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Larsen HE, Geisler UW, Gustafsson F, Pedersen ML, Jørgensen ME. Trends in cardiovascular disease among Inuit in Greenland from 1994 to 2021. ATHEROSCLEROSIS PLUS 2024; 56:12-20. [PMID: 38784720 PMCID: PMC11112263 DOI: 10.1016/j.athplu.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/01/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024]
Abstract
Background and aims Cardiovascular disease (CVD) poses significant health challenges globally. While substantial data exists for most populations, the Arctic Inuit's CVD incidence rates remain understudied. This research aimed to change this by estimating CVD incidence and mortality rates in Greenland from 1994 to 2021. Methods Using nationwide registers, a retrospective observational study was conducted, focusing on individuals born in Greenland to Greenlandic-born parents. Data were sourced from the Greenlandic Hospital Discharge Register and the nationwide electronic medical record. Results A total of 65,824 individuals were included. the age- and sex-specific incidence rates (IR) of ischemic heart disease, stroke, and heart failure (HF) declined from 1994 to 2021, with the most substantial decline observed for HF among women. Conversely, the IR of atrial fibrillation/flutter increased in both men and women, while the IR of myocardial infarction rose among men. The IR for stroke was particularly elevated compared to other CVD subgroups. Mortality rates for those diagnosed with CVD were 2.4 times higher than those without. Men exhibited a 40 % elevated mortality risk relative to women. Conclusion The study provides pivotal insights into CVD trends within the Arctic Inuit population, highlighting both positive developments and areas of concern. Given the increasing elderly demographic in Greenland, proactive health strategies are crucial. Emphasizing primary prevention and addressing specific CVD risks, particularly the elevated stroke IR, is imperative for future public health efforts.
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Affiliation(s)
- Hjalte Erichsen Larsen
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Medical Department, Queen Ingrid's Hospital, Nuuk, Greenland
| | | | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Michael Lynge Pedersen
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Marit Eika Jørgensen
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Steno Diabetes Center Greenland, Nuuk, Greenland
- University of Southern Denmark, Odense, Denmark
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Paul S, Haynes E, Rush K, Hiwi BT, Jakobi J, Robbins F. Hunting can increase physical activity of Indigenous peoples in Canada: pixem re yecwme'nstut. Appl Physiol Nutr Metab 2024; 49:818-823. [PMID: 38382052 DOI: 10.1139/apnm-2023-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
This study examined whether Indigenous peoples could achieve the Canadian Physical Activity Guidelines (CPAG) for adults while engaging in the cultural practice of hunting. It was hypothesized that Indigenous hunters would achieve or surpass the physical activity (PA) thresholds set forth by the CPAG on days spent hunting. Step count and heart rate were recorded from six male participants during mule deer hunts and days spent on-reserve. Step count was not statistically different between days spent hunting (28 803 ± 10 657 steps) and on-reserve (15 086 ± 7536 steps) (p = 0.10). Time spent in light (257 ± 45 min; p = 0.04), moderate (118 ± 71 min; p = 0.03), and vigorous (45 ± 42 min; p = 0.04) activities while hunting was greater than on-reserve (light, 180 ± 86; moderate, 71 ± 73; vigorous, 7 ± 10 min). The duration of moderate-to-vigorous PA (119 ± 95 min) for an average day hunting nearly meets the weekly CPAG recommendation of 150 min per week and is 1.8× greater than on-reserve (67 ± 80 min). Data suggest that hunting is probably a viable mode of PA for Indigenous adults to achieve health benefits. A strength of this study is the 10 h of daily recording which includes vehicular transportation to remote hunting areas. The duration of very light/sedentary PA did not differ between hunting (233 ± 211 min) and on-reserve (327 ± 164 min; p = 0.10), and highlights the importance of modernized vehicles in traditional Indigenous activities. A larger sample size would facilitate greater exploration of transportation, as well as success of the hunt on PA. These data suggest that health researchers and clinicians should consider traditional activities such as hunting as a means for Indigenous adults to increase participation in sufficiently vigorous PA to incur health benefits.
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Affiliation(s)
- Sidney Paul
- Esk'etemc First Nation, Alkali Lake, BC, Canada
- School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Elijah Haynes
- School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Kathy Rush
- School of Nursing, Faculty of Health and Social Development, The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Braden Te Hiwi
- Indigenous Studies, Faculty of Arts, The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Jennifer Jakobi
- School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Fred Robbins
- Esk'etemc Indian Band, Secwépemc First Nation, Alkali Lake, BC, Canada
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Durán Kairies JV, Rice EJ, Stutz S, Tan SWY, Simard A, Ross H, Mashford-Pringle A. Transform[ing] heart failure professionals with Indigenous land-based cultural safety in Ontario, Canada. PLoS One 2024; 19:e0302816. [PMID: 38781231 PMCID: PMC11115247 DOI: 10.1371/journal.pone.0302816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/14/2024] [Indexed: 05/25/2024] Open
Abstract
Cardiovascular disease is a leading cause of death worldwide, with disproportionate impacts on Indigenous Peoples in Canada. In Spring 2022, a land-based learning program was piloted and evaluated as an Indigenous cultural safety training for professionals at a cardiac care centre and university in a large urban city. Baseline and endline surveys showed an increase in knowledge of Indigenous histories, cultures, and practices; increased reflection on positionality and intention to create change; and strengthened relationships with the land. Future work should explore the long-term effects of land-based cultural safety training on participant behaviours, and health outcomes for Indigenous Peoples.
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Affiliation(s)
- Javiera-Violeta Durán Kairies
- Waakebiness Institute for Indigenous Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Emma J. Rice
- Waakebiness Institute for Indigenous Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sterling Stutz
- Waakebiness Institute for Indigenous Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sharon W. Y. Tan
- Waakebiness Institute for Indigenous Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anne Simard
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Heather Ross
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Angela Mashford-Pringle
- Waakebiness Institute for Indigenous Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Kwok A, Cheung D, Gordon M, Mudryk E, Manns PJ. Patient and therapist perspectives on physical therapy outcome measures and engagement after stroke: A case study. Physiother Theory Pract 2023; 39:2639-2650. [PMID: 35786128 DOI: 10.1080/09593985.2022.2092801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Outcome measures are highly recommended in stroke physical therapy, however, most of the existing research has been performed from the provider perspective. Understanding the patient perspective of outcome measures in conjunction with the therapist perspective may help to better support patient engagement and autonomy. PURPOSE The purpose of this study was to explore patient and therapist perspectives on physical therapy outcome measures post-stroke. METHODS This qualitative case study of a Canadian rehabilitation facility is based on patient-oriented research principles, with three patient partners embedded in the research team. Data collection included chart reviews, observations of physical therapy sessions, patient interviews, and therapist interviews. Field notes of observations and interview transcripts were analyzed using thematic analysis. RESULTS Ten patients and seven therapists participated. Analysis revealed the following two themes: 1) tracking progress; and 2) partnership. Tracking progress included the expectations patients had for improvement, the importance of objectively measuring change and the functional improvement observed day by day. Partnership described the relationship between therapist and patient including communication, encouragement and affirmation, the therapist as expert and the gradual shift in autonomy from therapist to patient. CONCLUSION Patients valued the objective results of outcome measures and were encouraged by measurable changes. Maximizing the use of physical therapy outcome measures may improve patient engagement and support relational autonomy.
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Affiliation(s)
- Alyson Kwok
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Healthcare Improvement Team, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Deacon Cheung
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Maysyn Gordon
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Evan Mudryk
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Patricia J Manns
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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Albertsen N, Hansen AS, Skovgaard N, Pedersen ML, Andersen S, Riahi S. Is the Pattern Changing? Atrial Fibrillation and Screening with Holter Electrocardiograms among Ischemic Stroke Patients in Greenland from 2016 to 2021. J Clin Med 2023; 12:5378. [PMID: 37629419 PMCID: PMC10455734 DOI: 10.3390/jcm12165378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
A standardized examination regime for ischemic stroke (IS) patients was implemented in Greenland in 2010. Prevalence of atrial fibrillation (AF) of 32% was found among discharged IS patients from 2011 to 2012, and our study aims to estimate the use of Holter ECGs for AF diagnostics and the current prevalence of AF among IS patients in Greenland. Patients discharged from Queen Ingrid's Hospital in Nuuk between 2016 and 2021 with an ICD-10 diagnosis of IS or stroke without specification were included. Data on Holter recordings, age, gender, medical treatment with rivaroxaban or warfarin, and ICD-10 and ICPC codes for AF were extracted for each patient. The overall incidence of IS from 2016 to 2021 was 133/100,000 and unchanged since 2012. Sixty-eight of the study's IS patients (14.5%) had AF, and 46% of IS patients with Holter data accessible had a recording according to international recommendations. Our results indicate that fewer IS patients in Greenland have AF than previously. However, the insufficient use of Holter as a diagnostic tool may explain part of the drop, as well as improved preventive treatment with rivaroxaban among AF patients in Greenland. Regardless, IS remains common, and a focus on diagnostics and preventable risk factors should be maintained.
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Affiliation(s)
- Nadja Albertsen
- Department of Geriatric Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (A.S.H.); (S.A.)
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
- Center for Health Research, Ilisimatursarfik (University of Greenland), 3900 Nuuk, Greenland (M.L.P.)
| | - Anne Sofie Hansen
- Department of Geriatric Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (A.S.H.); (S.A.)
| | - Nils Skovgaard
- Center for Health Research, Ilisimatursarfik (University of Greenland), 3900 Nuuk, Greenland (M.L.P.)
| | - Michael Lynge Pedersen
- Center for Health Research, Ilisimatursarfik (University of Greenland), 3900 Nuuk, Greenland (M.L.P.)
- Steno Diabetes Center Nuuk, 3900 Nuuk, Greenland
| | - Stig Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (A.S.H.); (S.A.)
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
- Center for Health Research, Ilisimatursarfik (University of Greenland), 3900 Nuuk, Greenland (M.L.P.)
| | - Sam Riahi
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark
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Nielsen MH, Backe MB, Pedersen ML. Prevalence of patients using antihypertensive medication in Greenland, and an assessment of the importance of diagnosis for the associated quality of care - a cross-sectional study. Int J Circumpolar Health 2022; 81:2110675. [PMID: 35938701 PMCID: PMC9364711 DOI: 10.1080/22423982.2022.2110675] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aimed to estimate the age- and sex specific prevalence of patients using antihypertensive medication in Greenland, and compared the quality of care between patients with and without a diagnosis for hypertension. The study was a cross-sectional study comparing patients using antihypertensive medication in 2020 (6,629 patients) and 2021 (7,008 patients), respectively. For data from 2021, patients with a medical diagnosis code were identified. Data was obtained from the Greenlandic electronic medical record. The population of Greenland was used as background population. Quality of care was evaluated based on suggested indicators by international guidelines and goals from Steno Diabetes Centre Greenland. The prevalence of patients aged ≥20 years using antihypertensive medication had increased from 16.7% in 2020 to 17.5% in 2021. The prevalence increased by age and was higher among women compared to men. In 2021, the prevalence of patients aged ≥20 years with a medical diagnosis code for hypertension was 7.9%. The use of antihypertensive medication in Greenland is common. The associated quality of care was low. However, process indicators were significantly improved when patients had a medical diagnosis code. Future focus must be on initiating initiatives ensuring that more patients are registered with a medical diagnosis code.
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Affiliation(s)
- Maja Hykkelbjerg Nielsen
- Steno Diabetes Centre Greenland, Queen Ingrid's Hospital, Nuuk, Greenland.,Greenland Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Marie Balslev Backe
- Steno Diabetes Centre Greenland, Queen Ingrid's Hospital, Nuuk, Greenland.,Greenland Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Michael Lynge Pedersen
- Steno Diabetes Centre Greenland, Queen Ingrid's Hospital, Nuuk, Greenland.,Greenland Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
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Florian M, Li B, Patry D, Truong J, Caldwell D, Coughlan MC, Woodworth R, Yan J, Chen Q, Petrov I, Mahemuti L, Lalande M, Li N, Chan LHM, Willmore WG, Jin X. Interplay of Obesity, Ethanol, and Contaminant Mixture on Clinical Profiles of Cardiovascular and Metabolic Diseases: Evidence from an Animal Study. Cardiovasc Toxicol 2022; 22:558-578. [PMID: 35429258 PMCID: PMC9107407 DOI: 10.1007/s12012-022-09738-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/28/2022] [Indexed: 11/05/2022]
Abstract
Obesity, ethanol, and contaminants are known risk factors of cardiovascular and metabolic diseases (CMD). However, their interplay on clinical profiles of these diseases remains unclear, and thus were investigated in this study. Male lean or obese JCR rats were given water or 10% ethanol and orally treated with or without a contaminant mixture (CM) dissolved in corn oil and loaded on two cookies at 0, 1.6, or 16 mg/kg BW/day dose levels for 4 weeks. The CM consisted 22 environmental contaminants found in human blood or serum of Northern populations. Over 60 parameters related to CMD were examined. The results revealed that obesity in JCR rats resembles the clinical profiles of non-alcoholic fatty liver disease in humans. Obesity was also associated with increased serum and organ retention of mercury, one of the chemical components of CM. Exposure to ethanol lightened hyperlipidemia, increased liver retention of mercury, and increased risk for hypertension in the obese rats. CM lessened hyperlipidemia and hyperenzymemia, worsened systemic inflammation and increased the risk for hypertension in the obese rats. CM markedly increased serum ethanol levels with or without ethanol exposure. Tissue total mercury contents significantly correlated with clinical parameters with altered profiles by both ethanol and obesity. These results suggest that obese individuals may be more prone to contaminant accumulation. Ethanol and CM exposure can alter clinical profiles associated with obesity, which may lead to misdiagnosis of CMD associated with obesity. CM can alter endogenous production and/or metabolism of ethanol, further complicating disease progression, diagnosis, and treatment.
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Drivers and health implications of the dietary transition among Inuit in the Canadian Arctic: a scoping review. Public Health Nutr 2020; 24:2650-2668. [PMID: 32914743 DOI: 10.1017/s1368980020002402] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The current study undertook a systematic scoping review on the drivers and implications of dietary changes among Inuit in the Canadian Arctic. DESIGN A keyword search of peer-reviewed articles was performed using PubMed, Web of Science, CINAHL, Academic Search Premier, Circumpolar Health Bibliographic Database and High North Research Documents. Eligibility criteria included all full-text articles of any design reporting on research on food consumption, nutrient intake, dietary adequacy, dietary change, food security, nutrition-related chronic diseases or traditional food harvesting and consumption among Inuit populations residing in Canada. Articles reporting on in vivo and in vitro experiments or on health impacts of environmental contaminants were excluded. RESULTS A total of 162 studies were included. Studies indicated declining country food (CF) consumption in favour of market food (MF). Drivers of this transition include colonial processes, poverty and socio-economic factors, changing food preferences and knowledge, and climate change. Health implications of the dietary transition are complex. Micro-nutrient deficiencies and dietary inadequacy are serious concerns and likely exacerbated by increased consumption of non-nutrient dense MF. Food insecurity, overweight, obesity and related cardiometabolic health outcomes are growing public health concerns. Meanwhile, declining CF consumption is entangled with shifting culture and traditional knowledge, with potential implications for psychological, spiritual, social and cultural health and well-being. CONCLUSIONS By exploring and synthesising published literature, this review provides insight into the complex factors influencing Inuit diet and health. Findings may be informative for future research, decision-making and intersectoral actions around risk assessment, food policy and innovative community programmes.
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Hayward A, Cidro J, Dutton R, Passey K. A review of health and wellness studies involving Inuit of Manitoba and Nunavut. Int J Circumpolar Health 2020; 79:1779524. [PMID: 32543995 PMCID: PMC7480607 DOI: 10.1080/22423982.2020.1779524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 04/16/2020] [Accepted: 06/01/2020] [Indexed: 01/22/2023] Open
Abstract
The purpose of this review is to summarise past Inuit health and wellness studies in Manitoba and the Kivalliq region of Nunavut to provide a snapshot of the types of studies available and identify the gaps in knowledge. Research to date has largely been disease-based and often provides comparisons between Indigenous and non-Indigenous people. Distinct Inuit experiences are rarely written about from an Inuit perspective. However, Inuit Tapiriit Kanatami, the national organisation of Inuit in Canada, and Pauktuutit Inuit Women of Canada have been leaders in strengths-based community research and publications that address priorities determined by the Inuit, including the 2018 Inuit Tapiriit Kanatami document National Inuit Strategy on Research (132).
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Affiliation(s)
- Ashley Hayward
- Student Peace and Conflict Studies, University of Winnipeg, Winnipeg, Canada
| | - Jaime Cidro
- Anthropology, University of Winnipeg, Canada Research Chair, Health and Culture, Winnipeg, Canada
| | | | - Kara Passey
- Development Practice: Indigenous Development (MDP) Student, University of Winnipeg, Winnipeg, Canada
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Kenny TA, Archambault P, Ayotte P, Batal M, Chan HM, Cheung W, Eddy TD, Little M, Ota Y, Pétrin-Desrosiers C, Plante S, Poitras J, Polanco F, Singh G, Lemire M. Oceans and human health—navigating changes on Canada’s coasts. Facets (Ott) 2020. [DOI: 10.1139/facets-2020-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ocean conditions can affect human health in a variety of ways that are often overlooked and unappreciated. Oceans adjacent to Canada are affected by many anthropogenic stressors, with implications for human health and well-being. Climate change further escalates these pressures and can expose coastal populations to unique health hazards and distressing conditions. However, current research efforts, education or training curriculums, and policies in Canada critically lack explicit consideration of these ocean–public health linkages. The objective of this paper is to present multiple disciplinary perspectives from academics and health practitioners to inform the development of future directions for research, capacity development, and policy and practice at the interface of oceans and human health in Canada. We synthesize major ocean and human health linkages in Canada, and identify climate-sensitive drivers of change, drawing attention to unique considerations in Canada. To support effective, sustained, and equitable collaborations at the nexus of oceans and human health, we recommend the need for progress in three critical areas: ( i) holistic worldviews and perspectives, ( ii) capacity development, and ( iii) structural supports. Canada can play a key role in supporting the global community in addressing the health challenges of climate and ocean changes.
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Affiliation(s)
- Tiff-Annie Kenny
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC G1V 0A6, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de québec, Université Laval, Québec, QC G1S 4L8, Canada
| | - Philippe Archambault
- Département de biologie, Faculté des sciences et de génie, Université Laval, Québec, QC G1V 0A6, Canada
- ArcticNet, Université Laval, Québec, QC G1V 0A6, Canada
| | - Pierre Ayotte
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de québec, Université Laval, Québec, QC G1S 4L8, Canada
| | - Malek Batal
- Département de nutrition, Faculté de médecine, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre de recherche en santé publique (CReSP), Montréal, QC H3C 3J7, Canada
| | - Hing Man Chan
- Department of Biology, Faculty of Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - William Cheung
- Institute of Oceans and Fisheries (IOF), University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Tyler D. Eddy
- Centre for Fisheries Ecosystems Research, Fisheries & Marine Institute, Memorial University of Newfoundland, St. John’s, NL A1C 5R3, Canada
| | - Matthew Little
- School of Public Health and Social Policy, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Yoshitaka Ota
- Nippon Foundation Ocean Nexus Center, EarthLab, University of Washington, Seattle, WA 98195-5674, USA
- School of Marine and Environmental Affairs (SMEA), University of Washington, Seattle, WA 98195-5685, USA
| | - Claudel Pétrin-Desrosiers
- Département de médecine familiale et de médecine d’urgence, Faculté de médecine, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Association canadienne des médecins pour l’environnement/Canadian Association of Physicians for the Environment (ACME/CAPE), Toronto, ON M5T 2C2, Canada
| | - Steve Plante
- Département Sociétés territoires et développement, Université du Québec à Rimouski, Rimouski, QC G5L 3A1, Canada
| | - Julien Poitras
- Département de médecine familiale et de médecine d’urgence, Faculté de médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Fernando Polanco
- School of Medicine, St. George’s University, St. George’s, Grenada, West Indies
| | - Gerald Singh
- Department of Geography, Memorial University of Newfoundland, St. John’s, NL A1B 3X9, Canada
| | - Mélanie Lemire
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC G1V 0A6, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de québec, Université Laval, Québec, QC G1S 4L8, Canada
- Institut de biologie intégrative et des systèmes (IBIS), Université Laval, Québec, QC G1V 0A6, Canada
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