ICCH16 Reports

I appreciate the support provided by the American Society on Circumpolar Health in form of a travel scholarship that awarded me the opportunity to attend the 16th International Congress on Circumpolar Health in Oulu and Rokua, Finland from June 8-12, 2015. My hope and expectation was to learn more about circumpolar health issues and network with circumpolar colleagues who are engaged in sexual health research and prevention projects to build partnerships and potentially collaborate on future adolescent sexual and reproductive health projects.

I am glad to say that ICCH16 met my expectations and was a great professional opportunity to learn about prevention efforts in other circumpolar countries to address and alleviate continuing disparities among Indigenous peoples and youth in the Arctic. The congress provided a wide range of topics from infectious disease and STIs to environmental contaminants, health status, mental health, injury prevention, women’s health, chronic diseases, health care systems and education. At the same time, presentations varied in approaches on how to address these topics in the circumpolar region and it was interesting to learn how circumpolar nations differed in addressing these issues, especially as it pertains to integrating Indigenous perspectives and voices. I found presentations from my Canadian peers on community-driven and community participator research very informative and have been able to identify several new resources that will be useful for my work (www.inuithealthmatters.aboutkidshealth.ca or www.cbrnorth.com). I also appreciated that the ICCH16 organizing committee found a good balance between epidemiology, surveillance, research and prevention programs. I particularly felt very inspired by several mental health presentations on suicide prevention among the Sami and learned quite a bit about their struggle for culturally appropriate and sensitive mental health services. It was by far the most impactful part of ICCH16.

I had the opportunity to share culturally appropriate STI/HIV and teen pregnancy prevention programs for Alaska Native youth in the STI session that otherwise was dominated by medical epidemiologists who primarily focused on STI trends, treatment and etiology. Although it seemed my presentations did not quite fit in at the time, I now feel fortunate that I was able to provide a different perspective and show our efforts towards addressing these STI trends and disparities that are largely shared among northern Indigenous populations. I was particularly excited about our first Circumpolar Network Group for Sexual and Reproductive Health meeting where we exchanged ideas and experiences in implementing sexual health research and prevention projects in the Arctic. It was a wonderful opportunity to meet circumpolar colleagues, make new professional connections and lay the foundation for future partnerships and collaborations. The exchange at the meeting reinforced my belief that we face similar health issues, questions, opportunities, challenges and needs. One of our first goals will be to work on a special sexual and reproductive health issue in the International Journal of Circumpolar Health, which will be a great way to create an inventory of prevention work in the circumpolar north.

I look forward to the next congress in Copenhagen, Denmark in August 2018 not only because of my very positive experience in Oulu, but also because I am excited to see more Greenlandic representation at ICCH17. It will be a great occasion for Denmark to demonstrate Inuit ownership and involvement in addressing health and well-being in Greenland.

I began travel Friday June 4, participated as faculty in the pre-Congress Summer School June 6-7, and also attended the Diabetes Symposium on June 8. I participated actively in the Congress, serving as Co-Chair/Moderator for five sessions, and also attended several side meetings, including the new Sexual and Reproductive Health Working Group, the U Arctic educational collaboration meeting, and the Circumpolar Health Research Network (CHRN) where I completed my term as a Board member and was confirmed as the new Editor in Chief of the International Journal of Circumpolar Health.

I participated in the IUCH meeting representing ASCH on Weds June 10th, highlighting our Hildes Award winner Sally Smith and nominating Vanessa Hiratsuka as our Jens Peder Hart Hansen Award winner. I also nominated Brenna as IUCH Treasurer and noted that Brenna Simons (President) and Philippe Amstislavski (Vice President) would be our ASCH representatives to the new Council. We welcomed the new Russian affiliate to the IUCH at that meeting and confirmed that Copenhagen would be the site of the next Congress in August 2018.

I also stayed afterwards for some collaborative project planning with arctic colleagues related to Sami health, with a multi-day field trip to Finnish and Norwegian Sami regions, including visits with Sami health care providers and the Sami Parliaments in both countries. We established some new connections and drafted a plan for collaborative work going forward.

It was a very productive trip and I am very appreciative of the ASCH travel support.

Thank you for the generous American Society for Circumpolar Health Travel Scholarship. The travel award from ASCH provided me with a unique professional opportunity during International Congress on Circumpolar Health in Oulu, Finland.

The Congress is a key event in the professional development of public health professionals like myself, whose research, teaching, and service center on the Northern health. The sessions during the ICCH16 provided me with up-to-date scientific information on environmental health issues of concern in Alaska and in Russian Arctic. They provided a great forum for scholarly exchange on Circumpolar health problems in the rapidly changing North.

In the course of scientific sessions I met with many colleagues from the Unites States, Canada, Russia and from other Northern countries who share my research interests, These initial meetings provided excellent networking opportunities to learn from the others participants’ vast research experience and knowledge of the High North. The funding from American Society for Circumpolar Health also provided m excellent opportunity to present on the two areas of my current research and teaching – spatio-temporal analysis the effects of climate change on the health the Indigenous peoples in the Circumpolar North; and on the biomaterials design to improve environmental health in our communities. These presentations not only provided a great opportunity to share my data and findings but also allowed for the free exchange of ideas with other researchers interested in those topics. I look forward to developing these professional exchanges into future collaborations.

In my new role as a Vice President-elect of the American Society for Circumpolar Health and together with my new ASCH colleagues President-elect Brenna Simons-Petrusa, and Abbie Wolfe, the ASCH Treasurer,

I attended several meetings where we represented ASCH internationally. One of these meetings was with the board of International Union for Circumpolar Health. We met the IUCH board members and learned that the Union provides critical link between the individual Northern countries’ circumpolar health societies and the Arctic Council, which in turn serves as an inter-governmental forum for Arctic governments and peoples. It was important in my new role at ASCH to understand the full scope of this governance structure.

My Russian colleagues and I met several times and discussed numerous opportunities for research collaboration on topics relating to climate change and physical and mental health. Together, we brainstormed a concept for a comparative cross-sectional study to assess the full range of adaptive responses to environmental and climatic changes in the remote and frontier Russian and American communities. We plan to meet online in August to select an appropriate avenue for extramural funding for this developing Russian-US project.

In conclusion, I found the ICCH16 to be most valuable experience for my professional development.

Thank you again for this travel award. I look forward to continue my involvement in the important work of the ASCH.

Dr. Jon Odland’s keynote, talking about the AMAP Human Health Assessment, set the tone of the conference for me—“We are global humans.” This conference has helped to move me out of my box or silo which has focused on childhood exposure to violence and Adverse Childhood Experiences (ACEs). The ICCH16 painted the big picture of Arctic Health and Wellness and made me realize that it is imperative that we increase awareness around the globe about Arctic issues and that I expand the scope of my world to consider all the implications of of Dr. Odland referred to as “the rapidly changing north.” This means climate change, food insecurity, looking at the bigger picture of intergenerational wellness and ultimately how what happens in the Arctic will impact the world. As Dr. Odland noted, we cannot look at the Arctic health without including serious threats of contaminants and food insecurity. I realize now that these issues, such as how high mercury levels in seal liver can affect fetal and early brain development and the alarming rates of food insecurity in areas of the Arctic (up to 68% of Inuit families in Nunavut), are important considerations when we look at the effects of trauma and building community resilience.

While Dr. Alan Parkinson’s (U.S. Centers for Disease Control and Prevention) keynote focused on infectious disease, this talk was also a trauma-informed moment. The Spanish flu brought in by ship to villages around Nome, Alaska in 1918 had a death rate of 85% in five days. This is just one example that is a poignant reminder of what is typically referred to as historical trauma. The impact of these epidemics have far reaching implications for communities that are not limited to the past. It is about a level of loss at an ecological level that is hard to grasp and western labels such as posttraumatic stress disorder do not begin to capture the loss of culture and grief for communities and cultures.

It is always amazing to hear about the birth cohort studies and data in Scandinavian countries. What I hope to hear about each time is that social determinants of health such as adverse childhood experiences (ACEs) are being integrated into that research but I do not believe that is the case yet for family violence related measures. Websites such as www.birthcohorts.net were shared so it will be informative to see what social determinants are being considered that may not have been mentioned as this is an extraordinary opportunity to look at the implications over the lifespan for an entire population and they are looking at social wellbeing as an outcome in the Northern Finland Birth Cohort.

While adverse childhood experiences (ACEs) has become a global movement, particularly with the work of the World Health Organization, my presentation was the only ACEs-focused content. Interestingly, the Barker Hypothesis which proposes how fetal exposures can lead to long-term health problems was mentioned more than once. I would say that the ACEs research and developmental neuroscience supports and goes beyond the Barker Hypothesis so I see tremendous opportunity to advance more awareness of ACEs in circumpolar regions and this conference galvanized my commitment to do so (please follow our progress by visiting www.ACEsconnection.com and joining the "ACEs in the Arctic" group).

There was some content during the conference on domestic violence, more so than I have seen in the past so that's a start but given the prevalence of this issue in the north and its well documented consequences for families and children, this issue still needs to be lifted up. I would see "domestic violence" listed in summary slides on health concerns and knew that 10 years ago, it would not be included so that's progress. I made a great contact with the family violence research group at the University of Oulu and will be visiting them next spring to learn more about the work they are doing on violence against women and gender equity. I plan to explore how we can work collaboratively to integrate ACEs into other family violence work in the circumpolar world. As you can see, the opportunity you have provided to participate in this conference is having tremendous influence on the vision for the direction of my work on ACEs in the circumpolar world and my research for the Fulbright Arctic Initiative.

One of my favorite quotes from the conference was Dr. Sara Frazer (University of Montreal) and I plan to follow-up with her. One take-home from her research was: "How do we protect children? We protect community." She shared a great slide on 25 determinants of well-being that I need to request. She talked about her work in the Canadian Arctic to learn what communities need and how to make services more culturally relevant. In a nutshell, feedback from interviews suggested was that it's not so much about needing more services but rather how services are configured--adding community space and integrating, a multi-generational approach and be honest in that we really don't know what best practices are and we won't know for a long time relative to indigenous populations and circumpolar communities but we can build trust and learn to work together...obvious yet profound.

There were some new approaches and players such as Priscilla Ferrazi, an attorney working on therapeutic jurisprudence. I think the conference will greatly benefit from expanding from a more traditional clinical/medical model to engaging new partners. There were two neuroscience students who shared their research with in vivo MRI studies--lofty stuff and very interesting. I am staying in touch with both of these students.

Dr. Jon Petter Storr and "Piere" Bergkvist, a Sami reindeer herder, shared the work they are doing through SANKS (Norway) to prevent suicide among the Sami, particularly young men. I tweeted about Piere sharing his personal story which will stay in our hearts forever. I frequently heard from the Sami about how often someone seeking help has to spend their energy educating the service provider about their culture, further adding to their burden and often posing a barrier to accessing care. I also heard how service providers are being impacted vicarious/secondary trauma, which compromises their health and capacity to function, which made me think about how important it could be to share our work/training on that at a future event. Hearing that this is an unaddressed problem was an affirmation for our project to keep doing this work. I hope to visit SANKS next spring to learn more.

I heard about a lot of great resources including a great one here in Alaska that I did not previously know about---www.arctichealth.org! Through the internet, we will continue to have extraordinary opportunities to consolidate and share resources.

I will close with the many words of wisdom from Dr. Gert Mulvad, a physician who has spent his lifetime in Greenland. His insights are profound for all Arctic dwellers. Talking about suicide, mental health issues and other pervasive Arctic health issues, he noted "you have to treat the whole family." As I learn more and more about building family resilience, his words could not ring truer. "Family well-being is the most important, strongest thing we have in the Arctic--if we are not focusing on the family then we will not be successful." Thank you, Dr. Mulvad.

Thank you for the opportunity to attend the 16th International Congress on Circumpolar Health in Oulu and Rokua, Finland. Overall, the congress provided a strong and diverse representation of all health issues that face the Arctic, from food security and environmental pollutants to mental health wellness and prevention. Being able to attend ICCH16 not only allowed me to focus on my own key interests but also provided me the opportunity to expand my understanding of other, no less important, ongoing dialogues concerning circumpolar health. I especially valued the opportunity to learn more of mental health disparities in the circumpolar north, from many points of view. I have come to appreciate much more the importance of mental health for people in the circumpolar north.

ICCH16 was a very busy and productive, but enjoyable time in Oulu and Rokua. The congress had an immense amount of information to offer, but also balanced that with time to relax and discuss with colleagues outside of the formal presentation sessions. The sessions were organized with an emphasis on an overlying theme, rather than a specific type or model of circumpolar health research. For instance, the STI session feature both medical epidemiologists describing STI prevalence and investigation as well as social scientists implementing and adapting community-based participator research projects that were working towards prevention of STIs. This organization provided a broad, but well-rounded view of the circumpolar health topic. As a scientist, I tend to categorically view sessions based on methods and techniques rather than the overall topic. ICCH16 sessions broadened and changed the way I view circumpolar health issues.

I had the opportunity to present on my research focused on chronic hepatitis B viral infection, which is a health disparity in the Arctic, especially for indigenous peoples. I participated in the successful first meeting of the Circumpolar Network for Sexual and Reproductive Health which was held during ICCH16, where researchers and public health officials from many different disciplines came together to share knowledge and experience and establish a network for continued collaboration. I also had the opportunity to join the circumpolar viral hepatitis working group and share my work and seek input from other circumpolar investigators.

Because of ICCH16, I was able to continue and grow my ongoing collaborations with colleagues from all over the world. I have also made many new professional connections that include both new colleagues that I will be able to collaborate and share experiences with, but also new mentors that I hope to gain valued experience and insight from. Our circumpolar partners are truly those who we can relate and identify with most closely as we all face similar health concerns, questions and needs. Having built my circumpolar network even further, I am looking forward to continuing to my new partnerships and working together towards solutions.

ICCH16 was a tremendously resource-rich learning environment and a wonderful experience in my professional development as a junior investigator in circumpolar health. I highly encourage other ASCH members to consider attending ICCH17 which will be held in 2018 in Copenhagen, Denmark.

During ICCH16 I was fortunate enough to be part of re-developing connections and interest in the Sexual Health Working Group. On the evening of June 8th we met for an hour and a half to redevelop the the purpose, goals and objectives of this group. In addition to building colleagueship across the circumpolar north, this event allowed people working across all avenues of Sexual Health (policy, clinical, prevention, research and more) to participate in actionable items moving forward. Since this meeting, we have created botha Facebook and LinkIn page, distributed minutes and scheduled a follow up call for meeting leads.

The ICCH16 event was powerful and effective not just to re-establish my circumpolar relationships. The event provided a venue for new projects to grow, both in the circompolar north and among indigenous communities everywhere. As a result of ICCH16, I am proposing to add to a current project by using methods learned from a Yukon survey of Injection Drug Use I learned about at a poster session and working to compile a journal issue to review sexual health in the circumpolar north. Lastly, learning practices, ideas and policies in other circumpolar north countries has encouraged involvement in on indigenous rights and advocacy.