From the Vault: Preserving culture, protecting health
Part 3 of an in-depth look at northern research at the University of Alberta.
From tackling stomach disease to helping protect precious life traditions, University of Alberta researchers are working together with the peoples of Canada’s North to overcome challenges posed to preserving health and cultural well-being.
Hampered by vast, isolated expanses and influenced by Western lifestyle, maintaining health and culture in the North can be difficult.
Spanning a wide area of disciplines, U of A scientists are exploring, through close consultation with northern communities, how their research can help protect and preserve the well-being of those communities.
Several U of A researchers are slowly breaking new ground in exploring what may seem to be an abstract link between health and culture.
“The idea of culture has come up time and time again — it’s in the literature for sociology or philosophy, but there’s no real empirical evidence,” said Richard Oster, who led a recent study linking low First Nations diabetes rates to higher levels of cultural knowledge. “We knew culture was an important factor, but we wanted to provide some evidence of that through hard science.”
Aside from a study done in British Columbia in the 1990s linking suicide rates to cultural continuity, the work hadn’t been repeated in any other context, so Oster and the BRAID diabetes research group in the U of A’s Faculty of Medicine & Dentistry examined the link between culture and diabetes in 31 Alberta First Nations communities, including the far northern part of the province.
“You can’t have a strong and healthy community unless there’s a strong connection to culture.” — Richard Oster
“Speaking with leaders from the communities, they were all unanimous in believing that culture and health were inseparable,” Oster noted. “They talked about language, traditional games and medicines, living off the land. Cultural continuity for them means being who they are. You can’t have a strong and healthy community unless there’s a strong connection to culture.”
The study showed that First Nations who had more people speaking their language had significantly lower rates of diabetes. In some cases, the rate was lower than that among the general public.
“The First Nations leaders we spoke to described their language as an inseparable piece of culture,” Oster said. “There was no written history; it was passed down orally, so instructions on how to live correctly in the world are in the language. If they aren’t speaking it, those teachings are being lost as well.”
Linked to those teachings is a rich tapestry of knowledge that can influence physical health, he added. “If First Nations people are connected to their culture, they are probably living off the land more. Hunting, fishing, trapping — there’s more physical activity. But it goes further than that; it goes back to a sense of shared identity, and having the culture provides a sense of belonging and community that leads to spiritual tranquility and less stress, and we know stress is involved in diabetes.”
Oster hopes the study’s insights help build the case for greater awareness. “Our study provides evidence that we do need to protect First Nations culture, and we hope communities can use this study to advocate for that cause.”
Breaking down health-care barriers in the North
Also vital to community well-being is good access to health-care services. In remote northern expanses, economics and geography pose a challenge that Kue Young — dean of the School of Public Health and a U of A expert on northern and Aboriginal health — is exploring through his role as principal investigator of a CIHR-funded Circumpolar Health Systems Innovation team.
Young is working with other researchers, northern government agencies, regional health authorities and Aboriginal groups in the Northwest Territories, Nunavut, Greenland, Alaska and several northern regions in Scandinavia to seek solutions to health-care delivery problems.
“We are looking at ways to improve efficiency and effectiveness of health care in the North.” — Kue Young
“We are looking at ways to improve efficiency and effectiveness of health care in the North,” Young said. “People are concerned about cost, access and quality, and this kind of research will help these communities.”
Currently, health-care delivery in Canada’s northern territories costs roughly double the amount spent in the south on a per capita basis, Young noted.
The five-year research program, now in its second year, has researchers gathering input from northern doctors, nurses and administrators about what they see as barriers to health-care delivery. In small isolated communities, nurses are typically on call 24/7 and they face challenges in managing a wide variety of health conditions, communicating with doctors in regional hospitals for clinical support, and deciding on evacuation that may be hours away by plane. Also at issue is very high turnover of staff, which leaves new doctors and nurses without comprehensive knowledge of the communities they are serving.
Part 1 of an in-depth look at northern research at the University of Alberta.medium.com
Use of telehealth and other technology can provide possible solutions. Part of the research also involves reviewing transportation costs and travel patterns, especially the use of air ambulance flights. The findings will be reported to territorial health policy-makers. “We will provide useful information so the decision-makers can make changes,” Young said.
The findings could also apply beyond Canada’s North, he added. “There are many areas of the world with scattered populations where remoteness and scarcity of human resources are major obstacles.”
Seeking answers to the riddle of H. pylori
U of A researchers in the Faculty of Medicine & Dentistry are tackling another health problem facing Northern populations: Helicobacter pylori, a chronic bacterial infection of the stomach.
Epidemiologist Karen Goodman says H. pylori poses challenges — it remains unclear how to keep it from spreading and efforts to develop an effective vaccine have failed so far, “so we have no prevention strategies developed yet.” It can also be asymptomatic, it is difficult to treat and it increases the risk of stomach cancer in people who harbour it long-term.
Goodman directs the Canadian North Helicobacter pylori Working Group (CANHelp), a community-driven collaboration formed in 2006, at the request of Northwest Territories health authorities and concerned community leaders. Compared with the rest of Canada, northern Aboriginal communities are disproportionately affected by chronic H. pylori infection and stomach cancer, with both occurring more often in less affluent settings worldwide.
Goodman and fellow U of A researcher and gastroenterologist Sander Van Zanten, along with other members of CANHelp, have collected data from four Aboriginal communities in the Yukon and Northwest Territories and are starting to launch additional community projects in each of the regions. Working with a local planning committee in each community to keep the research focused on community priorities, they are describing the burden of disease associated with H. pylori infection, using assorted data including mobile endoscopy clinics and conducting trials to identify optimal treatment regimens and factors associated with treatment failure.
“We are doing research that communities want done.” — Karen Goodman
The CANHelp group implements ongoing strategies to share what it knows about the challenges posed by H. pylori infection with community members who seek ways to get rid of the health problem and with health care providers who are looking for ways to reduce the risks from this infection among their patients. “Our focus is to listen to community concerns and priorities, design research aimed at improving clinical and public health strategies to control the infection and discuss with the community our progress and the unsolved questions with respect to the research goals,” Goodman said.
To date, CANHelp has shared knowledge about H. pylori to help community members understand the infection and its consequences; it has also screened participants in community projects for the infection and provided treatment to those who needed it.
The team has also found that H. pylori treatments that work in the rest of Canada tend not to be as successful in the North, so they are conducting trials to identify more effective treatment for Arctic Aboriginal communities.
Though there is still much work to do to answer the challenges of H. pylori, Goodman is motivated by the community-driven approach she and her collaborators implement in their work.
“We are doing research that communities want done; it’s breaking new ground to conduct research in a way that is responsive to what communities want to know about and the kind of solutions they seek.”
Putting traditional knowledge in play
Traditional Aboriginal knowledge is inherent to Northern communities, and U of A researchers are exploring how that can positively influence well-being in different cultural aspects of life, including physical activity and sport, social norms — even architecture.
Funded by a Social Sciences and Humanities Research Council grant, U of A researchers Tara-Leigh McHugh and John Spence of the Faculty of Physical Education and Recreation are working with community partners in the Northwest Territories to explore the participation of Aboriginal youth in traditional Inuit and Dene games. The project is looking at how youth involvement in cultural games can support Sport Canada’s policy goals of growing participation of Aboriginal Peoples in sport, and to enhance capacity in support of Aboriginal sport.
“Key to this is making sure the youth voices are at the forefront. They are the experts in play, and we need to learn from their experiences.” — Tara-Leigh McHugh
“We want to understand the potentially important role of traditional Aboriginal games in sport,” said McHugh. “Key to this is making sure the youth voices are at the forefront, because very rarely are those voices heard in research literature. They are the experts in play, and we need to learn from their experiences.”
To hear those voices, McHugh is travelling to Yellowknife this winter to gather input from a sharing circle of youths, coaches and administrators at the Traditional Games Championship. Aboriginal children aged 10 to 12 will take part in matches of pole push, one-foot high kick, kneel jump, snow snake and other games influenced by life on the land.
“They optimize on qualities like endurance, strength and agility — all those skills that were historically necessary for survival. Each game has a set of teachings, and we want to understand how they could support Sport Canada’s goals.”
Part 2 of an in-depth look at northern research at the University of Alberta.medium.com
McHugh wants to get a sense of whether youth enjoy traditional games, which could provide a bridge to improving participation rates in sport. The youngsters will be asked about why they take part in the Traditional Games and what they like and don’t like. “Hopefully we’ll get a sense of any barriers or supports.”
The researchers will share their findings with Sport Canada, Northern communities and the Northwest Territories government, as well as through academic avenues. Ultimately, McHugh hopes it will help support Aboriginal culture “by acknowledging the role of traditional games in sport.
“There’s a connection to culture that we might be missing in some of our other sports,” she added. “And traditional games might provide an avenue for addressing holistic health.”
Heeding the law of the land
Rich social traditions spring from living on the land and ice in the North, and U of A researcher Sean Robertson is exploring that connection by working with elders and Inuit communities in Nunavut, who want to ensure traditional knowledge is passed to future generations.
Robertson, an assistant professor in the Faculty of Native Studies, is exploring Inuit social norms and law, and the role that emotions play. By mapping these “emotional geographies of law,” he hopes to create more opportunities for the exchange of knowledge between elders and youth — and to broaden awareness of indigenous law as part of the Canadian legal system.
“Indigenous knowledge has historically been discounted because it seemed to be non-rational, but now people are starting to understand that part of being a thinking human always involves emotions. It’s not just about reason.” — Sean Robertson
“Indigenous knowledge has historically been discounted because it seemed to be non-rational, but now people are starting to understand that part of being a thinking human always involves emotions. It’s not just about reason.”
He is conducting his research through two community-based projects: one in Gjoa Haven that investigates local knowledge of caribou and Inuit traditional law, and one in Kugaaruk that explores traditional law and social norms in the contexts of fishing and sealing.
“In both communities, many of the elders grew up on the land and lived a traditional life,” Robertson said. “These are people who lived in caribou-skin tents in summer and in igloos in winter. They’ve seen a tremendous amount of change and feel their knowledge about animals, plants and the land is important for youth to learn.”
In a harsh climate where survival has historically hinged on such knowledge, “the elders feel it is important to have those skills,” Robertson said. Such traditional know-how is closely tied to Inuit identity, which the elders want to maintain, he added. “Their knowledge contains practical information and also underlying principles about Inuit world views.”
These social views are explored in land camps that are partially funded through Robertson’s research. Two have been held to date, bringing young people and elders together to experience life on the land — and as one of the participants, Robertson has been able to see first-hand how Inuit knowledge plays out.
“With caribou, for instance, the Inuit have a word for every single part down to the smallest bone, and every part of the animal is used. They figure out how everything can benefit their survival. The knowledge is both practical and profound.”
The research data, once gathered, will be stored at the heart of each community, on hard drives at the local schools, presented to the community through various means, and published academically in a forthcoming book.
The next land camp, set for 2016, will focus on the skills and norms related to fishing for Arctic char. And even though they are plugged into technology like their counterparts across Canada, youth in the community are excited about the event, Robertson noted. “They are interested in learning more about their own culture; there is a thirst for Inuit knowledge.”
Building culture into the community
Traditional knowledge can also take the form of bricks and mortar — or in the case of Trout Lake, N.W.T., whatever materials can be harvested from the land.
Gavin Renwick, Canada Research Chair in Design Studies in the U of A’s Faculty of Arts, is designing a community gathering place for this tiny fly-in Dene community of 100 people. Based on a Dene myth about a giant who lay down and created the dip that became Trout Lake, the look of the building will reflect the cultural needs of the community, not traditional Western housing.
“Designing and building this gathering space is about knowledge transfer,” said Renwick, who teaches and works in architecture and design. Passionate about the concept of cultural design, Renwick is working closely with the people of Trout Lake to build a structure that serves as much more than shelter.
“We wanted to design a facility that will promote cultural continuity for years to come and encourage dialogue and storytelling between elders and youth.” — Gavin Renwick
“We wanted to design a facility that will promote cultural continuity for years to come and encourage dialogue and storytelling between elders and youth. There will be as much of the community in the building as possible.”
To get a feel for what was needed in the building’s design, Renwick spent time on the land as a “cultural intermediary” with elders at moose-hunting and fishing camps, experiencing traditional lifestyles and skills. “I wanted to find out how people live on their own terms and how to bridge their tangible skills with intangible cultural knowledge.”
The structure is being designed as a multi-functional set of individual gathering spaces housing an assortment of facilities, including a community space, a kitchen, an art studio and a gallery. If the people of Trout Lake approve the final design this summer, construction of the federally funded project begins in 2016.
Renwick believes it is important to include traditional Aboriginal knowledge and skill in northern architectural art and design. To that end, he is now working with colleagues in Alaska, Scotland and Scandinavian countries to create a multicultural incubator for northern design and innovation that could be used for building projects across the circumpolar North.
“To create that dialogue is necessary for contemporary Canada,” he said. “This country has an untapped resource in Aboriginal knowledge, and if we are talking seriously about inclusive design and sustainability, not to have a dialogue with that world is a missed opportunity, because what you have is inherited knowledge that goes back millennia on living lightly on this land.”
For almost as long as there’s been a Canada, there’s been a University of Alberta. Over the next year, in honour of Canada’s 150th anniversary, we’re proudly celebrating the people, achievements and ideas that contributed to the making of a confederation.
Originally published at ualberta.ca on February 19, 2015.