This is an atlas about the health of the diverse populations who inhabit the circumpolar regions in the northern hemisphere. As an atlas, it uses maps, charts, tables, and images to describe and explain visually the major health patterns and related issues.

As the editors, we would like to make it clear to the readers that we define and conceptualize “health” very broadly, and it is also our conviction that health researchers, service providers, and policymakers working in the North and for the North need a broad and multidisciplinary understanding of northern conditions to put health into its proper context....

The physical features of the Arctic lands are varied. There are plains, plateaus, mountains, hills and valleys, traversed by rivers and dotted with lakes. Its long coast line is indented by fjords and the majestic glaciers plunge dramatically into the sea (Fig. 2.1). As the map of physical regions (Fig. 2.2) shows, there is remarkable symmetry between Eurasia and North America at their northernmost margins.

Starting with Alaska and moving from west to east across the circumpolar world, we first encounter the windswept, treeless islands out on the Bering Sea. The Big and Little Diomedes are separated by the International...

Climate is a statistical concept that summarizes a variety of weather data such as temperature, humidity, precipitation, atmospheric pressure, and wind over long periods of time. The World Meteorological Organization uses a thirty-year period (e.g., 1961–1990) to define “climate normals” for a specific locality. Climate is relevant to health because it constitutes part of the physical environment to which all human beings are exposed.

The type of climate experienced in circumpolar regions, as defined in this atlas, goes beyond what is usually considered as Arctic or polar and includes continental and even temperate climate. A popular climate classification system,...

The circumpolar regions vary in biodiversity. From the temperate rainforest in southeastern Alaska, it decreases progressively northwards through the boreal forest (taiga) to the tundra. While the number of species is small compared to more southerly biomes, individual species may be present in large numbers, and there are seasonal bursts of high productivity. Within one locality, there is also considerable year-to-year fluctuation. Table 4.1 provides a taxonomic guide to selected mammals and birds for the amateur Arctic naturalist.

The major Arctic mammals include different species of seals and whales, polar bears, muskoxen, caribou/reindeer, walruses, Arctic foxes, hares, and wolves (Figs....

The population of circumpolar regions belongs to many different ethnic and cultural groups (Fig. 5.1). Many groups consider themselves to be indigenous, while others came as settlers and colonizers from other lands. Today, the ethnic diversity of the circumpolar regions is further enhanced by increasing immigration from all over the world to the Arctic states, including their most northern regions (Fig. 5.2).

The world’s languages can be grouped into families, although linguists and anthropologists do not completely agree on their classification and nomenclature.

Table 5.1 presents one approach. In Arctic North America, the Eskimo-Aleut family extends from Greenland to Alaska...

Through statistical analyses of genetic markers, it is possible to show the genetic relationships among the diverse peoples in circumpolar regions. However, extensive intermarriage and adoption of the languages and cultures of neighbouring groups over long periods of time can obscure such relationships.

Genetic “distances” measure the degree to which populations share genetic variation. By analyzing so-called classical markers such as blood groups, red cell enzymes, serum proteins, white cell antigens, and immunoglobulins, it is possible to construct a genetic “tree.” One such tree, based on sixty genes, shows the relationship between sixteen Eurasian and North American Arctic groups (Fig....

The recorded history of the circumpolar regions is interwoven with the history of the nation-states to which they belong, or used to belong. Tables 7.1 and 7.2 provide a chronology of the major historical events in the circumpolar countries and their northern regions. For most regions, history over the past millennium was marked by exploration, trade, colonization, and de-colonization, although proceeding at different paces.

The seafaring Vikings or Norse from present-day Norway travelled far and wide across the North Atlantic. They settled the Faroe Islands and Iceland in the ninth century AD and Greenland in the tenth century (Fig. 7.1)....

In assessing the health of a population, knowledge of the size, composition, and growth of the population itself is required. An accurate enumeration of the population provides the denominator for rates and proportions that constitute many health indicators. Analyses of the population also help to identify “vulnerable” subgroups such as the elderly, children, and pregnant women who may have special health care needs.

Circumpolar regions differ in the size of their populations (Table 8.1) and their share of the total national populations. Alaska and the northern territories of Canada constitute less than 0.5 per cent of the total population of...

Some circumpolar regions are economic powerhouses while others are poverty-stricken. The land is rich in natural resources, and their exploitation has contributed to enormous economic growth in some regions. Within regions, substantial socio-economic disparities exist, particularly between indigenous and non-indigenous populations, more so in some regions than others.

The GDP (or gross regional product when referring to regions) is a well-established economic indicator that measures the goods and services produced within a region within a time period. The per capita GDP provides comparison across regions with different populations (Fig. 9.1). Table 9.1 shows that the GDP of most regions accounts...

This chapter introduces Part Three, which presents the spatial and temporal patterns of different diseases and health conditions in circumpolar populations.

Health can be represented by an iceberg, to use an Arctic analogy. Above the water, representing the most severe consequences of ill health, is mortality. Circumpolar countries have well-developed statistical agencies with mortality databases that record the number and causes of deaths, and also some demographic information about the decedents.

As most sicknesses do not result in death, it is evident that mortality can only provide a partial picture of health. There is, however, no overall measure of morbidity....

Relatively large numbers of children and youth in a society increase the need for services such as housing, education, health care, and employment.

As Fig. 11.1 shows, the youthfulness of the population varies across the circumpolar world. The highest proportions of the under-fifteen population are found in Nunavut and the Northwest Territories, Greenland, and Alaska, all regions with a high proportion of indigenous people. In contrast, the percentages of the population under fifteen years of age among the northern regions of Norway, Sweden, and Finland are very similar to the percentages in their national populations.

Children are a source of...

Women in their childbearing ages (arbitrarily set at fifteen to forty-four for statistical purposes) account for some 17–25 per cent of the population of circumpolar regions, with the high end of the range found in regions with large indigenous populations. Maintaining the health of this demographic group is thus critical for the health of the entire population, not just at the present time, but also for the next generation (Fig. 12.1).

The total fertility rate (TFR) can be interpreted as the mean number of children that would be born alive to a woman during her lifetime if she were...

Until the middle of the twentieth century, infectious diseases were major causes of death in circumpolar regions. Since then, mortality rates have decreased markedly, although the overall burden of infectious diseases in the Arctic remains high – and higher than in southern populations. There are also infections that are particular to the Arctic because of its physical environment and the cultural practices of its inhabitants.

Considerable variation in the incidence of tuberculosis (TB) exists across circumpolar regions (Fig. 13.1), with Nunavut, Greenland, and some Russian regions reporting the highest rates. Th e disparities are enormous, with Koryak AO having almost 100...

Cancer refers to the uncontrolled growth and spread of abnormal (malignant) cells. It is generally classified according to anatomic site (i.e., where the “primary” cancer originates, to be distinguished from “secondary” sites where it may have spread). However, within each site there may be several different histological types (such as squamous cell carcinoma, adenocarcinoma, etc.). Cancer may be detected at different stages in its natural history, often a reflection of the quality of preventive and diagnostic health services. Different risk factors have been identified, such as tobacco, diet, radiation, viruses, etc., although the causes of most cancers are unknown.

The...

Cardiovascular diseases (CVD), or diseases of the circulatory system (heart and blood vessels), are the leading causes of death in most developed countries. From a public health perspective, two types of CVD are particularly important: ischemic heart disease (IHD) – the narrowing of the coronary arteries leading to angina and myocardial infarction (“heart attacks”); and cerebrovascular disease (CBD) or stroke, involving the blood supply to the brain. Rheumatic heart disease, the result of rheumatic fever caused by type A streptococcal bacteria, has been on the decline since the mid-twentieth century due to advances in antibiotic therapy. Trends in IHD and CBD...

Substantial lifestyle changes have occurred in circumpolar regions since the 1950s. Among indigenous peoples, declining participation in hunting and fishing is associated with a decrease in physical activity and change from a traditional diet to a more Western diet. The interaction of environmental and behavioural factors with genetic susceptibility has resulted in an increase in the burden of obesity and diabetes.

Obesity is the excess of body fat or adipose tissue. While body fat serves a variety of essential metabolic functions, its excess predisposes to significant health problems, including diabetes, coronary heart disease, hypertension, and certain cancers. In population surveys,...

Among the most serious health problems affecting northern peoples in the decades since the 1940s are injuries sustained as a result of accidents and violence.

Injuries can be classified as to their nature (e.g., fracture, burns, etc.) or causes (e.g., motor vehicle collision, assault). Causes can be intentional, unintentional (or “accidents”), or have an undetermined intent. Intentional injuries may be self-inflicted (i.e., suicide) or inflicted by others (i.e., assault if the victim lives, and homicide if otherwise).

Fig. 17.1 compares the age-standardized mortality rates (ASMR) from all injuries in circumpolar regions. Russia and its regions have the highest rates. In...

Circumpolar peoples are subject to immense mental stress as their communities undergo profound social and cultural changes. Particularly for indigenous peoples, the second half of the twentieth century has been a period when the traditional life irrevocably gave way to modern “Western” lifestyles. Among the mental health problems experienced by indigenous peoples, suicide is clearly the most significant, more so in some populations and regions than in others.

Mental well-being can be evaluated by the presence or absence of common mental symptoms such as gloom, unhappiness, anxiety, and distress, or by scales of mental health status based on responses to...

The genetic diversity of circumpolar peoples is discussed in chapter 6. Genetics plays an important role in the causation of many diseases and their variation in populations. Genetic studies in the Arctic have ranged from identifying rare clinical syndromes to understanding environmental-genetic interactions in complex diseases. Much of the research has been conducted among indigenous peoples, especially the Inuit.

A gene is a segment of DNA (deoxyribonucleic acid) endowed with a specific function, usually the production of a specific protein. The double-helix-shaped DNA molecule is made up of sugars, phosphates, and fournucleotidebases: adenine (A), thymine (T), guanine (G),...

The circumpolar environment is characterized by marked fluctuations in temperature and photoperiod, with winters that are long, cold, and dark and summers that are short, cool, but bright. For much of the year, residents of circumpolar regions are exposed to cold at work, while travelling, and during their leisure time. The cold conditions in winter are often further aggravated by wind and precipitation. The reduced amount of daylight and the presence of snow and ice provide additional hazards. Cold affects the performance of a variety of tasks, and directly and indirectly affects human health (Fig. 20.1). In response, humans have...

As a health determinant, ‘environment’ is usually conceived of separately from ‘biology’, and encompasses all that is external to the human body. It is often further divided into ‘physical’ and ‘social,’ displayed in expanding concentric circles representing the home, the workplace, the community, and ultimately the entire planet itself. The distinction between physical and social environment is arbitrary, as there are close relationships between human activities in spheres and the integrity of the natural environment. These interact to influence health of populations.

The indigenous people of the Arctic no longer live in the traditional houses of stone, turf, and whalebone,...

The health of populations depends on the integrity of the natural environment, which is strongly affected by different types of human activities. The Arctic is often erroneously assumed be a pristine, unpolluted area. There are two major kinds of threats to environmental quality, which can be labelled ‘old’ and ‘new’. The old kind relates to defective water supply, sanitation, and solid waste management, which affect human settlements. The associated health problems are well recognized and solutions to them already exist. For a variety of technical, logistical, financial, and political reasons, however, they continue to be problems in circumpolar regions.

The...

As noted in chapters 15 and 16, cardiovascular and metabolic disorders are becoming more prevalent in circumpolar populations. Among main causes of such developments are changes in the diet and levels of habitual physical activity, part of the complex process of social transition to a globalized economy and its modern lifestyles.

For the indigenous people of the Arctic, food obtained from hunting and fishing, or ‘country food’, continues to be a major part of their diet. Subsistence and living off the land, besides the immediate nutritional benefits, promotes physical activity and enhances spiritual health.

There is variation across the Arctic...

Smoking and alcohol use are among the most important lifestyle determinants of health. As forms of addiction, they can be considered ‘diseases’ their own right, and not just risk factors other diseases. The modification of behaviours has become the mainstay public health programs in most jurisdictions.

Tobacco is indigenous to the Americas, where was cultivated and also gathered wild. Its use ceremonial and medicinal and it was widely traded among tribes, but its spread probably not extend into the Arctic. It was introduced into Europe in the sixteenth century. Tobacco has been popular with the Inuit since was introduced by...

There are fundamental differences in the political systems of the circumpolar countries which affect way health care, and indeed most government services and programs, are organized.

Canada, the United States, and the Russian Federation are federal states, with a division of authority between the national and subnational levels of government. There are ministries departments of health at both the national subnational levels, with some duplication of roles and responsibilities. The Nordic countries are unitary states where there is a national ministry of health with delegated service delivery functions to various regional or local governments (Fig. 25.1). The Faroe Islands and...

A health care system requires adequate financial resources to invest in infrastructure and equipment and hire different cadres of personnel to implement programs and services. With their different organizational structures and health care policies, circumpolar regions differ substantially in the sources of their finances and how they allocate and mobilize their resources. their from funded The private per cent health private 14.8% of GDP 15.8% of GDP

The various national health systems basically fall into three groups: (1) the United States, with its much higher level of per capita health expenditures – which account for 15+ per cent of gross domestic...

A health care system exists to deliver health services to the people. Across circumpolar countries there is a broad array of programs and services of varying quantity and quality.

Hospital services are core to any health care system. A variety of hospitals exist in circumpolar regions (Fig. 27.1), from highly specialized ones such as the Alaska Native Medical Center in Anchorage, and university hospitals in Tromsø, Umeå, and Oulu, to small ones in the remote towns of Greenland and Svalbard. The rate of hospital beds per 100,000 is the most commonly available indicator which is more or less comparable across...

To improve health care and the health status of circumpolar populations, a long-term strategy requires improving the standard of education in general, and that of health professional training in particular, and also increasing the capacity for health research to seek solutions that are relevant to northerners.

Circumpolar regions vary widely in terms of the presence of postsecondary or tertiary educational institutions. The Nordic countries, Russia, and Alaska are far ahead of Canada and Greenland in establishing comprehensive universities within the North itself (Fig. 28.1). Northern postsecondary students, however, can pursue a variety of programs outside their home regions in national...