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Climate Change, Health, and Vulnerability in Canadian Northern Aboriginal Communities Author(s): Christopher Furgal and Jacinthe Seguin Source: Environmental Health Perspectives, Vol. 114, No. 12 (Dec., 2006), pp. 1964-1970 Published by: Brogan & Partners Stable URL: http://www.jstor.org/stable/4119614 . Accessed: 18/06/2014 15:53 Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at . http://www.jstor.org/page/info/about/policies/terms.jsp

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ResearchI Mini-Monograph Climate Change, Health, and Vulnerabilityin CanadianNorthernAboriginal Communities ChristopherFurgal' and Jacinthe Seguin2 1NasivvikCentrefor InuitHealth and Changing Environments, Public Health Research Unit, Centre hospitalier Universitairedu Qu6bec Centre hospitalier Universite Laval,Departmentof PoliticalScience, LavalUniversity,Qu6bec City, Quebec, Canada;2ClimateChange and Health Office, Health Canada, Ottawa, Ontario,Canada central part of their livelihoods and cultures (Van Oostdam et al. 2005). to dinmate faceuniquechallengesandthatthereis a needto expandthe assessmentofvulnerabilities Northerners have witnessed profound changeto includethesecommunities.EvidencesuggeststhatCanada'sNorth is alreadyaperiencsocial,political,and economic environmental, s in its that arehavingnegativeimpactson the lives of climate-hae ing significantchanges recent in decades (Damas 2002; inthese changes Research ondimate in heath and northAboriginal people living regions. impacts change ernCanadathusfarhasbroughttogetherAboriginalcommunitymembers,govenmentrepresenta- Wonders 2003). Researchon contaminants, andis chartingnewterritory. and more recently on climate change, has tives,andresearchers uncovered what many northerners have ANDRESULT:In this artidewe reviewexperiencefromtwo projectsthat havetakena METHODS known for some time: the Arctic environto and to the of and effects community-based dialogueapproach identifying assessing vulnerability ment is stressedand irreversiblechanges are dimatechangeandthe impacton the healthin two Inuitregionsof the CanadianArctic. CoNrCuSos: The resultsof the two caseprojectsthatwe presentarguefora multi-takeholder, par- occurring.At the same time, many communities are transitioning economically, having that the enhancetipatory framework supports necessary analysis,undersaing, and forassessmet mentof capabilities of localareasto respondandadaptto theheath impactsat thelocalleveL become more permanent than they were 40 yearsago. Many communitiesnow have a KEY WORDS: climate Arctic, Aboriginal, Ensirsw adaptive capacity, vulnerability. change, Inuit, Health Perspect114:1964-1970 (2006). doi:10.1289/1ehp.8433availablevia bttp://ldxdoiLorg/ mixed economy of traditional or land-based 11 activities and wage employment, with many [Online July2006] of the wage employment opportunities now associated with large-scale development of There is strong evidencethat Canada'sNorth change. In this article we review experiences nonrenewable natural resources (e.g., minis alreadyexperiencingsignificantchanges in fromprojects thatuseda community-baseding). These increases in development and its climate(e.g., McBeanet al. 2005). The cli- dialogue-oriented approach to identifying cash income have resultedin changesin local matic and environmental changes that have and assessing potential health impacts and economiesand increasedaccessibilityto many been observedduring the last centuryrequire vulnerabilitiesto climate change in two Inuit marketitems typicallyavailablein urbancengreater understanding and involvement by regionsof Canada'sNorth. These experiences ters to the south. Further,dramaticpolitical individualsand institutionsto define effective build a strong case for a multi-stakeholder, changeshave resultedin Aboriginalgroupsin adaptation strategies. Through signing the qualitative, and participatory approach to many regions now leading regionally based 1992 United Nations FrameworkConvention identifying and assessingriskswhile enhanc- forms of self-governmentor being currently on Climate Change (2006) and ratifyingthe ing the capacity of local areasto respond to engaged in negotiations to establish such Kyoto Protocol (2006), Canadahas shown its the impactsof climatechange. arrangements that include land claim and commitment to the global effort to slow the resource settlements. One example of this rate of warming, reduce emissions, conduct The Canadian North arrangement is the establishment of the research, and initiate action at the national A common definitionof Canada'sNorth that Territory of Nunavut in 1999 [Indian and and regional levels to develop adaptation we use hereincludesthe threeterritorial NorthernAffiarsCanada(INAC) 1993]. tominimize theimpact strategies Just over half of the approximately throughoutadministrativeregions north of 600 latitude the country (Government of Canada 2003). (Yukon,NorthwestTerritories,and Nunavut) 100,000 northernresidentsareAboriginaland Canada has recognized that Aboriginal and aswellastheregion northof 550 belong to distinct cultural groups including of Nunavik, northerncommunitiesface unique challenges in the provinceof Qubec and the Inuit settle- the Yukon First Nations (Yukon), Dene, and that it is necessaryto expand the assessment region of Nunatsiavutwithin Labrador. "Climate ment of vulnerabilities to effects of climate The lattertwo regionscomprisecommunities Thisarticleis partof themini-monograph andHumanHealth:NationalAssessments of Change all to areas of the with share and Canada, change including large Aboriginal populations and Adaptation." Impacts North (Government of Canada 2003). This many biogeographiccharacteristicswith the Addresscorrespondenceto C. Furgal,Department work is essentialfor the developmentof effec- territorialArctic. Together, this region covers of IndigenousStudiesand Departmentof Environtive adaptivestrategiesto protectthe healthof approximately 60% of Canada's landmass mental ResourcesStudies/Science,GzowskiCollege, Canadiansin all regionsof the country. TrentUniversity 1600EastBankDr.,Peterborough, (Figure1). The vast coastline, islands, and perma- Ontario,CanadaK9J7B8.Telephone:(705)748Assessing the impacts that these climate 1011, ext. 7953. Fax:(705) 748-1416. E-mail: changes are having or may have on peoples' nent multiyearice found in Canada'sNorth lives requires a combination of disciplinary are rich in geography and biodiversity. The chrisfirgal@`trentuca and contribution We admowedge the participation approachesand methods (Patz et al. 2000). residents andorganizations to this diversity of the regions' ecosystems, climate madeby northern Research on climate change and health and cultures forms a socioecologic collage work to date. C.F. acknowledgesCanadianInstitutes - Institute forAboriginal Peoples' impacts in northernCanada is in its infancy across the top of the country (Canadian of HealthResearch Health for to his work et al. It providedthrougha support uses and focuses Arctic Contaminants Assessment 2002). (Furgal parReport II ticularlyon indigenous knowledge and local 2003). Communities are spread along grantto the NasivvikCentre.Thanksarealsoextended observationsof environmentalchange along Canada'snortherncoastlineand interior,and to threeanonymousreviewersfor theircomments. The authorsdeclarethey have no competing with scientific assessments of the impacts the land and sea provide northern residents financial interests. associated with these and other forms of with a primarysourceof nutritionand form a Received17June2006;accepted11July2006. BACKGROUND: Canadahas recognizedthatAboriginaland northerncommunitiesin the country

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Aboriginalhealth vulnerabilityand climate role in the ability of northernAboriginalpeo- between 3 and 40C and upwards of 70C in ples to observe,detect, and anticipatechanges winter months.Winterwarmingis expectedto in theirnaturalenvironment. be greatestin the more centrallylocated areas of southern Baffin Island and Hudson Bay Climate Change in (3-9?C). A 30% increase in precipitation is Canada's North predictedby the end of the 21st century,with The breadth of scientific research on the the greatest increases occurring in areas of Canadian northern environment has grown greatestwarming(Welleret al. 2005). The predicted impacts on the environment, regional significantly in recent decades. Scientific research,monitoring,and observationsand the economies,and people arefarreaching.Recent knowledge we have acquiredfrom Aboriginal researchprojectshavebegun to identifyspecific people have resulted in an awareness that localvulnerabilitiesand riskmanagementmeachangesaretakingplace.Observedtrendsvary sures/adaptationstrategiesthat are alreadyin dependingon the region and period analyzed. place or that can be planned (e.g., Berkesand For example, the western and central Arctic Jolly 2002; Ford et al. 2006; Nickels et al. have experienceda generalwarming over the 2002); however,very little attention has been past 30-50 years of approximately 2-30C given to healthimpactsand adaptationsin this (Weller et al. 2005). This warming is more regionto date. pronounced in winter months. It is not until the last 15 or so yearsthat this same warming Assessing Health Impacts and trend, although not to the same extent, has Vulnerability been observed in eastern regions of the Health data series and regional scale assessCanadianArctic. Observedimpactsassociated ments in the Canadian North are limited. with these changes include a significantthin- However,recentqualitativestudiesexamining ning of sea- and freshwaterice, a shorteningof the potentialhealth impactsof environmental the winterice season,reductionin snow cover, change provide new insights with which to changesin wildlifeand plant species'distribu- focus research and proactively develop tion, melting permafrost,and increasedcoastal response strategies. They show the need for erosion of some shorelines (Cohen 1997; community participation in filling informaHuntington and Fox 2005; Ouranos 2004; tion gaps and increasingour understandingof Weller et al. 2005). According to the Arctic factorsthat enhance or inhibit adaptivecapabilities (Furgal et al. 2002; Nickels et al. Climate Impact Assessment (ACIA 2005) designatedclimate models, the predictionsare 2002). The cases we review below present for increased warming and precipitation some of these experiences. Climate change and health in Nunavik throughoutthe CanadianArctic.Annualmean warming in the west is projected to range and Labrador.The project Climate Change and Health in Nunavik and Labrador:What We Know from Science and Inuit Knowledge InuvialuitSettlementRegion (Furgal et al. 2001) was conducted in Aklavik Inuvik Tuktoyaktuk the communities of Kuujjuaq, Nunavik (Quebec), and Nain, Nunatsiavut(Labrador), in 2000-2001. The project was initiated by membersof regionalAboriginal(Inuit) agencies in charge of local environmental health Nunavik f / issues in cooperation with a university /Yukon i, researcher (C. Furgal, Laval University, ,./ .Kuujjuaq Northwest Quebec City, Quebec, Canada). The project \ Nunavut 1 Territories was conducted to establish a baseline under\ \. Nunatsiavut I of the relationshipbetween environstanding Nain mental changes observedin the communities anrland e and the potentialimpactsof these changeson Ondiand Hvso SO(.. ~Nanavik health, as perceived by participants and reportedin the healthsciencesliterature. Nunavik is home to approximately9,000 Inuit residentsliving in 14 villagesdistributed L-. along the coasts of Ungava Bay, Hudson ... Straight,and the easternshoreof Hudson Bay (Figure 1). In 2005, the autonomous Inuit of Nunatisavutwas establishedvia a triUSA region "+ Communities participating in ?projects discussedinpaper partite agreement between the federal and provincial governments and the Inuit of 600km Labrador.This region is situated within the Figure1. Mapshowingterritoriesandregionsof the CanadianNorth.Communities engagedin projects mainland boundary of the province of suchas thosediscussedinFurgal et al.(2002),Nickelset al.(2002),andinthispresentarticleareidentified. Newfoundland and Labrador.The region is

Metis and Gwich'in (Northwest Territories), and Inuit (Nunavut, Nunavik, the new Inuit land claim area of Nunatsiavut within the region of Labrador and the Inuvialuit Settlement Region of the Northwest Territories). Many of the communities are characterizedby an increasingly young and rapidlygrowingpopulation:54% of the population of Nunavut is under 15 years of age compared with the national averageof 25% (Statistics Canada 2001). Many still experience lower health status than their southern counterparts. For example, life expectancy among Aboriginal people in some regions, such as Nunavik, is as much as 12 yearslower than the national average for both sexes (Statistics Canada 2001). In addition, many remotecommunitiesarechallengedby limited accessto health services,lower averagesocioeconomic status, crowding and poor-quality housing, and concernsregardingbasicservices such as drinking water quality (Statistics Canada 2001). Despite these challenges, all northern cultures retain a close relationship with the environmentand a strongknowledge base of their regional surroundings. Even today, the environmentand the countryfoods that come from the land, lakes, riversand sea remaincentralto the way of life, culturalidentity, and health of northernAboriginalpeople (Van Oostdam et al. 2005). More than 70% of northernAboriginaladults harvestnatural resourcesthrough hunting and fishing and of those, > 96% do so for subsistence purposes (StatisticsCanada2001). This strongrelationship with their environment plays a critical

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Furgal and Seguin home to approximately4,800 Inuit living in five coastal communities (Figure 1). Despite recent economic, political, and social changes in the regions of Nunavik and Nunatsiavut over the pastdecades,residentsremainclose to their traditions, and many aspects of a landbased traditionallifestyle are still commonly practiced. To identify potential impactsof observed climate-relatedchangeson health, the project gathered information from various sources. Investigatorsreviewedthe availablescientific with literature,conductedexpertconsult'ations northernhealth and environmentprofessionals and researchers, and documentation of Inuit knowledge and perspectives via focus groups with 16 Inuit hunters, elders, and women in the two communities.A processof thematiccontent analysiswas then performed on the qualitativedata, and common groups or categories of environmental changes and human impactswere developed(Tesch 1990). This analysisof the collectivebase of information identifieda seriesof potential direct and indirect health impacts associated with climatic changes observed in Nunavik and Nunatsiavut(Table 1; Furgalet al. 2002). Most observations and impacts were common between the two regions. For the purposesof the our discussionhere to present the scope of changesand impactsobservedto date, the resultsof these two regionsare combined. Participantsin the two regions identified changes in climatic conditions over the past 10 years not previously experienced or reported in the region. Some changes were identified as having a direct impact on the health of individuals. Respiratorystress was reportedamong elderlyparticipantsand those with decreasedrespiratoryhealth in association with an increasein summer temperature extremes that now exceed 30"C in both regions.The reportedincreasein uncharacteristic weather patterns and storm events had significant impacts on travel and hunting/ fishing safety.As one focus group participant reported: it changesso quicknowyou find.Muchfaster thanit usedto. . . . lastwinterwhentheteacher wascaughtout it wasperfectin themorning... thenit wentdownflatandtheycouldn'tseeanything. . . . Eighteen people were caught out then,

and they almost froze, it was bitterly cold. (Nunatsiavut focus group participant, unpublisheddata,2001)

Significantly more indirect associations between climate-relatedchanges and health were reported by local residents, northern environmentand healthprofessionals,or were found in the pertinent scientific literature (Table 2). For example,warmingwinter temperaturesin the areasaroundboth communities were reportedto have changedthe timing of ice freeze-up and decreased its thickness

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and stability. For Inuit communities, sea ice travelis criticalfor accessingwildlife resources and traveling between communities during winter months. There are anecdotalreportsof an increase in the number of accidents and drowningsassociatedwith poor or uncharacteristicice conditionsduring times of the year that are predictable and typically very safe. More events are reported each year, such as that occurringin 2003 when two young Inuit men went through the ice on their skidoos and drownedneartheircommunityas a result of a strange thinning ice phenomenon that was reported to have been "becoming more common in recent years" (Nelson 2003). With a young and increasinglysedentarypopulation spending more time in communities engaged in wage employment and less time on the land, a combinationof factorsappears to make this group morevulnerableto the climate-relatedchangesbeing reportedin many northernregionstoday. Moreover,changesin the timing of the ice season are reported to impact the frequencyand timing of hunting activitiesin communities, as indicatedby the following comment:

This yearandlastyear,we havebeenstopped whenweweregoingto go fishing.Theice broke up quickly.Wewouldhavegonefishingmorein the past. (Nunavikfocus groupparticipant, data,2001) unpublished The implications of these changes on food security and potential implications on nutritional health among these populationswhich receivesignificantenergyand nutrientcontributions to their total diet from these country foods is only now being investigated.In fact, a number of focused researchprojects have been initiatedwith the communitiesinvolved in this present study and others in these regions. For example, work on climate and water quality, hunting behavior, women's health, and emergingand chronic diseasesin the North arecurrentlyunderway. In general,the impacts identifiedby local residents in this project were supported primarily by scientific evidence and the published literature,although, in some cases, the effects represented new findings. Many impacts were based on individuals' experiences in relation to observed climate-related changes in the local area.Other impactswere

healthimpactsinNunavik andLabrador. of potentialdirectclimate-related Table1. Summary Potential directhealthimpacts climate-related Identified change heat-andcold-related andmortality andfrequency) extremes Increased Increased morbidity (magnitude temperature andseverity ofaccidents while infrequency ofextreme weather Increased Increase andintensity frequency ininjuries, andtraveling, events(e.g.,storms) death, hunting resulting inuncharacteristic stress Increase weather psychosocial patterns risksofskincancers, infectious Increased Increased burns, UV-B exposure diseases, (cataracts), eyedamage immunosuppression ultraviolet B.Adapted fromFurgal etal.(2002). UV-B, healthimpactsinNunavik andLabrador. Table2. Summary of potentialindirectclimate-related Potential indirect healthimpacts ininfectious and Increase diseaseincidence transmission, disruption psychosocial ofaccidents while Increased andseverity frequency ininjuries, andtraveling, death, resulting hunting stress psychosocial accesstocountry fooditems;decreased Decreased values foodsecurity, erosion ofsocialandcultural associated withcountry foodspreparation, sharing, andconsumption inquality forsafetywhile insnowcomposition ofsnow to building shelters (decrease (igloo) Challenges Change withincreased ontheland foriglooconstruction humidity) toexisting andnewvectorborne inrangeandactivity ofexisting andnew Increased Increase exposure diseases infective flies) agents(e.g.,biting inincidence inlocalecology infec- Increase ofdiarrheal andotherinfectious ofwaterborne andfoodborne Change tiveagents(introduction ofnewparasites andperceived diseases ofnewdiseases inquality ofnatural watersources) decrease Emergence drinking and structural ofpublic decreased health, Increased stability Decreased stability housing, permafrost melting, infrastructure transportation withcommunity associated Psychosocial disruption orcomplete) relocation (partial withinfrastructure associated Sea-level rise Psychosocial disruption andcommunity relocation orcomplete) (partial damage ofrespiratory andcardiovascular inairpollution Increased incidence (contaminants, pollens, spores) Changes to environmental diseases;increased exposure onhealth contaminants andsubsequent impacts development fromFurgal etal.(2002). Adapted Identified climate-related change Increased andfrequency) temperature (magnitude extremes inicedistribution, of Decrease andduration stability, coverage

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Aboriginalhealth vulnerabilityand climate identified as "potential,"as they were logical extrapolations for residents considering the observed patterns of change in regional climate variablesand the perceivedrelationship between Inuit health and the environment (Tables 1 and 2). Inuit community workshopson climate change. In response to growing concern among Inuit communitiesabout environmental changesbeing observed,the nationalInuit organization in Canada, Inuit Tapiriit Kantami, initiated a project in cooperation with regional Inuit organizations and Canadian researchinstitutions to document changes and impacts experiencedin communities and to discuss how communities currently are adapting or may adapt in the future. In the first series of workshops in Januaryand February2002, a researchteam involving regionally based Inuit representatives visited three of the six communities in the Inuvialuit Settlement Region of the Northwest Territories(Tuktoyaktuk,Aklavik, and Inuvik, Northwest Territories;Figure 1). Community workshopsoccurredover 2 days in each community, and researchteam members documentedInuit residents'observations of environmental changes and the reported effects they were experiencingin association with these changes. At the same time, communities began to identify existing strategies or develop potential adaptationstrategiesfor local-level response (Table 3; Nickels et al. 2002). The processesused for the workshop drew on participatoryanalysisand planning techniques including Participatory Rural Appraisal (PRA) and Objectives Oriented Project Planning (ZOPP) [Chambers 1997; Deutsche Gesellschaft fUr Technische Zusammenarbeit (German Agency for TechnicalCooperation)1988].

The communities of the Inuvialuit SettlementRegion (ISR) have been observing changes associated with warming in their region for a longer period than those living in the easternArctic communities. Changes in the ISR appearmore pronounced.For example, increasedmean summer and winter temperatures,temperatureextremes, an increase in uncharacteristic weather patterns and storm events, a decreasein precipitation,and of the ice season changesin the characteristics similar to those reportedin the easterncommunities (Furgalet al. 2002) were discussed in ISR community workshops (Nickels et al. 2002). These changes affect the health of individuals and communities, and in some cases communities are already beginning to respond(Table3). For example, in associationwith summer warming, residentsare reporting an increase in the number and species of biting flies and insects, including bees. Many residents are concernedbecauseof the potential for spread of disease or potential allergic reactions to stings, as many of these insects have never been seen beforein this region.Consequently, a public educationprocesswas recommended by workshop participants to inform people about what action could be takento minimize the risk of being bitten and to alleviatepublic fear. Currently, little information on these topics existsor is availablein the communities (Table 3). Locally appropriate strategies were suggested to addressclimate-relatedimpacts on animal distribution and decreased human accessto importantcountryfood sources(e.g., caribou and geese). Furgal et al. (2002) reported that some people (e.g., Elders and those with limited equipment and financial resources)were challenged in their access to

country food species, particularlyduring fall and spring because of changes in ice conditions, water levels, or shifts in animal migrations. These changes were resulting in increasedcosts and time associatedwith traveling longer distances to procure these foods and a decreasein consumptionof these items for some membersof the community.Because of these problems,it was recommendedthat a community hunting and sharingprogrambe formalizedto ensureaccessto these food stuffs for all (Table3). Currently, more reactive than proactive strategies are in place to adapt to climaterelatedhealth impacts in these communities. Changes in hunting behavior, increased investments in equipment or infrastructure (e.g., smoke houses, freezers),and the importance of increasededucationand information exchange were identified. As in the eastern Arctic communities, these initial workshops have led to the establishmentof a variety of projects that addressspecific issues. Some of these projectswill potentiallylead to proactive primary adaptations to reduce exposure (Casimiroet al. 2001).

Understanding the Capacity of Canada's North for Health Adaptation

A summaryof examplesof adaptivestrategies from the work presentedin Table 3 is indicative of the inherentlyadaptivenatureof Inuit society and northern Aboriginal cultures in general (Adger et al. 2003; Nickels et al. 2002; Reidlingerand Berkes2001). However, the ability to respondvariesamong communities and regions and is influenced by some common critical factors. The World Health Organization frameworkfor health adaptation (Grambschand Menne 2003) identifies

Table3. Examples of environmental residentsinthe Inuvialuit SettlementRegionto changes,effects,andcopingstrategies/adaptations reportedbycommunity minimize negativehealthimpactsof climatechange. Observation Warmer temperatures

Effect Notabletostorecountry foodspoils foodproperly whilehunting; lesscountry foodsareconsumed quicker;

Warmer temperatures insummer

Cannolonger fishinthesameway:"Itgets dried/smoked prepare cookedintheheat" Lessdried/smoked fisheaten insources ofgoodnatural Decrease wateravailable (raw) drinking whileontheland riskofwaterborne illnesses Increased Increased insectbites concern abouthealtheffectsofnewbitinginsects Increasing notseenbefore

Lower waterlevelsin someareasandsome brooks/creeks drying up Moremosquitoes and other(new)biting insects animal Changing routes travel/migration

Makeshunting moredifficult morefuel,gear,andtime) (requires Someresidents cannot afford to hunt,thus (e.g.,Elders) lesscountry foods consuming

Coping strategy/adaptation Return tocommunity whilehunting to moreofteninsummer storefoodsafely(incooltemperatures) Needed: investment ofmorefundsforhunting activities withfewer Decrease amount offuture andstorage hunting placestostoreextrameat ingovernment-supported Needed: freezer re-investment community program Alterconstruction ofsmokehouses: buildthicker roofsto regulate temperature andsmoking Adapt drying techniques andtakenontrips Bottled waternowpurchased orsprays Useinsectrepellent, lotion, andentrances to houses Usenetting andscreensonwindows andeducation fliestoaddress Needed: information oninsectsandbiting current perception/fear ofa community foractivehunters toprovide meatto Initiation program others totravel/hunt conditions whoareunable under (e.g.,Elders) changing andinstitutional Needed: financial to establish support program

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Furgaland Seguin seven elements that influence vulnerability and adaptation to climate-related health impacts, many of which are applicableto the northerncommunitiesdiscussedhere. The ability to overcomechangesin access to or availability of country food resources, which are important for nutritional and socioculturalwell-being, is significantlyinfluenced by an individual's access to economic resources and technology. The ability to invest more in the requiredtools and equipment for hunting and traveling,or the access to other forms of transportation(e.g., snow machine, four-wheel all terrain vehicle, flat bottom or largerboat) allows individuals to adapt more easily to changing environmental conditions (Duhaime et al. 2002; Ford et al. 2006). Similarly, the generation and sharing of local or traditionalknowledgeof regionalenvironments and the relationship between the environmentand humansfurthersupportthis ability to adapt while on the land and safely navigateincreasinglydangerousand uncharacteristicconditions.The abilityto shift species, alterhunting behaviors,and readenvironmental cues (e.g., weatherprediction,ice safety)all increasehunting and travelsafetyand success. The importanceof this knowledge is gaining recognitionamong scientificand policy communities (e.g., Huntington and Fox 2005); however, its generation is being challenged locally with shifts toward a more "western lifestyle"involving more time spent in communities engaged in indoor wage-basedeconomic activities and less time on the land (Chapinet al. 2005). The support provided through institutional or formal arrangementsfor aspects of traditional lifestyles and health may become increasinglyimportantwith climatechange in Arctic regions. As many communities begin to representmore pluralisticsocietiesin terms of livelihoodsand lifestyles,establishingcountry food collection, storage and distribution programs,and economic supportfor the pursuit of traditionalactivitiesbecome important in reducingthe vulnerabilitiesto and enhancing adaptive capabilities for climate-related changes. Also important is the formalization of traditionalknowledge documentation and sharing mechanisms through the establishment of such things as community-basedice monitoringprograms(Lafortuneet al. 2004). With warming temperatures and the potentialfor the introductionof new waterand foodborne agents and permafrost melting, which threatensbuilt structuresin coastalcommunities, some basic public health infrastructures (e.g., water treatmentand distribution, areincreasinglyvulemergencytransportation) nerable. The security of basic public health infrastructurein small remote communities that are alreadychallengedregardingprovision 1968

of some basic servicesis a significantdeterminant of adaptiveabilityin theselocations. Finally, existing health status issues in Inuit populations (e.g., nutritional deficiencies, increasingratesof diabetesand some cancers associated with shifts toward a more "western diet" and sedentary lifestyle, and ratesof respiratoryillness)appearto be further exacerbatedby changes in local climate. The combination of environmentalchange, basic health needs, limited economic choices, and shifts in northernsociety and lifestyleappears to increasevulnerabilityand limit the ability of some Arctic communities to respond. When many of these factorsoverlap and the population is already facing some critical health issues, the impact of climate change is greaterbecauseof the population'svulnerability (e.g., small remote communities, with a limited naturaland economicresourcebase).

Discussion Indigenous populations are often more vulnerable to climatic changes because of their close relationshipwith the environment,their reliance on the land and sea for subsistence purposes,the fact that they are more likely to inhabit areas of more severe impact such as coastal regions, often have lower socioeconomic status, are more socially marginalized, and have less accessto qualityhealth careservices (Kovatset al. 2003). In the public health sector, this combination of the currentexposure-response relationship, the extent of exposure,and the possible preventativemeasures in place createsa vulnerabilitybaseline againstwhich the effectivenessof future policies can be measuredvia changes in the burden of disease(Ebi et al. 2003). The dialogue approachwe presenthere shows the value of establishingthis baselineand engagingArctic Aboriginalcommunities on these issues by a process very similar to that outlined by Ebi et al. (2006). The findings presentedin these two small studies are supported by others (e.g., Ford et al. 2006; KrupnikandJolly 2002). A workshop with Northern health professionals, community leaders,and Aboriginalrepresentativesfrom acrossthe North reportedsimilar results (Health Canada 2002). Critical issues identified included challenges related to northern home design and a lack of ventilation causing heat stress among elderly on increasinglywarm days;impactsto food security becauseof changesin sea-iceaccessroutes to hunting areas or ice-road stability and effects on reliable transport of market food stuffs; combined impacts on mental health due to reducedability of individualsto practice aspects of traditional lifestyles; and impacts to infrastructureand threatsof community disruption or relocation (Health Canada2002).

Although a regionallybased analysiswas not possiblewith the dataavailable,variations in vulnerabilitiesand adaptiveabilitiesappear to exist between and within regions on the basis of a number of common factors (see "Understanding the Capacity of Canada's North for Health Adaptation"; Grambsch and Menne 2003). Similarly, both projects were conducted with Inuit communities,and hence, differences between Arctic cultural groups were not identified.However, as each Aboriginal group is uniquely adapted to its geographyand local ecology, it is reasonable to speculate that each group's socioecologic resilience and adaptive capacity for health issues is similarly unique. Observed climate changes, impacts, and response abilities of Yukon First Nations living in the interior of the western Arctic likely are very different from those of the Inuit communities presented here. It is thereforecriticalto conduct such assessmentslocally. As in other regionsof the world, enhancing adaptivecapacitycan be regardedas a "no regrets"option in the North, as it not only reducesvulnerabilitybut also improvesimmediate resilience to currentday stresses (Yohe and Tol 2002). Strengthening access and availabilityto country foods throughout the year for communities or increasing public health educationassociatedwith environmental causes of disease are such examples. Establishingcommunity freezerand distribution plans will help in addressing current nutritional and other food issues as well as increase the capability of an individual to access safe and healthy foods in the face of environmentalchanges. Increasedknowledge and awarenessof environmentalcausesof disease will addressperceivedrisks and provide valuableinformationto empower individuals to continue to makehealthydecisions. Both the Nunavik-Nunatsiavut(Labrador) projectand the workshopsin the ISR arestarting points in the collection of informationto support community, regional, national, and international processes on climate change. Many new projectshave since begun on components of the climate-health relationshipin northerncommunities,and many of these are takinga similarlyparticipatoryapproach(e.g., ArcticNet 2004). Arctic indigenous peoples have also participated in the international assessmentof climatechangeimpactsthrough their involvementin the ACIA with academic and government researchers(ACIA 2004). This level of engagementand contributionis a significant advance in environmental health impact and vulnerability research. Despite these advances,researchon climateand health in northern Aboriginal populations is sparse (Bernerand Furgal2005), and the identification of the impacts on local populations and community adaptationsis still in its infancy

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Aboriginalhealth vulnerabilityand climate and requirescontinuedeffortwith attentionto thresholdsand limitsto adaptation(Berkesand Jolly2002). The studiespresentedhere on populations in Canada's North and a review of other recent research in this region (e.g., ACIA 2005; Ford et al. 2006; Health Canada2003) identify data gaps that we need to fill and methods that we need to use to increaseour understanding of climate and health assessment, vulnerability,and the capacityto adapt in northern Aboriginal communities. They include the following:. Multiple-scale research and data. Community-basedassessmentsand systematic researchmust be conducted on the issues of climatechangeimpactsin the North and elsewherein Canada.Local,regional,and national levels are interconnected in supporting and facilitatingactionon climatechange;thus data at multiple levels and researchthat link scales to understandthese relationshipsare needed. Fine-scale meteorologic data is required in many northernregionsand must be collected in a way that allows the data to be linked to existingand futurehealthdata sets. Models of change and impact must be linked with currentlyused globalchangescenarios. Qua1ry, comparable,standardizeddata. Innovative approachesto health and climate assessment are needed and should consider the role of sociocultural diversity present among Arctic communities. This requires both qualitativeand quantitativedata and the collection of long-term data sets on standard health outcomes at comparabletemporaland spatial levels. These data must include local observations and knowledge collected using reliableand standardizedmethods. Integrated interdisciplinary approaches to assessment.Assessmentsthat take a multidisciplinary approach bringing together health scientists, climatologists, biologists, ecologists,social and behavioralscientists,and policy researchersand include demographic, socioeconomic,and healthand environmental data are required to develop an adequate understandingof impacts,vulnerabilities,and capabilitiesin Arcticcommunities. Increased analysis of historical data. Historical data (climate, health, social, economic) from appropriatelocations with climate systems similar to those projected for Canadiannorthern regions must be used for integrated and geographic analyses of the spreadof diseaserelativeto climate variables. These analyses would make efficient use of existing informationand increaseour understanding of these issues and their interconnectednature. Improvementofscenarios and modelsfor hbealtharsessmentDeveloping and improving regional scenarios is needed for areas projected to experiencesignificantimpacts, such Environmental HealthPerspectives

as the westernArctic. Socioeconomic scenar- respond at the local scale. Such an approach ios to model and projectimpactsand changes may verywell prove useful in establishingthis within northern indigenous populations are baselinein otherregions. needed. Such scenarios are currently sparse, REFERNCES poorlydeveloped,and inadequate.

andanalytical understanding 2004.Arctic Climate Conceptual ACIA.

of mdnerabiltyand capacity.Work is needed at both the conceptualand analyticallevelsto define and increaseour understandingof vulnerabilityand community health,how best to measurethese concepts, and the use of these conceptsin makingdecisionsabout the health of the community and in risk management. This work should include local knowledge and informal institutions (e.g., culturalsharing networks) to best understandthese concepts in Aboriginalcommunities. Enhancement of local capacities to identij,, conduct, and analyze data related to climate changeand the impactson health. To ensure success and sustainabilityof adaptation strategies, development of local and regional monitoring, analyticaland decision making capabilities are needed to support cooperative and empowering approaches to researchand action.

Conclusions In the Canadian North the debate is no longer solely about identifyingand predicting effects of climatic change but rather about what can and should be done to adapt, as some communities are already reporting impacts. This researchfocuses on improving the understandingof the magnitudeand timing of the impacts of climate change, how individuals and communities cope with current and predictedchanges, and what public institutions should do to actively support adaptation. There is currentlysparseinformation on the effectivenessof any current strategiesfor dealingwith climate-relatedor environmental risks to health in the locations describedhere and in other areasof the country.This lack of informationis an importantgap in our understandingand abilityto assesswho, where, and when Canadians may be vulnerable to the effectsof climatechange.A significantcomponent is the lack of an assessment of the Canadianhealth sector'sabilityat variouslevels and in variouslocations to cope with and plan for the impacts of climate change. The cooperativeplanning, development,and conduct of projectsin Inuit communitiesbringing togetherscientists,northernenvironmentand health professionals,and communityresidents and experts,as presentedhere, has been essential to the successof the projectsdescribedin this article.The community-based,dialoguefocused approach has proven valuable in engagingcommunitiesand establishinga local baseline for understanding the changes, impacts, vulnerabilities, and the ability to

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