Background
Methods
Nunatsiavut, Canada
Healthcare provision in Nunatsiavut
Research design
Regional data collection: interviews with government employees
Demographic Information | Government | PhotoVoice | Community Survey Participants (%) | |
---|---|---|---|---|
Interviewees (%) | Participants (%) | CCI surveya | BPS surveyb | |
n=11 | n = 11 | n = 75 | n = 112 | |
Age | ||||
Youth (0–20) | 0 (0) | 1 (9) | 4 (5) | 8 (7) |
Adult (21–50) | 9 (82) | 7 (64) | 43 (57) | 69 (62) |
Elder (Over 50) | 2 (18) | 3 (27) | 28 (37) | 30 (27) |
No response | 5 (4) | |||
Sex | ||||
Male | 2 (18) | 6 (55) | 44 (59) | 52 (46) |
Female | 9 (82) | 5 (45) | 31 (41) | 60 (54) |
Community data collection: PhotoVoice workshops and surveys
PhotoVoice workshops
Community surveys
Analysis
Qualitative analysis
Quantitative analysis
Results and discussion
Observed climatic and environmental change: “It is meant to be cold, and snowy, and icy, and crisp, and fresh, and bright here”
The Land, Health, and Wellbeing: The land “is in their bones and in their blood”
I guess it's all the pieces, like dominoes, all touches each other. I mean everything you do, [our] Inuit way of life and our way of thinking is all intertwined and interconnected [to the environment]. So, something as significant as changes in the temperature, and in snow and rain and that kind of thing, it’s all going to have a ripple effect.
In regions where you have cultures like the Inuit, they need to think, you know everybody should be thinking more about looking at things through the social determinants [of health], because if you don't, you're never going to fix them. You know, you have to look at the causes of the causes. And climate change is a huge, huge impact for the Inuit.
I don’t see anything positive about it [climatic change] here. It is meant to be cold, and snowy, and icy, and crisp, and fresh, and bright here. For the most part, that’s what is natural and normal here. And that is what people expect and love about this weather here, that is why [Inuit] stay here–it is in their bones and in their blood.
Pathways of climate-health impacts
Culture and health: “Culture as a healer”
n | Odds Ratio | p | 95 % | ||
---|---|---|---|---|---|
CCI surveya | BPS surveyb | Confidence Interval | |||
Reported climatic change impacts on lifestyle | |||||
Did not observe changes in snow | 12 | Ref. | |||
Observed changes in snow | 63 | 6.2 | 0.018 | 1.30-40.40 | |
Did not observe changes in water systems | 28 | Ref. | |||
Observed changes in water systems | 47 | 3.8 | 0.016 | 1.25-12.12 | |
Did not observe changes in wildlife | 34 | Ref. | |||
Observed changes in wildlife | 41 | 3.5 | 0.024 | 1.16-11.10 | |
Did not rank climatic change as an important issue for the community | 13 | Ref. | |||
Ranked climatic change as an important issue for the community | 54 | 7.8 | 0.004 | 1.79-41.92 | |
Reported climatic change impacts on health | |||||
Did not report changes in wildlife or vegetation | 34 | Ref. | |||
Reported changes in wildlife or vegetation | 41 | 5.4 | 0.026 | 1.78-34.57 | |
Did not observe changes in the quality or quantity of fresh water | 28 | Ref. | |||
Observed changes in the quality or quantity of fresh water | 47 | 8.9 | 0.003 | 1.88-58.00 | |
Rated changes in fresh water quantity as a “strong threat” or “extreme threat” | |||||
Did not report concern that climatic change was causing illness | 70 | Ref. | |||
Reported concern that climatic change was causing illness | 31 | 2.8 | 0.039 | 1.04-7.87 | |
Rated changes in fresh water quantity as a “strong threat” or “extreme threat” | |||||
Men | 50 | Ref. | |||
Women | 60 | 6.0 | 0.003 | 1.69-27.55 | |
Rated changes in fresh water quantity as a “strong threat” or “extreme threat” | |||||
Men | 50 | Ref. | |||
Women | 60 | 2.7 | 0.026 | 1.11-6.67 | |
Reported feeling angry from changes in the environment | |||||
Men | 50 | Ref. | |||
Women | 60 | 2.8 | 0.028 | 1.10-7.53 | |
Reported feeling scared from changes in the environment | |||||
Men | 50 | Ref. | |||
Women | 60 | 3.0 | 0.014 | 1.23-7.80 | |
Reported feeling frustrated from changes in the environment | |||||
Men | 50 | Ref. | |||
Women | 60 | 2.8 | 0.018 | 1.17-6.84 |
Environmental Hazards: “Jeopardizing their lives going out on unstable elements”
suddenly the places that you can go for generations in the past, you can't because the snow has melted or the ice is melting, or they get caught somewhere. You know someone might have to go and search for people that are missing because they were on skidoo and now you need a boat.
Food Security: “That one, it’s almost hand-in-hand”
Last year we had no blueberries. And I mean blueberries are almost a staple. They're so good for you and they're so high in the antioxidants. There were none. And there is none because it got really hot in the spring and the berry, the bushes fried up. But to have no blueberries, it's unheard of. You know, to have that happen [long pause].
The conditions were horrible. People didn’t get what they normally get for caribou and then you rely on store food junk, because what other option do you have when you live in a remote fly-in only community? And, the foods sources that you usually get to, you can’t reach. There is not enough snow, there is not enough ice. It’s alarming that we are just seeing the beginning of climate change… And if the weather is down [bad] for five weeks, how do you get in and out of your community to access services? How do you get food in there? I mean the stores had to actually, I mean their stock was down to bare bones because there was no way to get food in.
Water Security: “There wasn’t a stitch of water – absolutely dry ground”
It also makes quite a big difference too at the cabins where you generally depend to get your water source while you’re there. There’s very little water trickling on the brooks and this is due to limited snow but then it’s a lot to do with the heat as well. The heat is really drying up a lot of those all those ponds and a lot of those brook areas.
Productivity: “An internal want to provide”
They [Inuit] have a real sense of purpose when they’re there [on the land]. You know, in the past when they [Inuit] lived on the land, everybody had a role and everybody had a job to do and those kinds of things. I think people, when they're out on the land, they feel that sense of independence and interdependence… People completely change–it's like they have a different personality when they're out on the land and connected to that. And there’s a real spiritual quality about that as well.
Horrible, horrible, horrible. So, that is my first thought [about climate change]… already look at what has happened with people losing that sense of identify and pride and people feel proud of bringing that fish home and that caribou home and they share it with people. So, losing the ability to provide that, and give that satisfaction from giving and sharing and feeding your family–it is going to continue to erode.
Mental Wellness: Being on the land “is the best and the most beautiful, peaceful, rejuvenating thing”
They [Inuit] get rejuvenated, they feel good when they are out of the land and when they are in nature, when they are [at] their cabin, when they are hunting or fishing, when this happens they feel good. So, that to me is healing–feeling good about yourself, being proud of what you are doing–feeding your family, being creative, being resilient.
I think the trauma of being forced to assimilate … will be felt further if climate change affects [land-based] activity so you don’t find that worth through [land-based] activity, through cultural traditions, that some of those [assimilation] effects will seem to be a bit stronger to you and then the southern dependency needs to be more so. And, so I think the emotional health of people through [land-based] activity and through [country] food and the ability to produce something through their activity will be negatively impacted if the climate change affects us severely … I think if you take away those [land-based] activities and people feel less capable, less able to provide, and less healthy about themselves then those [assimilation] impacts will either come more to the forefront and have to be dealt with, or they [assimilation impacts] may just be built upon.
Every conversation was around the ice was thin, it was unsafe to go, then they added some worry to that because people were still craving to get out on their skidoos on thin ice, with people going through the ice, and then there were family members that was off and didn’t come back. So, a lot of extra anxiety and disappointment, and unfulfilled needs…it [the weather] was definitely different than it was expected here normally.
Social Cohesion: “a common denominator of outdoor-based activities”
My mom and I, God rest her soul, used to have our absolute best times berry picking… we talked about things we've never talked about before because it's very relaxed, beautiful day, and you’re out. Then you got your picnic lunch, and you're just picking berries and you're chattin’, she might be over there and I'm over there and everything was sa.., it’s safe, it’s a safe place to, even air things that are never talked about, is when you're out berry picking. It's wonderful. And you're walking and you’re bending and, it's just good for your soul, it’s good for everything.
I think that community health is based on cohesiveness, and the cohesiveness doesn’t have to be physical. It doesn’t mean that you visit all the time, which is great as well. It doesn’t mean that you have to be seeing people all the time. But, it usually means there’s some camaraderie in [land-based] activity… there’s a cohesiveness that needs to continue, and if that cohesiveness is usually on a common denominator of outdoor-based activities, cultural based activities, it’s sort of somewhat fragmented [because of climate change]. The cohesiveness that now bonds the community could be jeopardized because what else are you bonding on?
Western and Indigenous Education and Knowledge: “Knowledge is still passed on; the relevance of it all becomes a question”
Housing: “Couch-surfing, homelessness, and lack of sufficient housing”
Healthcare Services: “Huge effects on planning”
There is not as much snow as we normally get, and it definitely had an effect–but being able to get staff into the community–or staff in the community can’t get out of the community, patients can’t get to the hospital for their appointment if they need to do that. People that came out for appointments can’t get back into the community–so it is huge–it is huge and those [travel interruptions] were not normal. You know, 11, 12 days at a time when the planes can’t get into the community is not normal for here.
You have these freak periods of heavy snow that knock down the radio tower that knock down the telecommunications, so then people were literally back in the old days… but that is how climate change can affect so many layers of remote living. Right from using your ATM card to being able to fly out because someone is having a heart attack. It’s all related.