A report supporting the development of the IHACC research program.by Sherilee Harper.
Brief Introduction
Both scientific measurements and oral stories confirm that there are significant climatic changes in Northern communities, which are impacting human health (physical, mental, emotional, and spiritual) and causing changes in the land and local livelihoods—changes which require adaptation strategies in order to enhance resiliency. While research examining the potential impacts of climate change on human health in the North has been increasing in recent years, there are very few published studies in this area; as such, further research that is locally relevant and culturally appropriate is required. Therefore, we conducted a pilot exploratory study limited to assessing the health priorities and characterizing community health systems in Nunatsiavut, Labrador, Canada. This pilot research is also a part of an International Research Initiative on Adaptation to Climate Change (IRIACC), funded by the International Development Research Center – Canada (IDRC), with parallel field study sites in Uganda and Peru. The pilot study attempts to identify and understand health priorities and vulnerability to climate stressors in the Nunatsiavut region through a series of interviews with regional human and environmental health representatives, as well as PhotoVoice workshops with community members. The objectives of this study are to:
- Develop a baseline understanding of the climate-related health issues affecting Indigenous peoples in Nunatsiavut;
- Determine how climate-related health issues are currently experienced and managed; and
- Identify regional and local climate-related health research priorities.
Methods
Interviews with Government Employees
Individuals representing provincial, regional, and community levels were invited via email to participate in the interviews. In all, eleven interviews with key stakeholders from both the Nunatsiavut Government and the Labrador Grenfell Health Authority were conducted to identify and understand health priorities and vulnerability to climate stressors in the Nunatsiavut region. The interviews included mainly open-ended questions to capture data that would be useful in addressing all research objectives. Interviews were conducted in a conversational format in order to allow the interviewee to expand upon the questions being posed, thus allowing for a diversity themes to emerge. The confidential interviews were conducted in-person at the participant’s workplace between July 20 and August 12, 2010 and lasted an average of 50 minutes (34-67 minutes). All interviews were audio-recorded with permission and transcribed verbatim.
Community PhotoVoice Workshops
PhotoVoice is a participatory data-gathering technique that places the camera in the hands of local residents, and recognises that community members are the most knowledgeable about changes in their community. This method allowed participants to take photos of areas or items or concepts that express how climate change is impacting their health, as well as existing or new adaptation strategies to manage these impacts. Three workshops were co-facilitated with a trained community member: two workshops with all female participants (n=5) and one workshop with all male participants (n=6). The workshops with all female participants provided two hours of initial brainstorming, explanation, and camera training, with emphasis placed on photo composition, lighting, and storytelling through photography. The workshop with all male participants began alongside a Rangifer Anatomy Project workshop, where participants shared their knowledge on caribou anatomy, physiology, and health, as well as discussed climate change observations and resultant environmental impacts. After the initial meetings, all participants were then given two days to take new photographs, as well as collect old photographs that addressed the workshop question: “How does the environment impact your health?” Then, the group re-convened to share the photographs and explain the stories and messages behind them. Photos were then grouped into common, re-occurring themes. Currently, the community co-facilitator is working one-on-one with participants to prepare a short recorded or written explanation of how the photographs represent the impacts of climate change on human health and/or current or potential adaptation strategies. These narratives will accompany the photographs.
Preliminary Results
Climate-health priorities that emerged from the interviews and PhotoVoice workshops are outlined below (note: these are preliminary findings).
Social Determinants of Health: All participants commented implicitly (community residents) or explicitly (interviewees) on how climate change continues to impact Inuit determinants of health: acculturation, productivity, income distribution, housing, education, food security and nutrition, health care services, quality of early life, addictions, social safety nets, and the environment. Many interviewees suggested that we should stop focusing on particular diseases and ailments, and rather focus on the underlying conditions that impact all diseases, ailments, and overall health and wellbeing of Inuit. Interviewees emphasized the importance of approaching climate change impacts on health through the ‘determinants of health lens’. Workshop participants did not use the ‘determinants of health’ terminology; however, the various determinants were mentioned throughout the workshop (e.g. food security, housing, education, income, addictions, environment).
Food Security: All stakeholders emphasized the significant impact that climate change has had, and will continue to have on food security. Country foods contribute to a substantial proportion of Nunatsiavut Inuit diet as a result of traditional practices and the high cost of store bought food in the region. Furthermore, harvesting country foods enhances societal well-being and cultural identity, and these foods are promoted by the Nunatsiavut Government and Health Canada as the foundation to a healthy diet in the region. Participants indicated that climate change has impacted migration routes of some animals, changed the quality of berries and meat, and the accessibility of traditional hunting grounds in Nunatsiavut. While many food security factors were mentioned (e.g. changes in food abundance, tastes, and zoonotic disease), stakeholders were most concerned about access to country foods and its impact on the health and wellbeing of the region.
Mental Health and Wellbeing: The impact that climate change continues to have on Inuit wellbeing was considered to be a major concern by all participants. Inuit are closed tied to and reliant upon their surrounding environment, thus even subtle environmental changes impacts Inuit lifestyle, culture, and health. Participants were particularly concerned about how climate change impacts Inuit ability to access the land: unpredictable weather patterns, unstable ice, as well as later freeze-up and earlier break up has forced residents to stay in town for longer periods of time. Participants mentioned how this decreasing access to the land has already impacted cultural identify and self worth particularly in men and Elders. Many government interviewees commented on the anecdotal seasonality of heightened suicide and depression rates during freeze-up and break-up in the region, and suggested that further research was warranted. One government interviewee linked this year’s unusually high mortality rates to the unusually poor winter season: as her Elders always told her, “green Christmas: full graveyard.”
Water Security: The impact that climate change has on the quantity and quality of fresh drinking water was a concern for some stakeholders. While all Nunatsiavut communities have municipally treated piped water, most residents still prefer fresh untreated surface water while in town. Furthermore, while Inuit are on the land, they rely completely on untreated brook and stream water. Participants reported that the decrease in snow fall has contributed to brooks and ponds drying up in the region, impacting the accessibility of fresh drinking water while Inuit are on the land. As well, participants noted that summer ice found in certain caves, which was traditionally available to keep food fresh while on the land, has been impacted by the warmer summer temperatures and is no longer available. Water quality concerns included exposure to infectious agents (e.g. Giardia) and contaminants (e.g. heavy metals from mining). While stakeholders considered current water quality to be good in the region, they were concerned about how changing weather patterns (e.g. periods of heavy rainfall) might impact water quality (i.e. through turbidity and runoff) in the future.
New Hazards and Safety Concerns: Participants reported that climate change has impacted weather predictability and ice stability, resulting in travel safety concerns. Travel routes that have been traditionally relied upon on are no longer safe, resulting in an (anecdotal) increase in snowmobiles falling through the ice in recent years.
Emerging Infectious Diseases: Some government interviewees were concerned about new diseases emerging in their region due to shifts in climate. In particular, some employees wanted to know more about how climate change could change the region’s risk of vector-borne and foodborne diseases.
Impacts on Health Services and Delivery: Government employees were particularly concerned about how climate change continues to challenge health care delivery in the region. All Nunatsiavut communities are remote and accessible only by air in the winter and by air and ship in the summer; however, health services are only provided by air. Each community has a clinic staffed with a resident nurse – but all emergency patients are evacuated by air out of the region to a hospital. While the region has continued to adapt to challenges in new weather patterns (e.g. communication outage policies and procedures, “Rosie the Robot” in Nain), interviewees reported that current policies and procedures would not be able to cope with the continual impacts that the changes in have had on the region. Many interviewees suggested that an evaluation should be conducted to identify and understand system vulnerabilities to climate change, in order to be better prepared for current and potential climate change-related impacts on health care delivery, instead of their present reactive ad hoc responses to events, which can be costly both in terms of possible effects on patient health, as well as economically.