Marita Melhus

Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study.

BACKGROUND International studies of the health of Indigenous and tribal peoples provide important public health insights. Reliable data are required for the development of policy and health services. Previous studies document poorer outcomes for Indigenous peoples compared with benchmark populations, but have been restricted in their coverage of countries or the range of health indicators. Our objective is to describe the health and social status of Indigenous and tribal peoples relative to benchmark populations from a sample of countries. METHODS Collaborators with expertise in Indigenous health data systems were identified for each country. Data were obtained for population, life expectancy at birth, infant mortality, low and high birthweight, maternal mortality, nutritional status, educational attainment, and economic status. Data sources consisted of governmental data, data from non-governmental organisations such as UNICEF, and other research. Absolute and relative differences were calculated. FINDINGS Our data (23 countries, 28 populations) provide evidence of poorer health and social outcomes for Indigenous peoples than for non-Indigenous populations. However, this is not uniformly the case, and the size of the rate difference varies. We document poorer outcomes for Indigenous populations for: life expectancy at birth for 16 of 18 populations with a difference greater than 1 year in 15 populations; infant mortality rate for 18 of 19 populations with a rate difference greater than one per 1000 livebirths in 16 populations; maternal mortality in ten populations; low birthweight with the rate difference greater than 2% in three populations; high birthweight with the rate difference greater than 2% in one population; child malnutrition for ten of 16 populations with a difference greater than 10% in five populations; child obesity for eight of 12 populations with a difference greater than 5% in four populations; adult obesity for seven of 13 populations with a difference greater than 10% in four populations; educational attainment for 26 of 27 populations with a difference greater than 1% in 24 populations; and economic status for 15 of 18 populations with a difference greater than 1% in 14 populations. INTERPRETATION We systematically collated data across a broader sample of countries and indicators than done in previous studies. Taking into account the UN Sustainable Development Goals, we recommend that national governments develop targeted policy responses to Indigenous health, improving access to health services, and Indigenous data within national surveillance systems. FUNDING The Lowitja Institute.

Population based study of health and living conditions in areas with both Sami and Norwegian populations--the SAMINOR study

Objectives. The overall aim of the SAMINOR project was to study health and diseases in relation to living conditions among the Sami population and to compare these with the Norwegian population in the same area. This article provides an overview of the background of the study and a description of the methods employed for the data collection. We give sample characteristics and elaborate on different definitions of ethnicity. Study Design. Cross-sectional, population-based study, including questionnaires, a clinical examination and analyses of blood samples. Methods. All individuals 30 or 36 to 79 years of age who were living in defined municipalities or specified local areas with a known Sami population were invited to a cardiovascular screening program. The data were collected during 2003–2004. The questionnaires focused on living conditions, health, Sami traditions and ethnicity. The eligible population consisted of 27,987 individuals and 16,865 (60.6%) participated by answering at least one questionnaire. Analyses were restricted to the 36 to 79 year-old age group which had 16,538 participants. The screening program comprised a blood sample, measurements of blood pressure, height, weight, and waist and hip ratio. Different definitions of Sami ethnicity were explored. Results. Of the sample, 35.6% reported Sami background, and 13.2% reported that they, their parents and their grandparents had Sami as their domestic language. This stringent definition of Sami produced clearer differences between Sami and Norwegians, as shown for some measures of socioeconomic status. Conclusions. The findings that are related to more strict definitions of Sami ethnicity have important implications for the interpretation of earlier works and for future studies.

Ethnic discrimination and bullying in the Sami and non-Sami populations in Norway: the SAMINOR study

OBJECTIVES: To investigate the prevalence of self-reported experiences of ethnic discrimination and bullying among Sami and non-Sami adults. STUDY DESIGN: Cross-sectional, questionnaire-based survey. METHODS: SAMINOR is a population-based study of health and living conditions that was administered in 2003–2004 in 24 different Norwegian and Sami populated municipalities within central and northern Norway. This analysis was based on 12,265 men and women aged 36-79 years. Ethnic distribution was Sami (33.1%), Kvens (7.8%) and the ethnic Norwegian majority (59.1%). RESULTS: Overall, Sami and Kven respondents reported more ethnic discrimination and bullying in general than ethnic Norwegians (p > 0.001). The reporting was highest among the younger participants (p > 0.001). Men reported more ethnic discrimination than women, while women reported more bullying. Respondents with the strongest Sami affiliation reported higher levels of ethnic discrimination outside the Sami Language Act’s district, while respondents with weak Sami affiliation, Kvens and ethnic Norwegians, reported higher levels inside this district. Among the respondents that reported bullying previously, the most common type was discriminating remarks and the most common location was public schools. For those who reported bullying in the past year, the most common types were gossiping and discriminating remarks, and the most common locations were at work and in the local community. Two out of three of those reporting ethnic discrimination, independent of ethnicity, also reported bullying. CONCLUSIONS: The findings from this study show that the Sami and Kven population more often experience bullying and ethnic discrimination than ethnic Norwegians. These results are consistent with experiences from other minority and marginalized groups that experienced colonization. More research is needed to understand the role bullying and ethnic discrimination play in the wellbeing and health of the Sami and Kven population.

DIETARY PATTERNS IN THE POPULATION LIVING IN THE SáMI CORE AREAS OF NORWAY - THE SAMINOR STUDY

OBJECTIVES: To identify dietary patterns and to investigate their association with selected life-style and demographic factors, ethnicity and self-perceived health. Study design. Population-based cross-sectional design, using food frequency questionnaires. METHODS: A total of 12,811 subjects aged 36–79 years participated from the municipalities in Norway where more than 5-10% of the population reported to be Simi in the 1970 Census, in addition to some selected districts. The data were collected during 2003-2004. A principal component analysis was used to assess the associations among food variables. Seven principal components were then used as input in a cluster analysis. RESULTS: Five dietary patterns were identified and labelled “reindeer”, “fish”, “average”, “fruits and vegetables” and “Westernised, traditional marine”. The reindeer pattern was highly represented by subjects with three generations of Sami language (Sami I), obese subjects and those with low levels of physical activity. The fish pattern was dominated by women and had the largest proportion of individuals who reported their health as being “not so good” (35%). However, this pattern had the largest proportion of subjects in the oldest age categories. The fruits and vegetables pattern was characterised by a health-conscious life-style, included more women than men, and had the largest proportion of subjects reporting “very good” health. Ethnicity did not play a major role in predicting dietary patterns except for the reindeer pattern, especially in the inland areas. CONCLUSIONS: In the dietary cluster analysis we identified five distinct dietary patterns that were also characterised by additional life-style factors.

Ethnicity, self-reported health, discrimination and socio-economic status: a study of Sami and non-Sami Norwegian populations

Objectives. Investigate the association between ethnicity, social factors and self-reported health conditions of Sami and non-Sami Norwegian populations. Study design. Cross-sectional questionnaire. Methods. SAMINOR is a population-based study of health and living conditions that was conducted in 24 municipalities in northern Norway during 2003 and 2004. The present study included 12,265 individuals aged between 36 and 79, whose ethnicity was categorized as Sami (33.1%), Kven (7.8%) and Norwegian majority population (59.1%). Results. Sami respondents reported inferior health conditions in comparison to the Norwegian majority population. The most unsatisfactory conditions were reported by Sami females living outside the defined Sami area (with greater integration and assimilation) (p&0.05). Females typically reported less favourable health conditions than did males. Health inequalities varied by age and were more apparent in persons aged in their mid-50s or above. Across ethnic groups, respondents with the highest education and household income were healthier than others. Furthermore, those reporting to have been frequently discriminated against were more likely to report poorer health than those who did not; the odds ratios (95% CI) was found to be 2.88 (1.92–4.32) for women and 1.61 (1.08-2.42) for men. When discrimination was included in the logistical model, the increased risk of poor self-reported health decreased to non-significance for Sami respondents. The estimated risk decreased further when the socio-economic status was taken into account. Conclusions. The findings of this study suggest that self-reported ethnic discrimination combined with low socio-economic status contributes to inequalities in self-reported health when Sami and Norwegian majority population are compared.

Ethnic differences in the prevalence of general and central obesity among the Sami and Norwegian populations: the SAMINOR study.

Aims: To estimate the prevalence of general (body mass index) and central (waist circumference and waist/hip ratio) obesity in an area with a mixed Sami and Norwegian population. Methods: A cross-sectional population-based study carried out in 2003— 2004, the SAMINOR study. The attendance rate was 60.6%. A total of 7,301 men and 7,841 women, aged 36—79, were included in the analyses. Height, weight, waist and hip circumference were measured, body mass index (BMI) calculated and information concerning lifestyle was collected by questionnaire. Results: The prevalence of general obesity (BMI ≥ 30 kg/m2) in participants who had Sami as their home language for three generations (Sami I) and Norwegian participants was 38.7% and 24.3% for women respectively; and for men 26.9% and 23.4% respectively. More than 40% of the women had central obesity (waist circumference ≥88 cm), and the highest prevalence was found in Sami I women (45%). The highest prevalence of central obesity (waist circumference ≥102 cm) was found in Norwegian men (24.2%). The ethnic differences persisted after adjustment for age, education, physical activity in leisure time, and smoking habits. Conclusions: The prevalence of obesity was high in this population and central obesity was most pronounced in women, particularly in Sami women. Sami men were less obese than Norwegian men. Further studies are necessary to examine a possible explanation for these findings, especially to elaborate on the impact of diet.

Childhood diet in relation to Sámi and Norwegian ethnicity in northern and mid-Norway--the SAMINOR study.

OBJECTIVE The purpose of this work was to identify dietary patterns in the past using cluster analysis of reported diet in childhood, and to assess predictors for dietary patterns in relation to ethnicity in the population in the Sámi core areas in Norway. The Sámis are an indigenous population living in the border areas of Norway, Sweden, Finland and Russia. DESIGN Population-based, cross-sectional study, using self-administered questionnaires. A food-frequency questionnaire covering selected food items eaten in childhood was used. The questionnaire also provided data on ethnicity. SUBJECTS AND SETTING This study was based on data collected from 7614 subjects participating in The Population Based Study of Health and Living Conditions in Areas with a Mixed Sámi and Norwegian Population (the SAMINOR study) who grew up in the SAMINOR geographical areas, i.e. areas with mixed Sámi and Norwegian populations in Norway. RESULTS Four dietary clusters were identified: a reindeer meat cluster; a cluster with high intakes of fish, traditional fish products and mutton, in addition to food sources from the local environment; a Westernised food cluster with high intakes of meat balls and sausages; and a cluster with a high intake of fish, but not any other foods in the questionnaire. The cluster distribution differed by ethnicity, but the effect of ethnicity on diet differed by coastal and inland residence. CONCLUSION Our study has shown that data gathered through the limited questionnaire could be used to group the study sample into different dietary clusters, which we believe will be useful for further research on relationships between diet in childhood and health in the Sámi core areas in Norway.

Sami speakers are less satisfied with general practitioners` services

OBJECTIVES: The government’s Action Plan for Health and Social Services states as a goal that the Sami population’s encounter with health and social services should be just as good as what the rest of the population experiences. The goal of this study is to investigate patient satisfaction with the municipal GP service in areas with both a Sami and Norwegian population. STUDY DESIGN: A cross-sectional population study using questionnaires. METHODS: The data were taken from the population based study of health and living conditions in areas with both Sami and Norwegian populations (SAMINOR) in which respondents were asked about their satisfaction with GP services in their municipalities. This population survey was carried out in the period 2002–2004. The analyses include 15,612 men and women aged 36-79. RESULTS: The Sami-speaking patients were less satisfied with the municipal GP service as a whole than were the Norwegian speakers; RR 2.4 (95% CI 2.1–2.7). They were less satisfied with the physicians’ language skills; RR 5.8 (95% CI 4.8-7.0); and they felt that misunderstandings between physician and patient due to language problems were more frequent; RR 3.8 (95% CI 3.3-4.3). One-third expressed that they did not wish to use an interpreter. CONCLUSIONS: The results indicate that it is necessary to place greater emphasis on the physicians’ language competency when hiring GPs in municipalities within the Administrative Area for the Sami Language. This could improve satisfaction with the physicians’ services.

Iron status in a multiethnic population (age 36–80 yr) in northern Norway: the SAMINOR study

Objectives:  Northern Norway consists of a multiethnic population of Sámi and non‐Sámi. We evaluated iron status in these two groups with respect to gender, age and residence.

Distribution of apoB/apoA-1 ratio and blood lipids in Sami, Kven and Norwegian populations: the SAMINOR study

OBJECTIVES: To assess the distribution of blood lipids, lipoprotein and apoB/apoA-1 ratio in a multi-ethnic population of Sami, Kvens and Norwegians in Norway. Study design. A population-based cross-sectional study was carried out in 2003–2004 in an area with a mixed Sami, Kvens/Finns and Norwegian population, the SAMINOR study. METHODS: A self-administrated questionnaire was distributed and total cholesterol, HDL cholesterol, triglycerides, apoB and apoA-1 counts were analysed in 6461 women and 5772 men between the ages of 36 and 79. RESULTS: In 36–64 age group, Sami men and women had the highest apoB/apoA-1 ratio of the ethnic groups. The ethnic differences remained after adjustment for waist hip ratio, cigarette smoking, systolic and diastolic pressures, alcohol consumption, physical activity during leisure time and family history of myocardial infarction (MI). There were no significant ethnic differences in apoB/apoA-1 ratio in the older age group. Total cholesterol was significantly lower among Sami men and women, aged 65-79 years, than among the Norwegian. The opposite occurred in the 36-49 age group, with higher levels in the Sami population. We found no ethnic differences in HDL cholesterol and triglycerides. CONCLUSIONS: Middle-aged Sami women and men have increased levels of apoB/apoA-1 ratio and total cholesterol compared with Norwegians.