The health issues facing the Inuit is a topic near and dear to my heart as I was fortunate enough to spend 2 years travelling around the Canadian Arctic providing medivac services and living for weeks at a time in Northern Communities such as Rankin Inlet, Iqaluit, and Churchill Manitoba. The history of the Inuit is one that is unknown to most of our Country. I am an admirer of Sheila Watt-Cloutier, author of "The Right to Be Cold" (2015) a novel recollecting her personal experience growing up in the Arctic, being taken away from her home and placed in residential schooling, and finding her way back to reclaim her culture and the importance of the Inuit as guardians of the arctic and "the mercury in the thermometer of the world".
Traditionally nomadic, the Inuit would venture out on the sea ice, following the natural migration of caribou, seals, whales, arctic birds, and other sources of country food. The Inuit lived in harmony with the land for thousands of years in this way, communal sharing of the hunt was, and is, still an important aspect of Inuit culture and health.
The Inuit are the most food insecure group in North America. Based on geography and climate in the post-colonialism world, crops do not grow here and food is flown in or via sea lift. Country food for the Inuit is a lifeblood - highly nutritious and readily available in the North. Unfortunately, the affects of climate change are greatest at the earth's poles - the Inuit witness these affects from season to season. The sea ice is changing so drastically that it is affecting their ability to venture out on the land to hunt and feed their communities. The changing ice means unsafe conditions, accidents (4 times higher for Inuit than non-Inuit Canadians), drownings, exposure, changes in animal migrations and food scarcity leading to nutritional deficiencies as long-shelf life foods are consumed.
Societal influences, such as the ban on seal pelt importation in the 70’s and 80’s, meant the loss of a subsistence-compatible income source that has had lasting crippling effects (Fawcett et al., 2018). Extreme weather events (i.e. forest fires, floods) disproportionately affect many indigenous communities (Richards et al., 2019). The new anxiety and danger of a changing world means a significant loss of freedom and self-determination (Durkalec et al. 2015). The environmental changes are compounded by the historical impacts of colonization – further affecting culture and livelihood (Richards et al., 2019).
The transition from tents and igloos to homes constructed of materials shipped from the South means that expanding housing as needed is impractical so multigenerational families live in over-crowded settings (Fraser et al., 2019). Community housing is hard to come by, due to the shortened building season and difficulty transporting materials and labour to remote fly-in communities. The vast majority of homes are in disrepair. This leads to further overcrowding, poor indoor air quality, higher TB infections, poor respiratory health especially in children, and physiological stress. This combined with, melting sea ice discourages subsistence activities and escape from undesirable social problems in small communities (Riva et al. 2020).
We can move from catastrophic fatalism to positive action through adaptation strategies that moderate the health effects of climate change (Ford et al., 2014). The best responses to the disparity facing Inuit groups are found in their inherent resilience. Work with communities should reinforce the strengths already present. It is important to understand that setting objectives in Inuit communities can be “recolonizing”. Even well-intentioned service providers tend to focus on outcomes and requirements established by those with power outside the community and social context with little consultation with the community itself and how its own members experience health inequity (Fraser et al., 2019). Projects that respect Indigenous sovereignty such as the Climate Change and Health Adaptation Program (CCHAP), support communities in conducting their own research and using funds as the community sees fit to address resiliency and adaptation to climate change. Projects “for communities are by communities” (Richards et al., 2019). A review of the literature reveals common themes derived from Inuit traditional knowledge that have been observed among successful adaptive solutions: encouraging subsistence activities, consideration of geographical context, fostering community wellness, and eliciting elder leadership.
Subsistence activities – Many members of Inuit communities continue to live off the land, hunting, fishing, trapping, and gathering – health and well being are connected to the land (Richards et al., 2019). Fawcett at al. (2018) describes the flexibility of Inuit hunters as dependant on their access to income and freedom from work and social commitments to exercise their land skills. Addressing these adaptation constraints would be prudent in many solutions to improve health in the Northern context. Despite profound environmental and societal changes, subsistence activities continue to have strong dietary, economic, and cultural importance for Inuit communities (Fawcett et al., 2018).
Geography and isolation mean that for solutions to be sustainable, they need to come from human resources already present in the community so efforts should transform existing institutions while supporting the creation of new community-based and culturally driven organizations and programs (Fraser et al., 2019). CCHAP supported a project in Arviat, NU that targeted food security by revitalizing the activities of local harvesters and hunters that had been displaced through social and cultural dislocation, where diabetes was on the rise due to reliance on store-bought food. Here, the Elders identified the value of food-sharing and invested in a community freezer, a composting system, and local greenhouse (Richards et al., 2019).
Prioritizing Community wellness helps to balance the needs of the individual with overall community goals by promoting supportive relationships and group cohesion. Initiatives that are informed by community knowledge have the most lasting effects (Waddell et al., 2017). Community wellness is not, however, a concept that can be generalized across all communities, it should be considered locally within a culturally specific and situationally determined context (Waddell et al., 2017). Community importance cannot be understated as it provides social supports, food security, and benefits the most vulnerable amongst the most vulnerable (i.e. single mothers and elderly community memebers) (Fawcett et al., 2018).
Leadership – Elders, traditional knowledge and the Northern context mean a need for different survival skills. Indigenous knowledge has been identified as a key component to climate change resiliency as it is knowledge relevant to the local contexts of cultural and kinship systems that enable place- and culture-specific adaptive capacities (Richards et al., 2019). As the keepers of knowledge, Elders should be engaged to identify strategies for community wellness (Waddell et al., 2017). For example, CCHAP supported the Selkirk First Nation to encourage youth to connect with Indigenous knowledge to promote mental wellness through traditional on-the-land activities at winter fish camps as well as participate in local research (Richards et al., 2019). This project reinforced intergenerational knowledge transfer as well as incorporated participatory action research to identify and meet the needs of specific communities to foster collective empowerment and agency (Waddell et al., 2017).
Many of the adaptive themes identified above are summarized in the following table published by (Fawcett et al., 2018) that presents resilience over the course of several years in a single community:
There are good examples of projects that have supported community-led initiatives that promote climate change resiliency that also demonstrate the importance of localizing adaptation under the framework of Indigenous knowledge (Richards et al., 2019). The described themes are interrelated and interdependent, representative of the Inuit value of holistic and ecocentric perspectives of health and well-being (Waddell et al., 2017). Developing an evidence base to further advance our understanding of adaptation policy should be a key focus of future research in Canada (Ford et al., 2014).
Commentaires