible outbreaks were detected in the fall of 1995 and 2001, of which one coincided with a previously recognized outbreak. Overall, incidence of NGI fluctuated from 1991 to 2001 followed by a tendency for rates to decrease from 2002 to 2008.ConclusionsThe distribution of NGI notifications varied widely according to geographic region, season and year. While the analyses highlighted a possible bias in the surveillance data, this information is beneficial for generating hypotheses about risk factors for infection.

A descriptive analysis of notifiable gastrointestinal illness in the Northwest Territories, Canada, 1991–2008

Objectives To describe the major characteristics of reported notifiable gastrointestinal illness (NGI) data in the Northwest Territories (NWT) from January 1991 through December 2008. Design Descriptive analysis of 708 reported cases of NGI extracted from the Northwest Territories Communicable Disease Registry (NWT CDR). Setting Primary, secondary and tertiary health care centres across all 33 communities of the NWT. Population NWT residents of all ages with confirmed NGI reported to the NWT CDR from January 1991 through December 2008. Main outcome measure Laboratory-confirmed NGI, with a particular emphasis on campylobacteriosis, giardiasis and salmonellosis. Results Campylobacteriosis, giardiasis and salmonellosis were the most commonly identified types of NGI in the territory. Seasonal peaks for all three diseases were observed in late summer to autumn (p<0.01). Higher rates of NGI (all 15 diseases/infections) were found in the 0–9-year age group and in men (p<0.01). Similarly, rates of giardiasis were higher in the 0–9-year age group and in men (p<0.02). A disproportionate burden of salmonellosis was found in people aged 60 years and older and in women (p<0.02). Although not significant, the incidence of campylobacteriosis was greater in the 20–29-years age group and in men (p<0.07). The health authority with the highest incidence of NGI was Yellowknife (p<0.01), while for salmonellosis and campylobacteriosis, it was Tlicho (p<0.01) and for giardiasis, the Sahtu region (p<0.01). Overall, disease rates were higher in urban areas (p<0.01). Contaminated eggs, poultry and untreated water were believed by health practitioners to be important sources of infection in cases of salmonellosis, campylobacteriosis and giardiasis, respectively. Conclusions The general patterns of these findings suggest that environmental and behavioural risk factors played key roles in infection. Further research into potential individual and community-level risk factors is warranted.