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Indigenous knowledge is central to understanding environment and health sciences in the Arctic, yet limited research in these fields has explored the human–animal–environment interface from the unique perspectives of Inuit women. Using a community-led, Inuit-centred research approach, we characterized the use and meaning of country food in the context of community well-being for Inuit women in Nunavut, Canada. In-depth conversational interviews and focus groups (n = 16) were held with Inuit women (n = 10) who are knowledge holders in the Qikiqtani region that hold decades of country food knowledge. Data were analyzed using thematic analysis and constant comparative methods. Inuit women described country food in the context of (1) well-being, connection, and identity, (2) hunger, craving, and healing, (3) food security and nourishment, and (4) change and adaptation. Inuit women described a wide range of country food as central to physical and mental health, food security, identity, culture, healing and medicine. Adaptive strategies were discussed, such as eating more fish when caribou were scarce. This research highlights the critical role of country food for health and well-being for Inuit women and shares knowledge and perspective that is relevant to wildlife and environment researchers, public health practitioners, policy makers, and others interested in advancing health, well-being, and food sovereignty in Inuit communities.

Abstract Background There is concern in the international community regarding the influence of climate change on weather variables and seasonality that, in part, determine the rates of malaria. This study examined the role of sociodemographic variables in modifying the association between temperature and malaria in Kanungu District (Southwest Uganda). Methods Hospital admissions data from Bwindi Community Hospital were combined with meteorological satellite data from 2011 to 2014. Descriptive statistics were used to describe the distribution of malaria admissions by age, sex, and ethnicity (i.e. Bakiga and Indigenous Batwa). To examine how sociodemographic variables modified the association between temperature and malaria admissions, this study used negative binomial regression stratified by age, sex, and ethnicity, and negative binomial regression models that examined interactions between temperature and age, sex, and ethnicity. Results Malaria admission incidence was 1.99 times greater among Batwa than Bakiga in hot temperature quartiles compared to cooler temperature quartiles, and that 6–12 year old children had a higher magnitude of association of malaria admissions with temperature compared to the reference category of 0–5 years old (IRR = 2.07 (1.40, 3.07)). Discussion Results indicate that socio-demographic variables may modify the association between temperature and malaria. In some cases, such as age, the weather-malaria association in sub-populations with the highest incidence of malaria in standard models differed from those most sensitive to temperature as found in these stratified models. Conclusion The effect modification approach used herein can be used to improve understanding of how changes in weather resulting from climate change might shift social gradients in health.

Abstract Background Detailed qualitative information regarding Indigenous populations’ health-seeking behaviours within Peru’s plural healthcare system is lacking. Such context-specific information is prerequisite to developing evidence-based health policies and programs intended to improve health outcomes for Indigenous populations. To this end, this study aimed to characterize health-seeking behaviours, factors affecting health-seeking behaviours, and barriers to obtaining healthcare in two Indigenous Shawi communities in Peru. Methods Community-based approaches guided this work, and included 40 semi-structured interviews and a series of informal interviews. Data were analysed thematically, using a constant comparative method; result authenticity and validity were ensured via team debriefing, member checking, and community validation. Results Shawi health-seeking behaviours were plural, dynamic, and informed by several factors, including illness type, perceived aetiology, perceived severity, and treatment characteristics. Traditional remedies were preferred over professional biomedical healthcare; however, the two systems were viewed as complementary, and professional biomedical healthcare was sought for illnesses for which no traditional remedies existed. Barriers impeding healthcare use included distance to healthcare facilities, costs, language barriers, and cultural insensitivity amongst professional biomedical practitioners. Nevertheless, these barriers were considered within a complex decision-making process, and could be overridden by certain factors including perceived quality or effectiveness of care. Conclusions These findings emphasize the importance of acknowledging and considering Indigenous culture and beliefs, as well as the existing traditional medical system, within the professional healthcare system. Cultural competency training and formally integrating traditional healthcare into the official healthcare system are promising strategies to increase healthcare service use, and therefore health outcomes.

The Canadian Arctic has a long history with diarrheal disease, including outbreaks of campylobacteriosis, giardiasis, and salmonellosis. Due to climate change, the Canadian Arctic is experiencing rapid environmental transformation, which not only threatens the livelihood of local Indigenous Peoples, but also supports the spread, frequency, and intensity of enteric pathogen outbreaks. Advances in diagnostic testing and detection have brought to attention the current burden of disease due to Cryptosporidium, Campylobacter, and Helicobacter pylori. As climate change is known to influence pathogen transmission (e.g., food and water), Arctic communities need support in developing prevention and surveillance strategies that are culturally appropriate. This review aims to provide an overview of how climate change is currently and is expected to impact enteric pathogens in the Canadian Arctic.

Abstract Background Climate change is a defining issue and grand challenge for the health sector in North America. Synthesizing evidence on climate change impacts, climate-health adaptation, and climate-health mitigation is crucial for health practitioners and decision-makers to effectively understand, prepare for, and respond to climate change impacts on human health. This protocol paper outlines our process to systematically conduct a literature review to investigate the climate-health evidence base in North America. Methods A search string will be used to search CINAHL®, Web of Science™, Scopus®, Embase® via Ovid, and MEDLINE® via Ovid aggregator databases. Articles will be screened using inclusion/exclusion criteria by two independent reviewers. First, the inclusion/exclusion criteria will be applied to article titles and abstracts, and then to the full articles. Included articles will be analyzed using quantitative and qualitative methods. Discussion This protocol describes review methods that will be used to systematically and transparently create a database of articles published in academic journals that examine climate-health in North America.

Abstract Background The effects of food insecurity linked to climate change will be exacerbated in subsistence communities that are dependent upon food systems for their livelihoods and sustenance. Place-and community-based forms of surveillance are important for growing an equitable evidence base that integrates climate, food, and health information as well as informs our understanding of how climate change impacts health through local and Indigenous subsistence food systems. Methods We present a case-study from southwestern Uganda with Batwa and Bakiga subsistence communities in Kanungu District. We conducted 22 key informant interviews to map what forms of monitoring and knowledge exist about health and subsistence food systems as they relate to seasonal variability. A participatory mapping exercise accompanied key informant interviews to identify who holds knowledge about health and subsistence food systems. Social network theory and analysis methods were used to explore how information flows between knowledge holders as well as the power and agency that is involved in knowledge production and exchange processes. Results This research maps existing networks of trusted relationships that are already used for integrating diverse knowledges, information, and administrative action. Narratives reveal inventories of ongoing and repeated cycles of observations, interpretations, evaluations, and adjustments that make up existing health and subsistence food monitoring and response. These networks of local health and subsistence food systems were not supported by distinct systems of climate and meteorological information. Our findings demonstrate how integrating surveillance systems is not just about what types of information we monitor, but also who and how knowledges are connected through existing networks of monitoring and response. Conclusion Applying conventional approaches to surveillance, without deliberate consideration of the broader contextual and relational processes, can lead to the re-marginalization of peoples and the reproduction of inequalities in power between groups of people. We anticipate that our findings can be used to inform the initiation of a place-based integrated climate-food-health surveillance system in Kanungu District as well as other contexts with a rich diversity of knowledges and existing forms of monitoring and response.

Globally, co-management systems have emerged as negotiated agreements designed to share responsibilities among Indigenous Peoples and State governments for the management of fish and wildlife. Co-management practitioners and policies regularly make decisions that influence the ways in which Indigenous Peoples interact with the lands, waters, and natural resources. The goal of this systematic critical review was to characterize the ways in which published research on co-management governance systems in Canada did or did not explicitly engage with Indigenous Peoples’ health and well-being as a key focus. ProQuest®, Web of Science™, and JSTOR® databases were searched to identify literature published from 1973 to 2020 about co-management systems in Canada. The citations and articles were screened for relevance by two independent reviewers, using inclusion criteria developed a priori. Relevant articles were analyzed descriptively and qualitatively, using a health and well-being framework developed as an analytical framework for this study by integrating key attributes from three Indigenous social determinants of health models in Canada. The search resulted in 9,905 citations; 74 publications met the inclusion criteria and were analyzed. None of the included publications explicitly analyzed co-management from a public health or well-being lens; however, social determinants of health topics were implicit, prevalent, and connected to co-management throughout the literature. Social determinants of Indigenous Peoples’ health, such as land and ecosystems, food systems and security, Indigenous knowledge systems, culture, self-determination, and colonialism, were frequently represented in the co-management literature, even if not directly framed by the authors from a health perspective.

Many caribou populations are declining across the Circumpolar North, presenting challenges for many Indigenous Peoples who have deep and enduring relationships with this animal. In Labrador, Canada, caribou herds have recently experienced population declines, including the George River herd, which has dropped by 99% from its peak, leading to the enactment of a total hunting ban in 2013 issued by the Government of Newfoundland and Labrador. The decline and subsequent hunting ban have affected various aspects of Inuit well-being. Using Inuit-led multi-media methods, this project heard voices of Inuit across the Nunatsiavut and NunatuKavut regions in Labrador, Canada, which (1) described the importance of caribou for Inuit social connections, (2) explored the ways in which the changes in caribou populations and management strategies are influencing these social connections, and (3) discussed the meaning and value of these social connections for Inuit well-being and the sustainability of Inuit-caribou relationships into the future. Data from video interviews (Nunatsiavut region: n = 54; NunatuKavut region: n = 30) were collected and analyzed using video and photography-based methods. Results characterized how caribou are important social connectors: human-caribou relationships are core to Inuit socialization, inter-connection, and shared experience and memory regarding families, communities, and food and knowledge sharing across Labrador’s landscape. Thus, declines in caribou populations and associated social interaction have had serious implications for Inuit identity, livelihoods, emotional well-being, cultural continuity, and knowledge transfer. In order to support the broader social-ecological system and the well-being of those who are connected to caribou, increased understanding and integration of these social connections into caribou-related decision making and research is recommended.

We examine factors underlying hunting productivity among Inuit in Ulukhaktok, Northwest Territories, Canada. Specifically, we focus on the role of gasoline use as the main variable of interest—commonly cited as a crucial determinant of hunting participation. Over the course of 12 months, 10 hunters recorded their on-the-land activities using a GPS tracking system, participatory mapping sessions, and bi-weekly interviews. A multivariable linear regression model (MvLRM) was applied to assess whether factors such as consumables used (i.e. heating fuel, gasoline, oil, food), distances traveled, or the number of companions on a trip were associated with the mass of edible foods returned to the community. Results indicate that, despite being positively associated with hunting trip productivity when assessed through a univariable linear regression model, gasoline is not a statistically significant determinant of standalone trip yield when adjusting for other variables in a multivariable linear regression. Instead, factors relating to seasonality, number of companions, and days on the land emerged as more significant and substantive drivers of productivity while out on the land. The findings do not suggest that access to, or the availability of, gasoline does not affect whether a hunting trip commences or is planned, nor that an increase in the amount of gasoline available to a hunter might increase the frequency of trips (and therefore annual productivity). Rather, this work demonstrates that the volume of gasoline used by harvesters on standalone hunting trips represent a poor a priori predictor of the edible weight that harvesters are likely to return to the community.

This article provides a synthesis of the forthcoming first order draft of the Canadian Government’s National Assessment on Climate Change ‘Rural and Remote’ chapter, highlighting key health concerns from the literature associated with climate change in rural and remote regions, as well as existing and future adaptation strategies. To support the health and wellbeing of those experiencing the negative effects of climate change, and utilizing systematic search processes, this synthesis article highlights the importance of considering the specific socio-cultural, economic, and geographic elements and existing expertise of individuals and communities in rural and remote regions.

Cet article présente une synthèse de la version préliminaire du chapitre à venir « Collectivités rurales et éloignées » de l’Évaluation nationale des changements climatiques du gouvernement du Canada, et il répertorie les principales préoccupations en matière de santé exposées dans la littérature sur les changements climatiques à propos des régions rurales et éloignées, ainsi que les stratégies d’adaptation actuelles et celles à mettre en place. Cet aperçu, fondé sur un processus de recherche systématique, souligne l’importance de tenir compte des composantes socioculturelles, économiques et géographiques spécifiques de ces régions ainsi que de l’expertise dont disposent déjà leurs habitants et leurs collectivités si l’on veut contribuer à la santé et au bien-être des populations qui subissent les effets nocifs des changements climatiques.

With the widespread use of digital media as a tool for documentation, creation, preservation, and sharing of audio-visual content, new strategies are required to deal with this type of “data” for research and analysis purposes. This article describes and advances the methodological process of using documentary film as a strategy for qualitative inquiry. Insights are drawn from a multimedia study that explored Inuit-caribou relationships in Labrador, Canada, through the co-production of community-based, research-oriented, participatory documentary film work. Specifically, we outline: 1) the influence of documentary film on supporting the project conceptualization and collaboration with diverse groups of people; 2) the strength of conducting filmed interviews for in-depth data collection, while recognizing how place and activities are intimately connected to participant perspectives; and 3) a new and innovative analytical approach that uses video software to examine qualitative data, keep participants connected to their knowledge, and simultaneously work toward creating high impact storytelling outputs. The flexibility and capacity of documentary film to mobilize knowledge and intentionally create research outputs for specific target audiences is also discussed. Continued and future integration of documentary film into qualitative research is recommended for creatively enhancing our abilities to not only produce strong, rich, and dynamic research outputs, but also simultaneously to explore and communicate diverse knowledges, experiences, and stories.

The history of health research in Inuit communities in Canada recounts unethical and colonizing research practices. Recent decades have witnessed profound changes that have advanced ethical and community-driven research, yet much work remains. Inuit have called for research reform in Inuit Nunangat, most recently creating the National Inuit Strategy on Research (NISR) as a framework to support this work. The present study details the process undertaken to create a research program guided by the NISR to address food security, nutrition, and climate change in Inuit Nunangat. Four main elements were identified as critical to supporting the development of a meaningful and authentic community-led program of research: developing Inuit-identified research questions that are relevant and important to Inuit communities; identifying Inuit expertise to answer these questions; re-envisioning and innovating research methodologies that are meaningful to Inuit and reflect Inuit knowledge and societal values; and identifying approaches to mobilizing knowledge that can be applied to support food security and climate change adaptation. We also identify considerations for funding agencies to support the meaningful development of Inuit-led research proposals, including aligning funding with community priorities, reconsidering who the researchers are, and investing in community infrastructure. Our critical reflection on the research program development process provides insight into community-led research that can support Inuit self-determination in research, enhance local ethical conduct of research, privilege Inuit knowledge systems, and align Inuit-identified research priorities with research funding opportunities in health research. While we focus on Inuit-led research in Nunavut, Canada, these insights may be of interest more broadly to Indigenous health research.

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Technology of the twenty-first century has transformed our ability to create, modify, store, and share digital media and, in so doing, has presented new possibilities for how social science research can be conducted and mobilized. This paper introduces the use of collaborative podcasting as a research method of critical inquiry and knowledge mobilization. Using a case study, we describe the methodological process that our transdisciplinary team engaged in to create the Water Dialogues podcast, a collaborative initiative stemming from a larger research project examining approaches to implementing Indigenous and Western knowledge in water research and management. We situate collaborative podcasting within an expanding field of collaborative and participatory media practice in social research, and consider how the method may align with and support research within a decolonizing agenda.

Abstract Background High rates of food insecurity are documented among Inuit households in Canada; however, data on food insecurity prevalence and seasonality for Inuit households with children are lacking, especially in city centres. This project: (1) compared food consumption patterns for households with and without children, (2) compared the prevalence of food insecurity for households with and without children, (3) compared food consumption patterns and food insecurity prevalence between seasons, and (4) identified factors associated with food insecurity in households with children in Iqaluit, Nunavut, Canada. Methods Randomly selected households were surveyed in Iqaluit in September 2012 and May 2013. Household food security status was determined using an adapted United States Department of Agriculture Household Food Security Survey Module. Univariable logistic regressions were used to examine unconditional associations between food security status and demographics, socioeconomics, frequency of food consumption, and method of food preparation in households with children by season. Results Households with children (n = 431) and without children (n = 468) participated in the survey. Food insecurity was identified in 32.9% (95% CI: 28.5–37.4%) of households with children; this was significantly higher than in households without children (23.2%, 95% CI: 19.4–27.1%). The prevalence of household food insecurity did not significantly differ by season. Demographic and socioeconomic characteristics of the person responsible for food preparation, including low formal education attainment (ORSept = 4.3, 95% CI: 2.3–8.0; ORMay = 3.2, 95% CI: 1.8–5.8), unemployment (ORSept = 1.1, 95% CI: 1.1–1.3; ORMay = 1.3, 95% CI: 1.1–1.5), and Inuit identity (ORSept = 8.9, 95% CI: 3.4–23.5; ORMay = 21.8, 95% CI: 6.6–72.4), were associated with increased odds of food insecurity in households with children. Fruit and vegetable consumption (ORSept = 0.4, 95% CI: 0.2–0.8; ORMay = 0.5, 95% CI: 0.2–0.9), as well as eating cooked (ORSept = 0.5, 95% CI: 0.3–1.0; ORMay = 0.5, 95% CI: 0.3–0.9) and raw (ORSept = 1.7, 95% CI: 0.9–3.0; ORMay = 1.8, 95% CI: 1.0–3.1) fish were associated with decreased odds of food insecurity among households with children, while eating frozen meat and/or fish (ORSept = 2.6, 95% CI: 1.4–5.0; ORMay = 2.0, 95% CI: 1.1–3.7) was associated with increased odds of food insecurity. Conclusions Food insecurity is high among households with children in Iqaluit. Despite the partial subsistence livelihoods of many Inuit in the city, we found no seasonal differences in food security and food consumption for households with children. Interventions aiming to decrease food insecurity in these households should consider food consumption habits, and the reported demographic and socioeconomic determinants of food insecurity.

Abstract Background Drinking water insecurity and related health outcomes often disproportionately impact Indigenous communities internationally. Understanding media coverage of these water-related issues can provide insight into the ways in which public perceptions are shaped, with potential implications for decision-making and action. This study aimed to examine the extent, range, and nature of newspaper coverage of drinking water security in Canadian Indigenous communities. Methods Using ProQuest database, we systematically searched for and screened newspaper articles published from 2000 to 2015 from Canadian newspapers: Windspeaker, Toronto Star, The Globe and Mail, and National Post. We conducted descriptive quantitative analysis and thematic qualitative analysis on relevant articles to characterize framing and trends in coverage. Results A total of 1382 articles were returned in the search, of which 256 articles were identified as relevant. There was limited coverage of water challenges for Canadian Indigenous communities, especially for Métis (5%) and Inuit (3%) communities. Most stories focused on government responses to water-related issues, and less often covered preventative measures such as source water protection. Overall, Indigenous peoples were quoted the most often. Double-standards of water quality between Indigenous and non-Indigenous communities, along with conflict and cooperation efforts between stakeholders were emphasized in many articles. Conclusion Limited media coverage could undermine public and stakeholder interest in addressing water-related issues faced by many Canadian Indigenous communities.

In Northern Canada, climate change has led to many acute and interrelated health and environmental impacts experienced among Inuit populations. Community-based monitoring, in which community members participate in monitoring initiatives using various forms of technology, is a key strategy increasingly used to detect, monitor and respond to climate change impacts. To better understand the landscape of existing environmental and health monitoring programmes mobilising different technologies and operating in the North we conducted a review that used environmental scan methodologies to explore and contextualise these programmes. We consulted with academic researchers with experience in community-led monitoring, conducted systematic searches of grey and peer-reviewed literature, and conducted a secondary search for environment-health mobile-phone applications. Following specific criteria, we identified 18 monitoring programmes using information and communication technologies in the North, and three global monitoring mobile-phone applications, which cumulatively monitored 74 environment and health indicators. Several themes emerged, including the need for: (1) community leadership, (2) indicators of environment and/or human health and (3) innovative technology. This synthesis supports the development of community-led, environment-health monitoring programmes that use innovative technology to monitor and share information related to the health implications of climate change in and around Indigenous communities throughout the Circumpolar North.

Background: Health research knowledge translation (KT) is important to improve population health outcomes. Considering social, geographical and cultural contexts, KT in Inuit communities often requires different methods than those commonly used in non-Inuit populations. Objectives: To examine the extent, range and nature of literature about health-related KT in Inuit communities. Design: A scoping review was conducted. A search string was used to search 2 English aggregator databases, ProQuest and EBSCOhost, on 12 March 2015. Study selection was conducted by 2 independent reviewers using inclusion and exclusion criteria. To be included, studies had to explicitly state that KT approaches were used to share human health research results in Inuit communities in the Circumpolar North. Articles that evaluated or assessed KT approaches were thematically analysed to identify and characterize elements that contributed to KT success or challenges. Results: From 680 unique records identified in the initial search, 39 met the inclusion criteria and were retained for analysis. Of these 39 articles, 17 evaluated the KT approach used; thematic analysis identified 3 themes within these 17 articles: the value of community stakeholders as active members in the research process; the importance of local context in tailoring KT strategies and messaging; and the challenges with varying and contradictory health messaging in KT. A crosscutting gap in the literature, however, included a lack of critical assessment of community involvement in research. The review also identified a gap in assessments of KT in the literature. Research primarily focused on whether KT methods reflected the local culture and needs of the community. Assessments rarely focused on whether KT had successfully elicited its intended action. Conclusions: This review synthesized a small but burgeoning area of research. Community engagement was important for successful KT; however, more discussion and discourse on the tensions, challenges and opportunities for improvement are necessary.

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. Designs: 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

Background: The incidence of self-reported acute gastrointestinal illness (AGI) in Rigolet, Nunatsiavut, and Iqaluit, Nunavut, is higher than reported elsewhere in Canada; as such, understanding AGI-related healthcare use is important for healthcare provision, public health practice and surveillance of AGI. Objectives: This study described symptoms, severity and duration of self-reported AGI in the general population and examined the incidence and factors associated with healthcare utilization for AGI in these 2 Inuit communities. Design: Cross-sectional survey data were analysed using multivariable exact logistic regression to examine factors associated with individuals’ self-reported healthcare and over-the-counter (OTC) medication utilization related to AGI symptoms. Results: In Rigolet, few AGI cases used healthcare services [4.8% (95% CI=1.5–14.4%)]; in Iqaluit, some cases used healthcare services [16.9% (95% CI=11.2–24.7%)]. Missing traditional activities due to AGI (OR=3.8; 95% CI=1.18–12.4) and taking OTC medication for AGI symptoms (OR=3.8; 95% CI=1.2–15.1) were associated with increased odds of using healthcare services in Iqaluit. In both communities, AGI severity and secondary symptoms (extreme tiredness, headache, muscle pains, chills) were significantly associated with increased odds of taking OTC medication. Conclusions: While rates of self-reported AGI were higher in Inuit communities compared to non-Inuit communities in Canada, there were lower rates of AGI-related healthcare use in Inuit communities compared to other regions in Canada. As such, the rates of healthcare use for a given disease can differ between Inuit and non-Inuit communities, and caution should be exercised in making comparisons between Inuit and non-Inuit health outcomes based solely on clinic records and healthcare use.