Climate Change and Public Health in the Canadian North

The Canadian North is a region where both land and society are vulnerable to climate change. Commonly defined as territory above 60° latitude (Yukon, Northwest Territories [NWT], and Nunavut), as well land in Quebec north of 55° latitude and Nunatsiavut in Labrador, the North is demographically dominated by Inuit and First Nations peoples whose health is intimately associated with their environment (Figure 1). Health in this region is administered by Health Canada, as well as provincial governments and non-governmental institutes such as Inuit Tapiriit Kanatami, Inuit Circumpolar Council Canada, and Qaujigiartiit Health Research Center. The need for specific health policies to unify the association of health agencies has been identified in literature, [1] and accordingly Canada has developed a series of climate-specific policies that emphasize capacity building and information type initiatives that identify leading health determinants associated with climate change, including food security, housing and sanitation, and mental health. [2]

Figure 1:

The Canadian North is commonly defined as the territories above 60° latitude (the
Yukon, Northwest Territories, and Nunavut) as well as Quebec north of 55° and Nunatsiavut in
Labrador, here highlighted in blue (Indigenous and Northern Affairs Canada, www.aadnc-
aandc.gc.ca/eng/1450197908882/1450197959844).

Arctic Food Security
Lack of access to food resources has been well documented as a widespread problem in the Canadian Arctic, [3] with 28% of households in Nunavut reporting severe or moderate food insecurity. [4] This problem is especially prevalent among Inuit; a 2007 survey revealed 60% of respondents were worried about finding enough food, largely due to low income and high costs of food. [5]

Climate change exacerbates food security problems in the North as warming temperatures, changes in precipitation, ice melt, and altered phenology threaten subsistence harvest and invalidate traditional knowledge, while increased fuel prices inhibit access to hunting. [6] Research from the International Polar Year has suggested that climate change contributes to nutritional deficits, which in turn contribute to obesity, diabetes, and vitamin D deficiency. [7] The safety of traditional food is also impacted by climate change: warmer temperatures have altered and enhanced uptake of toxic metals such as mercury and increased incidences of zoonosis in animals, including those traditionally hunted by Arctic Canadians. [8]

In response to threats of food insecurity, Canada has initiated the Nutrition North Canada program to encourage the consumption of traditional foods and ease access to commercialized country foods with subsidies. [9] Provincial governments have also encouraged community-driven programs, such as the Healthy Foods Program, community freezers in Nain, Nunatsiavut, and the successful community food program in Inuvik, as well as collaborative strategic plans such as those developed by the Nunavut Food Security Coalition. [10] Furthermore, Health Canada has assisted in comprehensive reviews of environmental contaminants and human health in the Canadian Arctic in 1999, 2005, and 2010, [11] and has established and staffed local laboratories to provide pathogen and biological contaminant diagnostics in food sources in Nain, Nunatsiavut, and Yellowknife, Northwest Territories, as well as Trichinella diagnostics in Nunavik during walrus harvest. [12] Efforts to enhance public understanding of zoonotic and environmental contaminations among food sources, as well as increased material support for food and broader socioeconomic programs, have been cited as potential future actions to improve food security in the Canadian Arctic. [13]

Increase Sanitation Problems and Housing Shortages
Climate impacts on underdeveloped Arctic infrastructure, especially with respect to sanitation and housing, has been identified as another key public health priority by the Canadian government. Freshwater resources in Arctic Canada, stressed by rapidly growing populations in towns such as Iqaluit and Rankin Inlet, are increasingly vulnerable to contamination due to climate change, which also accelerates uncertainty of freshwater availability. [14] Similarly, high costs of construction and maintenance-repair contribute to housing shortages in Northern Canada, where 53% of Inuit homes are considered overcrowded (Figure 2). [15] Increase in extreme weather events, rising costs of fuel and material transport, and challenges of melting permafrost all link climate change to housing shortages in the North and pose a very physical threat: poor ventilation in overcrowded homes increases the propagation of infectious diseases such as tuberculosis, and has been shown to increase risk of respiratory infection in infants. [16]

Need for improved housing and sanitation infrastructure is being noticed and acted upon by both local and national governments in Canada. Beginning in 1999, Canada and the Province of Quebec committed CAD$10 million each per annum to the construction of housing in the North from 2000 to 2005, while Northern Affairs Canada and the government of Nunavut have developed an actionable ten-year plan for Inuit housing. [17] Likewise, the 2017 Federal Budget of Canada has targeted CAD$300 million in support of public housing in the North over the next eleven years, allocated to the governments of the Yukon, NWT, and Nunavut, as well as an additional CAD$225 million for Indigenous peoples at large. [18]

In addition to budgetary commitments, the Canadian government has hosted workshops to discuss potential solutions to the Northern housing crisis, especially focused on building and defining relationships from national to local communities. [19] Local commitments, especially at the territorial and provincial level, have focused on monitoring and standardization of infrastructure, such as the Nunavut Public Health Act of 2016. Nunavut Tunngavik Incorporated noted that definition of municipal, territorial, and government roles and a timeline-driven strategic plan for improved infrastructure are required to help redress housing and water needs in the North as climate change progresses. [20] Suggestions for development of public drinking water infrastructure and identification of alternative drinking water sources have come from academia but remain difficult to enact because of uncertainty about the local impacts of climate change.[21] However, local monitoring for contaminants and pathogens or the development of water resource vulnerability indices may identify and address certain infrastructure problems. [22]

Figure 2:

This image, included in the 2017 Senate report We Can Do Better: Housing in Inuit Nunangat, shows a shed in Igloolik, Nunavut, where a young family lives, highlighting the nature of the Northern housing crisis (Senate of Canada, https://sencanada.ca/content/sen/committee/421/APPA/Reports/Housing_e.pdf).

Psychological Health
Mental health is increasingly recognized as a critical element of public health governance in the Canadian Arctic. Suicide rates in Yukon, NWT, and Nunavut are over three times the national average, and have risen dramatically among Inuit populations in recent decades, from 10 per 100,000 (1972) to 113 per 100,000 in 2014. [23] While many factors contribute to mental wellness, environmental and cultural changes as a result of climate change have been linked to poor mental health among Inuit. Loss of social structures, traditional knowledge, and sense of self-determination have been associated with climate change in Inuit communities, [24] while Inuit focus groups have make direct links between the ability hunt and travel on sea ice and their mental health. [25]

Canada has shown strong commitment to understanding and resolving the mental health crisis in the North. During their chairmanship of the Arctic Council, Canada sponsored two research groups to address the factors that contribute to high Arctic suicide rates and identify community-focused approaches to redress mental health problems. [26] Budget Canada 2017 offers CAD$118.2 million to specifically address mental health in First Nations and Inuit communities. [27] Projects funded by the federal government to address mental health in Northern communities include those administered by Health Canada’s Climate Change and Health Adaptations for Northern First Nations and Inuit Communities program, which supported 95 local projects between 2008 and 2016, including those with key themes on mental health. [28] Local governments have also presented suicide prevention strategies to help mitigate the mental health crisis in the North, which include a focus on intergenerational access to the traditional lifestyle. [29]

Creating Resilient Northern Communities
As Canada looks to the next 150 years of Confederation in a changing world, the North and its people will continue to be a region of strategic importance as well as a role model for the world. From municipal to federal levels, Canada has recognized that determinants of health in Northern communities—food security, housing and sanitation access, and mental health—are vulnerable to climate change. Notably, Canada’s 2017 Budget proposes to address climate change for First Nations and Inuit people by establishing monitoring networks, health-professional education, and public awareness campaigns. With a nod to its future in a changing Arctic landscape, Canada has begun to develop climate change plans for Northern communities to address individual determinants of health while simultaneously enacting strategies for cultural adaptation, economic development, and improved access to medical infrastructure, ultimately strengthening the North, the nation, and the circumpolar community.

1. G. Lavoie, “Policy Silences: Why Canada Needs a National First Nations, Inuit, and Métis Health Policy,” International Journal of Circumpolar Health 72 (2013): 2269.
2. E. Austin, J.D. Ford, L. Berrang-Ford, M. Araos, S. Parker, and M.D. Fleury, “Public Health Adaptation to Climate Change in Canadian Jurisdictions,” International Journal of Environmental Research in Public Health 12 (2015): 623–51.
3. Inuit Tapiriit Kanatami, Social Determinants of Inuit Health in Canada (Ottawa: ITK, 2014), https://www.itk.ca/wp-content/uploads/2016/07/ITK_Social_Determinants_Report.pdf; S. Sharma, J. Gittelsohn, R. Rosol, and L. Beck, “Addressing the Public Health Burden Caused by Nutrition Transition through the Healthy Foods North Nutrition and Lifestyle Intervention Programme,” Journal of Human Nutrition and Diet 23 (2010): 120–28; T.L. Nancarrow and H.M. Chan, “Observations of Environmental Changes and Potential Dietary Impacts in Two Communities in Nunavut, Canada” Rural Remote Health 10, no. 2 (2010): 1370.
4. Inuit Tapiriit Kanatami, Social Determinants of Inuit Health.
5. Rosol, C. Huet, M. Wood, C. Lennie, G. Osborne, and G.M. Egeland, “Prevalence of Affirmative Responses to Euestions of Food Security: International Polar Year Inuit Health Survey, 2007–2008,” International Journal of Circumpolar Health 70, no. 5 (2011): 488–97.
6. Cannon, “Indigenous Peoples and Food Entitlement Losses under the Impact of Externally Influenced Change,” GeoJournal 35 (1995): 137–50; ACIA, Arctic Climate Impact Assessment (New York: Cambridge University Press), 2005, https://www.amap.no/documents/doc/arctic-arctic-climate-impact-assessment/796; P.J. Gregory, J.S.I. Ingram, and M. Brklacich, “Climate Change and Food Security,” Philosophical Transactions B 360, no. 1463 (2005): 2139–48; IPPC, “Climate Change 2007: Impacts, Adaptation, and Vulnerability,” in Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, ed. M. Parry, O. Canziana, J. Palutikof, P. van der Linden, and C. Hanson (Cambridge: Cambridge University Press, 2007), 967; S.D. Wesche and H.M. Chan, “Adapting to the Impacts of Climate Change on Food Security among Inuit in the Western Canadian Arctic,” EcoHealth 7, no. 3 (2010): 361–73.
7. Healey, “Exploring Health-Related Indicators of Climate Change in Nunavut” (Iqaluit, NU, 2015); S. Owens, P. De Wals, G. Egeland, C. Furgal, Y. Mao, G.Y. Minuk, P. Peters, M. Simard, and É. Dewailly, “Public Health in the Canadian Arctic: Contributions from International Polar Year Research,” Climate Change (2012), doi: 10.1007/s10584-012-0569-3.
8. W. Macdonald, T. Harner, and J. Fyfe, “Recent Climate Change in the Arctic and Its Impact on Contaminant Pathways and Interpretation of Temporal Trend Data,” Science of Total Environment 342 (2005): 5–86, doi: 10.1016/j.scitotenv.2004.12.059; J. Organ, H. Castleden, C. Furgal, T. Sheldon, and C. Hart, “Contemporary Programs in Support of Traditional Ways: Inuit Perspectives on Community Freezers and a Mechanism to Alleviate Pressures of Wild Food Access in Nain, Nunatsiavut,” Health & Place 30 (2014): 251–59.
9. Inuit Tapiriit Kanatami, Social Determinants of Inuit Health; Sharma, Gittelsohn, Rosol, and Beck, “Addressing the Public Health Burden”; Owens et al., “Public Health in the Canadian Arctic.”
10. Inuit Tapiriit Kanatami, Social Determinants of Inuit Health; Organ et al., “Community Programs”; J.D. Ford, M. Lardeau, H. Blackett, S. Chatwood, and D. Kurzewski, “Community Food Program Use in Inuvik, Northwest Territories,” BMC Public Health 13 (2013): 970, doi: 10.1186/1471-2458-13-970.
11. Van Oostdam, A. Gilman, É. Dewailly, P. Usher, B. Wheatley, H. Kuhnlein et al., “Human Health Implications of Environmental Contaminants in Arctic Canada: A Review,” Science of Total Environment 230 (1999): 1–82; J. Van Oostdam, S.G. Donaldson, M. Feeley, D. Arnold, P. Ayotte, G. Bondy et al., “Human Health Implications of Environmental Contaminants in Arctic Canada: A Review,” Science of Total Environment 351–52 (2005): 165–246; S.G. Donaldson, J. Van Oostdam, C. Tikhonov, M. Feeley, B. Armstrong, P. Ayotte et al., “Environmental Contaminants and Human Health in the Canadian Arctic,” Science of Total Environment 408 (2010): 5165–234.
12. Owens et al., “Public Health in the Canadian Arctic.”
13. Owens et al., “Public Health in the Canadian Arctic”; J. Lawn and D. Harvey, Nutrition and Food Security in Kugaaruk, Nunavut: Baseline Survey for the Food Mail Pilot Project (Ottawa: Ministry of Indian Affairs and Northern Development, 2003).
14. A. Warren, J.E. Berner, and T. Curtis, “Climate Change and Human Health: Infrastructure Impacts to Small Remote Communities in the North,” International Journal of Circumpolar Health 64, no. 5 (2005): 487–97; K. Daley, H. Castelden, R. Jamieson, C. Furgal, and L. Ell, “Water Systems, Sanitation, and Public Health Risks in Remote Communities: Inuit Resident Perspectives from the Canadian Arctic,” Society, Science, and Medicine 135 (2015): 124–32; A.S. Medeiros, P. Wood, S.D. Wesche, M. Bakaic, and J.F. Peters, “Water Security for Northern Peoples: Review of Threats to Arctic Freshwater Systems in Nunavut, Canada,” Regulation and Environmental Change 17, no. 3 (2007): 635–47.
15. Inuit Tapiriit Kanatami, Social Determinants of Inuit Health.
16. Inuit Tapiriit Kanatami, Social Determinants of Inuit Health; Owens et al., “Public Health in the Canadian Arctic”; Sustainable Development Working Group, Sharing Hope: Circumpolar Perspectives on Promising Practices for Promoting Mental Wellness and Resilience (Iqaluit, NU: Ministerial Meeting, 2015), https://oaarchive.arctic-council.org/handle/11374/411; T. Kovesi, “Respiratory Disease in Canadian First Nations and Inuit children,” Paediatrics and Child Health 17, no. 7 (2012): 376–80.
17. Inuit Tapiriit Kanatami, Social Determinants of Inuit Health.
18. Minister of Finance, “Budget 2017” (Ottawa: House of Commons, 2017), http://www.budget.gc.ca/2017/docs/plan/budget-2017-en.pdf.
19. Daley, “Meeting the Northern Housing Challenge,” Polar Knowledge Canada, 2017, https://www.canada.ca/en/polar-knowledge/publications/polarleads/vol1-no1-2016.html.
20. Nunavut Tunngavik Incorporated, 2006 Annual Report (Iqaluit, NU: Nunavut Tunngavik Incorporated, 2006), http://www.tunngavik.com/blog/publications/nti-annual-report-2006ntikut-ukiuk-tamaat-tuhaktakhat-2006miᓄᓇᕗᑦ-ᑐᓐᖓᕕᒃᑯᑦ-ᑎᒥᖓᑦ/.
21. Medeiros et al., “Water Security for Northern Peoples.”
22. Bakaic and A.S. Medeiros, “Vulnerability of Northern Water Supply Lakes to Changing Climate and Demand,” Arctic Science 3 (2017): 1–16; L. Alessa, A. Kliskey, R. Lammers, C. Arp, D. White, L. Hinzman, and R. Busey, “The Arctic Water Resource Vulnerability Index: An Integrated Assessment Tool for Community Resilience and Vulnerability with Respect to Freshwater,” Environmental Management 42 (2008): 523–41.
23. Hicks, “Statistical Data on Death by Suicide in Nunavut Inuit, 1920 to 2014” (Iqaluit, NU: Nunavut Tunngavik Incorporated, 2015), https://www.tunngavik.com/files/2015/09/2015-09-14-Statistical-Historical-Suicide-Date-Eng.pdf.
24. Daley et al., “Water Systems, Sanitation”; R.G. Condon, P. Collings, and G.W. Wenzel, “The Best Part of Life: Subsistence Hunting, Ethnicity, and Economic Adaptation among Young Adult Inuit Males,” Arctic 48 (1995): 31–46.
25. Durkalec, C. Furgal, M.W. Skinner, and T. Sheldon, “Climate Change Influences on Environment as a Determinant of Indigenous Health: Relationships to Place, Sea Ice, and Health in an Inuit Community,” Society, Science, and Medicine 136–37 (2015): 17–26.
26. Sustainable Development Working Group, Sharing Hope.
27. Daniel Brown, “Climate Change and Health Adaptation Programs for Northern First Nations and Inuit Communities,” online slides, April 12, 2016, https://adaptationcanada2016.ca/wp-content/uploads/2016/04/T1D-Brown.pdf.
28. Daniel Brown, “Climate Change and Health Adaptation Programs.”
29. Inuit Tapiriit Kanatami, Social Determinants of Inuit Health.

This post is part of the International Policy Institute Arctic blog series, IPI Arctic Fellows travel to Dartmouth and Busan. To overview the series, read the introduction.