| Summary: | This thesis responds to health system challenges in Arctic regions where there are complex and interrelated challenges related to climate change and environmental effects impacts, geographic remoteness, indigenous health needs and values, and health equity. Specifically, the United States (US), Canada, Norway and Finland are studied. The need to further understand the health system context has been emphasized in many international and Arctic forums. How health systems situate or optimize performance in the Arctic context has not been studied previously. This thesis explores how health systems respond with a stewardship framework that aspires to adopt ethical and multi-sector approaches to health. To broaden our lens, we developed new methods that recognize both indigenous knowledge and western science. We captured indigenous and national perspectives, and we enveloped notions of common values (humanity, cultural responsiveness, teaching, nourishment, community voice, kinship, respect, holism and empowerment) that provide a basis for health system comparisons in Arctic nations. Policies and strategies within circumpolar nations that respond to shared context and challenges were identified. In particular, we used a case study approach to highlight how circumpolar health systems organize and respond through health system stewardship functions to the shared circumpolar challenges. Overall, Canada and the United States demonstrated higher levels of self-determination, and Norway and Finland exhibited strengths in strategies and policies influencing work across sectors. While the emphasis on stewardship functions differed, government statements that promoted work across sectors were present in all nations, as were dialogues on the self-determination of indigenous peoples. The findings provide some ssurance that there are common values and goals in Arctic regions, and that the concept of stewardship is an effective response within this context. The findings provide a collection of policy resources and a direction for value-based stewardship of health systems in Arctic regions at the regional, national, self-governing and international level of governments. The development of a performance framework and scorecard for this context will enhance the ability to learn from different approaches to stewardship, and guide trusting relationships and health equity in circumpolar nations. Ph.D.
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