The Circumpolar Inuit: Health of A Population in Transition

The Circumpolar Inuit: Health of A Population in Transition Peter Bjerregaard, T Kue Young Munksgaard, 40.50 [pounds sterling], pp. 288 ISBN 8716 119 053 Rating: ***

The Inuit ("Eskimo" is seen as derogatory) are a group of races of common ancestry who inhabit an area encompassing Greenland, Canada, Alaska, and Chukotka (at the northeastern tip of Asia). Over 5000 years they have evolved a culture determined by the extreme environment of the Arctic and available food sources, mostly large sea mammals, game, and fish. Contact by Europeans was made around AD 1000 but had little impact on the traditional way of life until the 20th century. About 128 000 Inuit live in the circumpolar area, and this book describes their health problems. The data are largely based on the 1993-4 Greenland health interview study. Data from Canada and Greenland are good, while statistics from Alaska and Chukotka are more patchy.

As a general practitioner in rural Scotland, I can identify with many of the problems raised in this book. For example, the excessive use of alcohol, in binges, contributes to high mortality from accidents and suicide. In Scotland we berate ourselves about our poor health, but the figures presented in this book about rural and isolated areas of relatively developed countries are truly shocking, approaching those of the Third World. Average life expectancy at birth for Greenland Inuit men is only 60.3 years, compared with Scotland's 72.5. Some, but by no means all, of this discrepancy is accounted for by much higher infant mortality (26/1000) and child accident rates. Mortality from drowning in the circumpolar area is about 50/100 000 compared with 6.0/100 000 in the Western and Northern Isles of Scotland, where it is seen as a public health problem. The suicide rate among Inuits of 126/100 000 compares with 16/100 000 in Scotland, where a Health of the Nation target of 10.7/100 000 is proposed. Alcohol contributes to high rates of teenage pregnancy, and sexually transmitted disease.

As in other countries, pollution of the environment, low educational attainment, unemployment, low income, and poor housing are all related to poor health and contribute to variation in rates at the community level. Many of the health problems identified are those of a society whose traditional way of life, values, and support systems have been eroded without new ones having developed. The virtues of independence, self reliance, physical strength, and non-interference with others suited the hunter on the ice but are less well adapted to a wage economy and a more "urban" way of life.

There are some good points. High mortality from infectious diseases has been lowered by improvements in housing and diet. A very low incidence of ischaemic heart disease probably relates to genetic factors, diet, and regular exercise. Most Greenlanders report "going on the land" frequently to hunt or fish, with beneficial effects on exercise and diet. It remains to be seen what effect increasing obesity, sedentary lifestyle, Westernisation of the diet, and smoking will have on these strengths.

What is to be done? The authors identify mistakes of the past, when experts descended from centres of excellence and imposed their ideas on rural populations without regard to local beliefs and lifestyle. They call for more research to take place in rural communities and the development of ongoing links with "urban" researchers. The role of social policy as a determinant of health is highlighted.

I would recommend this book to anyone who is interested in the health of rural communities, both as a resource for possible solutions and to help to avoid the mistakes of the past. It is impressive in its breadth, and the authors' affection for the Inuit is clear.

David Syme, general practitioner, Killin, Perthshire

COPYRIGHT 1999 British Medical Association
COPYRIGHT 2008 Gale, Cengage Learning