Regional Studies of Indigenous Health: Europe and Russia
Summary and Keywords
The indigenous peoples of Europe and Russia comprise the Inuit in Greenland, the Sami in northern Norway, Sweden, Finland and Russia and forty officially recognized ethnic minority groups in northern Russia plus a few larger-population indigenous peoples in Russia. While the health of the Inuit and Sami has been well studied, information about the health of the indigenous peoples of Russia is considerably scarcer. The overall health of the Sami is in many aspects not very different from that of their non-indigenous neighbors in northern Scandinavia; the health of the Inuit is similar across Greenland and North America and far less favorable than that of Denmark, southern Canada and the lower 48 American states, respectively; the health of the indigenous peoples of the Russian north is poor, partly due to poverty and alcohol.
This article is about the indigenous peoples of northern Russia, northern Scandinavia (including Finland) and Greenland. Geographically, Greenland belongs to North America but being a part of the Kingdom of Denmark it is included here. Siberia, northern Europe and Greenland span the globe from 169 degrees east to 73 degrees west and thus comprise 67 % of the circumpolar expanse. Their landmass is twice as big as that of the remaining circumpolar area, and the number of indigenous peoples is higher than in Alaska and Canada, especially in northern Russia. The total indigenous population, however, is only around 400,000 compared to 1.5 million in Alaska and Canada. The region is sparsely populated. While indigenous people are a minority in northern Scandinavia and northern Russia, the Inuit make up 90 % of the population in Greenland (Figure 1).
There are few major towns in the area. In (European) Russia, towns like Murmansk (total population 300,000), Archangelsk (350,000), and Syktyvkar (235,000) have few indigenous inhabitants. The same goes for towns like Tromsø in Norway (65,000), Umeå in Sweden (85,000) and Rovaniemi in Finland (62,000). The capital of Greenland, Nuuk, has a total population of 17,000, of which the majority is Inuit and this is probably the town with the highest concentration of indigenous people in the region.1
The Inuit in Greenland share a common culture and language with Inuit in Canada and Alaska, but influence of Danish, Canadian and American culture has modified most aspects of life. In the early 21st century it has become possible to estimate the relative genetic distribution on Inuit and European ancestry (Moltke et al., 2015). Despite the relatively minor presence of Europeans during colonial times, around 80 % of more than 4,600 survey participants ethnically classified as Inuit had some European ancestry; on average 25 % of the genome. The relative distribution varied across the country and was, as expected, least in villages and remote parts of Greenland. No trace was found of Norse Viking or Dorset admixture.
Greenland is the world’s largest island but it is habitable only on a narrow coastal strip. Greenland stretches from 59o 46ʹ to 83o 39ʹ northern latitude, but in the 21st century the country is uninhabited north of 78o on the west coast and 71o on the east coast, not counting military and scientific presence. The population is scattered in 17 small towns and approximately 60 villages. A town is defined historically as the largest community in each of 17 districts. The capital, Nuuk, has 17,000 inhabitants, the second largest town 5,600 and the villages between 500 and less than 50 inhabitants. In the towns are located district school(s), health center or hospital, church, district administration and main shops. These institutions are absent, or present to a much smaller extent, in villages. The only means of transport between communities are by boat, although rough weather conditions and sea ice makes this impossible for much of the year, or by commercial airlines at prohibitive prices; there are no roads connecting the communities. The majority (92 %) lives on the west coast, around 3,500 people live on the southeast coast, and about 750 people live in Avanersuaq in the extreme northwest corner of the island. The communities in the east and extreme north are poorer and less developed than the rest of the country. Countrywide there are marked socioeconomic and infrastructural differences between towns and villages.
Greenland has been populated repeatedly from the west and the east but human presence has only been uninterrupted since 985 when Erik the Red arrived from Iceland and started the Norse colonization which lasted until the early 16th century. The first human presence in West Greenland, the Saqqaq culture, arrived in Greenland from Alaska via Canada about 4,500 years ago. This culture is similar to the paleoeskimo Denbigh culture in Alaska and the Pre-Dorset culture in Arctic Canada. Subsequent waves of immigration from the west included the Dorset people and later the bearers of the Thule culture, who were the direct ancestors of the present-day Inuit or Kalaallit/Greenlanders as they are called in Greenland. From the 12th century the latter were present on both sides of the 50-km wide Smith Sound that separates Canada and Greenland (Gulløv et al., 2004). The Inuit and the Norse coexisted for several hundred years but while the Norse disappeared the Inuit stayed and remain the indigenous and majority population of Greenland. From 1500 to 1700 Greenland was occasionally visited by European whalers and a few expeditions, but in 1721 the missionary Hans Egede laid the foundation for a colonization of Greenland by the Kingdom of Denmark and Norway which lasted until the second half of the 20th century. East and north Greenland were colonized later, East Greenland in the late 19th century and north Greenland/Avanersuaq in the early 20th century.
During the 18th century, Christianity replaced the religion of the Inuit, and as the result of a variety of enticements, Inuit hunters were convinced to trade the blubber and fur of marine mammals for consumer goods such as tobacco, coffee, sugar, and cloth. Alcohol, however, was not for sale to the common Greenlanders throughout the colonial period. Education and literacy followed in the footsteps of religion. The traditional livelihood of the Inuit was the hunting of marine mammals, seals in particular, which necessitated a decentralized settlement pattern. A transition toward commercial fishing, cash economy and urbanization started at the beginning of the 20th century. The colonization period formally ended in 1953 when Greenland became an integrated part of the Kingdom of Denmark but even after the introduction of home rule in 1979 and self-government in 2009 aspects of economic and cultural colonization persist. The economy of Greenland is currently supported by Denmark with fixed subsidies amounting to 27 % of the GNP.
Since 1953 a massive infrastructural development has taken place. The population increased from 24,000 to 56,000 in 2018 and movement from villages to towns took off. While in 1950, 50 % of the population lived in villages, this proportion had decreased to 13% by 2018. Hospitals were built in all towns. Alcohol consumption increased, and by 1960 surpassed the average consumption per capita in Denmark. There were never many colonists and the Danes rarely settled permanently in Greenland. According to Statistics Denmark, Danes made up 2.3 % of the population in 1901, a proportion that had increased to 4.4 % by 1950. After this the proportion of migrant workers from Denmark increased dramatically reaching a peak of 19 % in 1975. In 2018, the population of Greenland numbered 55,877 of whom 90 % were born in Greenland; most of the remaining 10% were born in Denmark. Place of birth is a proxy for ethnicity used by Statistics Greenland and other agencies; for adults living in Greenland, this is a rough but useful estimate of ethnicity as Greenlander (Inuk) or Dane. Greenlandic (Kalaallisut), an Inuit language, is the vernacular spoken by virtually everybody, while Danish is the major second language, spoken by a substantial proportion, although far from all. Aspects of colonial inequity persist. One example of this is the widespread use of Danish as the language of administration and education, which puts many monolingual Greenlanders at a disadvantage. However, several negative aspects of colonization reported from the history of other Arctic indigenous peoples, such as forced enrolment in boarding schools and forced relocation of tuberculosis patients southward, were absent in Greenland (Bjerregaard & Larsen, 2016).
Information on health from the beginning of the 20th century was compiled by the erstwhile Chief Medical Officer of Greenland Alfred Bertelsen.2 Mortality and causes of death have been recorded since 1924, and since 1968 a Greenlandic register of causes of death has existed at the individual level. Although ethnicity is not recorded in population statistics, the fact that at least 90 % of the inhabitants in Greenland were born in Greenland and hence most probably are Inuit make studies of mortality of Inuit in Greenland relatively reliable. A register of admissions to hospital has existed since 1987 but only few studies have used the health information for scientific purposes.
Beginning in 1993 five countrywide health examination surveys of adults in Greenland have been carried out by the Department of Health in Greenland and the National Institute of Public Health in Denmark. The participants in these surveys are identified by their unique personal ID number, so they may be followed as a cohort in later surveys, hospital registers, and the register of causes of death. The topics covered in the health surveys include social conditions and lifestyle, self-reported physical and mental health, diabetes, hypertension, and cardiovascular disease. Interview surveys among schoolchildren have similarly been carried out by computerized anonymous interviews.
In addition to these official sources the contemporary health of Greenlanders has been analyzed in a large number of studies focusing on specific health conditions. Scientific articles have been published in English, amounting to more than twice as many as for the Sami and the indigenous peoples of the Russian North, according to the bibliographic tool Medline. In addition, a significant volume of publications in Danish throw light on current health conditions.
Relatively little is known about the health of the Inuit at the time of the first contact with Europeans in the 17th century. Whalers and explorers left no information. The first description of the health of the Inuit was given by missionary Hans Egede (1741) according to whom epidemics (such as plague and smallpox) were unknown until 1734 when the first smallpox epidemic killed thousands of Greenlanders. Information on health was sparse during the colonial period and based on laymen’s observations, but a number of epidemics were recorded. During the 18th and 19th centuries repeated epidemics of influenza, respiratory infections, smallpox, and typhoid fever decimated the population, as was the case all over the Americas during the early years of contact. In some communities the whole population died, in others only a few children were spared. In one community of 400 inhabitants, 357 (90 %) died in the smallpox epidemic of 1800 (Bertelsen, 1943). Starvation and hunger deaths were not uncommon in the 18th century and persisted into the early 20th century. In 1884 in East Greenland cases of survival due to cannibalism were reported. Starvation was to some extent kept at bay by the distribution of hunger relief to those most in need, but this was far from adequate, and almost every winter witnessed periods of severe starvation when the Greenlanders were forced to eat their skin clothes, the soles of their boots and the skin covering of their kayaks (Bertelsen, 1937).
Based on information from Bertelsen (1935), the annual reports of the Chief Medical Officer and the Greenland Registry of Causes of Death, Figure 2 gives an overview of causes of death in the Inuit population of Greenland since 1924.
Mortality from tuberculosis and acute infectious diseases declined significantly until the 1960s, and have since then been negligible as causes of death. Since 1960, the decrease in mortality from infectious diseases, heart diseases, and accidents has been balanced by an increase in mortality from cancer and suicides. The decrease in mortality from tuberculosis and acute infectious diseases can be attributed to a combination of improved living conditions, including housing, and improved healthcare in the postcolonial period. The increase in mortality from cancer has to a great extent been due to lung cancer and other tobacco-related cancers (Bjerregaard & Larsen, 2018).
A number of population health surveys as well as public health documents produced by the Greenland government have identified alcohol, tobacco, and obesity as main risk factors (Bjerregaard, 2004; Greenland, 2012). These issues have been reviewed by Bjerregaard and Larsen (2018).
Alcohol, Adverse Childhood Experiences, and Suicide
A high prevalence of misuse of alcohol and marijuana is a great public health challenge in Greenland. Alcohol is not only considered a challenge for those who drink but even more so for the family, and is closely linked to the high prevalence of adverse childhood experiences. Complex social- and mental-health issues are often tied to alcohol problems in a family, as is the neglect of children. The typical consumption pattern in Greenland is characterized by weekly or monthly episodes of high consumption, binge drinking, which has multiple health and social risks (Dahl-Petersen, Larsen, Nielsen, Jørgensen, & Bjerregaard, 2016). The misuse of alcohol is often combined with marijuana and to some extent problematic gambling behavior.
In 1955, the sale of alcohol was permitted to the general population and the import of alcohol increased from the equivalent of 6 liters of pure alcohol per adult (age 15+) in 1960 to 22 liters in 1987, though it has decreased steadily since then and has been less than 10 liters since 2011 (Statistics Greenland, 2019). Although the import of alcohol has gone down since the 1990s, Greenland still struggles with the consequences of several generations who grew up with alcohol problems in their childhood home (Bjerregaard & Larsen, 2016). In generations born between 1965 and 1995 as many as 65 % reported alcohol problems in their childhood home. In Greenland, growing up in a home with alcohol problems is closely linked with other common adverse childhood experiences, notably sexual abuse and violence during childhood, both with long-term effects on children’s and adults’ mental and physical health. Across birth cohorts about one-third of the respondents in population surveys report having been victims of sexual abuse before they turned 18, while two-thirds report having experienced alcohol problems in their childhood home and/or having been a victim of violence or sexual abuse. Child sexual abuse does not generally happen between close relatives. More often it is the case that parents are unable to control what is happening in a home steeped in alcohol.
There is a close link between the adverse childhood experiences illustrated above and suicidal behavior, with a higher prevalence of suicidal thoughts and attempts among those who experienced sexual abuse and alcohol problems during childhood (Bjerregaard & Larsen, 2016). The overall rate of suicides in Greenland has been unchanged throughout the past 40 years and remains among the highest in the world. A significant increase took place from 1960 to 1980, and since 1980 the crude suicide rate has been around 100 per 100,000 person-years (Bjerregaard & Larsen, 2015). Suicides are considerably more common among men than among women. There is a distinct peak in the age group 20–24 for men and 15–19 for women, and suicides are committed at an increasingly younger age in the youngest generations.
Smoking is a major public health challenge in Greenland because of its high prevalence and the related morbidity and mortality from a number of diseases. Lung cancer is the most common cancer in Greenland, amounting to 34 % of cancer deaths during 2000–2014. According to Statistics Greenland, the import of cigarettes peaked in 1980–1984 at 11.1 cigarettes per person per day and has declined steadily since then. However, the import of cigarette paper has increased considerably, which jeopardizes the validity of the cigarette import statistics as a measure of tobacco consumption. The population health surveys from 1993 to 2014 show that the self-reported prevalence of smoking is decreasing, albeit slowly. There was a clear decrease in the proportion of the population reporting themselves as daily or occasional smokers, from 78 % in 1993 to 60 % in 2014, but this was mostly due to a reduction of occasional smoking. Since 1999 the prevalence of daily smoking has remained stable at around 57–59 %. There is little gender difference but a distinct social trend in smoking. The prevalence in 2014 was considerably lower among white collar employees (35 % and 41 % among men and women) than among the unemployed (82 %).
Diet and Obesity
Obesity is a major public health challenge in Greenland because of its high and rapidly increasing prevalence and its association with cardiovascular disease, diabetes, and other chronic diseases. Obesity, diet and physical activity are closely linked. The traditional diet of the Inuit consisted mainly of sea mammals and fish, with some local plants such as seaweed and berries. During colonial times imported food items (grain, dried peas, dried fruit, and sugar) were added to the diet but around 1900 82 % of the population’s energy intake still came from locally harvested sources. During the 20th century and especially since 1990 a combination of dietary transition and reduced physical activity has resulted in a rapidly increasing prevalence of obesity.
A number of dietary surveys conducted since 1953 have focused on the proportion of locally harvested food in the diet. Although the methods have been different there is a clear trend of decreasing consumption of especially sea mammals from 35 % in 1955 to 21 % in 2007. Studies from the beginning of the 21st century using food frequency questionnaires covering multiple local and imported food items have shown that the intake of the traditional diet increases with age while the adherence to an unhealthy diet (fast food, cakes, sweets, soda pop) decreases with age. A parallel secular trend was also present (Dahl-Petersen et al., 2016). The decreased consumption of traditional food was accompanied by an increased consumption of sugar and saturated fat, but also of fiber, while the intake of the beneficial omega-3 fatty acids (“fish oils”) decreased. There is no time series for total dietary energy intake.3
Food insecurity has only in since 2010 become an issue of scientific study in Greenland. Food insecurity was shown to be closely associated with socioeconomic conditions, including region of residence; in remote East Greenland 20 % of participants in a survey in 2014 reported occasional lack of food during a 12 month period due to lack of money, compared with 10 % in West Greenland and 7 % in the capital (Dahl-Petersen et al., 2016).
The level of total physical activity has decreased, since the reduction due to increased mechanization of labor and domestic chores has not been balanced by an increase in leisure time physical activity (Dahl-Petersen, Jørgensen, & Bjerregaard, 2011). Neither the population health surveys nor other studies offer time series for physical activity.
One study of middle aged Inuit in East Greenland showed a proportion of obese persons in 1963 (BMI > 30 kg/m2) of 2.0 % in men and 8.5 % in women (Andersen et al., 2014). With a similar cut point and age group the figures from the first countrywide population health survey in 1993 were already significantly higher (19 % among men and 11 % among women). Population health surveys have monitored the prevalence of obesity in countrywide samples among Inuit of all ages since 1993. The prevalence of obesity (Body Mass Index ≥ 30 kg/m2) as well as that of central obesity (waist circumference ≥ 102 cm for men and ≥ 88 cm for women) more than doubled from 1993 to 2014. Specifically, obesity increased from 12.6 % to 27.3 % and central obesity from 23.2 % to 47.4 %.
Women were more often obese than men (Figure 3), especially for central obesity. In numerous studies from around the world, obesity is associated with metabolic risk factors such as, for example, 2-hour glucose and insulin, blood pressure, triglyceride and HDL cholesterol. The Inuit in Greenland had lower levels of these risk factors than a population sample from Denmark at any given level of obesity, possibly due to a different distribution of body fat (Jørgensen et al., 2003).
Diabetes and Cardiovascular Disease
Diabetes was uncommon in the 1960s, but in 1999 a population health survey including an oral glucose tolerance test showed a high prevalence of diabetes and impaired glucose tolerance, which is a precursor of diabetes. The prevalence and mortality from cardiovascular disease was previously, probably erroneously, believed to be low due to a high level of omega-3 fatty acids in the marine diet, but epidemiological studies have shown the prevalence and mortality from heart attack to be similar to those of European populations, while stroke is more common. Behavioral risk factors for cardiovascular disease have generally increased since 1950 and it is therefore remarkable that mortality from heart attack has decreased since the 1960s (Jørgensen & Young, 2008).
While the total cancer incidence rate was similar to other Nordic countries, the distribution between cancer sites differed. Incidence rates were elevated in Greenland for cancer of nasopharynx and salivary glands, lungs, esophagus, stomach, liver, pancreas, uterine cervix, and ovaries and low for prostate cancer. While cancer mortality decreased in the other Nordic countries there was no secular change in Greenland (Yousaf et al., 2018).
The Sami is the only indigenous people in Scandinavia. In total the Sami number around 100,000 in Norway (60,000), Sweden (36,000), Finland (10,000) and European Russia (2000) mostly concentrated in the northernmost jurisdiction of those countries. However, questions on ethnicity are not included in censuses or official population statistics in the Nordic countries, so the numbers given are estimates; hence, studies of health among the Sami face certain difficulties.
The history of human presence in this area goes back to the end of the last ice age and Sami-speaking peoples formerly probably occupied a larger area than at present but information about the arrival of these peoples in northern Fennoscandia is not precise. Traditionally, the Sami were reindeer herders but also relied on fishing and farming. The colonization of northern Scandinavia by traders and shortly after by the State began during medieval times, and Christianity was introduced at the same time. From the 15th century the Sami came under increasing pressure from the emerging national states in the south. After centuries of attempts to culturally and economically assimilate the Sami, a political and cultural revival took place towards the end of the 20th century and the Sami remain a viable ethnic minority in northern Europe.
A fair number of population health surveys which have specifically included the Sami have been conducted in northern Scandinavia in since 2003. At the University of Tromsø in northern Norway the SAMINOR 1 study of health and living conditions was conducted in 2003–2004 by the Centre for Sami Health Research. The SAMINOR 2 study was conducted in 2012–2014, consisting of a health interview survey followed by a clinical survey. In SAMINOR 1, Sami participants made up 13 % of 16,500 participants. These were identified as survey participants who had had Sami as their domestic language for three generations. In addition, 22 % had one or more linguistic or cultural markers of Sami identity. The composition of SAMINOR 2 was similar; among 11,600 participants 34 % had one or more markers of Sami ethnicity and 13 % had Sami as their home language. The Survey of Living Conditions in the Arctic (SLiCA) is a study primarily of social conditions among indigenous peoples in Alaska, Canada, Greenland, Norway, Sweden, Finland and Russia. The small health component has been published from the Sami perspective.4 In Sweden, researchers at the Southern Lapland Research Department have created the Swedish Sami Cohort, a database of Swedish Sami from a variety of sources. This database may be used to identify Sami in health surveys.
Sami-specific government statistics are not available, but the health of the Sami has been described in a fair number of PhD theses on chronic and mental disease from the northern universities in Scandinavia as well as in many scientific papers.5 In Sweden, only minor differences in health were found between the Sami and their non-Sami neighbors. Overall mortality and life expectancy were similar, but Sami men had slightly lower mortality from cancer and higher for accidents. Sami women had slightly higher mortality from diseases of the circulatory and respiratory systems. Reindeer-herding Sami had lower risk for prostate cancer and lymphoma but higher risk for stomach cancer. Incidence of stroke was higher among the Sami. The traditional Sami diet, which to some extent is still consumed today by Sami, is rich in red meat, fatty fish, berries and boiled coffee and poor in vegetables, bread and fibers. This diet was not associated with health benefits. In northern Norway Sami women were found more often to be obese than non-Sami women (Body Mass Index ≥30 = 38.7 % vs. 24.3 %), while the difference between Sami and non-Sami men was less (26.9 % vs. 23.4 %). Sami women were also more often centrally obese than non-Sami women (45.5 % vs. 39.9 %), while Sami men were slimmer than non-Sami men (17.6 % vs. 24.2 %). For both men and women, suicide rates were moderately higher among Sami than non-Sami (Standardized Mortality Ratio 1.27) whereas suicide attempts among adolescents did not show ethnic differences. Adolescent cigarette smoking showed only minor ethnic differences (29 % current smokers among Sami and non-Sami youths) but young Sami reported lower drinking rates than non-Sami.
Self-rated health is a simple measure of a person’s general health usually based on the question “How would you rate your health in general [compared with others of the same age]?” that correlates well with clinical measures of health and eventually mortality. A majority of both Inuit (62 %) and Sami (89 %) youth reported “good” or “very good” self-rated health while, accordingly, the proportion of less than good self-rated health was three times higher among Inuit than Sami (38 % vs. 11 %). Significantly more Inuit females than males reported less than good self-rated health (44 % vs. 29 %), while no gender differences occurred among Sami (12 % vs. 9 %). In accordance with other studies of indigenous adolescents, suicidal thoughts were strongly associated with poorer self-rated health among Sami and Inuit, while physical activity was protective (Spein et al., 2013). While no significant effects of acculturation on self-rated health were detected among the Sami in Norway, acculturation was a strong risk factor for poorer self-rated health in Greenland and among female Iñupiat of Alaska (Eliassen, Braaten, Melhus, Hansen, & Broderstad, 2012a)
Among the Sami, self-rated health was associated with self-reported ethnic discrimination in combination with low socio-economic status (Hansen, Melhus, & Lund, 2010). Other studies showed that for Sami people living in minority areas, self-reported ethnic discrimination was associated with indicators of poor cardiovascular health, diabetes, chronic muscle pain, metabolic syndrome, and obesity (Hansen, 2015).
Compared internationally with other indigenous peoples the overall health of the Sami is good and at the same level as that of their non-indigenous neighbors (Anderson et al., 2016; Hassler, Kvernmo, & Kozlov, 2008). Although the Sami as an indigenous minority have suffered from acculturative stress, mental health problems including alcohol abuse and very high suicide rates are seen to a lower extent than in other indigenous peoples of the Circumpolar North. Also the rates of diabetes, obesity, tobacco-related diseases and infectious diseases are not elevated compared to the majority population.
Indigenous Peoples of the Russian North
The Russian North stretches across European Russia and Siberia and its vast landmass constitutes the major part of the Circumpolar North. Much of the land is low-lying and swampy with tundra in the north and taiga (conifer forest) in the south. It is home to a large number of indigenous peoples. From the original 26 peoples, official Russia recognizes 40 such peoples, the “Numerically small peoples of the North, Siberia and the Far East”; by definition each of these has less than 50,000 people and according to the 2002 census they totaled about 280,000. Among these the Evenks, Nenets, and Khanty numbered more than 20,000 in 2002 while the Oroki and Enets numbered less than 500. There are additional ethnic groups in the North that officially are neither considered indigenous nor are numerically small, e.g. the Buryat and the Yakut with populations of almost half a million each, the Komi and Komi-Permyaks both with more than 125,000 people. In the west the Sami on the Murmansk Peninsula are ethnically similar to the Sami in the Nordic countries, while in the Far East the Siberian Yupik living on the Chukotka Peninsula are closely related to the Alaska Yu’pik and the Inuit.
The Russian North was settled during the Paleolithic. Russian settlers started to arrive in the area in in the 17th century. In the 21st century, Russians make up by far the largest ethnic group in all jurisdictions. During the Soviet period collectivization, among other things, nearly destroyed the indigenous way of life. Health improved but still lagged behind that of central Russia. The collapse of the Soviet Union further destroyed social structures and severely affected the economic well-being and health of the indigenous peoples in a negative way. There was an acute population decline in particular due to the out-migration of non-indigenous people.6
A number of indigenous peoples have been included in health surveys and studies of specific diseases but a systematic overview of the health conditions of the many indigenous peoples of Russia is not available.7 Much information is published in Russian language only, but Russian researchers regularly participate in the International Congresses on Circumpolar Health where results from Russia are presented in English, as are results concerning the indigenous peoples of Russia.8 Results of studies on health among the many indigenous peoples of Russia are by nature scattered. Much of the English-language literature on health studies in northern Russia is published in the International Journal of Circumpolar Health. Much research is focused on chronic diseases (cardiovascular disease, diabetes), human physiology and adaptation to cold, maternal and child health, and mental health.
A considerable amount of research has been carried out in Yakutsk.9 Here, the average life expectancy in indigenous minority groups was between 44.7 and 54 years for men and 55.6 and 65 years for women. The infant mortality rate had declined from 25.6 per 1,000 live births during the 1990s to 15.3 per 1,000 live births during 2001–2005, but this could be much higher in other indigenous groups. An estimate for the original 26 numerically small peoples of the North from 2003 gave a figure of 34 per 1,000 live births, twice that for all of Russia.
Based on a number of overviews and other publications, a cautious estimate of public health conditions can be made but reliable, comprehensive and up-to-date information is difficult to obtain.10 Poverty, unemployment and alcoholism are important determinants of health. Overall, life expectancy is low, on average 10 years lower than the 65 years in Russia as a whole. Infant mortality is considerably higher than in Russia as a whole. Respiratory diseases are frequent and tuberculosis is increasing. As in the rest of the country, alcohol and tobacco consumption are high. Alcohol related injuries are frequent in the North in general and in indigenous communities in particular. Suicide rates are high, in some groups twice as high in the indigenous than the non-indigenous population of the North. As an example, crude suicide rates were 80 per 100,000 person-years among the Nenets compared with 49 among non-indigenous persons from the Nenets Autonomous Okrug in northwestern Russia.
The Inuit in Greenland, the Sami in northern Scandinavia and the indigenous peoples of northern Russia represent three very different situations regarding socioeconomic position and health. At one extreme, the indigenous peoples of northern Russia suffer from poor socioeconomic and health conditions, compared with other Russians and by international standards. Alcohol and tobacco consumption is high. In addition, information about health in these populations is scarce. At the other extreme, the Sami in Norway, Sweden and Finland are socioeconomically close to their non-indigenous neighbors and, although some acculturative stress is noted, their physical and mental health is also by and large similar to that of the non-indigenous population of the Scandinavian North. While both Sami and indigenous peoples in Russia are minorities in their respective countries, the Inuit are a majority in Greenland. The Greenlanders have not only enjoyed extensive autonomy for the last 40 years but are also on the road to outright independence. This, however, seems not to have resulted in improved health, and both socioeconomic and health conditions are considerably worse than in the Nordic countries, with very high suicide rates and smoking rates, transgenerational alcohol problems and a postcolonial burden.
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(1.) Population figures are based on information from Wikipedia (2018).
(2.) Alfred Leopold Bertelsen (1877–1950) served as physician in Greenland for 25 years and later as Chief Medical Officer for Greenland, based in Copenhagen. He was a prolific writer both about health in Greenland and other issues. He is known for his monograph Grønlandsk medicinsk Statistik og Nosografi [Greenland medical history and nosography. In Danish], which was published in Meddelelser om Grønland vol. 117 in 1935, 1937, 1940 and 1943.
(3.) The diet in Greenland has been studied by a variety of methods for dietary assessment. Bertelsen (1937) used national import statistics, Uhl (1955) recorded food intake in four locations during several days while later studies were nationwide Food Frequency Surveys (Bjerregaard & Jeppesen, 2010; Jeppesen & Bjerregaard, 2012). The comparability of the results may therefore be questioned.
(4.) Further information on the Saminor studies may be found at the website of the Center for Sami Health Research and in Lund et al. (2007) and Brustad, Hansen, Broderstad, Hansen, and Melhus (2014). The health component of SLiCA was described by Eliassen, Melhus, Kruse, Poppel, and Broderstad (2012b).
(6.) This section is based on Kozlov’s and Lisitsyn’s (2008) synthesis of Russian-language sources. For a description of each of the original 26 Numerically Small Peoples of the North, Siberia and the Far East, see Funk and Sillanpää (1999).
(7.) For an overview in English of studies among the Yamal-Nenets, Khanty-Mansi, Komi-Permyak and indigenous groups in the Chukchi AO, the Tyumen, Perm and Murmansk Oblast, Krasnoyarsk and Khabarovsk Krays, and the Buryat Republic, see Kozlov, Vershubsky and Kozlova (2007).
(8.) ICCH (International Congress of Circumpolar Health) is held every three years in various locations in the Arctic States. In 2006 the ICCH took place in Novosibirsk and many papers were published in the proceedings edited by Murphy and Krivoschekov (2007).
(9.) See the publications from The Yakutsk Research Center for Complex Medical Problems (Burtseva et al., 2013, 2014). Apart from the Yakut, these studies include Evenk, Even, Dolgan, Yukagir and other ethnic minorities.