6
Chapter 2
Ethno-cultural Adaptation
of the Peoples of the Arctic Region
ญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญญ
Peter Bjerregaard
Summary
Over the last 50 years, the population of most re-
gions of the Arctic has dramatically increased. Much of
The Arctic regions of the world share many common
this increase is due to the reduction in infant mortality,
characteristics but there are significant social, cultural,
and the reduction in mortality from infectious diseases,
and political differences. The indigenous peoples of the
particularly tuberculosis and the vaccine preventable
Arctic include the Inuit and I๑upiat who inhabit the north-
diseases of childhood. Safe water supplies and improved
ern part of the North American continent, and Greenland;
sewage disposal have also contributed to the reduction
the Saami of northern Scandinavia, Finland, and the Kola
in disease, and the development of rural hospitals, and
Peninsula; in northern Russia the Yakuts together with
in some regions, community-based medical services have
some sixteen indigenous minorities, ranging from the
provided improved care in the event of injuries or illness.
Saami and Nenets in the west to the Chukchi and Eskimo
All regions have developed greatly improved transporta-
(or Yupik) in the east; the Aleuts, Yup'ik, Athabaskans
tion infrastructure, with the resulting availability of
and other indigenous groups of Alaska; and in Canada
western food items, tobacco, and alcohol on a scale not
the Dene and Yukon First Nations Indians, who occupy
previously possible. In addition, communication tech-
the northwest Arctic and subarctic regions along with the
nology has made western culture visible in even the most
M้tis (Figure 1ท3). The indigenous peoples of the Arctic
remote settlements. To facilitate the provision of services
are estimated to comprise nearly 650 000 individuals,
and economic opportunities Arctic indigenous popula-
most of whom live in northern Russia. Past colonization
tions are, in most regions, encouraged to live in fixed
and the resulting contact with outsiders had a major
settlements. Survival often depends on a complex mix of
negative impact on the health of these peoples causing
government-funded economic support, combined with
devastating epidemics, which resulted in severe depopu-
primarily service-based employment in schools, sanita-
lation. After a period of stabilization and recuperation,
tion facilities, and transportation infrastructure. In this
societal changes during the last 50 years have had both
setting, the local culture, including related subsistence
positive and negative impacts on health. Life expectancy
food gathering, is frequently the primary source of psy-
has increased, infant mortality and the importance of in-
cho-social support for a community. The local culture is
fectious diseases have decreased dramatically, and health
subject to stress by competing western culture and, in
care has improved, while psycho-social health has gener-
some areas, commercial resource exploitation. Concerns
ally deteriorated. Chronic diseases such as cardiovascular
for the security of traditional food resources due to con-
disease and diabetes have increased due to changing
taminants and the presence of zoonotic and parasitic
lifestyles. In some areas, the indigenous peoples enjoy the
diseases associated with some traditional food species
same level of health as the non-indigenous populations,
and preparations (e.g., trichinosis, echinococcosis or
but in most areas their health is significantly poorer.
botulism) also increase this stress on indigenous culture.
As a result, erosion of cultural support, decrease in tra-
ditional activities, and substitution of western foods for
2.1. Population overview
traditional foods have resulted in changes in causes of
The Arctic regions of the world share common character-
morbidity and mortality of Arctic populations. In some
istics such as sparse population, a hostile climate, similar
respects, the morbidity and mortality rates now more
geographic features, and characteristic seasonal extremes
closely resemble western populations. However, differ-
of daylight hours. Within the Arctic, however, there are
ences between countries, and differences between cul-
significant differences in political systems, languages and
tural groups within each country, make generalizations
culture, and economic and service infrastructure.
concerning social and health changes in the Arctic in-
The inhabitants of the Arctic include a diverse group
digenous peoples difficult.
of indigenous peoples, located near the Arctic Circle in
The peoples of the Arctic were described in detail in
Norway, Sweden and Finland, and in the Russian Feder-
previous AMAP assessments (AMAP, 1997, 1998). Sec-
ation from the Norwegian border to the Chukotka re-
tions 2.1.1. to 2.1.3. provide brief descriptions based
gion, from Alaska to Canada, and eastward to Green-
mainly on these sources.
land. The lives of the indigenous peoples and other Arc-
tic inhabitants are closely linked to natural resources that
2.1.1. Arctic North America and Greenland
provide food for nourishment, and spiritual and cultural
connections to the land (AMAP, 1997). Arctic indige-
There are three groups of Alaska Natives, commonly
nous peoples rely on the food that they hunt and harvest
called the Aleuts, Inuit (or Eskimo), and Indians. About
from the land, as it provides for much of their nutri-
73 000 individuals belonging to these groups live in Arc-
tional intake and their cultural identity. These natural
tic Alaska, where they make up 15% of the total popu-
resources may also be important for economic reasons.
lation. In Canada, three groups of indigenous peoples

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7
are recognized: the Inuit, the M้tis, and the First Na-
twelfth century, the population of the Norse colonies in
tions, who in the Arctic include the Dene, Gwich'in and
Greenland reached as many as 5000 to 7000 inhabi-
Athabaskans. Together, the indigenous groups make up
tants. However, for a variety of reasons, including cli-
47 500 people or about half the population of Canada
mate change, the Viking settlements were vacated, or
north of 60บ N. The total population of Greenland is
had died out by the late fifteenth century. By that time,
56 000 of which 90% are Inuit.
European whalers had already been hunting in the Baf-
Life expectancy at birth is consistently lower among
fin Bay area off the coast of Labrador and Greenland for
the indigenous peoples of North America and Greenland
more than a hundred years. The exploration of the Arc-
than in the general populations of Denmark, Canada,
tic started in the sixteenth century and colonization fol-
and the United States. Although the incidence of and mor-
lowed. However, areas of the central Canadian Arctic
tality from infectious diseases have decreased substan-
and northern Greenland remained unexplored until the
tially, they remain considerably higher than in the general
early part of the twentieth century.
populations of the three countries. Mortality from acci-
Contact and colonization were accompanied by cul-
dents and suicide is high, particularly among men, and
tural change, which proceeded at a different pace across
this contributes to the low life expectancy (see chapter 3).
the circumpolar region. The Inuit adopted some items of
European material culture and Christianity replaced
traditional beliefs, but the hunting lifestyle remained
2.1.2. Scandinavia, Finland, and the Kola Peninsula
largely intact well into the twentieth century in most re-
The Saami live in northern Norway, Sweden, Finland and
gions. The population expanded rapidly during and
the Kola Peninsula of northwest Russia. The Saami popu-
after the Second World War, when economic develop-
lation is estimated to total some 50 000 to 70 000 per-
ment and military activities in Alaska, northern Canada
sons; they constitute a minority in all four areas. The Saa-
and Greenland greatly increased the influence of western
mi make up about 2.5% of the population in the Arctic
culture on the indigenous Inuit populations.
areas of Norway, Sweden, Finland, and the Kola Peninsula.
The social changes that resulted from contact with
There are no socio-medical differences between the
non-Inuit people have followed the same general outline
Saami in Finland, Norway and Sweden and the non-indi-
in all Inuit communities. The changes can generally be di-
genous population. Access to health care is identical for
vided into three phases: 1) an initial period of profound
both population groups and life expectancy is the same.
and disruptive transformation, 2) a period of relative sta-
bility and, 3) a second period of intense transformation
and adaptation (Bjerregaard and Young, 1998). The ini-
2.1.3. Northern Russia
tial phase was the period from the first contact until es-
According to the 1989 census, the total population of
sentially the whole Inuit society had adopted Christian-
Arctic Russia is approximately 2 million people, of
ity. This took place at different times, in West Greenland
whom approximately 67 000 are indigenous minorities:
from the mid-seventeenth to the mid-nineteenth century,
the Dolgans, Nganasans, Nenets, Saami, Khanty, Chuk-
but much later in other regions. The third phase started
chi, Evenks, Evens, Enets, Yupik, Yukaghirs, Selkups,
in the 1950s and is still ongoing. Over a very short pe-
Chuvans, Mansi, Kets, and Koryaks. The Yakuts, who
riod, the subsistence-oriented traditional way of life has
number approximately 350 000 people, are too numer-
given way to wage earning and a western lifestyle.
ous to be considered a minority, but their traditional
way of life is similar to that of the other indigenous
2.2.1. Phase 1 and 2
groups in the area.
Mortality and morbidity statistics indicate a poor
The size of the Inuit population in North America, in-
health situation relative to both the general population
cluding Greenland, was estimated to be about 74 000
of Russia and in comparison with other indigenous peo-
during the sixteenth to eighteenth centuries. The popula-
ples of the Arctic. Life expectancy is 10 to 20 years
tion declined throughout the nineteenth century and by
lower than the Russian average. Injuries, infectious
1900 it is believed to have reached its nadir at 35 000.
diseases, especially tuberculosis, cardiovascular disease,
The population slowly recovered during the twentieth
parasites, and respiratory disease are common causes of
century, reaching 52 000 by 1950 and reaching the pre-
death. Many health problems are related to alcoholism.
contact level by 1970 (Ubelaker, 1992). Introduced dis-
Infant mortality is very high.
eases, especially infectious diseases, played a major role
in the post-contact depopulation. Influenza, smallpox,
and measles spread rapidly through populations that
2.2. Health and socio-cultural changes
in the Arctic: A case study of the Inuit
had no prior immunity.
Specific information is available from a few loca-
This chapter cannot adequately describe all the social
tions. Before contact, approximately 4000 people inhab-
and cultural changes that have occurred among the Arc-
ited St. Lawrence Island. In 1878, a combination of fam-
tic indigenous peoples, but rather will use as an example
ine and epidemic struck the island and two thirds of the
the situation of the Inuit to describe briefly the effects of
population perished. The population decline continued,
social and cultural change on health.
to 222 in 1917, since when the population has still not re-
Among the indigenous North Americans, the Inuit
covered to its pre-contact size. In Canada, the Inuvialuit
were the first to encounter Europeans, and also the last.
suffered severe depopulation due to diseases introduced
The first Europeans to come into contact with the Inuit
by American whalers in the late nineteenth century.
were the Vikings who established a colony in Greenland
The first epidemic (of smallpox) was reported in
toward the end of the tenth century. At its height, in the
Greenland in 1734 only a few years after the coloniza-

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8
AMAP Assessment 2002: Human Health in the Arctic
tion. It was followed by the epidemic of 1800 in which
generally brought about with the Inuit as spectators, and
the population of entire districts perished. During the fol-
increased contact with the rest of the world through
lowing centuries recurrent epidemics of respiratory infec-
travel, radio and television, plus an unprecedented pop-
tions, influenza, smallpox and typhoid fever killed a sub-
ulation growth and relocation to larger communities.
stantial proportion of the population. The last epidemic
Last but not least, non-Inuit people have poured into the
of smallpox took place in 1852 although a few isolated
Inuit communities and taken over many of the well-paid
cases were seen later (Gad, 1974; Bertelsen, 1943).
jobs and influential positions that were created in the
A number of major epidemics swept through most
modernization process. Through self-government and
Inuit communities of Alaska. The indigenous people of
Home Rule the Inuit are gradually redressing the bal-
Alaska have borne an exceptionally heavy burden of dis-
ance and taking charge of their present and future.
ease and disability since early contact (Fortuine, 1975).
Other changes with more direct effects on health and
With the arrival in Alaska of the Russians and other Eu-
disease are dietary changes, along with an increased re-
ropean explorers, beginning in the mid-eighteenth century,
liance on store bought food, a more sedentary lifestyle,
new factors began to influence the traditional way of life.
increased access to alcohol and tobacco, and improve-
In Alaska syphilis was the first major disease to
ments in comprehensive health care.
spread, reaching epidemic proportions in the Aleutian
During the first few years after the Second World
Islands and in southeastern Alaska during the Russian
War, mortality decreased dramatically while fertility
period. Two epidemics rank among the most significant
continued to increase resulting in a sharp increase in
single events in the history of the peoples they affected.
population size. This was a period of receding epidem-
The first was the smallpox epidemic of 1835 to 1840,
ics. However, measles epidemics occurred for the first
and the second was the influenza epidemic, `The Great
time in many places and caused numerous deaths. Dur-
Sickness' of 1900. Thousands of people died, and entire
ing the 1950s tuberculosis and acute infections lost their
villages were wiped out. Another influenza epidemic
importance as causes of death. Mortality decreased until
struck in 1918 to 1919 (Fortuine, 1975).
around 1970, first rapidly, then later at a relatively
When exactly tuberculosis was introduced is uncer-
steady rate (Bjerregaard and Young, 1998).
tain, but by the late eighteenth century it was well estab-
Since the 1970s, suicide rates have increased. Suicide
lished in the general population and remained active for
rates are exceptionally high in the circumpolar indige-
the next 150 years. The tuberculosis epidemic reached
nous populations and are higher among the Greenlan-
its peak after the end of the Second World War, and was
ders than among the Inuit of Alaska and Canada (see
associated with one of the highest death rates from tu-
chapter 3). Contrary to the pattern in most western
berculosis recorded worldwide. Gonorrhea and alcohol
countries, where the suicide rates increase with age, it is
abuse were also prominent causes of major ill health in
predominantly young people, and more often men than
Alaska during the nineteenth century (Fortuine, 1989).
women, who commit suicide in the circumpolar popula-
The disruptive first phase of social change was fol-
tions. The temporal association of the rising suicide rate
lowed by some years of relative tranquility. During this
with rapid societal development in many communities
second phase of development, epidemics of respiratory
lends itself to a causal relationship, but it is not clear
infections, diarrhea, whooping cough, diphtheria, ru-
what specific aspects of the modernization process in-
bella, mumps, and poliomyelitis, to name but a few, con-
crease suicidal behavior in young people.
tinued to be common. For several epidemic diseases the
Arctic populations were too small to act as reservoirs for
2.2.3. Consequences of
the infectious agent and the diseases were reintroduced
recent societal development on health
from outside at different times. Typhoid fever, dysentery,
hepatitis, and meningitis were endemic. Starvation and
In much of the literature, rapid socio-cultural change is
chronic malnutrition were still common but tuberculosis
invariably seen as detrimental to physical and mental
was the most serious threat to public health. Neverthe-
health. Change, however, is in itself not necessarily
less, despite all this, fertility increased while mortality
stressful (Bjerregaard and Curtis, 2002). In the recent
decreased, resulting in a general growth of the popula-
history of indigenous peoples change has often been as-
tion during the second period.
sociated with powerlessness and frustration, but it has
also offered increased opportunities for survival and
economic as well as cultural development. This section
2.2.2. Phase 3
describes some examples of recent changes in Inuit soci-
By the end of the Second World War, the regions inhab-
eties resulting in negative health consequences and some
ited by the Inuit differed considerably with respect to
resulting in positive health consequences (Bjerregaard
their degree of integration into modern western society.
and Young, 1998).
However, in all Inuit communities it is the last 50 years
The change from an economy based on hunting to
that have completed the change from the relatively iso-
modern wage earning has resulted in a decreased mor-
lated, self-reliant communities based on hunting and
tality from accidents. The traditional Inuit life was ex-
fishing that existed at the time of the first contact with
tremely perilous and many hunters died at an early age
Europeans to communities that are integrated within
leaving wives and children in poor social conditions.
their respective national states.
With modern hunting methods and weaponry, combined
Among the most important changes that have af-
with traditional methods, the hunter-gatherer role is
fected health are the transition from subsistence hunting
overall more successful than in previous centuries. How-
and fishing to an economy based on wage earning, a
ever, an increase in accidental deaths from all-terrain ve-
comprehensive change of infrastructure and housing,
hicles and snow machines is seen in Alaska (Smith and

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Chapter 2 ท Ethno-cultural Adaptation of the Peoples of the Arctic Region
9
Middaugh, 1986; Landen et al., 1999). Alcohol plays a
nous populations, the Inuit may be genetically predisposed
major role in overall accident causation.
to atherosclerosis thus supporting the idea that the low
Housing conditions, sanitation, and food security
prevalence of disease must be caused by a protective life-
have generally improved. Household sizes are smaller
style (Bjerregaard and Young, 1998; Hegele et al., 1997).
and houses are larger with more rooms, thus decreasing
Recently conducted dietary surveys indicate that con-
the transmission of infectious diseases, in particular tu-
sumption of marine mammals and fish is greater among
berculosis and other respiratory infections. Sanitation
the older members of the population, and considerably
has improved in towns and most villages, thereby de-
less among some of the younger members of the same
creasing exposure to several microorganisms. Nutrition
population. Nevertheless, young Inuit still consume more
has generally improved, if not qualitatively then at least
marine food than the average westerner (see chapter 7).
with respect to reliability. Seasonal starvation has disap-
It is reasonable to believe that the mechanization of
peared from all Inuit communities thus increasing gen-
many tasks and the change to sedentary occupations
eral resistance to infections.
have not been sufficiently counterbalanced by physical
Increased contact with the rest of the world through
activities during leisure time. The widespread use of to-
travel and migration has brought a number of infectious
bacco is another factor with a significant impact on the
diseases to the Inuit communities that had previously
disease and mortality pattern. Cigarette smoking is a
been relatively spared; these include measles, gonorrhea,
major contributory factor in several cancers. It is also an
syphilis, and HIV/AIDS.
important contributing factor to cardiovascular disease
The influx of non-Inuit people, rapid growth of the
and chronic lung disease, both of which are emerging
Inuit populations, and increasing population concentra-
health problems among the Inuit.
tion in larger communities of up to several thousand in-
The traditional diet is nutritious and is believed to re-
habitants have profoundly altered the social structure of
duce the risk of developing atherosclerosis and diabetes.
Inuit communities. Together with other socio-cultural
From this perspective it is disturbing to note a decreasing
changes this has resulted in acculturative stress and in-
preference for traditional food items among the younger
creased prevalence of mental health problems, including
adults. Further details of this transition from traditional
suicide.
to non-traditional diets can be found in chapter 7.
Dietary changes leading to an increased reliance on
Furthermore, as a result of global pollution by poly-
store bought food, an increasingly sedentary lifestyle,
chlorinated biphenyls, pesticides and mercury, the ma-
and increased access to tobacco have resulted in the
rine mammals that make up a substantial proportion of
emergence of chronic diseases well known in western so-
the traditional diet of the Inuit have become contami-
cieties, e.g., obesity, diabetes, atherosclerotic heart dis-
nated. Blood concentrations of several organochlorine
ease, and dental caries.
compounds and mercury are often above established lev-
Increased access to alcohol and tobacco has led to an
els of concern for Inuit in Greenland and eastern Canada
excessive use of these substances in most Inuit communi-
(see chapter 5). Potential health consequences include
ties. Although in some regions alcohol importation to
sex hormonal effects, damage to the immune system,
villages is not allowed, alcohol abuse is, in general, a
and transgenerational effects (see chapter 6). Clinical
major contributing factor to the high prevalence of vio-
overt damage to health, however, has not yet been dem-
lence, suicide and social pathologies among the Inuit. In
onstrated (AMAP, 1998).
some communities, alcohol addiction is considered to be
the main health problem.
2.3. Conclusions
Last but not least, along with infrastructural and socio-
cultural changes, the Inuit have achieved general access
The indigenous peoples in the Arctic are in most coun-
to modern health care systems. Although accessibility to
tries a minority of the population. Their living condi-
health care services is less for Inuit living in villages than
tions, dietary habits, employment, subsistence activities,
for the predominantly urban populations in the southern
and access to health care often differ from those of south-
regions of Arctic countries, and although tertiary level care
ern populations. In most regions of the Arctic, the health
usually involves travel to hospitals in the south, the health
of the indigenous peoples is worse than that of the gen-
care services have been important in reducing morbidity
eral population of the countries in which they live, al-
and mortality from tuberculosis and several other infec-
though the gap has narrowed considerably in recent years.
tious diseases, in reducing perinatal mortality, and in im-
During the last 50 years the indigenous peoples in
proving dental health. The health care services have also
the Arctic have experienced large increases in life ex-
played a substantial role in improving the quality of life for
pectancy as a result of decreasing infant mortality and
many people due to early treatment of disabling diseases.
the successful prevention and treatment of many infec-
tious diseases, among other things. Whether health in
general has improved or declined due to the recent soci-
2.2.4. Lifestyle changes, cardiovascular disease,
and diabetes
etal changes depends on whether the positive or negative
is emphasized; a simple answer is impossible to give. It is
Traditionally, the Inuit appear to have been protected from
undeniable that physical survival has increased in all age
atherosclerotic diseases and diabetes. This may have been
groups, but it has probably been at the expense of men-
the result of a lifestyle and diet which had been character-
tal and social health. The disease pattern of the future
ized by a high intake of marine mammals and fish, a high
will depend on whether the current lifestyle trends can
level of physical activity, and low tobacco consumption,
be shifted in a more healthy direction. The rapid changes
all of which contribute to a low cardiovascular risk pro-
in culture and disease spectrum require a major change
file. Recent studies indicate that, like certain other indige-
in health care for those indigenous peoples concerned.

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