Post on 14-Dec-2015
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)