Disparities amidst plenty: a health portrait of Indigenous peoples in circumpolar regions

Figures & data

Table 1. Alaska – Selected health indicators.

		Alaska Natives	Alaska Whites	US Whites
Health Determinants
	1. Educational attainment high school+ (%)	82	95	89
	2. Income (USD)	45,997	79,475	57,407
	3. Current smoking (%)	36	18	19
	4. Obesity/overweight (%)	70	65	62
Health Status
	5. Self-reported health very good/excellent (%)	38	58	51
	6. Life expectancy at birth (years)	71	78	79
	7. Infant mortality rate (per 1000 livebirths)	6.7	3.3	5.2
	8. Unintentional injury mortality rate (per 100,000)	99	39	42
	9. Suicide mortality rate (per 100,000)	41	18	14
	10. Heart disease mortality rate (per 100,000)	208	133	168
	11. Cancer incidence rate (per 100,000)	553	415	465
	12. Tuberculosis incidence rate (per 100,000)	37	0.5	0.6
Health Care
	13. Breast cancer screening (%)	75	71	77
	14. Cervical cancer screening (%)	78	84	79
	15. Colorectal cancer screening (%)	69	64	71

Notes and sources:

(1) % of adults aged 25+ who completed high school, from 2011–15 ACS reported in ANTHC [10]

(2) Median household income from all sources excluding subsistence activities, in US dollars, from 2011–15 ACS reported in ANTHC [10]

(3) % of adults aged 18+ who have smoked at least 100 cigarettes in their lifetime and currently smoke some days or every day, from 2011–14 BRFSS reported in ANTHC [10]

(4) % of adults aged 18+ with body mass index (BMI) >25 (kg in self-reported weight/m² height), from 2011–14 BRFSS 2011–14 reported in ANTHC [10]

(5) % of adults aged 18+ who reported overall health as excellent or very good; age-standardised to the 2000 US population, from 2011–14 BRFSS reported in ANTHC [10]

(6) Life expectancy at birth computed from 2009–13 data by Alaska Division of Public Health and NVSS, and reported in ANTHC [10]

(7) Death rate of infants under 1 year of age per 1000 livebirths, from 2009–13 data by Alaska Division of Public Health and NVSS, and reported in ANTHC [10]

(8)(9)(10) Death rates age standardised to the 2000 US population, from 2012–15 data by Alaska Division of Public Health and NVSS, and reported in ANTHC [10]

(11) Incidence rates age standardised to the 2000 US population, from 2012–16 data obtained from CDC’s USA Cancer Statistics [15]

(12) Crude incidence rate from 2014–18 data obtained from CDC’s Online Tuberculosis Information System [16]

(13) % women aged 50–74 who received mammography within past 2 years, from 2010–14 BRFSS reported in ANTHC [10]

(14) % women aged 21–65 who had at least one Pap smear within past 3 years, from 2010–14 BRFSS reported in ANTHC [10]

(15) % adults aged 50+ who had ever undergone flexible sigmoidoscopy or colonoscopy, from 2010–15 BRFSS reported in ANTHC [10]

Table 2. Northern Canada – Selected health indicators.

		Inuit		First Nations			All Canadians
		North/ Nunavut	Canada	Yukon	NWT	Canada
Health Determinants
	1. Community well-being index scores	61	61	72	63	58	78
	- Income	67	68	74	72	54	76
	- Education	35	26	54	36	40	56
	- Housing	65	66	83	70	71	95
	- Labour force activity	75	76	78	75	69	84
	2. Daily smoking (%)	63	52	40	37	43	16
Health Status
	3. Self-reported health very good/excellent (%)	40	45	40	53	44	63
	4. Life expectancy at birth (years)	70	73	68	-	75	84
	5. Suicide mortality rate (per 100,000)	94	72	-	24	24	8
	6. Tuberculosis incidence (per 100,000)	276	211	42	55	22	5
	7. Cancer incidence (per 100,000)	434	-	-	258	-	303
	8. Prevalence of diabetes (%)	3	5	7	2	16	7
Health care
	9. Contact with a medical doctor (%)	49	59	79	59	78	80
	10. Has a regular doctor (%)	23	39	74	24	80	85

Notes and sources

(1) Mean (max 100) of individual community scores computed from published tables by Indigenous Services Canada, based on 2016 census [44]

(2) Inuit (aged 15+) data are from 2012 APS [45]; northern First Nations data (aged 12+)are from a merged dataset of CCHS, 2007–2010 [17]; First Nations data (aged 18+) are from the 2008–2010 FNRHS [46]

(3) Inuit (aged 15+) data are from 2012 APS [47]; First Nations (aged 18+) data from the 2008–10 FNRHS [46]

(4) National Inuit and First Nations data from the 2011–16 CanCHEC cohort [21]; data for Yukon First Nations from Yukon Bureau of Statistics for the decade ending in 2016 [48]

(5) Death rate age-standardised to the 2011 Indigenous population of Canada; based on the 2011–16 CanCHEC cohort [22]; Yukon data suppressed due to small number of cases, likely < rate for NWT

(6) Crude incidence rate for the year 2012 [23]

(7) Incidence rate for the 2004–08 period age-standardised to the World Standard Population [24]

(8) Inuit (aged 15+) data from 2012 APS [47]; First Nations (aged 18+) data from the 2008–10 FNRHS [46]

(9)(10) Inuit (aged 15+) data from 2012 APS; northern First Nations data (age 12+) from merged 2007–2013 CCHS [49]; national First Nations (off-reserve) data are from APS 2012 [50]

Table 3. Greenland – selected health indicators.

	Greenland
	Indigenous^a	Total population	Denmark
Health determinants
1. Income (DKK)	-	305,133	352,501
2. Education attainment basic schooling only (%)	60	56	20
3. Unemployment rate (%)	-	9	5
4. Alcohol consumption (litres)	-	9	9
5. High consumption of alcohol (%)	9	-	18
6. Binge drinking at least monthly (%)	34	-	27
7. Daily smoking (%)	54	-	17
8. Obesity/overweight (%)	59	-	51
Health status
9. Life expectancy at birth (years)	70	70	80
10. Infant mortality rate per 1000 live births	-	8.6	3.5
11. Suicide mortality per 100,000	68	71	11
12. Cancer incidence (per 100,000)	-	320	347
13. Tuberculosis incidence (per 100,000)	-	138	6
Health care
14. Density of physicians (per 1000)	-	1.8	3.7
15. Density of qualified nurses (per 1000)	-	4.9	10.4
16. Per capita health expenditure (DKK)	-	23,859	36,891

Notes and Sources:

a(5)-(8) refer to self-identified Indigenous Kalaallit in surveys; (2),(9) and (10) refer to residents of Greenland who were born in Greenland

(1) Disposable household income in Danish kroner, 2014–16, from Statistics Greenland [25] and Statistics Denmark [26]

(2) % of adults aged 25–64 with basic schooling only (grundskole, 10^th grade), 2014–2016 data from Statistics Greenland [25] and Statistics Denmark [26];

(3) Monthly average % of labour force aged 18–65 unemployed; 2014–2016 data from Statistics Greenland [25] and Statistics Denmark [26]

(4) Import of litres of pure alcohol per person aged 15+ per year; 2014–2016 data from Statistics Greenland [25] and Statistics Denmark [26]

(5) % adults aged 15+ who drink >14 (men) or > 7 drinks (women) per week; 2017–2019 data for Greenland from Larsen et al. [28], Danish data from Sundhedsstyrelsen [29]

(6) % adults aged 15+ who consume 5 drinks or more on the same occasion at least monthly; 2017–2019 data for Greenland from Larsen et al. [28], Danish data from Sundhedsstyrelsen [29]

(7) % adults aged 15+ who smoke daily; 2017–2019 data for Greenland from Larsen et al. [28], Danish data from Sundhedsstyrelsen [29]

(8) % adults aged 15+; body mass index (BMI) 25+ calculated from weight and height; 2017–2019 data for Greenland (measured) from Larsen et al. [28], Danish data (self-reported) from Sundhedsstyrelsen [29]

(9) Life expectancy at birth, both sexes combined, computed from 2014–2015 data; Greenland data from Statistics Greenland [25]; Danish data from Nordic Council of Ministers, Health Database [27]

(10) Computed from information on live births and deaths at age 0 from Statistics Greenland [25] and Statistics Denmark [26]

(11) 2011–2015 Indigenous data from the National Institute of Public Health’s Greenland mortality database and Denmark’s data from Eurostat [51]; 2010–13 data for total Greenland population from Statistics Greenland [25]; all rates standardised to the Standard European Population as revised by Eurostat in 2013

(12) Incidence rate age-standardised to the World Standard Population; 2010–2014 data from NORDCAN [52]

(13)-(16) 2014–2016 data from Nordic Council of Ministers, Health Database [27]

Table 4. Northern Scandinavia – Selected Health Indicators.

Indicator	Region	Methods	Results
Health determinants	SAMINOR 1: northern, central Norway	Questionnaire survey	Income and education similar between Sami and Norwegians; history of discrimination and higher level of assimilation associated with poor health [55]
	Västerbotten, Sweden	Questionnaire survey, clinical exam	Behavioural risk factor profile similar; Sami herders (M) lower diastolic BP, more physically active and higher job demand and decision latitude than non-Sami [56]
General health	SAMINOR 1: northern, central Norway	Questionnaire survey	Self-reported health: Sami worse than Norwegians [55]
	Northern, central Sweden	Questionnaire survey, SF-36 scale	Quality of life: overall little difference; Sami (M) reindeer-herders higher than Swedes in physical function [57]
Mental health	Northern Norway	Retrospective cohort	Increased risk of suicide among Sami compared with non-Sami but suicide rates among Sami were moderate compared to several other Indigenous peoples [58].
	Northern Norway	Longitudinal questionnaire survey	No ethnic differences in prevalence of suicide attempts between Sami adolescents and their non-Sami peers [59].
Nutritional status	SAMINOR 1: northern, central Norway	Questionnaire survey, clinical exam	Obesity (BMI≥30): Sami (M,F) > Norwegians; central obesity (based on waist circumference): Sami (F) >, Sami (M) < Norwegians [60]
	Västerbotten, Sweden	Food frequency questionnaire	Higher energy intake; higher proportion from protein and fat; no difference in BMI [61]
Chronic diseases	SAMINOR 1: northern, central Norway	Questionnaire survey, clinical exam and blood tests	No difference in diabetes prevalence and metabolic syndrome; higher BMI among Sami (M,F) [62]
			Angina symptoms and history of angina higher in Sami; no difference in history of myocardial infarction [63,64]
	Sweden	Retrospective cohort	Acute myocardial infarction incidence: no difference; stroke incidence higher in Sami [65]
			Cancer incidence: all sites, colon, prostate lower in Sami (M); stomach higher (M,F) [66]
	Norway	Retrospective cohort	Cancer incidence: all sites, colon, lung lower (M,F) in Sami; prostate lower (M) [66]
	Finland, Inari and Utsjoki	Retrospective cohort	Cancer incidence: all sites, prostate lower in Sami (M); breast lower in (F) [66]
Mortality	Sami areas in Norway	Retrospective cohort	Mortality rates similar between areas with low and high density of Sami [67]
	Sweden	Retrospective cohort	Sami vs non-Sami: lower SMR for cancer lower, injuries higher (M), circulatory and respiratory diseases no difference (F) [36]
	Finland, Inari and Utsjoki	Retrospective cohort	All-cause mortality lower in Sami (M), no difference in (F); lower ischaemic heart disease (F) and cancer (M) in Sami; accidents 1.7 times higher in Sami (M,F) compared to all Finland [68]

Table 5. Arctic Russia – selected health indicators.

Indicator	Region	Methods	Results
Health determinants	Khanty-Mansi AO	Questionnaire survey	Perceived main factors for poor personal health: medical care, water quality, money for medicines and food quality among highest ranked [73]
	Yakutia	Questionnaire survey	Family conditions among different ethnic groups: Indigenous residents tend to have large family size, one parent missing, low income and domestic conflicts [74]
General health	Chukotka AO	Questionnaire survey among adults aged 18–77	Rand SF-36: Indigenous residents score lower than non-Indigenous across all scales [physical, social functioning, general health, mental health]; no difference between Chukchi and other Indigenous groups [75]
Dental health	Evenkia AO	Dental examination survey aged 15+	Dental health index: Indigenous residents score worse than non-Indigenous; declines with age [76]
Cancer	Chukotka AO	Death certificates review, 1961–1990; rates age-standardised to world population	Indigenous 2 x (M) and 3.5 x (F) those of Russia nationally; lung and oesophageal cancer most important sites [77]
Hypertension	Yakutia	Blood pressure survey of adults aged 15+	Indigenous 23% vs 28% in non-Indigenous [78]
Nutritional status	Khanty-Mansi AO	Vitamin levels in blood samples	Khanty vs non-Indigenous: lower level of vitamin A, higher E, no difference in C [79]
		Ca, I and Se in hair samples of school children	Iodine levels were low; calcium and selenium levels optimal [80]
Obesity	Nenets AO	Anthropometric and metabolic markers in women	No difference between Nenets and non-Indigenous women in prevalence of obesity based on BMI and waist-hip ratio [81]
Mental health	Yakutia	Questionnaire survey of adolescents on suicidal risks	Yakut and Evens higher in anxiety scale than Russians, but no difference in frustration, aggression or rigidity scales [82]
Suicide	Nenets AO	Autopsy records review, 2002–12; rates age-standardised to European population	Nenets 73/100,000 vs 51/100,000 in non-Indigenous; male rate 4.7 x female rate among Nenets [83,84]
Maternal health	Yamalo-Nenets AO	Clinical examination and blood tests of pregnant women	BMI≥30: Nenets (3%), non-Indigenous (19%); abnormal gestational weight gain: Nenets (5%), non-Indigenous (28%); abnormal indicators of carbohydrate metabolism: Nenets (2%), non-Indigenous (10%) [85]
Environmental health	Yamalo-Nenets AO	Mercury level in blood samples	High levels in all residents; Indigenous males 5x higher and females 3 x higher than non-Indigenous [86]

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