Gastrointestinal Illness in Canada’s North: Implications of Climate Change on Current and Future Inuit Health

• Main Author: Harper, Sherilee
• Other Authors: McEwen, Scott, Edge, Victoria
• Format: Thesis
• Language: English
• Published: 2013
• Subjects: Inuit health; acute gastrointestinal illness; ecohealth; enteric illness; diarrhea; Aboriginal; epidemiology; climate change; scenario planning; mixed-methods; burden of illness; Canada; Nunavut; Rigolet; inuit; Iqaluit
• Online Access: http://hdl.handle.net/10214/7742

Current and potential future trends in the burden of acute gastrointestinal illness (AGI) in Rigolet, Nunatsiavut and Iqaluit, Nunavut, Canada were investigated in the context of climate change. A concurrent mixed methods design was used in which quantitative and qualitative data were concurrently collected and analyzed and then combined to better understand the burden of AGI. In-depth interviews with government stakeholders (n=11), PhotoVoice workshops (n=11), and two community surveys (n=185) were conducted to identify and characterize climate-sensitive health priorities in the Nunatsiavut region. Then, four cross-sectional retrospective surveys in Rigolet (two community censuses, n=462) and Iqaluit (two surveys with randomly selected households, n=1,055), as well as in-depth interviews with cases (n=9) were conducted to examine the incidence, risk factors, and healthcare seeking behavior of AGI. Finally, a scenario planning approach was used to identify and rank trends and conditions driving changes in future waterborne disease in Nunatsiavut. This involved in-depth interviews with national and international experts (n=20) and community focus group discussions (n=29). Climate-sensitive health priorities identified in Nunatsiavut included food security, water security, mental health, new hazards and safety concerns, and health services and delivery. The annual estimated incidence of self-reported AGI ranged from 2.9-3.9 cases/person/year in Rigolet and Iqaluit, which are the highest published estimates globally. Significant risk factors for AGI included food, water, animal exposure, and socio-economic conditions; while community interviewees perceived hygiene, retail food, tap water, boil water advisories, and personal stress to be important risk factors. The proportion of AGI cases seeking medical services ranged from 3-19%, which are among the lowest published rates globally. In the scenario planning process, critical drivers of AGI included ‘extreme weather events’; ‘technology development’; and ‘global interest in Northern resources’. These results provided information about AGI-related exposures and sensitivities to climate change, which can be used to provide information for public health planning, prioritization, and programming in Inuit regions. The improved understanding of AGI in two Canadian Aboriginal communities sheds light on the need to better understand the burden in sub-sets of the population that might be at higher risk, including Aboriginal populations in the context of climate change. Vanier Canada Graduate Scholarship (CIHR); Public Health Agency of Canada; IRIACC initiative (CIHR, NSERC, SSHRC, IDRC); Nasivvik Centre for Inuit Health and Changing Environments