What Factors Influence The Practice Of Community-Based Participatory Health Research In The Canadian Arctic? Joanne (Jody) E. Butler Walker B.Sc. (with Distinction) University of Alberta, 1979 M.A.Sc. (Environ. Eng.), University of British Columbia, 1985 Thesis Submitted In Partial Fulfillment of The Requirements for the Degree of Master of Science in Community Health Science The University of Northern British Columbia December 2006 © Joanne (Jody) E. Butler Walker, 2006 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 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AVIS: L'auteur a accorde une licence non exclusive permettant a la Bibliotheque et Archives Canada de reproduire, publier, archiver, sauvegarder, conserver, transmettre au public par telecommunication ou par I'lnternet, preter, distribuer et vendre des theses partout dans le monde, a des fins commerciales ou autres, sur support microforme, papier, electronique et/ou autres formats. The author retains copyright ownership and moral rights in this thesis. Neither the thesis nor substantial extracts from it may be printed or otherwise reproduced without the author's permission. L'auteur conserve la propriete du droit d'auteur et des droits moraux qui protege cette these. Ni la these ni des extraits substantiels de celle-ci ne doivent etre imprimes ou autrement reproduits sans son autorisation. In compliance with the Canadian Privacy Act some supporting forms may have been removed from this thesis. Conformement a la loi canadienne sur la protection de la vie privee, quelques formulaires secondaires ont ete enleves de cette these. While these forms may be included in the document page count, their removal does not represent any loss of content from the thesis. Bien que ces formulaires aient inclus dans la pagination, il n'y aura aucun contenu manquant. i* i Canada Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ABSTRACT The literature about community-based participatory research for health offers an approach to investigating health issues that involves community members, practitioners and researchers as equal partners and co-investigators, on issues of importance to the community. There are currently few examples of how to develop and implement community-based participatory research (CBPR) projects in the Canadian Arctic. The study investigates the practice of CBPR in a project that took place in the Kitikmeot Region of Canada’s central Arctic. Research was conducted using a case study approach. Extensive documentation from all stages of the project in the Kitikmeot were critically examined through the lens of the principles of community-based participatory research, within a Northern context. The researcher was involved with all stages of the Kitikmeot project, and therefore contributed an insider perspective to the data analysis and interpretation. Findings about the factors influencing the practice of CBPR in the Arctic are reported relative to some key principles of CBPR, including community consultation, problem definition, cyclical and iterative processes, education, and communications. Various factors, including the formation of a community-based working group, adequate funding, sufficient time, attention to communications and education, and the importance of the issue to the community contributed to the successful completion of the project. The unique environment of the Arctic poses challenges to the practice of CBPR. Implications for capacity development, and policy, and recommendations for further research are identified. ii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TABLE OF CONTENTS Abstract ii Table of Contents iii List of Figures vi Acknowledgement vii Chapter One Chapter Two Chapter Three Introduction and Methodology Introduction Canada’s central Arctic - the Kitikmeot Region Purpose Research Question My Perspective Methodology Overall Research Design Case Study Qualitative Description Sampling Sampling in Present Study Data Sources Ethics Rigour Conclusion 1 4 6 7 7 8 8 8 10 11 12 13 14 15 15 The Northern Context Government of the Northwest Territories The Northern Contaminants Program The Beginning of the Territorial Maternal and Umbilical Cord Blood Monitoring Program Purpose of the Territorial Monitoring Program Conclusion 23 24 26 Literature Review Conceptual basis for Community-Based Participatory Research Meanings of Community-Based Participatory Research Action Research Participatory Research and PAR Community Development Adult Education Community-Based Participatory Research Comparative Analysis of CD, PAR, and CBPR 27 31 32 34 37 38 39 41 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 16 18 Roles of Community in Community-Based Participatory Research Definitions of Community Roles of Community in CBPR Roles of Practitioners in Community-Based Participatory Research Definitions of practitioners in CBPR Roles of practitioners in CBPR Roles of Researchers in Community-Based Participatory Research Definitions of researchers in CBPR Roles of researchers in CBPR Roles of Decision Makers in CBPR Conclusion Chapter Four Chapter Five The Kitikmeot Working Group: A Case of CBPR? Introduction Community Consultation: Development of a Community-Based Perspective The Hay River Workshop Problem Definition The Taloyoak Workshop Overview of the Kitikmeot Region’s Monitoring Program Formation of the Kitikmeot Contaminants Working Group Cyclical and Iterative Process Initial Phase Development of protocol components Education Completion of the Initial Phase Middle Phase Data Collection and analysis Education Planning for the Final Phase: Creating a Communications Strategy Final Phase Dissemination of Results Establishment of mechanisms for sustainability Conclusion 43 43 45 48 48 48 52 52 53 56 57 59 60 60 64 64 68 70 70 71 72 76 77 78 78 79 81 84 84 86 89 The Case Explored Through the Lens of CBPR in the North Introduction 91 Problem Definition 92 Community Consultation 93 Conceptualization of the Problem 93 Qualities of Communications and Education 96 Kitikmeot Contaminants Consultation Working Group 97 iv Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Chapter Six Cyclical and Iterative Process Collaboration Empowerment Factors that Facilitated CBPR in the Kitikmeot Region Funding Relevance of the Contaminants Issue Adequate Time Attention to Communications and Education Factors that Hindered CBPR in the Kitikmeot Region Existing Resources Multifaceted Protocol Institutional Support Distance Policy Conclusion 101 104 105 108 108 111 112 113 114 114 115 115 116 117 117 Taking A Step Back: Where to From Here? Summary Community Consultation The Role of Northern Leadership The Northern Context Implications Capacity Development Policy Changes Unique Role of Northern Practitioner Study Limitations Further Research My Experience Conclusion 119 120 121 123 126 126 126 126 127 128 129 129 References Appendix 1 Appendix 2 Appendix 3 Appendix 4 Appendix 5 131 Data Sources Summary of Kitikmeot Working Group meetings Samples from Participant Recruitment Package Example of Nutrition Fact Sheet for Traditional Food Species Examples of Results Communication Materials 139 142 143 146 149 v Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. LIST OF FIGURES Figure 1 Study location showing health regions during the study (prior to creation of Nunavut). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ACKNOWLEDGEMENT My sincere appreciation to the members of the Kitikmeot Contaminants Consultation Working Group - the opportunity to work with such a dedicated and talented group of people was a privilege I will long cherish. Particular thanks to Laura Seddon, whose skills with communication, facilitation, organization and meticulous documentation as Regional Coordinator and Chair of the Kitikmeot Working Group resulted in the data for the case study in this thesis. I thank my thesis supervisor, Dr. Martha MacLeod, for guiding me through the stages of qualitative research and for prompt returns on draft chapters. I also thank my Committee members, Dr. Howard Brunt, and Ms. Cathy Ulrich, and my external examiner, Dr. Budd Hall. My classmates in the Yukon Community Health and Social Work cohort enriched my learning experience tremendously. Special thanks to R. Sutherland, L. Prange, D. Yap, J. Kearns, and J. Lane at the Yukon College Library. Sincere thanks to my friends for your ongoing encouragement and interest in my thesis. I really appreciated it. My family has been a constant source of inspiration and support. My parents, Barbara and Frank Butler, instilled in me a love of learning that still burns bright. My sister, Dr. Margot Butler, shared her insight, knowledge, humor and encouragement during all stages of my thesis work for which I will always be very grateful. My brother, David Butler, and sister-in-law, Ayah Oziel, offered support, understanding, and many good laughs along the way. Exceptional thanks to my husband, Rob Walker, and our children, Nathan and Zoe, for your love, patience, hugs, encouragement and laughter. Thank you! vii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Chapter One Introduction and Methodology Introduction The term community-based research can be used to describe research that takes place in a community rather than in a hospital or research institution (American Academy of Pediatrics Policy Statement, 2004) and it can also be used to refer to research in which the community is involved in all stages of the research process (Minkler & Wallerstein, 2003). The use of the same term referring to a range of community involvement in the research process is confusing and may lead to a situation where the assumptions of the researcher about the extent of community engagement are quite different from those of the community. Such differences in assumptions can be problematic. Differing assumptions about the level of community involvement in a research project can reduce the likelihood of successful research outcomes for either or both the community and the researcher, leading to mistrust and confusion. In Aboriginal communities, particularly in the North, there is an increasing need to identify and clarify assumptions about roles and responsibilities in a community-based research initiative. The focus on Northern community-based health research as one of two pillars of Canada’s contribution to the upcoming International Polar Year (2007-2009) has accelerated the need for this clarification (IPY, 2006). In less than 10 years, an approach to research that emphasizes “the participation and influence of nonacademic researchers in the process of creating 1 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. knowledge” (Israel, Parker & Becker, 1989, p. 177), has gained sufficient momentum to be included in an authoritative book on qualitative research. Guba and Lincoln, (2000), added “Participatory” as an inquiry paradigm to Denzin and Lincoln’s Handbook of Qualitative Methods that was published in 2000 (p. 168), however, it was not included in the description of paradigms in the earlier version of the Handbook that was published in 1994 (noted in 2000, p.164). Participatory research is now an accepted research paradigm and a methodology. At the same time, the literature is sparse about how to operationalize the principles of participatory research into practice, particularly in remote communities. In the early 1990’s, a specific issue in Canada’s North provided an opportunity for a community-based health research project to develop which appears to reflect principles of participatory research, and which will be the focus of the present research. The issue was that of environmental contaminants. The widespread presence of environmental contaminants in the Arctic, which originated outside not only the borders of the Northwest Territories but also of Canada, was a unique situation. The awareness of these contaminants, and the many questions that they invoked, took shape over the course of only a few years in the mid to late 1980’s (Shearer & Han, 2003). Environmental contaminants such as polychlorinated biphenyls (PCBs), toxaphene and DDT were identified in several species of traditional foods consumed by indigenous Northerners, including Inuit and Dene/Metis. In particular, marine mammals such as polar bears, seal, beluga, narwhal, walrus and some species offish had elevated levels of some metal and organochlorine contaminants (Lockhart, 2 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Wagemann, Tracy, Sutherland & Thomas, 1992; M uiretal., 1992). What was at stake with the identification of contaminants in the North was the health and safety of indigenous Northerners as a result of consuming traditional foods that were the mainstay of their diet and culture. Traditional foods were not, and are still not, under the jurisdiction of Health Canada’s food safety regulations because they are not commercially bought or sold. In response, an ad hoc committee was established in 1989 that was chaired by the federal Department of Indian Affairs and Northern Development (DIAND) with membership that included Aboriginal organizations, territorial governments, other federal departments, and two universities. This ad hoc committee developed what would become the conceptual framework for the Northern Contaminants Program, which was subsequently included as one of four programs in the Arctic Environmental Strategy. In 1991, the Arctic Environmental Strategy was funded $100 million over six years (Environment Canada, 1996). The Treasury Board submission was drafted and approved quickly, relative to how long these steps often take, and the amount of funding allocated gave a clear indication that the federal government was committed to environmental issues in the Arctic, including environmental contaminants. One of the projects that was funded by the Northern Contaminants Program in 1992 was called Human Contaminant Trends in Arctic Canada (HCT). This project was led by the Government of the Northwest Territories, and was intended to produce a baseline of exposures to priority environmental contaminants in maternal and umbilical cord blood in the Northwest Territories 3 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. (NWT) and Nunavut (NU). In 1992, there were five health regions in the NWT, which included NU at that time (Fig. 1). The first health region to participate in the HCT project was the Kitikmeot region. The work that took place in the Kitikmeot by a community-based working group pioneered and implemented the approach and developed the materials that would be used or adapted by other health regions in the NWT and Nunavut in their participation in the Human Contaminant Trends in Arctic Canada project. As such, examining the processes and products related to the work that took place in the Kitikmeot region provides a unique opportunity to examine mechanisms of community-based health research in the North. The ground-breaking work that would take place over nearly three years in the Kitikmeot region forms the case study of community-based participatory health research that will be examined in the present study. Canada’s central Arctic - the Kitikmeot Region The Kitikmeot region is located in the western region of Nunavut, with characteristics that clearly define it as both rural and remote. It is the smallest of the three regions in Nunavut, and had a population of 5067 according to the1996 census (Government of the Northwest Territories, 1996). There are eight communities in the Kitikmeot region which were populated by 87% Inuit in 1996. Communities in this region include Holman, Taloyoak (formerly called Spence Bay), Cambridge Bay, Pelly Bay, Kugluktuk, Gjoa Haven, Bay Chimo, and Bathurst Inlet. In 1996, community size ranged from 50 in Bay Chimo to 1350 in Cambridge Bay. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Figure 1. Study Location showing health regions during the study (prior to creation of Nunavut). Ncrth Am eri'_a ilNUVIK •ftEG ION BAFFIN : f e g iq : i ' "4.....1 lim it >jetis Other ACKEN2IE REGION rF s x fx C .IC x a ■gmoOr.AfrWCS lim it ; • Y xp Scukss .'C S S ! 5 ex)art o f t h e u m b i l i c a l c o r d t h a t is a t t a c h e d to t h e a f t e r b irt h , o r p l a c e n t a . A ll m o t h e r s a ls o h a v e b l o o d t a k e VI rj^ a s c w s . For w om en w ho w ish to participate in this program , additional blood will be collected from the m qthe} and \yt o rd er to find out if there are contam inants present. give my informed consent to be a participant in tt uj7r6 ilical cord in Blood Mont B y g iv in g m y c o n s e n t, I u n d e rs ta n d t h a t . . . y y y / have been provided the opportunity to discuss this\ that I can provide my informed consent tO/dartibipate ir I h a v e t h e o p p o r t u n it y to a s k f u r t h e r q u e s t h e P r o g r a m C o o r d in a t o r a t a n y tim e . u rs e , d o c ro g ra m C o o rd in a to r so a n d m y p a r t i c ip a t io n f r o m m y n u r s e , d o c t o r o r m y p a r t i c ip a t io n is v o lu n ta I c a n w i t h d r a w f r o m this p C o o r d i n a t o r k n o w o f this d e c is io n m y n a m e , da, a u th o ritie s d a c o n tam p a r t i c i p a t e g irj m is p ro g r s a m p le s t the a ra d itio n a ib lo com m um t y le ttin g m y n u r s e , d o c t o r o r th e P r o g r a m o n v e n i e d k a f i d a c c e p t a b l e to m e . e n t ia l a n d w ill be u s e d f o r f o ll o w - u p b y r e g i o n a l h e a l t h f e l i n e s ) are f o u n d t o be o u t s id e o f a n a c c e p t a b l e r a n g e . ^ e ^ s i g r H n g th is c o n s e n t fo r m , c o m p l e t i n g a b rie f s u r v e y a n d p e r m i t t i n g b l o o d ?r d e s c r i b e d a b o v e . o ile c te w ill be provid e a X h e man to c h e c k fo r e n v i r o n m e n t a l c o n t a m i n a n t s . k n o w in g 'T n y o w n r e s u lt s fo r t h o s e c o n t a m i n a n t s w h ic h h a v e k n o w n g u id e li n e s . ;mve b e e n m a d e a v a i l a b l e to m e , t h e g e n e r a l r e s u lt s o f t h e p r o g r a m will b e p r o v i d e d to re g fo n a V a g e )? c ie s, a n d w ill b e u s e d b y g o v e r n m e n t s of t h e N o r t h w e s t T e r r it o r i e s a n d C a n a d a , in 3 th e \ n o r th e r n c o u n t r ie s , t o h e lp s t o p p o llu t io n . fio p a n t's N a m e (p le a s e print) W itn e s s ' N a m e (p le a s e print) P a rtic ip a n t's S ig n a tu re W itn e s s ' S ig n a tu re P a rtic ip a n t’s TH IS n u m b e r D a te F ax th is form to P ro gram C o o rd in a to r as so o n as it is s ig n e d , th en m ail: 920*6523 (p h o n e ) 920*4 015 (fax). N W T 4 3 2 3 /1 0 9 4 PROG RAM COORDIN ATOR R eproduced with perm ission o f the copyright owner. F urther reproduction prohibited w itho ut perm ission. M ATERNAL A N D C O RD B LO O D M O N IT O R IN G PROGRAM M a c k e n z ie Regional H e a lth S ervice and K itik m e o t H e a lth Board F u n d e d by the A r c t i c E n v iro n m e n ta l Strategy (N o r t h e r n C o n ta m in a n t s Program ) a n d in p artn ersh ip w ith N W T A b o r i g i n a l g ro up s a n d G N W T H e a lth a n d S o c ia l Services. T h e M a c k e n z i e R e g io n a l H e a lt h S ervice and K i t i k m e o t at t h e i r c o m m u n i t y h e alth c en tre o r c l i n i c . I n f o r m a t i o n H e a lt h kit s a b o u t the p ro g r a m are g iv e n to w o m e n b y nurses: B oard M a c k e n z ie are and d e liv e rin g K itik m e o t a p ro g r a m in the w h ic h lo o k s at reg io ns these kit s have in f o r m a t io n e n v i r o n m e n t a l c o n t a m in a n t s in m o t h e rs a n d babies. c o n ta m in a n ts and h o w T h is pro gra m . program bega n in May 1994 after e x t e n s iv e c o n s u lta tio n w ith c o m m u n itie s , o r g a n iz a t io n s , h e a lth pro fe ssio n a ls A b o rig in a l and GNWT p rogram about to be c o m e e n v iro n m e n ta l in v o lv e d in the W o m e n an d th e ir fa m ilie s ca n discuss the w ith h e alth c e n tre nurses o r the P ro g ra m C o o rd in a to r. D e p a r t m e n t s , a n d w i l l c o n t i n u e u n t il M a r c h 1 9 9 5 . P a rtic ip a n t A c tiv itie s P urpose o f the P rogram P a r t ic i p a t i o n in this p ro g r a m is v o l u n t a r y . W o m e n w h o Early w o r k d o n e in the N W T and a r c tic Q u e b e c have w a n t to p a r tic ip a t e can sign a c o n s e n t f o r m . O n c e the d e m o n s t r a t e d tha t t r a d i t i o n a l foo ds o f fish and w i l d l i f e c o n s e n t f o r m is signed, a short s u rv e y is c o m p le t e d : h a v e m a n y i m p o r t a n t b e n e fits to p e o p le . q u e s t io n s asked h e lp to id e n t i f y li fe s ty le c h o ic e s that has also b e e n be c o n t a m in a n t s in f o u n d in p e o p le . W h e n a w o m a n d e liv e r s he r b a b y at t r a d i t i o n a l fo o d s . C u r r e n t l y there is litt le in f o r m a t io n the h o s p ita l, b l o o d sa m ple s for this p r o g r a m are take n r e g a r d in g c o n ta m in a n ts in NWT at (he s a m e t i m e that the h o s p i t a l c o l l e c t s b l o o d f o r its m o n ito rin g program a first to some tha t N o r th e r n H o w e v e r , it can exposed found e n v iro n m e n ta l p e o p le residents. The m a y i n f l u e n c e the types an d le vels o f c o n t a m in a n t s if o w n h e a l t h tests: one sa m p le is take n f r o m the m o t h e r c o n t a m i n a n t s are in p e o p l e an d if c o n t a m i n a n t le vels a n d a n o t h e r sa m p le is take n fr o m the u m b i l i c a l c o r d are in c r e a s in g o r d e c re a s in g . O t h e r n o r th e r n c o u n t r ie s after the b a b y has be en d e liv e r e d . are also m o n ito rin g is t h e ir step p e o p le : to s e e in g to g e th e r , these c o u n t r ie s are w o r k i n g to s top the p r o d u c t i o n an d use o f these c o n t a m i n a n t s w o r l d w i d e . W h a t W ill be D one W ith th e Results? P a r tic ip a n ts can be i n fo r m e d of th e ir o w n results for c o n t a m in a n t s w h i c h have k n o w n g u id e lin e s . Results Types o f C o n ta m in a n ts Being M o n ito re d w i l l be a c c o m p a n ie d b y i n f o r m a t io n w h i c h w i l l h e lp T w o k in d s o f c o n t a m in a n t s w i l l be lo o k e d at in this p a r ti c ip a n t s un d e rsta n d th e ir results an d, if a p p ro p r ia te , pro gra m : o rg a n och lo rine s. w h ic h to m a k e in f o r m e d life style c h o ic e s in o r d e r to re d u c e c h e m ic a ls often pestic id es, fou nd in are m a n u f a c t u r e d f e r t iliz e r s in d u s tr i a l a c t iv itie s ; a n d h e a v y m etals, w h i c h and e x p o s u r e to ce rta in c o n ta m in a n ts . I n d i v i d u a l results occur w i l l be c o n f i d e n t i a l b e t w e e n p a r t i c i p a n t s a n d t hei r n a t u r a l ly b u t are f o u n d in h ig h e r le vels d u e to in d u s tr ia l r e g i o n a l h e a l t h a u t ho r i t y . S u m m a r iz e d results w i l l be a c t iv itie s . p r o v i d e d to each p a r tic ip a t in g c o m m u n i t y an d r e g io n . O rg a n o c h lo rin e s to be m e a s u re d i n c lu d e P C B 's w h i l e h e a v y m e t a ls in c lu d e m e r c u r y , le ad and S up p ort fo r th e P rogram c a d m iu m . C o n s u lt a t io n W o r k i n g G ro u p s have b e en e s ta b lis h e d for M o n ito r in g C o n ta m in a n ts in P eople C o n ta m in a n ts in p e o p le can be m o n ito re d b o t h re g io n s to p r o v id e a li n k b e t w e e n p a r t i c ip a t in g by c o m m u n i t i e s , A b o r ig in a l groups and r e g io n a l h e a lth e x a m i n i n g th e foo ds that p e o p le eat a n d b y a n a l y z in g a g en cie s. These W o r k i n g G r o u p s c o l la b o r a t e w i t h the b o d y tissues o r f lu id s . T h is p r o g r a m is m e a s u r in g fo r the h e a lth ag en cies in issue i d e n t i f i c a t io n , p r o g r a m de sig n p re s e n c e o f c o n t a m i n a n t s and im p l e m e n t a t i o n , an d r e p o r t in g of results. in b l o o d . Tests on b l o o d p r o v i d e g o o d i n f o r m a t i o n on le vels o f o r g a n o c h l o r i n e s a n d h e a v y m e t a ls in p e o p le . W o u ld You Like M o re In fo rm a tio n ? For in f o r m a t i o n ab ou t the p r o g r a m o r h o w to b e c o m e W h o Can P articip ate ? a p a r ti c ip a n t , c o n ta c t y o u r c o m m u n i t y nu rse or Laura The m o n i t o r i n g p r o g r a m is a v a ila b le to w o m e n l i v i n g in S e d d o n , P ro g ra m C o o r d in a to r . For i n f o r m a t i o n a b o u t th e M a c k e n z i e an d K i t i k m e o t reg io ns w h o d e l i v e r th e ir c o n t a m in a n t s b a b ie s at S ta n to n Y e l l o w k n i f e H o s p it a l. W o m e n are C o n t a m i n a n t s U n it ( G N W T H e a lth & Social Services) at in t r o d u c e d to the p r o g r a m d u r in g t h e ir p re -na ta l visits ( 4 0 3 ) 9 2 0 - 6 9 7 3 (ph) or ( 4 0 3 ) 8 7 3 - 5 0 7 2 (fx). Laura Seddon, Program Coordinator, Box S20, Yellowknife, N T X M 2N 4. in general, c o n ta c t Jod y (403)920-6523(ph) (403)920-401 S(fx) Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. W a lk e r , MATERNAL/CORD BLOOD MONITORING PROGRAM CONTAMINANTS IN THE NORTH FACT SHEET WHAT ARE CONTAMINANTS? Contaminants are substances that may be harmful to plants, animals and people. Contaminants may be manufactured, like pesticides, or may occur naturally, like mercury. Some contaminants can be easily seen, such as an oil spill o r a leaking battery. Others can be smelled, like contaminants in cigarettes. Some contaminants, however, may be too small to be seen or smelled. There are three groups of chemical contaminants: • • • organochlorines, such as PCB's, dioxins and furans, are manufactured and can be found in pesticides and fertilizers, and waste from pulp and paper mills or other industries; heavy metals, such as mercury, cadmium and lead, can come from cigarettes, car/truck exhaust fumes, mining and other industries and also occur naturally in low amounts; and radionuclides, such as strontium, cesium and uranium, are used in nuclear power plants and m ilitary weapons and also occur naturally in low amounts. HOW DO THESE CONTAMINANTS GET TO THE NORTH? Some contaminants are produced here in the NWT through activities such as community and industrial waste disposal. The majority, however, come from other parts of the world and arrive in the Canadian north and other northern countries through four m ajor paths: • • • air currents carry some contaminants north and fall to the ground with r a i n , snow or dust; water currents move some contaminants into northern waters; people bring products containing contaminants to the north for industrial or personal use; migrating animals, such as caribou and geese, may carry contaminants picked up from other areas. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. HOW DO CONTAMINANTS GET INTO OUR FOOD? Contaminants that enter our water, air and land can get into plants and animals that we eat. While some traditional foods may have some contaminants in them, they are also very nutritious and beneficial to people! It is im portant that people understand the health value of traditional foods while also being aware of contaminants: this information will help people make healthy lifestyle choices. CAN CONTAMINANTS AFFECT ANIMALS AND PEOPLE? W ork done on wildlife shows that contaminants can affect the way these animals grow and reproduce. However, very little is known about the kinds of effects different types and amounts of contaminants may have on wildlife and people. At this tim e, the Arctic Environmental Strategy is providing northerners with the opportunity to increase their knowledge about contaminants in order to make informed choices which will help to promote a healthy lifestyle and environment. WOULD YOU LIKE MORE INFORMATION? There are agencies which are looking at environmental contaminants in the NWT: GNWT Renewable Resources, GNWT Health, Regional Health Boards/Services, Department of Fisheries and Oceans, Department of Indian Affairs and Northern Development, the Canadian W ildlife Service, and the Dene and Metis Nations. Contact these agencies to determine what programs may be happening in your area. Contact GNWT Health (Contaminants Unit) for more information on NW T contaminants: 4 0 3 -9 2 0 -6 9 7 3 (phone) or 4 0 3 -8 7 3 -5 0 7 2 (fa x ). Contact Environmental Health Officers to discuss issues relating to contaminants for your region: for the Kitikmeot region: 4 0 3 -9 8 3 -7 3 3 3 (phone) 4 0 3 -9 8 3 -2 2 5 3 (fa x ) for the Mackenzie region: 4 0 3 -9 2 0 -6 5 9 2 (phone) 4 0 3 -9 2 0 -4 0 l5 (fa x ). Contact the Program Coordinator for more information about the Maternal Cord Blood Monitoring Program: 4 0 3 -9 2 0 -6 5 2 3 (phone) or 4 0 3 -9 2 0 -4 0 1 5 (fax). Find out how you can help protect our environment! A ugust 1994 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Appendix 4 Example of Nutrition Fact Sheet for Traditional Food Species Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. CARIBOU N U TR ITIO N FACT SHEET SERIES - / C A RIBO U IS GOOD FOR US ! WHAT DO WE KNOW ABOUT CARIBOU For generations caribou has been an important part of the Dene diet and culture. Caribou gives us many nutrients that help build and repair body tissues. It also provides us with energy and helps to keep us healthy. As well, many parts of the caribou are used for clothing and crafts. There is no waste of the caribou. 7 m The chart below shows the nutrient rating of different caribou body parts. Since there is little nutrient information on Caribou Fat, it is not listed as ; body part. As well no research has been done on caribou kidneys Our elders tell us that caribou liver and kidney are healthy for us. We think they have sim ilar nutrient values. «? to d y N u tr io T v ^ r u t R a tin g \ M eat E x cellen t S o u rce Protein G o o d Sou rce B V ita m in Blood Iron U ver Protein * Iron V ita m in A Iron P oor S ou rce C a lciu m B V ita m in Bone Marrow S tom ach Content* Fat P ro te in Iron Iron ' Ir o n Fa 1 V ita m in A 1 Fat B V ita m in P r o t e in C alciu m C a lciu m P ro te in Fj I In testin e P ro te in ( B V ita m in Fat B V ita m in | I V ita m in A C a lc iu m | * AN EXAMPLE OF HOW TO READ THE CHART: Caribou liver is an excellent source of Protein, Iron and Vitamin A. D ID YOU KNOW ? T O F IN D O U T W H A T OTHER FOODS PROVIDE • It is best to choose traditional foods because they are rich in nutrients. THESE N UTR IEN TS A N D W H Y THEY ARE • Smoking or drying helps preserve the meat and may increase the amount of some nutrients. This is due to moisture loss during the drying process. Smoked or dried meat b great for travelling and snacks. NUTRITION FACT SHEET SERIES O N NUTRIENTS IM P O R T A N T TO OUR HEA LTH , REFER TO THE • The fat content of caribou meat is very low (1%) compared to 12-45% for beef, pork and poultry. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. N utrient Bar Graph for 90 grams of Dried Caribou 120% * *r,Z \ M CD E E o fP i l I iPfH i v iM SSI 40% o wm mm At 0’ ^ V 0<° " V ”' This graph shows the percent of nutrients that 90 grams of dried caribou meat contributes to the Recommended Nutrient Intake (RNI) of a 13 -15 year old female. FOR MORE INFORMATION CONTACT: • Your Local Health Centre • Your Band Office • Your Regional N utritionist • The Dene Nation (403) 873-4081 T h e fo llo w in g resources w ill provide you with more information about Caribou: Native Foods and Nutrition - An Illustrated Reference Resource (1994). Health and Welfare Canada. Northern Food. Tradition and Health Kit (1992). Nutrition Section, Department of Health, GNWT. N utrient Bar Graphs. A Teaching Aid to Learn the Value of Native Foods (19841. Health and Welfare Canada. Nutrient Value of Some Common Foods (1988). Health and Welfare Canada. Use and Nutrient Composition of Traditional Sahtu (Hareskin) Dene/ Metis Foods (19941. Kuhnlein et al. CINE. P r o d u c e d b y M a c k e n z ie R e g io n a l H e a lth Service a n d the Dene N a tio n . Funded by the A rc tic E n viro nm ental Strategy. M arc h 199S R eproduced with perm ission o f the copyright owner. F urther reproduction prohibited w ith o u t perm ission. Appendix 5 Examples of Results Communication Materials 149 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Maternal/ Cord Blood Monitoring for Environmental Contaminants Kitikmeot Participant Newsletter # 4 (November, 141)5) What was the monitoring program all about? A s a p a rtn e r w ith o th e r n o rth e rn c o u n trie s , th e N W T is in vo lve d in m o n ito rin g p ro g ra m s fo r e n v iro n m e n ta l c o n ta m in a n ts . A s p a rt o f th is e ffo rt, th e K itik m e o t H ealth B o a rd and M a c k e n z ie R e g io n a l H e a lth S e rvice are lo o k in g a t w h a t ty p e s o f c o n ta m in a n ts m a y be fo u n d in m o th e rs and b a b ie s in th e M a c k e n z ie a n d K itik m e o t re g io n s. W o m e n w h o d e liv e re d th e ir b a b ie s at S ta n to n Y e llo w k n ife H o s p ita l v o lu n te e re d to p a rtic ip a te in th e p ro g ra m . M o st o f th e fu n d in g fo r this w o rk ca m e fro m the A rc tic E n v iro n m e n ta l S tra te g y. C o n ta m in a n ts in p e o p le can be m e a su re d by c h e c k in g fo r c o n ta m in a n ts in, fo r e x a m p le , hair, b lo o d a n d u rin e. In th is p ro g ra m , b lo o d w a s c h e c k e d fo r c o n ta m in a n ts b e c a u s e blo od p ro v id e s g o o d in fo rm a tio n on s o m e c o n ta m in a n ts . What will ttw program be able to tell you? T h e m o n ito rin g p ro g ra m w a s set up to p ro v id e so m e b a s ic in fo rm a tio n a b o u t w h a t kin d s o f e n v iro n m e n ta l c o n ta m in a n ts m a y be p re s e n t in p e o p le w h o live in the K itik m e o t and M a c k e n z ie re g io n s. T h is is th e firs t m o n ito rin g p ro g ra m in th e N W T to lo o k at v a rio u s ty p e s of c o n ta m in a n ts at th e sa m e tim e . T h is m e a n s th a t th e re m a y be so m e q u e s tio n s you h a ve th a t ca n b e a n s w e re d . H o w e v e r, th e re is still a lot th a t isn 't kn o w n by a n y o n e a b o u t th e s e c o n ta m in a n ts and th e ir im p a c t on th e e n v iro n m e n t, w ild life o r peo p le . T h e re is still a lot to le a rn ! W hat® program s i tell you. ✓ ✓ ✓ ✓ W hat kinds of environmental contaminants you may have been exposed to over your lifetime, especially the last few years. How much contaminants are present in your blood and in the umbilical cord blood of your baby. How your results compare to other participants' results. W hat you can do about contaminants, K itikm e o t H ealth Board & Mackenzie Regional Health Service ("November, 1995) X W hat your results mean for the health of you and your baby. The health effects of many of these contaminants are not known, especially when these contaminants are at low levels. X What you can do to remove contaminants from your body. There is no pill that you can take to remove contaminants from your body. However/your body can remove many of these contaminants over time - some contaminants can be removed from your body faster than others. "A Healthier Environment - Ours Now... Our Children's Forever " Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. What were the rau ltt of the monitoring program? • T h e c h a rts s h o w re su lts fo r s e ve ra l c o n ta m in a n ts . • M o s t p ro g ra m p a rtic ip a n ts s h o w e d so m e le ve ls o f c o n ta m in a n ts in th e ir b lo o d . T h is w a s e x p e c te d s in c e th e re is p o llu tio n all o v e r th e w o rld . M o st o f th is p o llu tio n c o m e s to the N W T fro m fa r aw ay. • F o r a c o n ta m in a n t su ch as ca d m iu m , it w a s p o s s ib le to sh o w h ow s m o kin g c ig a re tte s can in c re a s e a p e rs o n ’s c a d m iu m level. T h is is b e ca u se to b a c c o c o n ta in s c a d m iu m and m a n y o th e r c o n ta m in a n ts . • T h e p ro g ra m a lso fo u n d th a t the fo o d s p e o p le e a t can be a so u rce o f c o n ta m in a n ts . O th e r m o n ito rin g p ro g ra m s w ill h elp p ro vid e in fo rm a tio n on th is a re a . • O th e r c o n ta m in a n ts w e re m e a su re d , how eve r, th e re is little in fo rm a tio n a v a ila b le to u n d e rs ta n d w h a t th e se re su lts m a y m ean. Should people continue to eat traditional foodi Yes! Traditional foods have many, many health benefits. CariboL ftsh, birds and other wildlife prt the same or better nutrition ths bought foods. Will contaminants affect people's health? C o n ta m in a n ts in th e n orth h a ve been fo u n d a t low le ve ls. It's n o t kn o w n w h a t typ e s o f h e a lth e ffe c ts m ay co m e from th e s e low levels. W e only kn o w th a t low c o n ta m in a n t le ve ls Contaminants are low in most traditional foods, but tend to build up in the fat and organ meats in older animals, and animals which eat other animals. At the present time, contaminants are at low levels in most traditional foods. For example, people can eat unlimited quantities of caribou meat. d o n 't a p p e a r to be ca u sin g o b v io u s h ea lth p ro b le m s. Consider the kinds of lifestyle choice*' w e make: • re d u c e o r s to p sm o k in g ; * c o n tin u e to e a t a w id e v a rie ty o f tra d itio n a l fo o d s; Please contact your local health centre (H.C.) or your Kitikm eot Working 6roup representative.: K itikm eot Health Board & Mackenzie Regional Health Service ('November, 1995) * be careful when disposing of < household wastes like old paints or cleaners; • get involved in your community ... remember...what ends up in the dump doesn't just disappear; • be aware of your environment and report any changes you notice in the water, land, and wildlife around your community. "A Healthier Environment • Ours N o w ... Our Children's Fores e: ' Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Maternal and Cord Blood Monitoring for Environmental Contaminants Participant Results Summary O v e r th e p a s t y e a r w o m e n in th e M a c k e n z ie and K itik m e o t h a ve v o lu n te e re d to p a rtic ip a te in th e m o n ito rin g p ro g ra m . A b o u t 2 8 0 w o m e n g a ve b lo o d s a m p le s w h ile th e y w e re a t S ta n to n H o s p ita l d e liv e rin g th e ir bab y. T h e s e b lo o d s a m p le s w e re th e n lo o ke d a t fo r c o n ta m in a n ts . Row to read your chart: Y o u r re s u lts a re s h o w n by th e s ta r sym b o l on e a ch ch a rt. T h e re a re tw o ch a rts: o n e s h o w s th e m a te rn a l (m o th e r) le v e ls and th e o th e r s h o w s th e u m b ilic a l co rd le ve ls. N o s ta r s y m b o l on th e c h a rt m e a n s y o u r re s u lts w e re n ot a v a ila b le . T h e g re e n b a r c h a rts s h o w th e ra n g e o f re su lts fo r all p a rtic ip a n ts , g o in g fro m th e lo w e s t a m o u n t m e a s u re d to th e h ig h e s t a m o u n t m e a s u re d . A ll c o n ta m in a n ts a re m e a s u re d in ppb w h ich m e a n s p a rts p e r b illion . O n e p pb is a b o u t as m u ch as o n e c ra n b e rry in 2 0 ,0 0 0 pails o f c ra n b e rrie s . T h e a v e ra g e c o n ta m in a n t le ve l fo r all w o m e n p a rtic ip a tin g in th e p ro g ra m is m a rke d . "A v e ra g e " m e a n s m o s t w o m e n w e re clo se to this level. T h e lo w le v e ls o f c o n ta m in a n ts fo u n d fo r all w o m e n , in c lu d in g y o u rs e lf, d o n ot a p p e a r to be c a u s in g h e a lth p ro b le m s . Y o u r c h a rts a lso s h o w s th e le ve ls o f c o n ta m in a n ts w h e re so m e p e o p le co u ld b e g in to h a v e h e a lth p ro b le m s . T h is in fo rm a tio n , sh o w n in blue, is in c lu d e d to h elp yo u b e tte r u n d e rs ta n d y o u r re s u lts . C o m m u n ity h e a lth w o rk e rs (n u rse s, d o cto rs, C H R s) ca n d is c u s s y o u r re s u lts w ith you. Who else will see your results? • Y o u r re s u lts a re c o n fid e n tia l. T h e y are a va ila b le only to y o u a n d y o u r h e a lth w o rke r. • G e n e ra l p ro g ra m re s u lts w ill be a v a ila b le to p a rtic ip a tin g c o m m u n itie s and a g e n c ie s . R e su lts w ill a ls o be s h a re d w ith o th e r n o rth e rn c o m m u n itie s in C a n a d a and th e c irc u m p o la r north. T h is in fo rm a tio n w ill a s s is t n o rth e rn c o u n trie s in w o rk in g to s to p p o llu tio n . What happens next? O th e r re g io n s in th e N W T a re s ta rtin g m o n ito rin g p ro g ra m s o f th e ir ow n. In fo rm a tio n fro m th e s e m o n ito rin g p ro g ra m s w ill g iv e a p ic tu re a b o u t c o n ta m in a n ts in p e o p le all a c ro s s th e N W T. T h is Concerned abo^t your results? • Have a close look at your chart. Remember, everyone has smalf amounts of contaminants in their body. • Your health centre has more information about contaminants. There is a video and a fact sheet binder to help answer your questions. • if you are stilt concerned about your results then talk to your health worker. in fo rm a tio n w ill a s s is t n o rth e rn e rs in d e c id in g w h a t th e n e xt s te p s s h o u ld be. K itikm eot Health Board & Mackenzie Regional Health Service (November, 1995) "A Healthier Environm ent - Ours N ow ... Our C hildren's Forever." Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Letter to participants w h o had maternal results but no cord results. N o v e m b e r 1, 1 9 95 Maternal/Cord Blood Monitoring Program: Mackenzie S Kitikmeot Participants D ear Participant, A s you know, when participants delivered their babies at Stanton Yellowknife Hospital, a small am ount of blood was collected from the mother as well as from your baby's umbilical cord. This blood w as then looked at for environm ental contam inants (or pollutants). I am contacting you at this time to let you know that your blood results are now available. Please note that we are unable to provide vou with vour baby’s umbilical cord blood results. For som e participants, including yourself, cord blood samples were not available for testing for one of two reasons: (1) there was not enough blood sample available for contaminants testing after other routine blood tests had been completed by the hospital; or (2) the containers holding the blood samples were damaged during shipm ent to the laboratory which performs the tests. E nclosed is information for your review: 1. Participant newsletter #4; 2. A one-page summary to help you understand your results; 3. T w o charts: your blood results and a chart which shows general results fo r cord blood levels. Both charts give results for those contaminants which have known guidelines. 4. Fact sheets about the nutritional benefits of some traditional foods; 5. A booklet about environmental contam inants activities in the N.W.T. W ould you like to know more about environm ental contaminants? The Mackenzie Regional Health Service and the Kitikmeot Health Board are holding a phone-in TV show November 29, 1995 from 7:00 p.m.- 8:00 p.m on TVNC. A panel of northerners, who have a variety of working experiences in the environmental contam inants area, will answer your questions. A new video, about environmental contaminants and people's health, will also be shown. We hope you will participate in this "first time ever" phone-in show about environmental contaminants in the N .W .T. Call in with your questions. T h an k you again for your participation in the program. If you would like more information about environm ental contaminants, please contact your health worker. Y ours Truly, P rogram Coordinator Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Letter to participants w h o did not want to know their results. N o v e m b e r 1. 19 95 Maternal/Cord Blood Monitoring Program-. Mackenzie S Kitikmeot Participants Dear Participant, As you know, when you delivered your baby at Stanton Yellow knife Hospital, a small amount of blood was collected from yourself as well as from your baby's umbilical cord. This blood was then looked at for environm ental contaminants (or pollutants). W hen you volunteered for this program, your health care w orker let you know that, if you wished, you could learn of your own test results. At that time, vou indicated that vou did not wish to receive these results. For your information, program results are now available and have been forwarded to your medical file. Should you wish to see your results please request them from your health worker (nurse or doctor). Your own results will remain private between your health care worker and yourself. G iven your interest in this topic we are enclosing some information: 1. Fact sheets about the nutritional benefits of some traditional foods; 2. A booklet about environm ental contaminants activities in the NWT. ;; W ould you like to know more about environmental contaminants? The M ackenzie Regional Health Service and the Kitikmeot Health Board are holding a phone-in TV show November 29, 1995 from 7:00 p.m.- 8:00 p.m on TVNC. A panel of northerners, who have a variety of working experiences in the environm ental contaminants area, will answer your questions. A new video, about environmental contam inants and people's health, will also be shown. W e hope you will participate in this “first time ever” phone-in show about environm ental contam inants in the N.W .T. Call in with your questions. \ '}. v ; \ \ ■s j :j J Thank you again for your participation in the program. If you would like more information about environm ental contaminants, please contact your health worker. | Yours Truly, Program Coordinator * Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Maternal & Cord Blood Monitoring Program A fe w notes about the four contaminants and th eir possible health effects as relevant to the participants o f this m o n ito rin g program CADMIUM Sources? -4 o c c u rs n a tu ra lly in lo w a m o u n ts : v o lc a n o s and w in d -b lo w n d u s t are th e m a in n a tu ra l so u rce s. -4 u se d in b a tte rie s, fe rtiliz e rs , m in in g a c tiv itie s , and the m a n u fa c tu re o f p a in ts a n d p la stics. -4 g e n e ra te d fro m b u rn in g fo s s il fu e ls and w a s te s . -4 m a in s o u rc e s in p e o p le is fro m c ig a re tte sm o ke . Why is it found in the NWT environment? -4 c a rrie d to th e N W T by g lo b a l a ir and w a te r cu rre n ts. -4 fo u n d in c ig a re tte sm o ke . Possible health effects? -4 th e re a re no kn ow n h e a lth e ffe c ts fo r th o s e le ve ls w h ich w e re fo u n d in th is m o n ito rin g p ro g ra m . LEAD Sources? -4 o c c u rs n a tu ra lly in low a m o u n ts : fo u n d in rocks. -4 g e n e ra te d by in d u s tria l a c tiv itie s (s m e ltin g and s o ld e rin g ) a n d th e b u rn in g o f w a s te s and fo s s il fu e ls w h ich co nta in le a d . Why is it found in the NWT environment? -* c a rrie d to th e N W T by g lo b a l a ir c u rre n ts . -4 c o m m o n ly fo u n d in ro cks o f th e C a n a d ia n S hield (a large a re a o f w e s te rn /c e n tra l N W T). Possible health effects? •4 th e re are no k n o w n h e a lth e ffe c ts fo r th o s e le ve ls w h ich w e re fo u n d in th is m o n ito rin g p ro g ra m . Some info rm atio n on contaminants excerpted from the Department o f Health and Social Services fact sheets in C ontam ina nts and Y o u r H e a lth : N W T Fact Sheets. This summary page was com piled as part o f an inform ation package in the Maternal and Cord B lood M o n ito rin g Program (M ackenzie Regional Health Service and K itikm e o t Health Board), November, 1995. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Maternal & (ord Blood Monitoring Program A fe w notes about the four contaminants and their possible health effects as relevant to the participants o f this m onitoring program MERCURY Sources? -* -» occurs naturally in low amounts: released from the weathering of rocks, volcanoes and forest fires. used in electrical products, paints and mining activities. W hy is it found in the NWT environment? -> -> -> com m only found in rocks of the Canadian Shield (a large area of western/central NWT). T hese rocks may release more mercury into the environm ent than rock types in other parts o f Canada. carried to the NW T by global air currents and river/ocean currents. discharged as a by-product o f mining. Possible health effects? -» there are no known health effects for those levels which were found in this monitoring program . POLYCHLORINATED BIPHENYLS (PCBs) Sources? -» -» -» -> first m anufactured for commercial use in 1929: used in many industrial fluids because they are very stable and heat resistant. used in heavy electronic and heat-exchange equipm ent as well as in inks, oils, sealants and caulking compounds. North A m erican ban (1977) on the manufacture, importation and non-electrical uses of PCBs. electrical uses are being phased out, with strict regulations on handling and disposal of PCBs. im proper disposal and accidental spills during 1930-1970s resulted in the release of PCBs into the environm ent worldwide. Why is it found in the NWT environment? -♦ -» -» trace levels of PCBs have been found everywhere in the environment around the world. carried to the NWT by global air and water currents. older industrial equipment brought into the NWT may contain PCBs Possible health effects? there are no known health effects for those levels which were found in this monitoring program . Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.