Environmental change and social, cultural, and mental health in the Arctic

This is Chapter 15 of the Arctic Climate Impact Assessment.

Lead Authors: Jim Berner, Christopher Furgal; Contributing Authors: Peter Bjerregaard, Mike Bradley, Tine Curtis, Edward De Fabo, Juhani Hassi, William Keatinge, Siv Kvernmo, Simo Nayha, Hannu Rintamaki, John Warren.

The potential impacts resulting from direct (section 15.3) and indirect (section 15.4) mechanisms of climate change on human health have been presented in previous sections of this chapter. This section addresses climate change and its link with social, cultural, and mental health.

The association between health and social, cultural, and economic factors has been reported extensively. A gradient has been consistently demonstrated across different socio-economic classes, regardless of how they are defined, for various measures of mortality and morbidity, both for individual diseases and for all causes combined[3]. This gradient exists in many countries around the world, and has persisted despite major improvements in the overall health and wealth of populations. Also, numerous studies have shown correlations between unemployment and morbidity and mortality[4].The disparity in health status between Inuit and the larger national populations to which they belong (Canada, Denmark, Russia, United States) has often been attributed to their relatively poorer socioeconomic status. Furthermore, the link between socioeconomic conditions and health has been demonstrated within arctic populations. In a study of 49 Inuit and Dene communities in the Northwest Territories, based on community-level data from the 1992 NWT Housing Survey and routinely reported health and social service agency data, Young and Mollins[5] found a correlation between most indicators for housing and socioeconomic status with the rate of health center visits, used as a proxy measurement of morbidity. Among Canadian Inuit the proportion of respondents reporting excellent/very good health increased with the level of formal education[6]. Those in the highest income category are also more likely to report excellent health than those in lower income categories. The association between education and positive self-reported health was also found in the 1993-94 Greenland Health Interview Survey (controlled for age and sex)[7]. Among those with the most formal schooling, self-rated health was better in all age groups and with fewer reported longstanding illnesses.

 

caption Fig. 15.19. Interrelationship between social, cultural, and environmental factors known to affect health.

 

Figure 15.19 represents one view of the interrelationship between health and social, cultural, and environmental factors. At the center of the model is the individual with his or her genetic endowment, physiological adaptation, and personal life experience. Everyday life, for example, work and lifestyle, determine the extent to which individuals are exposed to factors within their immediate surroundings that directly affect health. Such factors include tobacco, alcohol, diet, contaminants, microorganisms, and psychological factors.

Everyday life is in turn determined by social, economic, and cultural factors within the wider society. All the individual, social, cultural, and socio-economic factors are influenced by the environment within which they are embedded and by possible changes in this environment (e.g., see Box 15.1).

The effect of change on communities resulting from climate related impacts, for example, by flooding and erosion, or warming temperatures and shifts in local resource access and availability, and the links between these changes in the physical environment and individual health are clear. Research using an ecological approach has also shown that the social environment of the community affects population health[8]. Studies have focused on the extent to which social relations, social capital, and the social vitality of communities influence individual health status[9].

Although the relationship between the social environment of the community and the health of the individuals is still not clear, studies have shown associations between, for example, social isolation and mortality[10] and social capital and poor self-rated health[11]. In both cases the association was present even after adjusting for individual risk factors. Even though the health advantages are not fully understood, research has shown that a healthy community can be characterized as a safe environment that provides opportunities for social integration, and is neither conflictual, abusive, nor violent[12].

Research and practice in health promotion have focused on the community level rather than on disease prevention in individuals. The role of the social environment for individual health argues this inclusion. Also, it is widely believed that the positive effects of health interventions result from a high degree of community ownership and participation in defining objectives, planning, and implementation of the initiative[13].

Research on health promotion and community health shows that community members’ involvement in the social life and their shared pursuit of broader social goals through psychosocial processes can positively affect health, and that participation is a condition for positive outcome of health promotion efforts.

The potential for future health promotion in combining these two perspectives on community health is obvious as increasing communities’ capacity to address problems and to work together to solve them will strengthen the effect of health promotion projects and help to improve the health of the population. Arctic communities have recently undergone rapid socio-cultural change and these changes will be further accentuated by the projected climate changes addressed in Chapter 4. Building communities’ capacity to meet these changes is an area that needs further attention throughout the Arctic.

Acculturative stress and mental health (15.5.1)

The concept of acculturation describes the cultural and psychological changes that result from continuous contact between people belonging to different cultural or ethnic groups[14]. At the population level, changes in social structure, economic base, and political organization frequently occur as a result of this contact, whereas at the individual level the changes are in such areas as behavior, identity, values, and attitudes. Berry et al.[15] described this process in indigenous cultures in relation to the impact of modernization on indigenous people and traditional groups (Fig. 15.20). Climate change can also impact on the traditional way of living via influences on reindeer herding, fishing, and hunting. Alterations of the physical environment can lead to a rapid and a long-term cultural change and loss of traditional culture which can, in turn, create psychological distress and mental health challenges (see Box 15.7).

Box 15.7. Climate, reindeer herding, and Saami culture

The Saami are indigenous reindeer herding people originally inhabiting arctic regions of Norway, Sweden, Finland, and western Russia. The Saami live in communities which have undergone rapid modernization and cultural revitalization. Some communities are more traditional while others are more modern with regard to the average lifestyle of their residents. In terms of mental health and social well-being, Saami people living in areas strong in culture and traditional ways of life appear just as healthy as the average population in these regions.

However, climate changes could have significant impacts on Saami communities and culture. Increasing temperatures may influence the seasonal migration of reindeer (see Chapters 11 and 12).The consequences of the climate changes are likely to be varied and include causing reindeer to stay for extended periods on less productive fields. Throughout the 1990s, overuse of the pasture lands by reindeer contributed to a crisis within the reindeer herding industry leading to a forced reduction in numbers of reindeer. This in turn forced several reindeer herders to stop herding. According to social workers in the Saami highlands, this led to higher rates of unemployment and dependence on social welfare in these communities. As reindeer herding is seen as a Saami activity, and reindeer herders as the carrier of the Saami culture, those individuals who left herding lost not just an important occupation but also status as an important protector of the Saami culture. Exclusion from this group has been a considerable stress for families and has had significant and far reaching impacts on the Saami culture as a whole.

 

caption Fig. 15.20. Four modes of acculturation[1].

 

Group strategies for dealing with changes in ways of living can vary from readily and easily adapting to the changes, to resisting them, or to collapsing under their weight[16]. Individuals adopt different acculturation strategies and their mental health is expected to vary both as a function of the strategy itself and in relation to the balance between the strategy which is possible or preferred by the individual and that of the majority group (see Fig. 15.20). From the mental health perspective, integration seems the most successful strategy and marginalization the most problematic, with separation and assimilation being intermediate in relation to mental health[17]. Marginalization reflects alienation and anomie and is a risk factor for mental health[18]. In integration, relationships to both cultures may provide the strongest socio-cultural foundation for good mental health including bicultural competence and coping strategies necessary for adaptation to both cultures[19].

 

The concept of acculturative stress refers to stress in which the stressors are identified as being rooted in the process of cultural change or acculturation. For arctic peoples these stressors can be loss of traditional food resources and habitats, unemployment, loss of cultural practices, and migration. Climate change can be an external factor that indirectly initiates the acculturation process by forcing people to behave in new ways, to change their ways of living, and to replace or drop old traditions (see Box 15.7).

Acculturative stress may be associated with psychological changes such as psychosomatic symptoms, feelings of alienation and marginality, and identity confusion[20]. If the acculturation experience overwhelms the individual with a feeling of loss of control, psychopathology may occur such as depression and anxiety, substance abuse, and suicide (Fig. 15.21). For instance, if climate change leads to a loss of herding, hunting, or fishing opportunities for people who are closely connected to and dependent upon such activities, this can result in feelings of loss and grief.This might result in longer-term feelings of marginalization which can contribute to substance abuse, depression, and suicide. A study of Saami males living in remote areas found a close relationship between marginalization and depression/anxiety[21], while a study conducted in Greenland found that growing up in a town and being fully bilingual, as compared to growing up in a small village and speaking only Greenlandic, was associated with better mental health status[22].This disagrees with the assumptions previously held that the social and psychological outcomes of acculturation are inevitably negative[23]. It appears that successful integration depends on having and taking advantage of the opportunities necessary to meet changing conditions.

 

caption Fig. 15.21. Acculturation stress and moderating factors[2].

 

Examples of the influence of rapid change on psychosocial health (15.5.2)

Several examples are used here to illustrate the relationship between the rapid socio-cultural and economic change witnessed in the Arctic over the past 20 to 50 years and the psychosocial health of the populations living there. A good understanding of such links is important in relation to the climate changes projected for the Arctic over the next hundred years (see Chapter 4). Further changes may result from climate-related changes in economic opportunities, traditional lifestyles, and subsistence activities.

A change in occupational patterns from hunting and small-scale fishing to an increase in wage-earning employment is seen across the Arctic. In Greenland villages, wage earning has been introduced along with institutions and service deliveries such as schools, stores, and sanitation infrastructure. In towns, there are factories and enterprises, banks, shops, and administrative services. The changes in occupational patterns are associated with decreased physical activity and a change from a traditional marine diet to a more western diet in many coastal indigenous groups and this is of particular importance in relation to cardiovascular diseases[24]. In many studies, cardiovascular risk increases with modernization and urbanization, but although mortality from ischemic heart disease is slightly lower among Inuit than in the general population of Denmark, Canada, and the United States, it has decreased over recent years while marine food has been increasingly replaced by store bought food. In contrast, mortality from other heart diseases and stroke is considerably higher in Inuit and shows an uncertain time trend[25].Type 2 diabetes increased considerably over the last 40 years among the Inuit in parallel with processes of modernization[26]. In Greenland, type 2 diabetes is now more prevalent than in Denmark (9.8 and 7.9% in the 40 to 64 year old age range, respectively[27], which leads to speculation about increased genetic sensitivity to environmental pressure in the Inuit. The change in dietary patterns from traditional foods to a more western diet with a higher consumption of store bought foods is important in relation to both the connection with obesity and other cardiovascular risk factors and with the loss of the sociocultural values related to eating and sharing traditional foods and their significance for health.

The amount of traditional food and the specific species consumed vary considerably among regions and population groups[28]. Older people and people in villages who fish and hunt themselves eat more traditional food, whereas the young wage earners consume more store bought foods often related to their convenience. However, regardless of the levels of consumption, traditional foods are highly valued by all population groups. They are considered filling and healthy and to provide strength, warmth, and energy in ways that store bought food does not[29]. Traditional food is also reported to be a significant contributor to cultural identity, tradition, and social cohesion in Inuit communities. To eat and like traditional food is perceived as a marker of identity in the same way as is speaking the Inuit language[30].

Inuit food has sustained us, nourished us, brought us together, and given us a sense of who we are. [31]
…in order to have a Greenlandic identity the person must eat … and like dried fish, raw mattak, etc. [32]
I can’t do without kalaalimernit [traditional Greenlandic food]. I eat it a lot. I was brought up with people who eat kalaalimernit. It tastes good and it feels good for you. For instance when I do sports I feel kind of stronger when I have eaten kalaalimernit. [33]

The rapid changes that have taken place within arctic communities and the migration from villages to larger towns has lead to psychosocial stress among populations that within little more than one generation have had to adapt to significantly different ways of life. Those who move may experience a lack of social relations in towns, where still more people live in single-family households and social relations are chosen and individualized. Traditional values may appear irrelevant, as language skills and formal education become the means to succeed and avoid unemployment. However, traditional knowledge and expertise in traditional activities is still very relevant, if not increasingly so, when aspects of the environment become more unpredictable or “risky” in which to practice subsistence activities and travel on land or sea.

Psychosocial stress is reflected in the incidence of social problems seen in many arctic communities today. Whereas alcohol abuse in western societies is usually characterized by an increasing daily consumption over many years, it is the occasional, sometimes regular, drinking spree or binge drinking which creates many problems in arctic communities[34]. The most important health implications are accidents and violence resulting in intentional and non-intentional traumas (cuts, bruises, fractures, head injuries). Drowning, falls, frostbite, burns, and pneumonia also result from intoxication and a direct association between alcohol use and incidence of suicides has been shown. Alcohol consumption is also associated with economic problems and job loss due to instability at work and to domestic abuse.

Studies have shown a high occurrence of violence and sexual abuse in some arctic populations[35]. A survey in Greenland showed that women and men have equally often been victims of violence (47% for women and 48% for men) but that women had more often been sexually abused (25% and 6%, respectively)[36]. Having been the victim of violence or sexual abuse was significantly associated with a number of health problems: chronic disease, recent illness, poor self-rated health, and mental health problems. The association between having been the victim of violence or sexual abuse and current health status was stronger for women than for men[37].

Similarly, suicide has played a significant role in many arctic communities and individuals’ lives. It has been argued, based on the much higher suicide rate in men than women that women in the Arctic have been more successful than men in adapting to social change.While women have been able to continue their traditional roles as caregivers, both in the family and in the labor market, the transition from hunter and sole breadwinner to wage-earner in a subordinate position or even unemployment has been a difficult transition for many arctic males. On the other hand, studies have shown that women more often than men have suicidal thoughts and mental health problems[38]. The finding that men suffer more from socio-cultural change related stress than women may be in part based on the more visible and more commonly reported manifestations of this stress or frustration common among men (i.e., they are more likely to become violent or to commit suicide). A population survey of adults in Greenland showed significant associations between suicidal thoughts and a number of social and cultural factors, the most important determinants being the occurrence of alcohol problems in the parental home and the experience of sexual violence during childhood[39]. Among Greenlanders who had neither experienced alcohol problems nor sexual violence in childhood, 10% reported suicidal thoughts, while for those who had experienced both, 82% reported suicidal thoughts (Table 15.1).

Alteration in subsistence species, changes in habitability of buildings, erosion of village sites (see Box 15.6), and disappearance of commercially critical species (see Box 15.1) may all cause dislocation of residents from smaller to larger communities, with a subsequent overload of scant resources in the receiving community. This combination of factors and interaction with the capacity of individuals and communities to adapt to or change with these climate and environmentally influenced shifts may have a significant bearing on the social, cultural, and mental health of individuals in arctic communities (for a discussion of community capacity and resilience see Chapter 17).

Example scenario of interactions between climate warming, ocean temperature, and health (15.5.3)

Climate change can influence health in the Arctic in many ways. These fall into two groups: direct (section 15.3) and indirect (section 15.4) influences. Two indirect pathways are of significance to individual and community health issues related to socio-cultural and economic transition. The first results in reduced opportunities for subsistence hunting and fishing as a result of changes in animal or plant populations, an increase in extreme events, and changes in sea-ice distribution and thickness, while the second forces populations to move. These factors include the movement or loss of crucial species for subsistence hunting, coastal erosion, breakdown of sanitation infrastructure, and increasing difficulties in maintaining transportation systems for goods and people. Both pathways, of which the latter is also a consequence of the former, may be related to climate changes and may be seen as mediated through acculturation and cultural loss. However, the modernization process in arctic communities over the last 50 years has been accompanied by a growth in the cash economy, making it increasingly difficult to maintain a livelihood from hunting and fishing and therefore encouraging people to move to more regional economic centers.

 

 Table 15.1. Prevalence of serious suicidal thoughts in Greenland Inuit according to childhood experience of alcohol misuse and sexual violence[40].

   No sexual violence during childhood
(n=1150)
Sexual violence experienced during childhood
(n=65)
 No alcohol problems in parental home (N=760)  10.3  21.7
 Occasional alcohol problems in parental home (N=355)  18.2  48
 Often alcohol problems in parental home (N=100)  39.8  82.4

 

caption Fig. 15.22. Example scenario of the link between climaterelated changes, and community and individual health in indigenous communities in Greenland.

 

Figure 15.22 shows two possible pathways between a cooling of ocean temperatures and decreased health status in indigenous communities. The first is via a reduction in the catch of commercially important species. This happened in Greenland in the 1960s when Atlantic cod disappeared from coastal waters off West Greenland (see Box 15.1). Unless new sources of income are generated, reduced catches will result in deterioration in economic conditions and unemployment. Unemployment is associated with social and mental health problems in communities, increased use of alcohol and violence, and suicide.

The second pathway of impacts is via a change in the availability of subsistence species. Historically, indigenous groups have responded to such a change by moving with the animals to places with better catches, however, human migrations are now far less easy with today’s settled villages. Decreased opportunities for catching seals, for example, result in both dietary changes and a loss of the knowledge required to recognize, harvest, and prepare traditional foods[41], and in a sense of cultural loss as hunting and food sharing is important for the identity and maintenance of the social well-being of the community[42].The lack of subsistence species also drives an eventual migration of individuals to towns where some will face unemployment.

The shift from a traditional marine diet to a more western diet, along with other behavioral changes that follow the transition from a lifestyle based on hunting and fishing to a more sedentary wage-based economy lifestyle, is of major importance in relation to the occurrence of cardiovascular disease in Inuit populations. In spite of the present cooling trend in parts of Greenland, the climate scenarios described in Chapter 4 project a warming trend for Greenland over the next 100 years. The health impacts of this warming are likely to be mediated by the same indirect mechanisms discussed in section 15.4. Changes in the distribution of commercially important fish species, as well as in subsistence species could affect health in the same way as ocean cooling. Increased risk to hunters and travelers due to ice changes, and political and economic policy decisions which result in the relocation of populations are also likely to have major health impacts. It is unlikely that periodic warmer weather could result in the same detectable changes in mortality from cardiovascular disease and stroke that are seen in large populations in the northern temperate zones of Europe and North America. The scattered, sparse population of the present cooling region of Greenland is too small for a significant number of well-documented mortality events. Significant warming in Alaska since the 1970s has resulted in significant impacts. Permafrost thawing and lack of seaice protection have resulted in the imminent threat of forced village dislocation, with severe stress on families. River and coastal erosion with continued warming will make this more widespread. In addition, the northward spread of beaver populations has resulted in the obstruction of many streams traditionally used by villages for surface water supply. Contamination of these sources by the zoonotic parasite Giardia lamblia makes outbreaks of human disease much more likely. At the same time, moose have extended their range into new regions and waterfowl habitat is increasing, making new subsistence foods available. Thus, in Alaska, new risks and new opportunities have resulted from warming. This makes the development of community monitoring a more urgent task, as only data will enable policy and public health responses to mitigate risks and maximize opportunity.

Despite the arguments made here for the connections between environmental change, socio-cultural transition, and health in the Arctic, many negative health outcomes are attributable to causes other than climate change. The modernization process in indigenous communities in the Arctic since the 1950s has been accompanied by many such health outcomes (e.g., increased use of alcohol, more violence, and higher mortality from suicides, heart disease, and diabetes), without any yet-reported association with climate change.

Summary (15.5.4)

Health is a multifactorial concept, influenced by a variety of determinants, climate change being one of many environmental factors. Many of these determinants are still poorly understood. The rapid social, cultural, and economic transition that arctic communities have seen over the past 50 years has influenced lifestyles and individual and community health. These changes are very likely to be affected and even accentuated by climate change in the future. The influence of adaptive behaviors resulting in changes to lifestyle and cultural loss further influence acculturative stress in arctic communities. Climate change has the potential to influence the rapid changes ongoing in communities today by challenging individuals’ and community’s relationship with their local environment, which has for thousands of years, been the basis of their identity, culture, and well-being.

 

Chapter 15: Human Health
15.1. Introduction
15.2. Socio-cultural conditions, health status, and demography
15.3. Potential impacts of direct mechanisms of climate change on human health
15.4. Potential impacts of indirect mechanisms of climate change on human health
15.5. Environmental change and social, cultural, and mental health
15.6. Developing a community response to climate change and health
15.7. Conclusions and recommendations

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Glossary

Citation

Committee, I. (2012). Environmental change and social, cultural, and mental health in the Arctic. Retrieved from http://www.eoearth.org/view/article/152609

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