Children’s health in Greenland;Interdisciplinary efforts necessary

Reykjavik, June 2, 2005.Henning Sloth Pedersen, MD, PhD

Experiences

• Primary and secundary health care in Greenland in 18 years

• Associated professor, Institute of Public Health, University of Aarhus, Denmark

• Mentor at James Cook University, Townsville, Australien, in Indigenous and Remote Area Health

• Advisor at WHO, Environmental and Occupational Health Impact Assessment and Surveillance

• Advisory Board for EU’s 7th frame programme for Environmental Research

Nuuk

The Future of Children andYouth in theArctic

1992-2001

Norway

Sweden

Finland

Denmark

Iceland

Canada

USA

Russia

Infant mortalityno of death per 1,000

0

5

10

15

20

25

Greenland 1997 Greenland 2004 Scandinavia

Tuberculosis among children (1992-2001), 0-24 years old

USA

Can

ada

Gre

enla

nd

Icel

and

Swed

en

Fin

land

cases/100,000

TotalIndigenous

Age of mother2002, 940 births

0

50

100

150

200

250

300

15-19 20-24 25-29 30-34 35-39 40-44 45-49

Teen mothers

• Increased rates of lower birth weights

• Pre-eclampsia (intoxication)• Social problems more common

(education, housing, single, income….)

Other health problems

• Weight problems increasing rapidly• Diabetes type 2 seen among children• Infections in general more prevalent

(lung, ear)• Serious dental problems• Smoking prevalent (8% of 11 years old,

and 65% of 15-19 years smoke cigarettes regularly)

• Allergi rapidly increasing

Contaminantspercent > safety threshold

0

1020

3040

5060

7080

90

100

lead mercury araclor 1260

survey, West Coast; >=18 years oldAMAP, umbilicalcordblood; 1995.

Better health parameters

• Less cancer• Less congenital disorders• Less drug abuse• Less alcohol abuse• Less fatal injuries

• Solvent abuse as Nordic countries (high in USA)

Self assessment of healthpercent, 11 years old, bad/not good

0 5 10 15 20 25 30 35

Sweden

Germany

Denmark

USA

England

Greenland

Russia

boysgirls

Never hungry to bed or in school

percent, in social class,11-17 years old, 2002

0

10

20

30

40

50

60

70

Low Mid-low Mid-high High

Education

• 60% of those leaving elementary school are not able to continue education

No. of police reports of violence

per 10,000 inhabitants

0

20

40

60

80

100

120

140

160

1998 1999 2000 2001 2002 2003

GreenlandDenmarkFaroe Island

No. of police reports of sexual crime

per 10,000 inhabitants

0

10

20

30

40

50

60

70

80

90

1998 1999 2000 2001 2002 2003

GreenlandDenmarkFaroe Islands

Summary of health characteristics

• Typical for ”Indigenous health”, caused of rapid transition of the society.

• Indigenous Peoples: 6,000 tribes; 300,000,000 individuals.

• Same pattern among certain ”ethnic minorities”.

Pregnancy programme

• 1,000 birth anually in Greenland• 100-120 more in Nuuk now, mainly

because of history of complicated delivery before

• In Nuuk: 6 midwifes (before 3)• 1 midwife – supervisor for labour

assistents outside Nuuk• 1 midwife – contact for patients outside

Nuuk

Pregnancy programme

• As soon as possible: need for social help?

• Guidance and close control of risk patients

• BMI>27 or blood glucose increased: control for diabetes

• Help to quit smoking (almost 50% quit smoking in pregnancy)

Skolemad væsentlig for indlæringen

Initiatives in the health sector

• Smoking prevalence decrease, but not among children

• Alcohol consumption decrease, but no major problem among children

• Sexual abuse of children programme• Drink water, quit soda pops• Food and life style guide for children• Lunch in the schools (probably)

Haemophilus influenza meningitis

No of cases

0

1

2

3

4

5

6

93 94 95 96 97 98 99 2000 2001 2002

Risk factors and diseases

Diabetes

Fertility

Obesity

Diet

Infections

We treat symptoms and diseases, and have researchProjects monitering risk factors.

Risk factors and diseases

Diabetes

Fertility

Obesity

Diet

Infections

Pollution Unemployment

Violence Housing

-factors outside the health sector’s traditional domaine influence health

Risk factors and diseases

Diabetes

Fertility

Obesity

Diet

Infections

Pollution Unemployment

Violence Housing

The generator:Social gap, culture, education

Health parameters and other parameters have common cause

Cindy Kiro, Maori from New Zealand

• “It is now widely accepted that the major determinants of health are outside the direct influence of the health sector.”

Health care expenditureper capita on average 1985-95

0 500 1000 1500 2000

Finland

Faroe Island

Denmark

Sweden

Norway

Icaland

Greenland

Euro

Miscaring of children

Miscaring of children

Health sector

EducationSocial sector

THE FAMILY

SECTORIALISM

Inequality, family fragmentation, immorality

Abuse, violence, miscaring, mental disorders, asocial behaviour

Health sector

EducationSocial sector

THE FAMILY

INTERDISCIPLINARITY

Inequality, family fragmentation, immorality

Abuse, violence, miscaring, mental disorders, asocial behaviour

• SECTORIALISM• Short-term• Not necessary to

understand and involve culture

• Treating symptoms• Monitoring risk factors• Specialist runned• Sectors in competition

with each other• ”Not my problem”• The family passive• Tell what to do

• INTERDISCIPLARITY• Long-term• Necessary to understand

and involve culture• Treating causes• Monitoring causal factors• Holistic runned• Sectors support each

other

• ”How can I help”• The family integrated• Teach how to do

Children’s health in Greenland;

interdisciplinary efforts necessary• Give a man a fish,

and he will have food for that day.

• Learn him to fish, and he will have food forever

(Ksuan-Tsu)