106
Chapter 10
Risk Reduction Strategies for Arctic Peoples
Andrew Gilman
Summary
vention on POPs, the Basel Convention on Wastes, and
the Rotterdam Convention on Prior Informed Con-
The Arctic region and its peoples are extremely sensi-
sent). When ratified and fully implemented, these Con-
tive to global environmental pollution. The levels of
ventions, Agreements and Protocols should signifi-
persistent organic pollutants (POPs) and metals in Arc-
cantly reduce new circulating sources of some of the
tic peoples and their traditional food supply vary con-
most dangerous POPs to which Arctic populations are
siderably throughout the circumpolar region and there
exposed. Considering the steady movement of these
remains a need for local risk reduction strategies in
compounds over months and years into the Arctic, and
some regions of the Arctic where current levels of POPs
their persistent nature, especially in polar regions, it
and/or metals are above levels of concern. In general, it
could take many years for significant reductions to be
has been most effective when local public health au-
observed in Arctic media, and especially in the fish and
thorities, working in concert with the community at
wildlife which serve as the primary food supply for in-
risk and experts from a variety of disciplines, develop
digenous populations.
risk reduction strategies that address the risks and ben-
The levels of POPs in Arctic peoples vary consider-
efits components for a specific concern. However, the
ably throughout the circumpolar region (chapter 5).
global nature of contamination by some POPs and met-
Based on current data on physiological, biochemical
als and their capacity to travel to the poles from the
and genotoxic effects of POPs (chapter 6) and their im-
mid-latitudes also requires international, regional and
pacts on population health (chapter 9) there remains a
national risk management approaches to control their
need for local risk reduction strategies in some regions
manufacture, use, transportation, storage, and dis-
of the Arctic where current levels of POPs and/or met-
posal. Based on current global trends, and various ac-
als are above levels of concern. In general, it has been
tivities to manage risks, there are likely to be minor de-
most effective for local public health authorities work-
creases in POPs in the tissues of Arctic populations in
ing in concert with the community at risk and experts
Greenland, the Faroe Islands, eastern Canada, western
from a variety of bio-medical, biological and physical
Alaska, and eastern and western Russia by 2010, and
disciplines to develop risk reduction strategies that ad-
minor increases in mercury (Hg) levels in Greenland
dress each specific concern. These local strategies are
and eastern Canada. There are likely to be major de-
able to take account of the nature of the problem, the
creases in both POPs and Hg levels in these same popu-
at-risk group(s) most in need of protection, the primary
lations by 2030. In general, levels of most POPs and
exposure route(s), the different levels of education and
metals in populations in western Canada, Iceland, Nor-
understanding in the community, and the social and
way, Sweden, Finland, and central Russia are already
cultural needs of the exposed group(s). Where a risk re-
reasonably low and are only likely to decline margin-
duction strategy involves decreasing exposure to con-
ally by 2030. These predictions will be heavily influ-
taminants found in food, local advice can be extremely
enced by prompt ratification and implementation of
specific, focusing on where and when animals are
the Stockholm Convention on POPs and other multina-
caught, what normally consumed parts of the animal
tional environmental agreements.
are best avoided (chapter 7), how food can be prepared
to lessen contaminant intake, how much can be safely
consumed while still ensuring that nutritional benefits
10.1. Introduction
are maintained, and when it is wise to decrease con-
The global nature of contamination by POPs and some
sumption because of age or fertility status. The likeli-
metals, and their capacity to travel from the mid-lati-
hood that local advice is implemented is enhanced be-
tudes to the poles requires risk management ap-
cause the governance (e.g., the local legal authority)
proaches that encompass international, regional, and
and support structure (e.g., public health support staff,
national strategies to control their manufacture, use,
phone information system, news media, etc.) are al-
transportation, storage, and disposal. Currently there
most always in place prior to the issuance of the public
are several international agreements that have been ne-
health strategy. As environmental, social, cultural, and
gotiated to address regional pollution (e.g., the Ĺrhus
economic conditions change (due to a variety of inter-
Protocols on Persistent Organic Pollutants and Metals
related factors such as climate change, the appearance
under the United Nations Economic Commission for
of new contaminants or changing levels of existing con-
Europe's (UN ECE) Convention on Long-Range Trans-
taminants, changes in local, regional and national gov-
boundary Air Pollution (LRTAP), and the North Am-
ernance policies, behavioral changes in the population,
erican Agreement on Environmental Co-operation
habits or genetics, etc.) so local risk reduction strate-
(NAAEC), which is the side agreement to the North
gies need to be developed that are more able to adapt
American Free Trade Agreement), and others to ad-
promptly and effectively to meet these changing local
dress global pollution issues (e.g., the Stockholm Con-
conditions and needs.
107
sentatives, the evaluation processes and decision-making
10.2. Risk reduction case studies
responsibilities lead to consensus building on necessary
This section discusses some recent risk reduction strate-
future action. The regional representatives wanted to en-
gies that have been applied in the Arctic countries. The
sure that the release of the contaminant information was
information is based on material submitted by the indi-
well coordinated, that the approach of providing `ad-
vidual countries and where possible describes the effec-
vice' be used rather than a restrictive advisory or warn-
tiveness of the strategies employed.
ing, and that the communication of any message must
come from regional Inuit leaders in an easily understood
local language. The following national press release was
10.2.1. Alaska
issued by the President of the ITK: "So far as we are
Following the issuance of national fish advisories by the
aware, the risks to public health from continuing to eat
U.S. Environmental Protection Agency (EPA) and the
beluga and seal blubber are very small and are out-
U.S. Food and Drug Administration (FDA), the latter
weighed by the benefits to you of these foods. However,
recognized that Hg levels in Alaskan fish were lower
Inuit must judge for themselves what is an acceptable
than average levels in other fish consumed in the United
risk for themselves and their families". Regional leaders
States and amended their original advisory; recommend-
presented the information to their communities in a co-
ing that Alaskan consumers contact their local health
ordinated fashion and through the ITK. They supported
and food safety authorities for specific consumption ad-
the basic message that the benefits of consuming these
vice. The Alaskan Division of Public Health has deter-
foods outweighed the risks and that food consumption
mined that Hg levels are very low in most of the fre-
decisions were ultimately individual decisions.
quently consumed fish species and that there are docu-
mented health, social, cultural, and economic benefits
10.2.2.2. Mercury in Arctic waterfowl
associated with fish consumption. This Agency through
a consensus process involving a variety of scientists,
In 2001, Health Canada released a health hazard assess-
health policy experts and community leaders concluded
ment for Hg and selenium (Se) levels determined by the
that `the known benefits of fish consumption far out-
Canadian Wildlife Service in livers from waterfowl har-
weigh the theoretical and controversial potential adverse
vested in northern Canada between 1988 and 1994. The
effects from mercury found in Alaska fish' and that `sub-
evaluation of the data led to a recommendation that
stitution of other less healthy, less nutritious food for
"...it would be considered prudent to limit consumption
Alaska fish would result in far greater harm to health'.
of the livers..." of some waterfowl species. The evalua-
It is strongly recommended by the Alaskan Division of
tion information was immediately provided to the Yu-
Public Health (and endorsed by ten partner organiza-
kon Contaminants Committee, the NWT Contaminants
tions) that all Alaskans, including pregnant women,
Committee, the Nunavut Contaminants Committee, the
women who are breast feeding, women of child-bearing
Nunavik Nutrition and Health Committee, and the La-
age, and young children continue unrestricted consump-
brador Inuit Association. The diverse membership of
tion of fish from Alaskan waters (SOA, 2001).
these environmental contaminants committees provided
the fora and perspectives necessary for a balanced dis-
cussion about the importance of the results for northern-
10.2.2. Canada
ers. Dietary survey information on consumption of wa-
A number of experiences in Canada have lead to an ap-
terfowl livers was also of value in the discussions be-
proach where scientists, health policy makers, and com-
cause it provided information on frequency and seasonal
munity leaders work together to develop specific advice
consumption of duck livers, as well as on economic,
pertaining to specific findings in a manner that is re-
spiritual, cultural, and social benefits. Based on the dis-
spectful of cultural and social issues and of maximum
cussions, the groups made the risk management decision
benefit to the health of local consumers.
not to issue advice to limit consumption of waterfowl
livers, but to update current communication materials
and to provide a fact sheet discussing the elevated levels
10.2.2.1. High levels of persistent organic pollutants
of Hg found in some of the bird livers.
in marine mammals
In 1995, Health Canada and Environment Canada offi-
10.2.2.3. Lead shot in traditional foods
cials presented research results on the levels of organ-
ochlorine compounds in Arctic marine mammals to the
The results of studies on cord blood lead (Pb) carried out
Northwest Territories (NWT) Technical Committee on
between 1993 and 1995 show that 7.6% of Nunavik
Arctic contaminants. This committee comprised north-
newborns (n=238) had blood Pb levels of 100 µg/L and
ern indigenous representatives, government health and
over, compared to 0.2% for babies from the southern
research representatives, as well as representatives from
part of Quebec (n=955). Subjects with high concentra-
the national Inuit organization, the Inuit Tapiriit Kana-
tions were uniformly distributed across the territory.
tami (ITK) (previously the Inuit Tapirisat of Canada
Moreover, 2.1% of the samples from Nunavik showed
(ITC)). The research indicated the presence of a number
blood Pb levels of >150 µg/L. These data, together with
of organochlorine compounds, including toxaphene,
data collected in Nunavik during the 1992 Santé Québec
dieldrin and polychlorinated biphenyls (PCBs), in high
survey, revealed that 24% of women between 18 and 39
concentrations in ringed seal (Phoca hispida) fat and
years had blood Pb levels of >100 µg/L. While Pb expo-
beluga whale (Delphinapterus leucas) fat and skin. The
sure through contamination from industrial activities,
Committee's discussion of the data with regional repre-
from vehicle emissions, from ingestion of old Pb-based
108
AMAP Assessment 2002: Human Health in the Arctic
paint or through drinking water was unlikely in the Inuit
10.2.2.5. Seabird egg intervention
communities of Nunavik, the consumption of contami-
on the lower north shore
nated game was a plausible source of exposure. Rela-
of the St. Lawrence River
tively high levels of Pb have been reported in caribou
(Rangifer tarandus) and many species of waterfowl
Traditional consumption of seabird eggs in communities
that are key elements of the traditional Inuit diet. Cari-
along the lower north shore of the St. Lawrence River
bou pick up Pb via the consumption of lichens, which
has led to a pattern of contamination in human tissue
in turn receive lead from the atmosphere. However, Pb
that is very similar to that observed in the eggs them-
levels observed in waterfowl are generally thought to
selves. Evaluation of the temporal trends of several per-
be due to the ingestion by birds of lead shot used by
sistent contaminants in umbilical cord plasma of new-
hunters. Isotopic analyses of the Pb in the blood of in-
borns in these remote Canadian coastal populations, fol-
fants from Nunavik and southern Quebec revealed that
lowing advice to reduce seabird egg consumption, re-
the source of Pb found in the infants from the two re-
vealed reductions of between 25% and 69% over a
gions is different. Based on analyses of various brands
seven-year period. No monthly or seasonal pattern was
of lead shot it has become clear that elevated levels of
detected. Using n-3 fatty acid concentrations in umbili-
Pb in Nunavik infants come primarily from the direct
cal plasma phospholipids as a surrogate for long-term
ingestion of lead shot, lead fragments and lead dust in
fish consumption, the decrease in tissue concentrations
hunted game and less from airborne sources (as was the
of OCs could not be explained by a reduction in fish
case in children from southern Quebec). Furthermore,
consumption. These results suggest that prenatal expo-
X-rays of the abdomen of Nunavik Inuit reveal the
sure to POPs has declined in this population. This de-
presence of lead shot in the digestive system, thus sup-
cline seems to be due to a decrease in the contamination
porting the hypothesis that lead shot ingestion is the
levels in the eggs themselves and a reduction in the con-
main source of contamination. This problem was also
sumption of seabird eggs following the public health ad-
observed in Cree communities from northern Ontario.
vice provided to the communities.
These findings in Nunavik support the current bans
in place in many countries on the use of lead shot (for
10.2.3. Greenland
the protection of waterfowl). They also suggest that
10.2.3.1. Lead levels
less toxic shot, such as steel shot, be used by hunters
wishing to protect themselves and their families from
As in other countries, levels of blood Pb have declined as
the health impacts of Pb exposure. Currently discus-
a result of the global reduction in use of leaded gasoline.
sions are underway with hunters associations and the
To further reduce human exposure to Pb, discussions are
regional Health Board on a complete ban on lead shot
underway with hunters associations to replace lead shot
and retailers are being asked to purchase only non-
with less toxic alternatives.
lead shot.
10.2.3.2. Consumption of traditional foods
10.2.2.4. Mercury exposure in Nunavik women
Greenland health authorities encourage the consump-
and the Arctic char promotion programme
tion of traditional foods for nutritional and cultural rea-
Studies in Nunavik have indicated elevated levels of Hg
sons. Despite documented high intakes of several con-
in women of reproductive age. Most concentrations
taminants through some dietary components, no advice
reported were in the range of a `level of concern' and
has been given to reduce consumption of any specific
some at or above the `action level', using Canadian ter-
traditional food items.
minology (see chapter 9, Figure 9·1), and may pose a
risk to the health of the fetus. However, local public
10.2.4. Iceland
health authorities took into consideration the high level
of intake of Se (which may counteract methylmercury-
Levels of POPs and metals in the Icelandic population
induced toxicity) in the diet of these same women, and
are among the lowest in the Arctic. No risk management
consequently did not recommend a reduction in sea-
initiatives related to reduction in exposure to POPs and
food consumption. Recently, a project to reduce risks
metals through food exposure are in place or contem-
among pregnant women exposed to food chain con-
plated at this time.
taminants has commenced in Nunavik. This pro-
gramme promotes the consumption of Arctic char (Sal-
10.2.5. Faroe Islands
velinus alpinus) among pregnant women living in three
10.2.5.1. Consumption of pilot whale meat and blubber
selected communities in Nunavik. Arctic char contain
very few contaminants and are very nutritious. The
Since 1989, research results from the Faroe Islands have
evaluation of this project will include how extensively
shown that dietary intakes of Hg, the primary source of
and consistently pregnant women participate in the
which is pilot whale (Globicephala melaena) meat and
programme and how efficient the programme is at re-
organs, is likely to slightly impair neurological develop-
ducing contaminant intake (especially Hg) while main-
ment in children. It is also suspected that dietary PCBs,
taining or improving nutritional status. Results of this
the main source of which is whale blubber, affect the
project will help regional public health authorities de-
central nervous system and sexual organs of the devel-
cide whether or not to recommend this moderate
oping fetus. Based on the demonstrated effects of Hg ex-
change in eating pattern among a broader number of
posure and on a general assessment of PCBs, the follow-
communities in Nunavik.
ing dietary recommendation, which placed special em-
Chapter 10 · Risk Reduction Strategies for Arctic Peoples
109
phasis on protection of women of child-bearing age, was
are often regularly consumed by coastal populations.
issued in 1998.
Women in these areas have been advised to avoid con-
sumption during their child-bearing years and especially
Blubber High PCB levels in blubber lead to a recom-
during pregnancy and nursing. The same high concen-
mendation that adults eat pilot whale blubber only once
trations have not been documented in coastal areas and
to twice a month. However, the best way to protect the
fjords north of the Arctic Circle.
fetus against the potential harmful effects of PCBs is for
girls and women not to eat blubber until they have given
birth to their children.
10.2.6.3. Flame retardants in bird eggs
Meat The mercury content of pilot whale meat is high
In early 2002, Norwegian health authorities announced
and is one of the main mercury sources. Therefore it is
a severe restriction on the consumption of gull (Larus
recommended that adults eat no more than one to two
spp.) eggs in northern regions because of findings of
meals [based on pilot whale] a month. Women who plan
high levels of persistent flame retardants in these eggs.
to become pregnant within three months, pregnant
Gulls and other fish-eating birds are known to biocon-
women, and nursing women should abstain from eating
centrate most POPs, sometimes as much as one million
pilot whale meat.
times relative to levels in water. This is the first human
consumption advisory based on flame retardants.
Organs - Pilot whale liver and kidneys should not be
eaten at all.
10.2.7. Sweden
These recommendations are still considered by the Far-
oese Public Health Authority to be the most appropriate
The Swedish National Food Administration revised its
advice at the present time. This dietary recommendation
advice on fish consumption in 1995 as a result of con-
may be revised as new information is acquired.
tamination levels determined in the Baltic Sea and some
Recent examinations have demonstrated that, on av-
inland lakes and recommended as follows.
erage, the Faroe Islands population has a PCB intake
All consumers A maximum of one meal per week of
which is five to ten times higher than that of Danes. In
pike (Esox lucius), Baltic herring (Clupea spp.), Baltic
addition it has been established that the PCB content of
salmon (Salmo salar), and eel and only occasional meals
breast milk of Faroe Island women is very high compared
of cod (Gadus morhua) livers.
to average breast milk PCB concentrations in most other
Western European countries. Pilot whale meat and blub-
Girls and women of child-bearing age No cod livers, a
ber have for many years been considered healthy for
maximum of one meal per week of pike, eel and halibut
human consumption, and in recent years it has been
(Hippoglossus hippoglossus), and a maximum of one
stated again and again that marine fats, as found in
meal per month of Baltic herring. For salmon the recom-
whale blubber, can prevent cardiovascular disease. Pub-
mendation is a maximum of one meal per month regard-
lic heath authorities in the Faroe Islands do not claim
less of whether it comes from the Baltic or inland lakes.
that pilot whale meat and blubber are unhealthy, but
Lactating women No consumption of pike, halibut,
rather point out that pilot whale meat and blubber con-
eel, or cod livers.
tain substances which international authorities consider
capable of causing health problems. Remarkably, levels
Pregnant women No consumption of pike, halibut, eel,
of Hg have declined by approximately 80% in the adult
or cod livers, a maximum of one meal per month of her-
population over the last nine years. Similar declines have
ring from the Baltic and salmon from either the Baltic or
not been seen in the PCB levels. The decline in Hg levels
inland lakes.
appears to be based on reduced consumption of pilot
whale products as proposed in the original public health
10.2.8. Finland
advisories, and the short biological half-life of Hg.
10.2.8.1. Food and fish advisories
Finland has set national limits for commercial food con-
10.2.6. Norway
tamination and applies these to all food sold in the coun-
10.2.6.1. Blood lead reductions
try, including the Arctic regions of Lapland. Levels of
Blood Pb concentrations have declined in the general
contaminants in sport fish are also monitored and there
population in Norway over the last three decades,
are no restrictions on fish consumption due to contami-
mainly due to the change from leaded to unleaded gaso-
nants. There are also no restrictions on the consumption
line. Concentrations of Pb in blood reported in the first
of reindeer meat from Finnish herds. Radionuclide con-
AMAP Assessment Report (AMAP, 1998) are some of
tamination from the Chernobyl reactor accident in Rus-
the lowest ever reported or determined. In 2001, Nor-
sia in 1992 did not lead to contamination of reindeer in
way decided to ban lead shot, based on the recent
Finland.
knowledge of Pb impacts on reproductive health and
child development, even at relatively low levels.
10.2.9. Russia
10.2.9.1. Blood lead levels
10.2.6.2. Organic contaminants in fish
Blood Pb concentrations in populations of the bigger
Fish taken from some coastal areas and fjords of south-
cities of the Kola Peninsula are moderately elevated
ern Norway have been found to contain concentrations
compared to levels in populations from neighboring
of POPs that exceed health guidelines. The same species
areas in Norway. This is probably due to the continuing
110
AMAP Assessment 2002: Human Health in the Arctic
use of leaded gasoline. Elevated blood levels (up to con-
Example B. In Greenland, a recent study of contaminant
centrations that are of medical concern) have been docu-
levels among the Inuit living on the east and west coasts,
mented in children living in remote areas of the Kola
both groups consuming a traditional diet high in marine
Peninsula, with a diet based on natural, local products.
mammals, indicated that while Hg levels in adults were
This has recently been linked to the use of lead shot. The
similar, PCB levels were almost five-fold different be-
authorities are now working to prepare new guidelines
tween the two groups. Dietary evidence revealed that
on the use of lead shot.
Greenlanders living on the east coast consumed polar
bear (Ursus maritimus) fat which has very high PCB lev-
els and moderate Hg concentrations, whereas the Green-
10.2.9.2. Social and cultural impacts of modernization
landers on the west coast eat more seals and walrus
in the Kola Peninsula
(Odobenus rosmarus) which are moderate in both PCBs
The pollution problems associated with the nickel (Ni)
and Hg.
smelters and refineries of the Kola Peninsula present a
Example C. Comparisons of non-indigenous and indige-
significant Arctic regional dilemma. Modernization of
nous groups in Siberian Russia reveal that the non-in-
the Ni producing facilities, which will also help to re-
digenous group has a three-fold higher concentration of
duce environmental pollution in the area, is likely to
DDT even though it is consuming lesser amounts of tra-
benefit the health of the workers and the general popu-
ditional food than the indigenous group. These data in-
lation of the area. However, modernization may also re-
dicate either contamination of the domestic food supply
sult in up to 50% of the workers losing their jobs. This
or a local source as the most significant contributor of
level of job loss in remote regions is likely to have dra-
DDT to population exposure in the region.
matic social consequences for communities and for the
well-being of workers and their families. The political
Examples A and B, and to the extent that food contami-
solution to date has been to slow the rate of the needed
nation is the cause, Example C, illustrate both the pri-
industrial rehabilitation, to give people the chance to re-
mary role of food in determining human body burdens
tire, to retrain or to find other types of work. Authorities
and the importance of understanding local dietary pat-
believe that remediation of the environment is of sec-
terns and contaminant levels in the dietary components
ondary importance to maintaining social cohesion dur-
when evaluating exposures and developing risk reduc-
ing rapidly changing economic conditions. Recent new
tion strategies.
economic development in the area is promising and may
The health chapter of the first AMAP Assessment
enable more rapid environmental rehabilitation. A num-
Report (AMAP, 1998) introduced the concept of the
ber of guidance documents for environmental health risk
`Arctic Dilemma' (i.e., vigorously supporting the con-
evaluation have been published by Russian public health
sumption of traditional foods with their known nutri-
authorities to promote the safety of populations in these
tional, social, cultural and spiritual benefits while recog-
and other parts of Russia.
nizing that these same foods are the primary source of
environmental contaminants). Data in the present report
10.3. Long-term impacts of
strengthen this concept. The weight of evidence for
risk reduction strategies and scenarios
harmful effects of POPs and metals has been augmented
through epidemiological investigation (chapter 9) and
for changing global conditions
biomarker studies (chapter 6). Yet knowledge of the nu-
This section discusses the long-term implications of cur-
tritional value of traditional foods and the links they
rent and future risk management strategies on the expo-
have with social, cultural, and spiritual integrity are also
sure of Arctic populations to pollutants, and the influ-
enhanced. Overall, the evidence is still compelling that
ence of changing global conditions on health in the cir-
traditional food is more nutritious than market food, re-
cumpolar region.
duces risk factors for several disease conditions such as
heart disease and diabetes, and can bind communities
10.3.1. The influence of Arctic food
together in ways that market foods do not. It is also
on health risk management decisions
clear that, in some areas of the Arctic, there is a need for
some groups such as women who are fertile or pregnant
As omnivorous consumers, humans act as predators in
to substitute their intake of the most contaminated food
the food chain. As a result they become exposed to ever
items with less contaminated but similarly nutritious
increasing amounts of contaminants the higher up the
items in order to minimize the risks for their babies. The
food chain they feed. It is clear that food is the primary
AMAP Human Health Expert Group affirms that, de-
source of exposure to most POPs and a significant
spite the presence of contaminants in human milk,
source of most metals, especially methylmercury. We are
breast feeding is the best and safest form of infant nutri-
what we eat.
tion, essential for optimal motherchild bonding, and
Strong evidence to support this reality occurs in recent
critical for proper development of the infant immune
findings provided in this report (see chapters 5 and 7).
system, and should therefore continue.
Example A. In Canada, the Inuit consume fish and ma-
rine mammals as part of their traditional diet whereas the
10.3.2. Global change and risk management
Dene/Métis consume fish and terrestrial mammals. Be-
cause marine mammals have significantly higher concen-
The development of risk reduction strategies for popula-
trations of POPs and metals than terrestrial mammals, the
tion groups must take account of changing global condi-
PCB and Hg levels in Inuit are approximately five times
tions and also changes in or surrounding the at-risk pop-
higher than the corresponding levels in Dene/Métis.
ulations themselves. These changes may impact social,
Chapter 10 · Risk Reduction Strategies for Arctic Peoples
111
cultural, spiritual, physical, or economic underpinnings
10.3.3. Future scenarios in the Arctic
of life in the circumpolar region. Some examples follow.
The availability, quality and delivery of healthcare
Evaluating the combined effects of global pressures and
can vary by region, size and location of community, and
local and global risk management strategies is specula-
as a consequence of competing governmental and public
tive and can only be qualitative. There are, however,
health fiscal priorities. These factors can affect necessary
some significant international initiatives and also some
monitoring of population trends (e.g., diseases, contam-
scientific aspects that can be applied to speculation on
inant exposure, food consumption patterns, etc.), med-
future outcomes related to POPs, metals, and disease
ical intervention and the availability of local advice from
rates.
health professionals. Nevertheless, there are encourag-
ing trends in health statistics that indicate overall popu-
10.3.3.1. Speculation factors for POPs
lation health is improving in many areas.
The emergence of new contaminants in the Arctic
1. The UN ECE Protocol on POPs is ratified by 2003
food chain (chapter 4), and, e.g., temperature changes
and primary sources of sixteen POPs are severely re-
that affect the permafrost, wildlife movements, disease
duced or eliminated in Europe, Canada and the
vectors, food availability, water quality and other physi-
United States by 2010 and in Russia by 2020.
cal factors can significantly affect where communities
2. The Stockholm Convention on POPs is ratified by
live or how communities live.
2004 and primary sources of several POPs are se-
Changes in the diet of indigenous communities to-
verely reduced or eliminated throughout the North-
ward consumption of less traditional food is, whilst low-
ern Hemisphere by 2020.
ering contaminant intakes, also leading to increased in-
3. Secondary sources (environmental sinks) continue to
take of carbohydrates, saturated fats and food additives,
yield POPs that are transported to the Arctic through
probably lower levels of intake of essential dietary com-
2030, however, the extent of the airborne transport
ponents, and increased incidence of diabetes and heart
from secondary sources declines by 20% by 2030.
disease (chapter 7).
4. Biological half-lives for POPs (the time it takes for
Levels of smoking undoubtedly vary among popula-
POP levels to decline to 50% of their starting value)
tion groups in the Arctic; however the rate is generally
in human tissues are between one and seven years de-
high and increasing in children and adolescents (chapter
pending on the POP. If there are no additional expo-
8) as has been seen in southern regions of the circumpo-
sures, and a mean half-life of five years is applied to
lar countries. Empowerment of communities to continue
existing tissue concentrations, then current levels of
to address smoking rates (greater than 35% of pregnant
POPs in the Arctic population will decline by ap-
mothers smoke in many areas) and a high intake of alco-
proximately 70% by 2010 and 98% by 2030.
hol (rates of fetal alcohol syndrome up to five times na-
5. Human intake of contaminants declines as the trend
tional averages) will be essential to reduce these signifi-
toward less consumption of traditional food (espe-
cant stressors of individual and community health.
cially marine mammals) continues over the next ten
Economic recession, natural resource development,
years. In addition, human intake of contaminants de-
increased immigration and tourism, low self-esteem
clines as levels of contaminants in food slowly begin
among individuals and within communities, and the
to decline after 2015 as a result of speculation factors
growing need for money to purchase commodities and
1 to 3.
food associated with a changing way of life can also af-
fect community integrity and responses. These factors
Conclusions. Overall levels of POPs currently found in
and other social pressures are likely to be partially re-
the tissues of Arctic residents may decline by 5% to 10%
sponsible for high suicide rates, increasing substance
by 2010 and by 30% to 50% by 2030 (Figure 10·1).
abuse and the growing sense of poor self-worth associ-
These changes will be most noticeable for PCBs, toxa-
ated with a lack of income (previously far less essential
phene, hexachlorobenzene, chlordane, DDT and DDE.
for traditional community life).
The Arctic regions that will be most affected by reduc-
The Arctic peoples appear to be extremely sensitive
tions will be western and eastern Greenland and the Far-
to global pressures, supporting the need for ongoing
oe Islands, followed by eastern Canada, western Alaska,
monitoring of social and ecosystem changes and popula-
and western and eastern Russia. Lesser reductions will
tion health and well-being.
be observed in western Canada, Iceland, Norway, Swe-
Change in tissue levels, %
Figure 10·1. Predicted percentage change in levels of
+10
POPs and metals in the tissues of Arctic residents by
0
2010 and 2030 relative to 2000 levels. Speculation
10
factors and assumptions taken into account in the
by 2010
20
predicted changes in tissue levels are described in
sections 10.3.3.1, 10.3.3.2, and 10.3.3.3.
30
40
Aggregated estimates for all existing POPs in tissues
are based on most affected Arctic areas (eastern/
50
by 2030
western Greenland, Faroe Islands, eastern Canada,
60
western Alaska, eastern/western Russia). Hg: Green-
70
land and eastern Canada only. Pb: All areas. Cd:
80
Combined reductions (smokers and non-smokers).
Ni: Russian nickle refinery areas only. Darker and
90
Existing
Emerging
Hg
Pb
Cd
Ni
lighter portions of columns show minimum and
POPs
POPs
maximun predictions, respectively.
112
AMAP Assessment 2002: Human Health in the Arctic
den, Finland, and central Russia (except for -HCH)
Conclusions: Levels of PBDEs, PFOS and -HCH (re-
where the levels are already low and there is almost no
sulting from use of lindane) will continue to increase by
reliance on marine mammals as a regular food source.
5% to 10% through 2010 and will decline marginally
by 10% to 20% by 2030 (Figure 10·1). Fewer POPs will
be detected in the Arctic after 2010, and those found
10.3.3.2. Speculation factors for metals
will be at lower levels, as most European and North
1. The UN ECE Protocol on Metals, which covers Hg,
American counties have been screening chemicals prior
Pb and cadmium (Cd), is ratified by 2005. A global
to their entry into commerce and those ratifying the
agreement is reached on metals emissions by 2010.
Stockholm Convention on POPs will be developing
2. Total emissions and long-range transport of Hg con-
screening systems.
tinue and even increase from North America and
southeast Asia through 2010 with continued reliance
10.3.3.4. Speculation factors for population morbidity
on fossil fuels (especially oil and coal) for energy.
and mortality
Traditional food consumption continues to decline
over the next ten years. Unlike POPs, it is established
1. Globalization through to 2010 leads to more immi-
that the half-life for mercury in human tissues is rela-
gration, tourism, resource development, and pressure
tively short.
for income to afford commodities advertised globally
3. Global use of leaded fuels continues to decline and is
and increasingly in the Arctic. The number and range
absent in the Northern Hemisphere by 2015. Lead
of products consumed in the Arctic increases steadily
shot is replaced by less toxic alternatives in the cir-
as does the potential for introduction of infectious
cumpolar region by 2010, reducing Pb levels in the
diseases.
environment and Pb fragments in food portions col-
2. Less traditional food and more commercial food are
lected through hunting. Traditional food consump-
consumed by Arctic populations through 2010 fol-
tion continues to decline over the next ten years. Un-
lowed by stabilization in the balance of traditional
like POPs, it is established that the half-life for lead
and commercial food consumption by 2030.
in human tissues is relatively short.
3. Increased awareness of globalization and contam-
4. Smoking, which is the single largest contributor to
inant issues and higher levels of attained education
Cd levels in human tissues, decreases only marginally
among Arctic populations through to 2030, leading
in Arctic populations by 2010 and significantly by
to greater awareness of risks and benefits of lifestyle
2030.
and diet choices.
5. Industrial emissions of Ni and other metals from
4. Better healthcare and availability of services region-
large smelting operations in the Arctic decrease sig-
wide by 2010 and greater emphasis on and accept-
nificantly in western Russia by 2010.
ance of disease prevention and management and
health promotion by 2030.
Conclusions. Mercury levels in populations living in the
5. Lower levels of exposure and body burdens of POPs
eastern Canadian Arctic and Greenland will remain at
and metals by 2030, as described in sections 10.3.3.1
current levels or increase by 5% through 2010 and will
to 10.3.3.3.
decline by 10 to 15% by 2030 (Figure 10·1). Lead levels
6. New and/or changing disease vectors associated with
measured in blood will continue to be low and will de-
climate change.
cline by 5% to 10% by 2010 and 15% to 20% by 2030.
The currently small proportion of individuals exposed to
Conclusions. Throughout the Arctic, disease rates for
lead shot fragments will reduce almost to zero by 2010,
circulatory disorders, diabetes and some cancers will in-
eliminating blood Pb levels above 50 µg/L across the Arc-
crease through 2010 as a result of globalization pres-
tic by 2030. The percentage of the population with high
sures, poorer dietary components including changes
levels of Cd will decline by 30% by 2030 as the propor-
away from traditional foods, smoking and alcohol con-
tion of smokers declines. Cd levels in individuals who
sumption, less exercise and, for cancers, current levels of
continue to smoke will only decline marginally by 2030
POPs (Figure 10·2). These rates will begin to stabilize by
as the number of cigarettes smoked per day per smoker
2030 as a result of lower levels of contaminants, greater
gradually declines. The reduction in Cd levels in the gen-
public awareness and acceptance of healthy lifestyle at-
eral population (smokers and non-smokers) will be mini-
by 2010
by 2030
mal by 2010 and between 10% and 20% by 2030. Ni lev-
Morbidity
els in individuals living near Russian smelters will decline
(chronic vascular disease, obesity,
by 50% to 60% by 2010 and 80% to 90% by 2030.
diabetes, cancers, AIDS)
Mortality
(all causes, especially accidental death)
10.3.3.3. Speculation factors for emerging POPs
Alcohol and tobacco use
1. National and international attention focuses on
emerging POPs, such as polybrominated diphenyl-
Nutritional status
ethers (PBDEs) and perfluorooctane sulfonate (PFOS)
(see chapter 4), and on the current use pesticides such
Figure 10·2. Qualitative future changes in morbidity, mortality, al-
as lindane, and others, leading to severe restrictions
cohol and tobacco use, and nutritional status among Arctic resi-
or elimination of these chemicals under the UN ECE
dents. Speculation factors and assumptions taken into account in
the predicted changes are described in section 10.3.3.4. Orientation
Protocol on POPs or the Stockholm Convention on
of the arrows and length of the shaft indicate direction of change
POPs by 2010.
and relative magnitude of change, respectively.
Chapter 10 · Risk Reduction Strategies for Arctic Peoples
113
tributes and better healthcare and disease management
The complexity of changing conditions and the need
approaches. Mortality rates will decline marginally by
for inclusion of multiple determinants of health in deci-
2010 and significantly by 2030 as deaths due to acci-
sion-making makes forecasting future population trends
dents are reduced and prevention and management of
very difficult. Based on current global trends, and vari-
diseases improves. Alcohol and tobacco use will con-
ous activities to manage risks, there are likely to be mi-
tinue unchanged through 2010 and decline by 2030 as
nor decreases in POPs in the tissues of Arctic popula-
awareness and understanding of the driving forces be-
tions in Greenland, the Faroe Islands, eastern Canada,
hind these lifestyle choices and greater community em-
western Alaska, and eastern and western Russia by 2010
powerment increase. Nutritional status will decline
and minor increases in Hg levels in Greenland and east-
through 2010 and stabilize by 2030 as Arctic popula-
ern Canada. There are likely to be major decreases in
tions return to consumption of nutritious traditional
both POPs and Hg levels in these same populations by
foods that have lower levels of contaminants.
2030. In general, levels of most POPs and metals in pop-
ulations in western Canada, Iceland, Norway, Sweden,
Finland and central Russia are already reasonably low
10.4. Conclusions and recommendations
and are only likely to decline marginally by 2030. These
The most effective and rapid risk management strategies
predictions are heavily dependent on prompt ratification
are those developed locally with the community that
and implementation of the Stockholm Convention on
they are designed to assist. Once evaluated for their ef-
POPs and other multinational environmental agreements.
fectiveness, they can be used as case studies to assist the
There remains a key need to fill in data gaps in order
development of risk reduction strategies in other parts of
to validate and update exposure and disease estimates
the Arctic. The key success factors for these strategies
for various regions of the Arctic. Special emphasis
will be based on how and when the people most affected
should be placed on children and youth, for whom data
are engaged in the decision-making process. Any strate-
are difficult to gather and who are most vulnerable to a
gies based on traditional food substitution should ensure
range of change agents, e.g., POPs, metals, early child-
that the value of the dietary components is sustained.
hood nutrition, education, availability of health care, to-
It is essential that countries ratify and implement
bacco and alcohol use, etc.
multinational environmental agreements, especially the
Serious consideration by all Arctic countries should
Protocols on POPs and metals to the LRTAP Conven-
be given to eliminating the use of lead shot as one rela-
tion, and the Stockholm Convention on POPs as these
tively simple means of reducing the small number of ex-
are the only effective long-term solutions for reducing
cursions in blood Pb among consumers (especially chil-
human exposure to POPs and metals.
dren) of hunted game.