Health of Indigenous Circumpolar Populations

Indigenous circumpolar populations have experienced profound transitions in lifeways over the past half-century as a result of economic development. Although there have been positive aspects of this social transformation, most circumpolar groups today have a triple burden of disease, with a modestly elevated infectious disease level, an elevated and increasing burden of chronic conditions such as obesity and cardiovascular disease, and high rates of mental health–related challenges. The health of contemporary circumpolar populations is not easily characterized because of dramatic regional differences that stem from socioeconomic disparities among nonindigenous groups, individual population histories, lifestyle factors, environmental pollution, and underlying biological variation. Overall health and well-being range from excellent among the Sami of Sweden and Norway to extremely poor among marginalized native populations in northern Russia. Circumpolar groups today are not only threatened by continued regional economic development and pollution, but also uniquely vulnerable to global climate change. 69 A nn u. R ev . A nt hr op ol . 2 01 3. 42 :6 987 . D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g by U ni ve rs ity o f O re go n on 0 9/ 14 /1 4. F or p er so na l u se o nl y. AN42CH05-Snodgrass ARI 18 September 2013 14:43 Persistent organic pollutant (POP): an organic compound from industrial processes [e.g., polychlorinated biphenyls (PCBs)] that resists degradation and can have human health effects INTRODUCTION The health of northern populations varies considerably, an unsurprising fact given the enormity of the circumpolar region (17 million km2), its five major areas (Alaska, northern Canada, Greenland, Scandinavia, and northern Russia), and a population of nearly 10 million residents (Chatwood et al. 2012). This collective circumpolar population is characterized by its diversity and includes an array of indigenous groups (several dozen representing seven language families) and a considerable number of recent migrants to the region (Young & Bjerregaard 2008b). Furthermore, circumpolar natives vary, from constituting a small minority of the total regional population (e.g., <1% in Scandinavia) to a near complete majority (e.g., ∼90% in Greenland), and the Inuit and several other native northern groups have territories that extend across multiple nations (Young & Bjerregaard 2008b, Young 2012). One prominent circumpolar researcher encapsulated this extreme heterogeneity by comparing the lifeways and health of an Inuit hunter, a Russian mine worker, and a Norwegian schoolteacher (see Chatwood et al. 2011). Thus, summarizing the health of circumpolar populations is an immense challenge, and consequently, no review can be truly comprehensive and without critical omissions. Here, I review the health of circumpolar populations. I begin with an introduction to the circumpolar region, describing the diverse array of northern environments inhabited by humans, as well as the cultural and biological adaptations they use to copewith severe climatic and ecological challenges. I then focus attention on circumpolar peoples, organizing the discussion by region and concentrating on the indigenous groups for which health data are most available. Next follows a section on patterns of indigenous circumpolar health and key factors such as diet, physical activity, and pollution that shape these health outcomes. I then highlight issues of Arctic health disparities and the risks of global climate change before concluding with a discussion of how anthropology provides a powerful approach through which to unravel the complex interactions among environmental exposure, social factors, and underlying genetic susceptibility in shaping the health of northern populations. THE CIRCUMPOLAR ENVIRONMENT Defining “circumpolar” is a surprisingly difficult task because one can delineate the region and people on the basis of latitude, temperature, permafrost boundaries, political divisions, or demographics. Here, “circumpolar” refers to Arctic (above ∼66.5◦N) and subarctic (55–66.5◦N) areas; the terms northern, high-latitude, and Arctic are used synonymously. Given the absence of native groups at the southern pole, the present review focuses on contemporary northern populations (Figure 1). The physical and biological environments in circumpolar regions are diverse and include temperate rainforest, boreal forest (taiga), tundra, and polar desert (Young 2012). A recurring misconception by outsiders is that the Arctic is untouched and pristine; instead, this region has experienced rapid economic development over the past half-century and has also endured the effects of environmental contaminants such as persistent organic pollutants (POPs) and heavy metals (Bjerregaard et al. 2004, 2008; Donaldson et al. 2010). Furthermore, circumpolar regions are currently experiencing rapid glacial and sea ice melting and decreased permafrost as a result of global climate change (Anisimov et al. 2007, IPCC 2007). Circumpolar environments provide a unique set of challenges to human populations, including prolonged and severe cold stress with average monthly temperatures that can, in certain regions, drop to −40◦C (−40◦F) (Snodgrass et al. 2007). This type of extreme temperature exposes populations to acute cold injuries (e.g., hypothermia and frostbite) and to an increased mortality 70 Snodgrass A nn u. R ev . A nt hr op ol . 2 01 3. 42 :6 987 . D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g by U ni ve rs ity o f O re go n on 0 9/ 14 /1 4. F or p er so na l u se o nl y. AN42CH05-Snodgrass ARI 18 September 2013 14:43 Arctic Ocean Alaska (USA)