The hidden costs: Identification of indirect costs associated with acute gastrointestinal illness in an Inuit community

Background: Acute gastrointestinal illness (AGI) incidence and per-capita healthcare expenditures are higher in some Inuit communities as compared to elsewhere in Canada. Consequently, there is a demand for strategies that will reduce the individual-level costs of AGI; this will require a comprehensive understanding of the economic costs of AGI. However, given Inuit communities’ unique cultural, economic, and geographic contexts, there is a knowledge gap regarding the context-specific indirect costs of AGI borne by Inuit community members. This study aimed to identify the major indirect costs of AGI, and explore factors associated with these indirect costs, in the Inuit community of Rigolet, Canada, in order to develop a case-based context-specific study framework that can be used to evaluate these costs. Methods: A mixed methods study design and community-based methods were used. Qualitative in-depth, group, and case interviews were analyzed using thematic analysis to identify and describe indirect costs of AGI specific to Rigolet. Data from two quantitative cross-sectional retrospective surveys were analyzed using univariable regression models to examine potential associations between predictor variables and the indirect costs. Results/Significance: The most notable indirect costs of AGI that should be incorporated into cost-of-illness evaluations were the tangible costs related to missing paid employment and subsistence activities, as well as the intangible costs associated with missing community and cultural events. Seasonal cost variations should also be considered. This study was intended to inform cost-of-illness studies conducted in Rigolet and other similar research settings. These results contribute to a better understanding of the economic impacts of AGI on Rigolet residents, which could be used to help identify priority areas and resource allocation for public health policies and programs

Readiness for climate change adaptation in the Arctic: a case study from Nunavut, Canada

There is limited knowledge on institutional factors constraining and enabling climate change adaptation in Arctic regions, or the overall readiness of governing bodies and communities to develop, implement, and promote adaptation. This paper examines the preparedness of different levels of government to adapt in the Canadian Arctic territory of Nunavut, drawing upon semi-structured interviews with government personnel and organizations involved in adaptation. In the Government of Nunavut, there have been notable developments around adaptation planning and examples of adaptation champions, but readiness for adaptation is challenged by a number of factors including the existence of pressing socio-economic problems, and institutional and governmental barriers. Federally, there is evidence of high-level leadership on adaptation, the creation of adaptation programs, and allocation of funds for adaptation, although the focus has been mostly on researching adaptation options as opposed to supporting actual actions or policy change. The 2016 Pan-Canadian Framework on Clean Growth and Climate Change, and increasing emphasis on climate change federally and in the Government of Nunavut, offer opportunities for advancing adaptation, but concrete steps are needed to ensure readiness is enhanced

Seasonal prevalence and determinants of food insecurity in Iqaluit, Nunavut

Background: Food insecurity is an ongoing problem in the Canadian Arctic. Although most studies have focused on smaller communities, little is known about food insecurity in larger centres. Objectives: This study aimed to estimate the prevalence of food insecurity during 2 different seasons in Iqaluit, the territorial capital of Nunavut, as well as identify associated risk factors. Design: A modified United States Department of Agriculture Food Security Survey was applied to 532 randomly selected households in September 2012 and 523 in May 2013. Chi-square tests and multivariable logistic regression were used to examine potential associations between food security and 9 risk factors identified in the literature. Results: In September 2012, 28.7% of surveyed households in Iqaluit were food insecure, a rate 3 times higher than the national average, but lower than smaller Inuit communities in Nunavut. Prevalence of food insecurity in September 2012 was not significantly different in May 2013 (27.2%). When aggregating results from Inuit households from both seasons (May and September), food insecurity was associated with poor quality housing and reliance on income support (p<0.01). Unemployment and younger age of the person in charge of food preparation were also significantly associated with food insecurity. In contrast to previous research among Arctic communities, gender and consumption of country food were not positively associated with food security. These results are consistent with research describing high food insecurity across the Canadian Arctic. Conclusion: The factors associated with food insecurity in Iqaluit differed from those identified in smaller communities, suggesting that experiences with, and processes of, food insecurity may differ between small communities and larger commercial centres. These results suggest that country food consumption, traditional knowledge and sharing networks may play a less important role in larger Inuit communities

Is the effect of precipitation on acute gastrointestinal illness in southwestern Uganda different between Indigenous and non-Indigenous communities?

Acute gastrointestinal illness (AGI) is a global public health priority that often disproportionately effects Indigenous populations. While previous research examines the association between meteorological conditions and AGI, little is known about how socio-cultural factors may modify this relationship. This present study seeks to address this research gap by comparing AGI prevalence and determinants between an Indigenous and non-Indigenous population in Uganda. We estimate the 14-day self-reported prevalence of AGI among adults in an Indigenous Batwa population and their non-Indigenous neighbours using cross-sectional panel data collected over four periods spanning typically rainy and dry seasons (January 2013 to April 2014). The independent associations between Indigenous status, precipitation, and AGI are examined with multivariable multi-level logistic regression models, controlling for relative wealth status and clustering at the community level. Estimated prevalence of AGI among the Indigenous Batwa was greater than among the non-Indigenous Bakiga. Our models indicate that both Indigenous identity and decreased levels of precipitation in the weeks preceding the survey period were significantly associated with increased AGI, after adjusting for confounders. Multivariable models stratified by Indigenous identity suggest that Indigenous identity may not modify the association between precipitation and AGI in this context. Our results suggest that short-term changes in precipitation affect both Indigenous and non-Indigenous populations similarly, though from different baseline AGI prevalences, maintaining rather than exacerbating this socially patterned health disparity. In the context of climate change, these results may challenge the assumption that changing weather patterns will necessarily exacerbate existing socially patterned health disparities

How do Canadian media report climate change impacts on health? A newspaper review

Research on climate change media coverage is growing. Few studies, however, have investigated how the media portrays climate change impacts on human health. This review, therefore, presents a quantitative spatiotemporal analysis of Canadian newspaper coverage of climate change impacts on health between 2005 and 2015. Using the ProQuest® and Eureka® databases, a multiphase systematic review strategy was employed to identify relevant English and French articles from two national and six regional high-circulation newspapers. Quantitative and qualitative data were extracted from 145 articles and analyzed to characterize the range, extent, and nature of climate-health newspaper coverage in Canada and to compare these characteristics by region and over time. Coverage varied by region, with the highest proportion of climate-health coverage in Northern Territories (Yukon, Northwest Territories, Nunavut). Over time, there was a decreasing publication frequency trend. Almost all articles described negative climate change impacts on health, with a predominant focus on infectious and chronic noninfectious diseases; however, less than half of the articles discussed climate change solutions. These trends suggest that current media coverage might not drive widespread public support for policies and actions needed to protect against projected climate-health risks. Consequently, as climate change continues to challenge human health, increasing media emphasis on climate change impacts on human health, as well as a shift toward enabling and empowering climate change communication, in which viable mitigation and adaptation options are emphasized, could help to spur action to reduce climate change health risks

Community-based monitoring of Indigenous food security in a changing climate: global trends and future directions

Climate change is expected to exacerbate existing food security challenges, especially in Indigenous communities worldwide. Community-based monitoring (CBM) is considered a promising strategy to improve monitoring of, and local adaptation to climatic and environmental change. Yet, it is unclear how this approach can be applied in food security or Indigenous contexts. The objectives of this paper are to: (1) review and synthesize the published literature on CBM of Indigenous food security; and, (2) identify gaps and trends in these monitoring efforts in the context of climate change. Using a systematic search and screening process, we identified 86 published articles. To be included, articles had to be published in a journal, describe a CBM system, describe any aspect of food security, and explicitly mention an Indigenous community. Relevant articles were thematically analyzed to characterize elements of CBM in the context of climate change. Results show that the number of articles published over time was steady and increased more than two-fold within the last five years. The reviewed articles reported on monitoring mainly in North America (37%) and South America (28%). In general, monitoring was either collaborative (51%) or externally-driven (37%), and focused primarily on tracking wildlife (29%), followed by natural resources (16%), environmental change (15%), fisheries (13%), climate change (9%), or some combination of these topics (18%). This review provides an evidence-base on the uses, characteristics, and opportunities of CBM, to guide future food security monitoring efforts in the context of climate change