Rethinking “Big Problems” in Arctic Health

Mixed methods approaches, community engagement, and indigenous perspectives help uncover the links between Inuit culture and health.

In October 2013, Elspeth Ready conducted an interview with Markusi, an Inuit elder in Kangiqsujuaq, Nunavik. Markusi politely answered her scripted questions about food security (the topic of her dissertation), but like many of the elders she met, Markusi really wanted to tell stories about how things had changed over the course of his lifetime. Markusi’s life story was punctuated by changes with equivocal outcomes. It was bad that the sled dogs were killed, but snowmobiles helped hunters to get back out on the land. The seal fur trade was good for hunters, but Greenpeace’s anti-sealing campaign did irreparable damage to the industry. Some imported foods, like chicken and pork chops, added variety to the diet, but other imports, like alcohol, had destructive impacts. Qallunaat (white) medicine helped heal injuries caused by snowmobiles and alcohol. Inuit today recover more quickly from injuries thanks to Qallunaat doctors, and medical care helped people live longer, too. New problems had replaced old ones.

Sunrise on Queen’s Bay Road, Ulukhaktok, October 2007. Peter Collings

In summer 2014, Peter Collings arrived in Ulukhaktok, poised to conduct a research project on food insecurity. Armed with community approvals suggesting local interest in the research, his first meetings with Inuit proved otherwise. As he explained his goals to a longtime friend, she rolled her eyes and said, “Oh, Pete, don’t do food. We’re sick of food research. Everyone is always asking us about food.… You know what this community needs? We need research about health. Health is a big problem for us.”

Health is a big problem for Inuit. As Markusi’s stories implied, the effects of Qallunaat medicine must be considered in the broader context of changes Inuit have experienced over the past five decades. Based on our experience in two communities, we consider the role that rapid culture change plays in Inuit health and suggest important questions and methods for future research.

Arctic health research

Despite the increasing availability of medical care, academic research among Inuit peoples in North America has established a trend of both declining health and increasing health disparities. The “big problems” of Inuit health include—from the perspective of medical researchers—diabetes, heart disease, tuberculosis, suicide, and drug and alcohol abuse. From the perspective of Inuit, however, the “big problems” also include many health care service providers’ lack of understanding of Inuit culture, the difficulty of accessing services from remote settlements, and the psychological, physical, and cultural legacies of colonialism.

These health trends are concurrent with rapid socioeconomic changes occurring in the region, including settlement in permanent villages, the rise and collapse of the seal fur industry, and increasing reliance on wage labor and imported foods. Medical and epidemiological research conducted with Inuit frequently acknowledges the importance of culture change to health outcomes, but until recently, “acculturation” has often been employed as a causal agent in declining health without specifying the mechanisms linking culture change and health. Past research on Inuit health generally described specific diseases or problems in a community and compared results to reference populations, without any detailed exploration of the social processes that contribute to these outcomes.

Coping with stress

After reworking his research to focus on health, Pete was interviewing a middle-aged Inuk about how he coped with stress. Participants in initial interviews frequently noted how stressful settlement life was, so he began asking people to identify both common stressors and coping strategies. The man, Walter, responded, “Well, I talk to my elders. That really helps, to talk with elders. And I read the bible.” He paused.

Pete pressed on, “Anything else?” Walter seemed unsure about answering. “How about pot? Do you smoke pot?”

Walter looked relieved, “Oh yeah. I smoke pot every day.”

Similar patterns of marijuana usage are prevalent in Kangiqsujuaq, especially among younger men and women. Talking to elders and getting out on the land are more traditional ways of coping with stress, well documented in the well-being literature, but putting together the cash for a week’s supply of pot is much easier than acquiring thousands of dollars’ worth of gear required for many traditional subsistence activities. Marijuana is used by many Inuit to help them “relax” and manage the constellation of stresses that are part of modern settlement life, including food insecurity, high rates of unemployment, interpersonal conflict, and substandard housing conditions.

Articulating connections between cultural practices, stress, and health requires assessment of the relationship between physiological indicators of stress and health outcomes, but it also requires that we ask questions about how Inuit define living well, and what kinds of situations or conditions produce stress.

Inuit concerns about stress, and the strategies they use to cope with it, are important in considering the role of cultural change in health outcomes. We suspect that stress engendered by settlement life is a likely candidate for the link between culture change and health. People who experience greater stress are at increased risk for poor health. For example, Mark Sorensen and collaborators (2009) found that psychosocial stress related to emerging economic inequality and lifestyle incongruity impaired immune function among Yakut in post-Soviet Siberia. The consequences of chronic stress include long-term tissue damage, metabolic dysregulation, and prolonged immunosuppression. These processes, in turn, have important implications for vulnerability to many health problems that are common in Arctic communities, including tuberculosis and cardiovascular disease.

The relationships between stress and the effectiveness of coping behaviors are culturally complex, though. For example, one hunter responded to Elspeth’s finding that young men who don’t hunt (and their families) are the lowest priority for food sharing in Kangiqsujuaq by saying, “Why would I share with them? They’re dopeheads.” An inability to participate in stress-relieving traditional activities, or being judged for choosing alternative pursuits, may well be additional sources of stress. Moreover, “traditional” cultural practices cannot be considered in isolation from other aspects of social life—Joshua Moses and colleagues’ (2017) research in Labrador found that traditional food and knowledge sharing networks overlapped with alcohol co-use networks. Marijuana and alcohol are an important form of stress relief for many, but the social and physiological consequences of their usage are not always straightforward.

Integrating culture, biology, and community

Articulating connections between cultural practices, stress, and health requires assessment of the relationship between physiological indicators of stress and health outcomes, but it also requires that we ask questions about how Inuit define living well. What stressors do community members encounter, and what coping strategies are available to them? What are the health outcomes associated with different stressors and coping strategies? Answering such questions requires quantitative epidemiological and biological measures of health in addition to a deep understanding of local conceptions of health, well-being, and success, and of the socially-embedded nature of individuals and their actions.

Incorporating these objectives—reconciling diverse local and medical definitions of what it means to be healthy and well, documenting experiences of stress and coping, and linking these experiences with health outcomes—necessitates placing local concerns at the core of research. Investigating stress and well-being inherently involves asking about local concerns and epistemologies, but research addressing issues important to community members must generate more than scientific understanding. To sustain community interest and engagement with intensive research, it must also contribute to developing culturally appropriate programs that address these concerns.

To date, however, despite increasing calls for the inclusion of native peoples in all phases of research through Community-Based Participatory Research models, there are relatively few projects developed at the behest of Indigenous communities or that attend to Indigenous epistemologies. The long-running Elluam Tungiinun (Towards Wellness) project in Western Alaska provides an example of research that approaches community health problems, particularly alcohol, by focusing on local meanings and experience. Although progress on decolonizing research has been slow, projects such as Elluam Tungiinun indicate that research in the health domain is trending in this direction.

Successfully tackling the “big problems” of Inuit health requires a better understanding of the relationships between culture change and health and upending a legacy of top-down approaches that historically dismissed the importance of local understandings. Combining mixed methods with decolonized approaches to research, grounded and driven by community needs and concerns, promises to generate a more complete understanding of the relationships between culture and health and generate positive social outcomes.

Elspeth Ready is a postdoctoral research associate in the Research, Evaluation, and Analysis for Community Health (REACH) lab at the University of Nebraska Lincoln and has worked in Kangiqsujuaq since 2011.

Peter Collings is associate chair of anthropology and Jessie Ball duPont-Magid Term Professor at the University of Florida, and has worked since 1992 in Ulukhaktok. Both authors’ recent work examines social networks, traditional food sharing, and food insecurity. They are currently collaborating on comparative research focused on stress and well-being in the Canadian Arctic.

Cite as: Ready, Elspeth, and Peter Collings. 2018. “Rethinking ‘Big Problems’ in Arctic Health.” Anthropology News website, January 24, 2018. DOI: 10.1111/AN.745

Comments

Wonderful essay, about more than a generation of drastic changes in Arctic Canada.
A core problem is that in these post-nomadic days, the Inuit have little choice in
defining what “success” now means in their lives. And much of the models of success
come from “outside” and very few Inuit have a chance of measuring up. No wonder
thousands of Inuit are leaving the Arctic. Apirqu Nilisi allakpuk

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