Inuit Gender-Based Analysis Framework
Excerpts from a Report on the Health of Pauktuutit Inuit Women of Canada

JESSICA GUILLOU AND DEREK RASMUSSEN

Research comminssioned and supported by Paukuutit Inuit Women of Canada and the Women's Health Bureau of Health Canada. [Literature review and analysis of culturally-specific factors in a gender-based analysis of Inuit Women's Health; submitted to Health Canada March 30, 2007.]

The world can tell us everything that we want to know. The only problem for the world is that it doesn’t have a voice.  But the world’s indicators are there.  They are always talking to us.                                                                          

                                                                            -Quitsak Tarkiasuk ¹

PART I

Introduction: Inuit Gender-Based Analysis

Medical and Social Health Differences between Inuit Women and Men in the Four Regions

Inuit women and families have specific health issues and needs based on their unique social, cultural, and environmental situations which may vary greatly in comparison to the health and social issues facing Inuit men².  The main conceptual approach employed by policy-makers and government to uncover and explain these differences is gender-based analysis (GBA)³.  “Gender-based analysis is an analytical tool, which systematically integrates a gender perspective into the development of policies, programs and legislation.”⁴ GBA includes both sex (the biological differences between men and women) and gender (the culturally-specific set of characteristics that identifies the social behaviors, roles and relationships of men and women).  However, without clearly articulated cultural reference points, GBA may tend to ignore or mask differences between Inuit men and women; it may also obscure the differences among Inuit women.

One of the striking observations from Pauktuutit’s research is that although there is disaggregation of data by sex (for example in the SLiCA surveys separate all findings by male/female⁵) there is little or no research on gender—on social and cultural roles of Inuit women and men and how these might impact health.  This gap in itself speaks to the need for an Inuit GBA and indicators that illuminate the interaction between gender roles and health of Inuit. For example, an indicator that inquires: does the gender division of traditional land-based activities—women staying at home (or in camp) and being more sedentary, while men are more active in hunting—does this more sedentary role put Inuit women at greater risk for developing diabetes?  Or, indicators related to diet and gender: do gender roles have any impact on Inuit women’s increased or decreased access to and consumption of country food?  One indicator that may shed light on domestic violence is an indicator used by researchers looking into overcrowding in Kinngait.  The Kinngait study discovered that lack of access to outpost camps or hunting equipment for men significantly increased anxiety in women in overcrowded houses.  The study speculated “that women may be anxious about the impact that not having equipment might have on the men in their lives and the implications for them of the depression, boredom and anger that this generates. Women may also be anxious about not being able to provide food for Elders and children.” ⁶  This issue and indicator raise another point of departure from southern gender-based analysis of issues like domestic violence and prevention of abuse.  As Pauktuutit’s Nuluaq Project has shown through its research with Inuit women elders⁷ , the approach to abuse prevention in the Inuit way operates from a different perspective than southern abuse prevention work⁸; indicators which shed light on these differences should also be part of an Inuit GBA of women’s health.

Cultural Differences between Inuit and First Nations

Inuit and First Nations are different cultures with different experiences, different languages, histories, geography, politics, social relations, values and beliefs. These differences merit respect and accommodation in developing an Inuit-specific health framework.  Different Aboriginal peoples employ different philosophical approaches to healing; for example, Inuit philosophy does not include concepts like the Medicine Wheel or the healing circle which are common to First Nations.  “The ‘Sacred Hoop’ and ‘Circle of Life’ concepts are also not applicable to the Inuit, who have their own rich and unique cultural heritage.” ⁹  

While the persons we interviewed supported an amended version of the circles framework, they also commented freely on the needs for indicators under different categories that reflected Inuit life.  Examples included traditional food as part of a definition of economic health in the North, wildlife availability as a measure for the physical environment and traditional knowledge as an important marker of Education and community wellbeing….Workshop participants emphasized that much of the literature speaks to international or Canadian First Nations contexts that do not reflect the context of Inuit people.  This underscored the importance of further exploring frameworks and indicators that include Inuit-specific understandings and measures of capacity.¹⁰

Traditionally, Inuit healing practices operate on the principle that each member of the community is responsible for her own and her family’s wellbeing; this is the principal tenet of health, which formed the foundation of social order and wellbeing among Inuit for thousands of years before colonization.  In the Inuit worldview, wellbeing occurs through the individual’s fulfillment of basic social obligations as members of the larger group; one’s personal quest for good physiological, moral and spiritual health occurs in tandem with the group; individual and community health and wellbeing are a collective responsibility.¹¹

Geographic Differences between Inuit and First Nations

While 96 percent of non-Aboriginal Canadians and 30 percent of the Aboriginal population live in major urban areas, only fourteen percent of Inuit live in southern (urban) Canada.  Most of Canada’s 55,000 Inuit live in the Arctic, in 53 communities, 51 of these 53 communities are located along the Arctic coastline; thus Inuit can be generalized as a sea-oriented people—in contrast to the majority of First Nations and European-Canadians.  Although only “20 percent of First Nations communities do not have year round road access, almost all northern Inuit communities are remote and do not have year round road access”¹²  Most Inuit live in remote communities with the “nearest hospitals usually hundreds of kilometers away, while major referral centres may be thousands of kilometers away.  For example, the distance from Iqaluit to Ottawa, the major tertiary care referral site for Iqaluit, is 2,055km.” ¹³

Medical Health Differences between Inuit and First Nations

In addition to differences in health concepts, prevalence of disease differs between Inuit and first Nations peoples, with some ailments being more severe and common among Inuit and others being more severe among First Nations.  The incidence of diabetes, although on the rise for Inuit, has not reached epidemic proportions that it has reached in First Nations communities.¹⁴ This suggests that early intervention now, and education to maintain healthy diet and practices resistant to diabetes, is most important to Inuit.  On the other hand, Inuit are at “extremely high risk for several cancers that are very rare in other populations: nasopharyngeal, salivary gland, and esophageal cancers”, the so-called “traditional Inuit cancers”.¹⁵  In their conclusions, the doctors who authored the 2004 Public Health Surveillance Report on Inuit of the four regions warned that:

A final general limitation of the surveillance activities and information available from the four regions is a frequent lack of available Inuit identifier or Inuit-specific information on the particular health issue under surveillance.  …[T]here clearly are differences in the relative importance for certain public health issues in the Inuit, as compared to the general Canadian population and also as compared to other Aboriginal populations, even within the same region.  Availability of Inuit-specific public health surveillance information would be beneficial for design, implementation and evaluation of public health planning at local, regional and national levels.¹⁶

Medical Health Differences Between Inuit Women and Southern Canadian Women

A preliminary look at just one disease, cancer, shows striking differences between the medical health of Inuit women and southern Canadian women.  The 2004 Public Health Surveillance Report on Inuit of the four regions reports the following differences between southern Canadian women and Inuit women in types of cancer diagnosed:

A cross-jurisdictional study of circumpolar Inuit from 1969-1988 showed that the most frequently diagnosed cancers (in descending order) were…[cancers] of the cervix, lung, breast and colon for women. When compared to North American/European populations, Inuit had higher risks of [cancer of the] lung, nasopharynx, salivary glands, esophagus, and gall bladder….[Inuit] women showed an increased risk of cancers of the cervix and kidney. Inuit showed lower risk of other cancers, including those of the bladder, skin, and brain….Notably…Inuit women [were] at lower risk of breast and endometrial cancer. Inuit women’s lower risk of breast cancer has been attributed to earlier pregnancies and more prolonged breastfeeding…. Lung cancer was strongly predominant, representing 39% of all the invasive cancer cases over the study period, and cases occurring on average ten years younger than in Canada as a whole. Cancers with rates higher than the overall Canadian population were salivary gland, nasopharynx, esophagus, colon, liver and lung.¹⁷

Cultural Differences Between Inuit Women and Southern Canadian Women

Conditions for Inuit have undergone rapid change in the last 50 years, perhaps a more dramatic series of changes than for any other population in Canada.  In its rationale for participating in the Survey of Living Conditions in the Arctic (SLiCA), Stascan noted that “adapting to these new conditions has not always met with success.  Indicators show higher unemployment, lower income levels, poorer health and more social problems among the indigenous populations than among the rest of the populations further south.  Further, these types of indicators are in many cases culturally biased and do not reflect the reality of conditions in the Arctic.”¹⁸   Regarding possible “cultural bias in indicators,” the Development Dictionary has warned that “the Westernization of the world…has imposed the concept of standard of living as the dominant category for perceiving social reality,” leading most societies to measure “only the “Westernized portions of their socio-economic reality.” ¹⁹  In a recent report on measurements of Inuit well-being, researchers also advised caution: “Whereas standard indicators like per capita income and Gross National Product, average life expectancy and infant mortality rates, may reveal something about the state of a national economy and the overall health of its population, they do not reveal what some consider to be the more important indicators of development and social well-being.” ²⁰

While wage-employment and income are important indicators for both Inuit and southern women, they may not give as complete a picture of Inuit women’s wellbeing as these indicators do of southern Canadian women.  Cultural bias is a danger when measuring the wellbeing of Inuit women from westernized frameworks which may focus on income, life expectancy and educational attainment.  As the recent Survey of Living Conditions in the Arctic (SLiCA, 2007) concludes, Inuit women and men report that “despite lifestyle changes that have swept into northern communities as non-natives move to remote areas, traditional values” like hunting and availability of local country food are still important to Inuit, and they are “willing to use their earnings in the cash economy to support those ways of life.”  SLiCA further reported that “despite historical efforts by national governments to assimilate native peoples and encourage them to give up native traditions in favor of wage labor, nine out of 10 Inuit continue to think traditional activities are important to their identity.” ²¹ Harvesting and “traveling upon the land, for Inuit, is not a holiday or retreat but rather is critical to good emotional and mental health and a direct channel towards that health.”²² Cultural indicators that mesh Inuit values and gender-based analysis are more sensitive to these factors not operative in the lives of southern Canadian women.

Historical and Cultural Considerations Behind an Inuit GBA

A Caution about the “Modern/traditional” stereotype

Pauktuutit’s GBA Framework model arises out of the need to focus attention on the issues of Inuit health and gender in a way that reflects an Inuit perspective.  The Inuit perspective includes Inuit adaptation to, resistance to, and absorption and integration of Euro-Canadian economic, government, regulatory, and institutional pressures.  The ‘Inuit Way’ is not static or a museum artifact; although the ‘Inuit Way’ has strong roots in the past it exists and—as recent SliCA surveys attest—is adapting and succeeding in the present.²³

Although SLiCA’s recent survey of Inuit living conditions and land use gives credence to Inuit assertions that the ‘Inuit Way’ is still present and relevant; media use of the modern-traditional paradigm in its coverage is a cultural bias that Pauktuutit Inuit Women of Canada will try to limit or qualify in the Inuit GBA framework.  It is not uncommon to find references to Inuit land-based activities as “traditional” and to find land-based activities or elders’ wisdom contrasted with wage-economy activities and formal education which are labeled “modern”.²⁴ Although it is obvious that much of the wisdom and skills of Inuit women and men have been carried forward from the past and used in new ways today, continuity with and learning from the past is not an activity exclusive to Inuit.  (A southern Canadian woman will engage in an activity like kayaking, or voting in a democratic election, without viewing these activities as “traditional”; despite the origin of these activities as ancient technologies—the kayak—or ancient customs—the concept of ‘one person one vote’ Democracy, which owes its origins in part to ancient Greece and in part to the Iroquois confederacy).²⁵  Much of southern Canadian life owes its design or origins or guiding practices to “Tradition”, yet southern Canadians may tend to refer to their practices as “modern” and contrast Inuit practices as “traditional”²⁶—a misleading label that might encompass associations like “backwards” or old-fashioned”.²⁷  “The ‘modern-traditional’ contrast plays the same analytical role in academic literature presently as the ‘civilized-primitive’ contrast the literature was forced to drop around 1960.”²⁸  Analysts tend to "take-for-granted the late nineteenth century Social Darwinian view of cultures as evolving from a primitive and backward to an advanced and progressive way of knowing.....the other key assumption they tend to hold: namely, that we in the West have nothing to learn from non-Western cultures—cultures [we ought] to think of as differently developed”.²⁹

As such, respectful intercultural dialogue encourages us to be cautious about employing dualistic extremes like linear notions of Progress (“everything newer is better”³⁰) and its opposite, golden age romanticism (“everything was better in the old days”³¹); these extremes should be avoided as much as possible in an Inuit-specific indicator framework in order to prevent potential cultural biases from casting a negative light on the Inuit Way.  To overcome these potential biases, southern analysts must make effort not to fossilize or otherwise conceptualize Inuit Culture as a historic artifact.  Because of the concerns noted here, the word “tradition” will be used in a cautious and limited way in this report; when it is used in a phrase like “traditional medicine,” the word is referring—not to a museum artifact—but to a growing and important Inuit area of study that can incorporate the wisdom of previous generations while including current scientific insights and medical discoveries.  To speak of Inuit tradition, is actually to speak of adaptability and openness to incorporate technological changes and some parts of Euro-Canadian customs without abandoning Inuit worldviews and ethics.

Consider Our History: Culturally Specific GBA as Part of Reconciliation (the History of Involuntary Relocation of Inuit for TB Treatment)

In the 1960’s, tuberculosis (TB) case rates in Canadian Inuit were among the highest ever recorded in a human population; and the rates remained 24 times higher among Inuit than in the general Canadian population from 1970 to 1984, and 11.5 times higher among the Inuit of Quebec than in Canada from 1990 to 1994. In 1998, the incidence of new active and relapsed TB among the Inuit was 58.7 per 100,000 compared to 21.3 and 1.5 among foreign-born and Canadian-born non-aboriginals, respectively.³²

Although First Nations and Inuit have brought considerable attention to the cultural destruction and terrible suffering caused by the residential school process and the removal of children from their families; Inuit suffered three other forms of relocation and cultural destruction which are still within living memory: relocation for government sovereignty purposes (the high arctic exiles)³³; relocation into settlements for reasons of ease of government administration (including killing of dogs to curtail nomadic hunting)³⁴; and institutional relocation for medical treatment.  Of the latter, the TB epidemic of the late 1950s is the most extreme example.  The involuntarily evacuation of large numbers of Inuit mostly by ship to a sanatorium in Ontario (which was the largest facility of its kind in the British Commonwealth) is one of the darker memories that Inuit share.³⁵ Many Inuit walked on board the C.D. Howe, a government supply ship, which also served as a floating medical station, and upon being diagnosed with tuberculosis, they were detained on the ship and taken south, with their family having no idea of their whereabouts.  Many died in the south.  This “scandalous” relocation of the 1950s-60s touched the lives of almost every Inuit family in Canada.³⁶  “The manner in which the federal government attempted to control and eradicate tuberculosis in the north was controversial and left a lasting legacy of bitterness among many Inuit today.”³⁷  Between 1958 and 1962, 1272 Inuit were hospitalized at Hamilton’s Mountain Sanatorium, making Hamilton Ontario the largest concentration of Inuit anywhere in Canada at that time.³⁸ To this day, many Inuit visiting the south make a pilgrimage to the cemetery near Hamilton to try and find gravesites of relatives who were taken away.   We cite the historical example of the TB experience to emphasize that another reason for  Inuit-specific GBA would be to sensitize southern health workers to how some Inuit feel in the face of current medical evacuations and health epidemics which may echo past injustices and suffering.  As Nunatsiaq News noted in a recent report on the residual effects of the 1950s TB relocations: “Meanwhile, the problem of how to smoothly transfer patients awaiting surgery from Nunavut to the South continues to confound health administrators today. The odd screw-up of medical travel flights remains an immensely emotional issue….The threat of tuberculosis hasn’t disappeared, either. The disease is spread by the coughs and sneezes of an infected person, and it flourishes in places where people live in overcrowded housing. That’s why tuberculosis is known as a disease of poverty, and why it’s again on the rise in Nunavut, where the same overcrowded conditions exist today, to the concern of the territory’s health practitioners.” ³⁹

Reframing health research in a culturally sensitive way is one way that government can indicate that it genuinely respects the culture of Inuit and that government has de-linked medical care from deliberate efforts to dissolve Inuit culture.  As one health text notes: “it is quite clear that cultural change was an important byproduct of tuberculosis treatment and that, combined with the separation of families and kin, it served to undermine Inuit society to some extent. Medicine and social change do go hand in hand.”⁴⁰

PART II

Explanation of the GBA Framework

How did we develop this framework?  This report, this framework is merely a conceptual model developed from a literature review and key respondent interviews.⁴¹ “A framework can be defined as a basic conceptual structure.  A health reporting framework is a model that sets out a particular way of looking at health and the factors that affect it.  It is important to remember that a framework does not represent the ‘truth’ but can be a useful tool to organize information for intended users.”⁴²

Pauktuutit’s Inuit GBA Framework model arises out of the need to focus attention on the issues of Inuit health and gender in a way that reflects an Inuit perspective.  Based on a review of literature, certain themes (below) were more heavily weighted and arose more frequently than others.  We suggest that these themes should be a starting point for an Inuit culturally specific framework, or for groupings of questions to illicit more detail to inform such a framework.  While southern Canadian health determinants tend to cluster around issues of wage employment, income, formal education attainment, mortality and disease, and while Inuit are not uninterested in these categories, Inuit women also hold to additional values that reflect their holistic approach to health and Inuit concern for ‘balance’ between negative and positive approaches to health (disease versus wellness)⁴³. “Inuit feel that it is detrimental to the health of individuals to continually tell them that they are at the highest risk for disease….People are interested in research on …concepts of wellness, and wellness indicators.”⁴⁴
   
The Inuit GBA Framework: Proposed Model

In the literature certain factors frequently occur in Inuit self-definition and when Inuit are articulating what is the “Inuit way”.  From this grouping of issues, four major themes emerged:

1) The Inuk woman, and her family, and community
2) Elders, culture and language
3) Land and country food
4) Euro-Canadian economy, institutions and government

These four domains are one way of forming categories of women’s health indicators that reflect the Inuit way.  All together, understanding the interactions of these four elements in a particular way would garner someone the title of one who is knowledgeable about Inuit philosophy, or one who knows things in the Inuit way.  While the roles and relationships of these four categories are intricately interrelated, they are not static.  The truth of fluctuations in environmental and social interactions results in a multitude of ways in which each element affects the others. When all parts are healthy the whole is healthy, but when stress or erosion, such as pollution for example, affects one or more of the elements, the overall health and wellbeing of Inuit women and their families, elders, culture and land is threatened.  For example, climate change is an effect of the Euro-Canadian economy upon the environmental or “land” factor; however it can also undermine elders’ wisdom about safe hunting practices, navigation, weather prediction, and ability to predict location of animals.  It may be that as climate change stresses the environment causing unreliable weather and ice, the resultant restrictions on land activity and a reduced use of country food may mean that families find less reason to go out on the land with elders or turn to elders for guidance.  Less time out on the land and less reliance on elders, may, in turn, shift the burden of addressing illness, boredom and stress toward the household and toward Inuit women within the family, as they deal with increased presence of men and boys in the home.  

Discussion of the Inuit GBA Proposed Framework

The Inuk Woman, her Family and Community

At the center of an Inuit gender-based health analysis is the Inuk woman, her family, her household, and her community.  Women in Inuit families have responsibilities for children, for maintaining the household and increasingly are the main wage-earners and often are the main activists bringing attention to local community development and social issues.⁴⁵ “The Inuk woman was the head of the household and made all the decisions on the running of the home….Traditionally, the sense of community was family and extended family, so Inuit women extended their role as head of the household into the community.”⁴⁶

Inuit women generally have higher education levels than Inuit men, yet they are paid less than men and are underrepresented in positions of political and economic authority.   Ruby Arngna’naaq puts this contradiction in context: “The women in our group were equal deciders.  But not necessarily publicly.  The public execution…of that decision was often left up to the man—unless he’s one of those very quiet ones and then the woman happened to be like me.  They carried out the decision and things went on.” ⁴⁷

Inuit rarely distinguish between household, neighbourly, and community work.  The household is based upon an extended family that often includes most of the community. Child-rearing, food acquisition (hunting) and preparation, clothing production, housing, and family care-giving activities are generally done on a volunteer basis.  These activities provide the intimate interactions that mesh the community together… This section of the informal economy is relatively difficult to identify as the activities are done without thinking and without expecting thanks or recognition…Inuit participate in a multitude of activities which they don’t stop to think of as volunteer work.  Child care, food, clothing, and care for elders is considered an invaluable contribution to improving the quality of their daily lives. ⁴⁸

Roles and Responsibilities of Inuit Women

Understanding the roles and responsibilities of Inuit women is critical to the successful analysis of their full health-care needs.  While generally enjoying autonomy in the running of the household⁴⁹, the amount of labor an Inuk woman does in a day is often proportionately larger than that of Inuit men, and perhaps larger than many non-Inuit Canadian women.  Inuit women also form the majority of the wage work force in the northern Inuit regions; they are also typically the primary caregivers to their children outside of wage working hours.  They are generally expected to be the sole provider of meals (shopping and cooking) for their husbands and children as well as other permanent house guests (which, due to the overwhelming problem of overcrowding in Inuit communities, usually amounts to a larger number of persons living in the home than in non-Inuit communities—over 50% of Inuit homes are overcrowded, compared with 5% for southern Canadians).  They also provide sewing for the family’s clothing needs and may also participate in hunting and gathering practices.  The large demand on Inuit women from their families, as well as demands from full or part time wage-based or land-based employment, are all factors in Inuit women’s physical, emotional and mental wellbeing.

Inuit women living in southern urban cities such as Ottawa or Edmonton may experience a difference in their roles and responsibilities than their northern sisters.  Due to differences in the work, home and community environments, as well as differing lifestyle choices (possibly) in the south (such as less access to country food and increased consumption of store-bought food), Inuit women living in the south may require particular consideration in the development of “Southern Inuit Women’s Health Indicators” specific to them.  While this report does not outline these differences, it is recommended that further research be undertaken to illuminate these differences.  

Although far from an exhaustive survey, some further considerations in the development of an Inuit-specific GBA are touched on below.

Inuit Women, Youth Pregnancy and Custom Adoption Practices

Children are highly cared for and respected in Inuit society and considered an important part of the community.⁵⁰ In part, perhaps due to the unique Inuit naming practices whereby a new baby is named after an elder who has passed away, there is a high degree of respect and care placed on the nurturing and support in the child’s development, and child neglect is uncommon.⁵¹   A clear cultural difference between Inuit and Euro-Canadians is the general lack of taboo associated with teen pregnancy in Inuit society.  An associated common and celebrated practice is that of custom adoption of babies into extended families, and the resultant interweaving or braiding together of different families and communities by their custom adoption links.  If there were a culturally sensitive method devised to quantify adoption and naming linkages, this might be an indicator of an Inuit woman’s well-being.

Multi-Generational Proximity: a New Indicator for Inuit Women and Families

Anecdotal evidence seems to indicate that Inuit women enjoy a higher level of support, from extended family members (for example aunties and grandmothers helping with childcare) than southern Canadian women.  The amount of social cohesion in Inuit families and communities is very high in comparison to the south.  One example of an Inuit-specific GBA indicator might be to inquire about the number of female relatives living within a five miles of a woman’s home.  Inuit families are distinctive for having often three generations living in close proximity and participating in family life and sharing work and play together.  Multi-generational proximity could be an indicator of an Inuit women’s well-being not currently captured in southern-style surveys.  Decreases in multi-generational proximity might shed light on the extent of family isolation and increased dependency on non-familial services and institutions like formal daycare services.  

One report speculates that a high level of social cohesion (thus far) may be part of the reason why Inuit have much lower rates of emigration away from Arctic communities compared to emigration rates for southern rural Canadians (into urban centres). “Despite less favorable economic, educational, and even entrepreneurial conditions in the smaller towns and villages of the Circumpolar Arctic, it is unclear why the demography of these regions has remained relatively stable… To explain this, it is necessary to look beyond the usual spectrum of indicators found in standard development studies to find indicators that [capture] the means of making a living and the means of making a meaningful life. …[Such a] model of social cohesion…indices [are:] measuring aboriginal language use, access to formal education, mobility, individual health, labor force participation, access to information technology, political participation, individual and household income levels, participation in the subsistence economy, and individual and community wellbeing.”⁵²  
The report authors suggest a useful set off indicators measuring the degree of household production in an Inuit household, since an Inuit household has productive as well as consumption role, residents consume things but they also produce (for money and for gift-sharing purposes)—within the house itself, sewing, food, crafts—much of this done by Inuit women.  “[A]n essential socio economic unit below the regional economy level [is] the household.  In the classic model households only consume.  Businesses produce, households consume.  The difference in the north is that households are a micro-enterprise—they consume but they also produce—through small enterprises, crafts, small businesses, etc.  What we’re trying to get at is to find indicators and measures of this phenomenon for both consumption and production as well as distribution.”⁵³

Indicators to study this production role were used in the recent SLiCA survey.  To these we would add indicators that track multigenerational proximity (beyond the household, but within the community), non-formal education and access to elders, and others listed below and in the follow-up report, Inuit Women Health Indicators.  Additionally, indicators should inquire whether the household has “adequate space to accommodate earning opportunities for women working outside the formal economy….in Kinngait inadequate attention has been made to the needs of women for space that permits them to sew, quilt, knit, weave and engage in other activities that have earning potential.”⁵⁴ 

Multi-generational Proximity and Overcrowding: Sometimes Mixed Feelings

Multigenerational proximity also gives rise to the question of overcrowding.  The issue of overcrowding is perhaps one of the best examples of the sensitive contradictions that should be accounted for in an Inuit-specific culturally relevant GBA health indicator.  What are the contradictions?  To a southern health analyst perhaps the issue seems clear-cut, if we base it only on numbers: more Inuit live in the oldest, most decaying, most overcrowded social housing (in the harshest climate) than any other Aboriginal or non-Aboriginal people in Canada.  This is a housing crisis.  The resultant high rates of respiratory illness have also been documented; some southern studies are also choosing to study the stress and anxiety and anger rates in overcrowded Inuit homes.  

Without question the first priority is new housing construction to address this terrible problem.  But there are also related health indicators that go unexplored that might address questions of social cohesion and well-being—but resist easy categorization.  When asked why Inuit take so many people into their homes, Inuit in Arctic Bay answer: “people need places”, and they say: “iglu qajaangituq—an Inuit house won’t explode” (it can keep filling up).⁵⁵ Even when Inuit move south they maintain this openness—filling their homes with visitors.  So this is an example of a contradiction that is difficult to capture in a health indicator: Inuit have a high degree of social cohesion and feeling of responsibility for others and so will fill their houses with fellow Inuit; but studies of the impacts of this overcrowding show negative medical health effects and have (so far) inquired about (and shown) negative emotional effects.  It is beyond the scope of this report to critique survey-design, however we choose this example to show some small part of the nuances that exist in living conditions in Inuit communities, and to suggest that Inuit GBA health indicators might also attempt to include how much happiness an Inuk mother feels at having her adult children move in with her, as well as how much irritation.

The Housing Crisis: Overcrowding and Domestic Abuse

Overcrowded and substandard housing is also a major problem for the Inuit living in the North.  As the result of increased building and fuel costs, 90 percent of Inuit families in the North rely on social housing.  In some communities, the waiting period for housing is several years, and families are overcrowded in small houses lacking adequate insulation, heating, plumbing and sewers.⁵⁶ 
(Pauktuutit Inuit Women of Canada)

As discussed earlier in this report (Section 2.1), sixty per cent of Inuit in Nunavut (13,000) live overcrowded and aging social housing and endure the “worst housing crisis in Canada.”⁵⁷  Nunavik’s overcrowding rates are even higher.⁵⁸  Overcrowding is an important factor causing stress in families and increasing the likelihood of domestic abuse. ⁵⁹  As stated by Pauktuutit Inuit Women of Canada in 1986: “Inuit women are particularly vulnerable to the impact of the housing crisis which exacerbates other social problems with which women must contend.  Inuit women wishing to leave abusive and violent relationships face innumerable obstacles.  Social pressure can cause many women to conceal the violence in the home for long periods.  Some Inuit women may be dependent on their spouses or partners for financial support and/or housing.  The virtual absence of vacant units and the overcrowding of existing housing in almost all communities means that there are very few places for women to turn for temporary shelter.  The homes of family and friends are likely to be as crowded as the one the woman wants to leave.  Many women find themselves forced to remain in a dangerous home situation.  Most communities are without shelters and a woman who decides to leave an abusive situation may also have to leave her community.  Leaving a community is replete with obstacles as well.  The high cost of air travel is one of the largest barriers.  If a woman is unable to pay these costs she will have to persuade a social worker or community worker that she is in danger and must leave for her own safety.  In small communities that service provider may also be a member of the family and therefore may be reluctant to arrange transportation.”⁶⁰

Preventing Harm to Women and Families: Domestic Abuse, Substance Abuse, and Suicide

Domestic violence poses widespread health concern for Inuit women and children. In The Nuluaq Project, Pauktuttit provides a background for understanding the causes of abuse and the context in which it occurs, identifies key information regarding abuse treatments and the cultural perspective of healing, and it further offers key recommendations for the future (which is included in this report in Appendix C).⁶¹  

The facts of domestic abuse in Inuit regions are stark and of grave concern.  In Nunavut, for example, “women are 10 times more likely to go to a shelter than women in the rest of Canada; the rate of spousal homicide in Nunavut is seven times higher than the rest of Canada; the rate of sexual offences in Nunavut is at least 10 times higher than the rest of Canada; Nunavut women are more likely to suffer potentially life-threatening forms of violence; and the amount of domestic violence in Nunavut is at least twice as high as the rest of Canada.”⁶²

Abuse is intimately connected to (if not a direct product of) a complex web of a variety of societal determinants (such as substance abuse, overcrowding, loss of cultural identity, unemployment, etc.).  In The National Strategy To Prevent Abuse Inuit Communities, the two key roots of abuse are identified as 1) loss of culture and tradition, and 2) loss of control over individual destiny.⁶³ When asked if she had any idea why there were so many social problems, traditional healer Meeka Arnakaq from Pangnirtung, replied: “There is a culture-clash happening. Another culture, that is not a part of our Inuit culture, has emerged in our communities.  It was as if we dropped our traditions and our culture when we thought that we could not have strength if we did not lose it. We know that if we have strength we will have better relationships among ourselves.  The Inuit way of life, or the elders' voices are no longer being used, due to the fact that the Inuit way has been tampered with. Our culture has clashed.  Too many people grabbed the culture that is not ours, this is where we shattered.”⁶⁴  Arnaqak’s comments and the causes of abuse identified by The National Strategy make a clear argument for the need for a cultural perspective on GBA indicators of Inuit women’s health.

We must consider not only singular incidents of abuse, but the cycles of abuse that often appear through generations.  Excerpted from a Nuluaq Project research report is the following outline of abuse cycles: “Abusive behavior takes many forms: verbal, mental, physical, and while causes may appear to stem from current stresses and problems; it is more likely that the root causes reside in the past.  The abuser may have experienced similar treatment in childhood, probably by an abuser who was, in turn, abused earlier.  For this reason, the fears, threats, hopelessness that are felt today will require an understanding of cultural history and behavioral patterns in order to be healed.”⁶⁵

A cultural approach is also necessary when addressing the issue of suicide, which sadly affects so many Inuit women and their families. “Young Inuit men kill themselves at higher rates than Inuit women and older men.  However, while data are not available on attempted suicides, it appears that women may match or surpass men in this area.”⁶⁶  At the Inuit Health Policy Forum, it was mentioned that suicide was listed as a severe problem in every region.⁶⁷ Much attention has been given to the staggering rates of suicide in the north as it is widely known that “Inuit have the highest suicide rate…of all Aboriginal peoples in Canada- and Aboriginal health status fall far below the national average”.⁶⁸

Another area of harm that affects Inuit women, families and communities is substance abuse.  As is commonly known, the use of tobacco, alcohol and drugs all pose serious health threats. Additionally, effects of substance abuse by other members of the family or the community, such as violence can cause serious threats to Inuit women and their children.  While this report will not go further into explanation on the topic, it is to be noted that Pauktuutit has done extensive study an cultural aspects of these issues and has incorporated indicators related to this in the Inuit women’s health indicator chart that are listed in a follow-up report to this one, Inuit Women Health Indicators.    

Inuit Women in Politics, Leadership and Local Control in Communities

In 1953, upset that a prospector was hammering stakes around her home and then telling her it was “his” land, an Inuk woman got all her neighbours in Coppermine together to sign a petition to Ottawa stating that, in fact, the land was theirs.⁶⁹  By rights this should be recognized as the first Inuit land claim put forward to the Government of Canada—seventeen years before the history books give this credit to the men who founded ITC (now ITK).  The role of Inuit women in politics and leadership are not heavily documented or surveyed, but they are worthy of investigation in an Inuit GBA, as ‘control over one’s destiny’ is noted as a factor in well-being and happiness.  The recent SLiCA survey reported that—for Inuit worldwide— “the sense of local control is important to well-being and subject to policy intervention."⁷⁰  We have added indicators to the Inuit Women GBA that may shed light on the under-representation of women in political roles: particularly in elected positions with government and land claims organizations.  Other indicators of Inuit women’s local control might be presence in elected positions in NGOs, community groups, Co-ops, Development Corporations and in other positions of authority at the community and regional levels.  As one commentator noted, “women’s action in Pangnirtung remains primarily focused on social and economic fronts, leaving municipal politics almost exclusively in the hands of men.”⁷¹

The majority of women I interviewed believe there are more successful female role models for young women to learn from within the community.  These role models help to maintain and encourage the development of a strong female consciousness in times of change.  Young men, on the other hand, have fewer local male role models who have succeeded in terms of formal education and wage employment.  Male role models include men who are first and foremost good hunters, some of who are also high profile leaders in the community despite their relatively low levels of schooling.⁷²

Elders, Culture, and Language
Elders are the embodiment of Inuit culture and language, they are the highest expression of culture and language.  In this there is no equivalent or comparison for southern Canadians.  A southern Canadian would not generally be able to point out a European or immigrant Canadian on the street and say: “that person represents our culture”, or “that person is the highest expression of the English language and English values.”  Culture, language and values for Euro-Canadians are generally the responsibility of schools, courts—institutions.⁷³  For Inuit, culture and language are living experiences, embodied in elders.

Elders and the Embodiment of Inuit Values
The development and preservation of Inuit philosophy and practices, called Inuit Qaujimajatuqangit (IQ) in Nunavut, which includes Inuit values, heritage, culture and language, has comprised the core identity of Inuit for over 5000 years.  While southern government and institutional forces have influenced the Inuit way of life over the last 50 or so years, Inuit values remain intact and a GBA of Inuit women and families must reflect this.  

Inuit Qaujimajatuqangit is a philosophical framework developed by the Nunavut Social Development Council, an organization under the Nunavut Land Claim Agreement (NLCA).  Inuit Qaujimajatuqangit  centres around “tuqturangniq”, the family and kinship, which is also the basis for the land-based economy and political decision-making in Inuit communities. “Tuqturangniq" is also the central means of knowledge transfer, the sharing of philosophy, ethics, customs and skills that comprise Inuit non-formal education.⁷⁴ 

NSDC's IQ framework considered six guiding principles based upon the traditional Inuit family model:
• Pijitsirniq - serving and leadership;
• Aajiiqatigiingniq - consensus decision making;
• Pilimmaksarniq - knowledge acquisition, skill development, capacity building;
• Piliriqatigiingniq - collaboration and mutual help;
• Avatimiik Kamattiarniq - environmental stewardship; and
• Qanuqtuurasugunnarniq - resourcefulness and creative problem- solving.⁷⁵

This framework, though helpful, is not necessarily acceptable or common to all Inuit regions in Canada, thus any incorporation of an "IQ" model into an Inuit GBA would require community testing and consultation to see if non-Nunavut regions would find it applicable.

One further consideration is that Inuit values may differ from southern values in ways not immediately evident to southern health analysts—here is an example:  In 1999 the federal government did a community-to-community tour to consult Inuit about the First Nations and Inuit Home and Community Care Program.  Annie Quirke, a health representative for NSDC reports that in Chesterfield Inlet the elders asked the government representative from Ottawa: “Why are you saying this money is only for taking care of Inuit?  Is this money for taking care of Inuit, or is it for taking care of people in the Inuit way?” When the government representative said it was the second, it was money to be used in the Inuit way, then the Chesterfield elders replied: “Well it is not the Inuit way only to care about Inuit.  The Qallunaat (non-Inuit) are our neighbors, they live amongst us.  If they are old and need help, it is our way to help them too; if we are in control of this money we will use it to take care of all the people, that is the Inuit way.”⁷⁶  

Sharing is routinely cited as an Inuit value: “Generalized reciprocity, a form of community sharing which lacks explicit obligations and concerns of indebtedness, has been practiced by the Inuit since time immemorial.  This form of sharing continues to be an integral part of the Inuit lifestyle today, which is practiced in the communities as well as in the hunting and fishing camps.  The sharing encompasses all aspects of the Inuit lifestyles, including everything from meat and tools, to children and knowledge, it is the glue that binds the community into a cohesive whole.  The sharing is so innate among Inuit that they find it very difficult to live in a culture where it is absent.  Where this generalized reciprocity has been broken down by southern intrusions, such as the monetary system, the sale of country food, or the drug trade, the community members often feel confused and frustrated.”⁷⁷   Any matrix of health indicators that does not inquire into sharing practices, levels of community cooperation and mutual helpfulness would not be a genuine reflection of Inuit women’s well-being.

Elders’ Wisdom, Non-Formal Education and Formal Education
Educational attainment and wisdom are not necessarily the same things.  Although a standard health indicator in southern contexts is educational attainment, and formal education of Inuit women and girls is important in developing their awareness of health wellness issues; Inuit culture also places importance on non-formal learning, particularly from elders.  This is said not to reject the viewpoint of a southern GBA but to give some breathing room to an Inuit cultural point of view of GBA that may be underrepresented in current measurement systems.

In southern Canada, where avenues and patterns of consulting elders wisdom are much less common, educational attainment is measured and valued in degree status (i.e. university or college degree and especially postgraduate degrees of a Masters or PhD).  However, educational attainment among Inuit is not based upon a degree granting system at all; it is based upon language and traditional knowledge.  “Inuktitut does not refer to the language, it is a lifestyle.  When the elders ask for Inuktitut to be taught in the schools they are not asking for the language to be taught, but rather the Inuit life skills and philosophies to be taught.  Inuit teachers in the school teach the language, not the Inuit lifeways or culture.”⁷⁸

In our Inuit heritage, learning and living were the same thing, and knowledge, judgment and skill could never be separated.  In institutional life these things are frequently pulled apart and never reassembled.  For example, schools spend much of their energy teaching and testing knowledge, yet knowledge by itself does not lead to wisdom, independence, or power….There are limits to how much can be achieved in a classroom.  Wisdom can only be gained by engaging with life, by honouring one’s heritage and by mastering the skills necessary for independence.  ⁷⁹

For these reasons, an Inuit GBA should not only address formal educational attainment of Inuit women as a determinant of health, but also include non-formal education and frequency (and quality) of interactions with elders as an indicator of Inuit women’s health.  

Elders, Inuit Healers and Inuit Healing

Traditionally, Inuit healing practices operate on the principle that each member of the community is responsible for her own and her family’s wellbeing. In the Inuit worldview, wellbeing occurs through the individual’s fulfillment of basic social obligations as members of the larger group: individual and community health and wellbeing occur in tandem.⁸⁰ A healer is “an Inuk who provides counseling and emotional support from an Inuit cultural perspective.”⁸¹   Although as the Inuit Healing in Contemporary Inuit Society report by Pauktuutit Inuit Women of Canada warns, elders who are

referred to as ‘healers’ …[do] not feel comfortable with this English language term. In Inuktitut a literal translation of the English word ‘healer’ means, “someone who fixes or repairs someone” and this goes against the Inuit cultural belief that healing comes from within the person needing to be healed. While we have chosen to use the English word ‘healer’ to describe those who facilitate healing, it is important to recognize that across the north there are Inuktitut words in all dialects that better describe this function.⁸²

All the elders interviewed by Pauktuutit described “the importance of an Inuit perspective and a way of looking at problems, life and people in a uniquely Inuit way….Importantly, Inuit healers are people who will not judge those who come to them for help but do give clear and culturally-based advice.”⁸³   Angaangaq describes healing as meaning “to help people stand strong…. To help them stand by talking with them, letting their feelings out, letting their thoughts out so that they may be able to stand . . . . The Inuktitut meaning of healing is that you can speak of your thoughts and your feelings. When you can speak of your feelings, then you can stand strong.”⁸⁴  Although medicinal knowledge cited by elders is extensive,⁸⁵  they place more emphasis on the personal qualities, attitudes and behaviours of a healer; qualities like: personal readiness, being holistic, telling one’s story, flexibility, immediate intervention, compassion and empathy, and Inuit cultural knowledge.⁸⁶   The Inuit healers are: “warm, enthusiastic, empathetic, humorous, self-confident, non-judgmental, spiritual, respectful, tolerant, practical, assertive, and had strong Inuit cultural beliefs and values and were proud of Inuit culture.” ⁸⁷

The Labrador Inuit Health Commission has reported that “86% of Inuit adults think that a return to traditional ways is a good idea for promoting community wellness.  They are particularly keen on traditional approaches to healing, revival of traditional roles for men and women, renewal of native spirituality and traditional ceremonial activity.  54% of adults indicated that they are familiar with plants or methods traditionally used to prevent or cure sickness.”⁸⁸

At Pauktuutit Inuit Women of Canada’s 2000 AGM, a Nunavik delegate suggested that Inuit women organize and coordinate Inuit traditional health practitioners to complement and fill in when southern nurses are unavailable. “When something happens in the community and there is no nurse, there should be people that know how to provide treatment the traditional way until they are sent away to the hospital. Some communities may not have nurses so this could be a good way to help each other in a crisis.  A community could work with one another to create this; to educate people to treat one another the traditional way.”⁸⁹   We have tried to capture this recommendation listed in our follow-up report to this one, Inuit Women Health Indicators, by including a new Inuit women’s health indicator measuring the availability of traditional health support and blended Inuit-European health services.

Elders and Inuit Midwifery

Traditionally, midwifery was an important role for an Inuk woman.  “Traditional midwives…had special status within Inuit communities and were respected and acknowledged for their skills.”⁹⁰   However once “nursing stations were permanently established in Inuit lands, the practice of Inuit traditional midwifery was no longer permitted… Pregnant women near delivery were sent to larger communities…Women were separated from their families and culture during an important life event.  The health services dealt with emergency cases and treatment rather than prevention and education.  Elders within Inuit communities say that Inuit pregnant women no longer follow traditional health teachings.” ⁹¹  Labrador’s Health Survey found that “84 percent of Inuit women found it stressful to leave home to have babies, and 54 percent reported that children left at home had problems during their absence.” ⁹²

The legacy of southern medical intervention and evacuation of Inuit women for childbirth has not always served the social and cultural interests of Inuit women and their families. Inuit women recognize the need to establish healthy community-based birthing practices that are culturally sensitive to Inuit ways and preferences —practices that reinforce family and cultural integrity. ⁹³

Inuit midwifery has been renewed in recent decades: “The maternity program at the Inuulitsivik Health Centre in Povungnituk, Quebec…was initiated in 1986 by an Inuit women’s group…local Inuit women were selected by the community and trained via a mentorship program as community midwives.  These community midwives are now important community leaders and health advocates… Since the initiation of the local birth program, perinatal outcomes have improved to levels that are better than the Quebec average and care is more culturally appropriate.”⁹⁴

In a participatory research project conducted by Pauktuutit Inuit Women of Canada, seventy-five interviews were conducted with traditional Inuit midwives (average age 62 years) who had assisted with a total 516 births.⁹⁵  Inuit midwifery is an important health indicator to be included in an Inuit women’s GBA.
 
Another issue (related) which Inuit women have cited as a serious concern is Fetal Alcohol Syndrome (FAS).  “Inuit women in particular indicated the need for studies on the prevalence of Fetal Alcohol Syndrome (FAS) in their communities, along with locally-developed education and prevention materials.”⁹⁶

The Land and Country Food

Numerous reports cited here have remarked on the value that Inuit women place on being able to get “out on the land.” Women “…refer to camping as a happy time when life seems “right” again.  In part, I believe this is because women are able to relax as they return to a lifestyle away from the problems and constant stress associated with settlement life.  For example, women report that there is little or no alcohol and drugs in the camps, and family violence is reduced or eliminated during this time on the land.  Life on the land is also a return to their cultural origins, so essential to their identification with the Inuit way.”⁹⁷

Importance of Country Food

One cannot understand the importance of country food to Inuit without understanding the complex web of meaning interwoven with the activities of hunting and gathering, food preparation, sharing and consumption.  

Our people are by tradition a people of the land.  Our culture is strongly tied to the land and so are our people and our communities.  Inuit have always recognized the fragility of the world they inhabited and the traditional Inuit way been to live in harmony with the land that feeds and sustains us. (Pauktuutit Inuit Women of Canada)⁹⁸

According to the most recent survey of Inuit around the circumpolar world, 90% think that traditional hunting and craft activities are important to their identity.⁹⁹   Research has shown what Inuit know: southern predictions of the demise of Inuit land-based traditions were incorrect.¹⁰⁰   A substantial portion of Inuit still engage in traditional activities in addition to working in the monetized economy.¹⁰¹   “Traditional food is of fundamental significance in the lives of Inuit individuals, households, and communities, holding nutritional, physical, cultural, spiritual and economic importance.”¹⁰²   Country food fully represents the culmination of Inuit values and culture.  “As many Inuit assert, the production and exchange of country food (i.e. food hunted, fished, and harvested locally, including caribou, marine mammals, arctic char, and wild plants and berries) are vital cultural activities practiced by a wide range of Inuit of all ages and backgrounds, and many Inuit claim that these activities are necessary for the survival of Inuit tradition and for the well-being of Inuit communities.”¹⁰³   The important personal, social and cultural attributes associated with hunting, gathering, and preparing of country food are summarized here from research conducted in Inuit regions over the past twenty years:

1. Hunting and preparing country food develops and maintains one’s physical, mental and spiritual health including contributing to physical fitness and overall good health;
2. it affords the opportunity for elders to teach spirituality and virtues such as patience, determination, modesty, humility and sharing practices;
3. it contributes to building one’s pride and confidence which fosters a healthy self-esteem; hunting and gathering practices bring respect from others while providing oneself and the community with healthy food; 
4. it favors sharing in the community and it saves money;
5. it keeps people “in tune with” nature, an essential aspect of Inuit life, and it strengthens cultural ties by providing opportunities to pass on traditional knowledge; 
6. it teaches survival skills still highly relevant for many Inuit who today continue to enjoy activities on the land and land-based work; it contributes to children’s education and education to all on the natural environment;
7. it teaches the various roles involved with food preparation, as well as sewing from the animal skins and using animal parts medicinally for healing purposes.¹⁰⁴  
   

Consumption of Country Food as a Positive Health Determinant

Country food consumption rates show wide variance between men and women: studies on Qikiqtani Inuit¹⁰⁵  show that Inuit men (aged 13-60) consume larger amounts of country food than Inuit women, however Inuit girls consume more country food than Inuit boys, and Inuit women over 60 years old consume slightly more country food than men in this age bracket.  Consumption rates and related affects of country food for male and females in different age brackets clearly show the relevancy and necessity for gender-based analysis.  It is also essential to consider the particular threats that chemicals ingested through food pose to pregnant and nursing mothers (see below).  Given the importance of country food to the Inuit woman’s diet, an indicator of her health might be the presence of a functioning community freezer in her community, and access to meat placed there by hunters for those who need it. ¹⁰⁶

Traditional economic activities, such as hunting, fishing and picking berries, and the traditional Inuit diet are considered vital components of an effective health promotion strategy…changes from the traditional way of life tend to increase the likelihood of Inuit developing the risk factors associated with heart disease and diabetes…research suggests that the traditional Inuit diet may provide important nutrients known to protect against respiratory infections and heart disease, and may also lessen risk factors associated with diabetes. ¹⁰⁷

All aspects of gathering, hunting, preparing and sharing country food are essential to the harmony and wellbeing of healthy Inuit communities.  Because country food encompasses such importance to Inuit, lack of access to or loss or contamination of country food poses the threat of deprivation, scarcity and a loss of one’s own cultural and social identity. In the recent first large-scale survey of Inuit and First Nation women’s hunting and fishing practices, affordability of hunting equipment was shown to be a factor significantly restricting Inuit women’s hunting and fishing activities.¹⁰⁸  Due to the high cost of hunting equipment, the survey shows that poverty prevents three times as many Inuit women from hunting and fishing than Yukon First Nations women. 

Decline in country food consumption also may have a contributing biological effect to decline in mental well-being of Inuit women and men. “The combined decline in mental health and the disappearance of traditional diets in circumpolar peoples makes a direct connection between diet and mental health in these people a very real possibility.”¹⁰⁹

Inuit Women and Food Security

The Food and Agricultural Organization defines food security as existing “when all people, at all times, have access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life.” ¹¹⁰  Unfortunately as many as forty-nine percent of Nunavut households reported having “often” or “sometimes” not enough to eat during the previous year.  This compares to the Canadian average of seven per cent.¹¹¹

This is mostly due to high prices; the cost differential between north and south is dramatic: “a nutritious food basket for a family of four that costs $125 in Ottawa, costs $209 in Salluit, Nunavik and $260 in Arctic Bay, Nunavut.”¹¹²  Even though they are expensive in Inuit communities, the store placement, marketing and sugar attraction of market foods can lead to increased consumption.  Perhaps “counter-intuitively”, poverty may also lead to increased consumption of “junk food” and associated obesity since the “association between poverty and obesity may be mediated in part by the low cost of  energy-dense foods, and may be reinforced by the high palatability of sugar and fat.”¹¹³   Traces of trans fats commonly associated with “junk food,” are now twice as high in Inuit as in southern Canadians.¹¹⁴

Contaminants in Country Food: An Inuit Women’s Health Indicator
The Arctic environment plays a significant role in the health of Inuit women. The McGill University based Centre for Indigenous Peoples and Nutrition and Environment (CINE) has done extensive research on persistent organic pollutants (POPs) and heavy metal contaminants found in the traditional food system in the Arctic.  Studies undertaken by CINE, Barry Commoner’s Source-to-Receptor research, and Canada’s Northern Contaminants Program, show that “levels of persistent organic pollutants (POP’s) in Canadian Inuit populations are among the highest observed in the world.”¹¹⁵   This is one of the most direct and growing health concerns for Inuit women.

POPs in the food chain are an example of the two general divisions of health issues: medical health issues (biological factors) and non-medical health issues (social, economic and environmental factors).  POPs are a medical health issue because they are known carcinogens and can be measured in breast milk of Inuit women; POPs are a general environment health determinant issue to the extent that they can be found deposited on the tundra and can be tracked back and “fingerprinted” to particular smokestacks (primarily in the USA).  “U.S. facilities were found to have contributed between 70-82% of dioxin deposited at the eight locations in Nunavut….Among the study’s main findings: relatively few types of sources and individual facilities are responsible for the majority of dioxin deposited in Nunavut, which makes remedial action more manageable.  For example, 35% of the dioxin present at…Coral Harbour is attributed to only 19 sources in the south.”¹¹⁶   Although much attention has focused on measuring the heath effects in the “receptor” population, just as valid an approach would be to predict health effects using the decreased or increased output from the (known) culprit smokestacks and sources as a health indicator.¹¹⁷

Due to the “leap-frog effect” of weather patterns moving through atmospheric pathways, chemicals such as PCB’s and POP’s migrate outward from the equator gathering in the highest concentration in regions closest to the poles; in the Canadian Arctic these are the Inuit regions.  Due to biomagnification the highest concentration of chemicals is found in those at the top of the food chain (humans, seals, bears) because they consume the accumulation of chemicals ingested by their prey (from carrier sources such as lichens, mosses, shrubs, and algae).¹¹⁸   These processes result in a disproportionate accumulation of chemicals being ingested by wildlife and humans in northern regions (which are otherwise some of the cleanest areas of the earth), and makes Inuit some of the most POP-exposed peoples in the world.  

Studies show that Inuit are more susceptible to POPs than inland Aboriginal peoples due to consuming high quantities of land-based and marine mammals whereas the inland Aboriginal peoples consume less quantity (generally) of only wild meat.  Within Inuit communities, pregnant women and children are at the greatest risk because “the periods of fetal and early childhood development are those associated with the greatest vulnerability to toxic substances.”¹¹⁹

While studies indicate high levels of some toxins in sea and land-based animals ingested by Inuit, there is also concurrent evidence of nutritional and preventative benefits of country food.  So it is a balancing act; Inuit have the right to make informed decisions when weighing the nutritional benefits of country food against the risk of contaminants.  For example, while mothers from the east coast of Hudson Bay in Nunavik may be aware that their breast milk and blood is known to contain organic chlorines (and that their PCB levels are approximately five times higher than those women in southern Canada) they are still advised—based on the widely acknowledged benefits and nutriments of breast milk—to breast feed their children.¹²⁰ 

“Understanding dietary intake in detail is needed to determine the best way to modify the diet (which species, how much?) to reduce intake of certain or all contaminants, while maintaining maximum possible nutrients and cultural benefits that traditional food provides.”¹²¹   For example, while caribou, arctic char and polar bear have lower levels of PCB’s and toxins, beluga, walrus and narwhal blubber, which are higher in fat, have a much higher rate of chemicals present. Accurate and updated seasonal food analysis and the associated gender and age health risks of various country foods is a vital health indicator for Inuit women and children.

This health indicator work must be done in a balanced and culturally sensitive manner in order to not dissuade Inuit women from consumption of country food and its associated benefits.  “To ignore the many benefits of traditional food while scrutinizing possible harmful elements in food and the environment is to focus on the “poison” and “repair medicine” when surrounded by health, and the beauty and meaning of culture.  Health promotion and health education would get so much further with the people involved if there would be more “good news” and reinforcement of the positive sides of health that exist within the local culture.”¹²² 

Dangers of Climate Change: Environmental Indicators as Health Indicators

Climate change is a serious concern for Arctic populations.  An increase in airborne and water contaminant and changes in temperature, wildlife migration, mobility, and accessibility to hunting, gathering and family outings on the land will continue to increase and effect the life of Inuit (and northern wildlife), and pose serious threat to the preservation of traditional cultural practices.  The short and long term effects of climate change are unclear; it is in the interest of Inuit health and wellbeing to closely monitor health indicators of climate change as new scientific evidence is presented from the international communities such as the Commission for Environmental Cooperation (CEC), the Arctic Monitoring and Assessment Program (AMAP), and the National Oceanic and Atmospheric Administration (NOAA), whose work also includes monitoring levels of pollutants and their effects in the Arctic.

The Euro-Canadian Economy, Government and Institutions

No analysis of Inuit women’s life is complete without including the pivotal role played by the southern economy, government and institutions.  Inuit women have integrated wage work, formal education, and western medicine into the Inuit way with a success that has surprised some observers who predicted the demise of Inuit culture.¹²³  Nonetheless, the southern way still exerts major pressures, some negative, on the Inuit way.  Airborne contaminants from the south affect Inuit land and country food; health and education institutions can displace or erode faith in Inuit elders and Inuit midwives and healers, and the Inuit women teachers who form the majority of the local workforce in most schools report that Inuit languages are deteriorating under pressure from English media,  schooling, and indifference from southern male school principals.¹²⁴

On the other hand, southern health services are valued even though they do not come close to approximating the level of service and access that southern Canadians enjoy.  In the words of Inuit leader Jose Kusugak: “Forget 2-tier, Inuit still after 1-tier care.”¹²⁵

Without reviewing all the economic indicators that will follow in the Inuit Women Health Indicator Report , it may still be worth drawing attention here to one area that emerges as a repeated concern from Inuit women in health fields: regulatory regimes that restrict Inuit hunting, restrict midwifery, restrict Inuit childcare, and restrict home businesses—and how these impact the economic and cultural life of Inuit women, and thus likely affect women’s health.  

Institutions and Regulations restricting Inuit Women’s Health and Cultural Practices
Southern determinants of health do not normally include indicators seeking to identify regulations interfering with wellness practices; however the health of Inuit women and families is detrimentally affected by certain government regulatory practices which are narrowly designed for southern Canadian culture.  The southern-designed Firearms law, for example, has had unintended but limiting effects on Inuit hunting.  Health indicator questions should ask Inuit respondents: “Were you or anyone in your family prevented from hunting for country food in the past year due to lack of possession of a Firearms Acquisition Certificate (FAC)?”  As country food is a vital part of Inuit well-being, southern laws restricting the age access to ammunition for hunters without an FAC has a direct impact on Inuit diet.  Inuit women without access to country food might be counseled to turn to Food Mail for shipments of subsidized nutritious food from the south (food mail is heavily subscribed to by non-Inuit in the Arctic); however most Inuit women in smaller communities would find food mail inaccessible due to banking requirements.¹²⁶

Southern regulatory practices have also restricted Inuit midwifery and daycare.  Despite the presence of successful Inuit midwifery project in Povungnituk, the Quebec government passed legislative barriers related to the practice of midwifery in 1999.  “This legislation makes no mention of either the educational or practical component of midwifery as delivered in Nunavik.  It has implied that Inuit women can no longer maintain responsible for maternity care services and their administrators, and must step aside to accommodate forced trusteeship from southern professionals.”¹²⁷   A culturally sensitive GBA of Inuit women’s health indicators should address availability of Inuit midwifery services and note the dangers of regulatory barriers.  Midwife and elder Elisapee Ootoova, who has assisted in dozens of births in Pond Inlet over 40 years, was also told by government health workers that she would have to obtain certification through an English-language midwife course in Ottawa or she would be barred from practicing (she speaks only limited English).¹²⁸

Availability of non-institutional home-based childcare is a key determinant of Inuit women’s health and the healthiness of their families.  In Nunavut, where the majority of Inuit women live in social housing, there are legal restrictions on home-based businesses including childcare facilities, preventing women from the accessing home—based childcare, the most common form available in the smaller communities.¹²⁹  Thus women involved in wage work are forced, for example in Iqaluit, to send their children to one of several English-only daycares in the city (the first Inuktitut daycare is just opening this year).   In turn, these English daycares “have to hire southerners because of the regulations.  The manager of the daycare centres complain that there are not as many regulations for NWT daycares as exist for daycares in Ontario.  The government regulations state that you can’t manage a daycare unless you have a degree – this eliminates any Inuit applicants.  Over-regulation of the daycare centres is a problem…”¹³⁰

Employing a gender-based analysis might lead us to speculate that an Inuit Land Claim group with an all-male Board of Directors may be more inclined to devote legal resources to fighting restrictions on hunting, but less likely to start court action to protect Inuit women’s childcare or midwifery rights; with this as a working assumption, organizations  might be able to suggest indicators that might expose these power imbalances and roadblocks.

In addition to over-regulation is a lack of economic and institutional support for traditional childcare within extended Inuit families.  Daycare subsidies are destined for institutional licensed operators and are not available to aunties and grandmothers who provide informal childcare to Inuit women and families.  Even the informal childcare practices of Inuit families are under siege: a southern male hamlet official in Qikiqtarjuaq (Broughton Island) has boasted to staff at Kakivak Association (Qikiqtani region) that if he could get the government subsidy for childcare doubled he would be able to “break them of their habit of keeping their children at home”, that is, convince the Inuit women of his hamlet to put all their children into the daycare centre and abandon small-scale family childcare entirely.¹³¹

This story and attitude help to illustrate the importance of distinguishing indicators that measure what is genuine community well-being for Inuit women and indicators that measure an increase in southern regulated services—services that may bring some assistance, but may also displace or disempower Inuit women and their communities.  “Whenever hierarchical systems become more powerful than the community, we see the flow of authority, resources, skills, dollars, legitimacy, and capacities away from communities to service systems.  In fact, institutionalized systems grow at the expense of the communities.  As institutions gain power, communities lose their potency and the consent of community is replaced by the control of systems; the care of community is replaced by the service of systems; the citizens of community are replaced by the clients and consumers of institutional products.”¹³²   Having an Inuktitut-speaking, Inuit-owned and run, daycare available in her community is likely an indicator of a woman’s wellness; having a southern English-run institution seeking to “break her of their habit of keeping her children at home” may not be a positive indicator.  In the cautionary words of the Nunavik Educational Task Force:

Wisdom is a respected part of our heritage....Wisdom was essential for survival on the land, but it is not essential for survival in institutions.  Institutions rarely encourage independence because they need people to comply with tasks that due to lack of time, have not been fully explained.  The negative effects of institutions are something that the elders of southern cultures have been concerned about for a long time....Once institutions are set up (they) can be very difficult to control, and can cause people to lose sight of wisdom, of humanity, and of what is really important in life....

With the introduction of …southern institutions into our lives it became more difficult to know if someone had wisdom.  In our past we had a high respect for anyone among us who knew what to do in different situations.  The elders, skilled hunters, artisans and healers among us were all highly respected.  So it was natural for us to respect the newcomers who seemed to know how to survive and how to make their organizations work.  Their power looked like wisdom... We now know that it is a mistake to automatically assume that people who work for organizations have wisdom, or even that they understand much of what they are doing.  Organizations ... operate by dividing actions up into many small pieces...  Life becomes much easier, but it also means that these people may never understand the whole, and never have a clear idea of what they are doing or why.

Without the need for it, wisdom does not appear.  Without wisdom, peoples’ bodies may live, but their spirit will die.  Institutions are very powerful, and they can do much good, but they can also have side-effects that act like poison to the spirit….Our people did not have any institutional immunity, just as we had no immunity to measles or alcohol.  When these institutions came into our lives we had no way to deal with their poisonous side effects, their tendency to undermine wisdom, and our spirits slowly began to die.  In our weakened condition we attracted even more services and more rescuers, and the cycle got worse.¹³³

Endnotes:
  1. Quitsak Tarkiasuk is quoted in Downie, D., Fenge, T.,(eds), Nothern Lights Against POPs: Combatting Toxic Threats in the Arctic, McGill-Queen's University, Press, 2003, p.xv
  2. R.Colman, A Profile of Women’s Health Indicators in Canada, Women’s  Health Bureau, Health Canada, July 2003, pp126-7
  3. Report of the Standing Committee on Status of Women, Gender-Based Analysis: Building Blocks for Success; April 2005
  4. Health Canada definition; retrieved February 28, 2007, from: http://www.hc-sc.gc.ca/hl-vs/pubs/women-femmes/gender/sexes_e.html
  5. Poppel, Birger, Jack Kruse, Gérard Duhaime, Larissa Abryutina. 2007. Survey of Living Conditions in the Arctic: SLiCA Results. Anchorage: Institute of Social and Economic Research, University of Alaska Anchorage. Retrieved March 27, 2007 from: web at www.arcticlivingconditions.org
  6. Frank James Tester & The Kinngait Harvest Society, IGLUTAQ (in my room): THE IMPLICATIONS OF HOMELESSNESS FOR INUIT; A Case Study of Housing and Homelessness in Kinngait, Nunavut Territory, Kinngait, Nunavut Territory, April, 2006, p.41
  7. See for example interview with Meeka Arnakaq, Pangnirtung elder; September, 2003, at Pauktuutit Inuit Women of Canada’s Nuluaq Project: National Inuit Strategy for Abuse Prevention, retrieved March 23, 2007, from: http://www.pauktuutit.ca/nuluaq/default.asp?pg=1033
  8. See for example “Research Report: Applying Inuit Cultural Approaches in the Prevention of Family Violence and Abuse”, Pauktuutit Inuit Women of Canada’s Nuluaq Project, retrieved March 23, 2007, from: http://www.pauktuutit.ca/nuluaq/default.asp?pg=1066
  9. Janet Smylie, A Guide for Health Professionals Working with Aboriginal Peoples: The Sociocultural Context of Aboriginal Peoples in Canada, Journal of the Society of Obstetricians and Gynecologists of Canada, December, 2000; p. 5
  10. B. Jeffery, S. Abonyi, R. Labonte, and K. Duncan, Engaging Numbers: Developing Health Indicators that Matter for First Nations and Inuit People, Journal of Aboriginal Health, NAHO, Ottawa, September 2006, pp 48-9
  11. J. O’Neil, “The Politics of Health in the Fourth World: a Northern Example,” in K.Coates and W. Morrison (eds) Interpreting Canada’s North, Toronto: Copp Clark, 1989, p.285
  12. Janet Smylie, A Guide for Health Professionals Working with Aboriginal Peoples: The Sociocultural Context of Aboriginal Peoples in Canada, Journal of the Society of Obstetricians and Gynecologists of Canada, December, 2000; p. 8
  13. Ibid, p.9
  14. note that low diabetes numbers may also be in part due to lack of monitoring: “A 2002 Study in Repulse Bay, Nunavut reported a diabetes prevalence of 5% among adults over 18 years of age, diagnosed by blood sampling. Seventy percent of cases had not been previously diagnosed.”  The authors go on to comment: “The history of development of high diabetes rates in other aboriginal populations worldwide, in combination with the prevalence of diabetes risk factors, does raise concerns about the potential for similar increases in Inuit diabetes rates.  However, the still relatively low prevalence of diabetes, when compared to other aboriginal groups, presents an opportunity for prevention of an epidemic among Canadian Inuit. Strategies for containing the profound effects of epidemic diabetes among Canada’s aboriginal people have been outlined in the Canadian Aboriginal Diabetes Initiative; the primary prevention component includes awareness-raising public education, particularly aimed at youth, as well as support for community-based activities that promote healthy eating and active lifestyles.  Community activities aimed at diabetes prevention could be beneficial for cardiovascular disease prevention as well, given the considerable overlap in risk factors for the two diseases. Secondary prevention activities should include mass population screening for diabetes, pre-diabetic conditions, and risk factors such as obesity and inactivity, with early intervention for affected or high-risk individuals and families. Tertiary prevention to limit the impact of established diabetes involves health care workers’ systematic implementation of the Canadian Diabetes Guidelines at the individual level.” L. Elliott, A. Macaulay, Public Health Surveillance In the Inuit of Canada’s Four Northern Inuit Regions: Currently Available Data and Recommendations for Enhanced Surveillance; Prepared for Inuit Tapiriit Kanatami; Department of Community Health Sciences, University of Manitoba; July 2004, p.21
  15. Aboriginal Health in Canada, p. 91
  16. L. Elliott, A. Macaulay, Public Health Surveillance In the Inuit of Canada’s Four Northern Inuit Regions: Currently Available Data and Recommendations for Enhanced Surveillance; Prepared for Inuit Tapiriit Kanatami; Department of Community Health Sciences, University of Manitoba; July 2004, p.48
  17. Statistics Canada, Survey on Living Conditions in the Arctic: Inuit peoples of Labrador, Nunavik, Nunavut and the Inuvik region: Feasibility Study Draft, Special Surveys Division, Statistics Canada, October, 1998:15
  18. L. Elliott, A. Macaulay, Public Health Surveillance In the Inuit of Canada’s Four Northern Inuit Regions: Currently Available Data and Recommendations for Enhanced Surveillance; Prepared for Inuit Tapiriit Kanatami; Department of Community Health Sciences, University of Manitoba; July 2004, p.18
  19. Statistics Canada, Survey on Living Conditions in the Arctic: Inuit peoples of Labrador, Nunavik, Nunavut and the Inuvik region: Feasibility Study Draft, Special Surveys Division, Statistics Canada, October, 1998:15
  20. S. Latouche, in Wolfgang Sachs (ed), The Development Dictionary: A Guide to Knowledge as Power, Witwatersrand University Press, Johannesburg, 1997; p. 256, 258
  21. Gerard Duhaime, Edmund  Searles, Peter J. Usher, Heather Myers & Pierre Frechette, Social Cohesion and Living Conditions in the Canadian Arctic: From Theory to Measurement, Kluwer Academic Publishers, Netherlands, December, 2002, page 300
  22. National Science Foundation and Science Daily report: “Family Ties And Traditional Activities Keep Arctic Communities Vital, Survey Reveals,” accessed from http://www.sciencedaily.com/releases/2007/03/070321130545.htm
  23. Minor, Kit, Issumatuq: Learning from the Traditional Healing Wisdom of the Canadian Inuit, Fernwood Publishing, Halifax, 1992; p.83
  24. Pauktuutit Inuit Women of Canada, The Inuit Way, 2006, p. 1, 6
  25. For example: “Many families leave the permanent communities during the spring and summer to set up their camps.  This is an important part of traditional culture, far from modern distractions, the young are immersed in their culture and language for long periods of time.  They learn harvesting and land survival skills used by Inuit for thousands of years.” In Inuit Tapiriit Kanatami, Inuit Kanatami: Inuit of Canada, Ottawa, 2003:18
  26. J. Weatherford, Indian Givers: How the Indians of the Americas Transformed the World, New York: Crown; p 136, 145
  27. see media coverage of SLiCA surveys of Inuit life today; for example: National Science Foundation and Science Daily report: “Family Ties And Traditional Activities Keep Arctic Communities Vital, Survey Reveals,” accessed from http://www.sciencedaily.com/releases/2007/03/070321130545.htm
  28. R. Sconlon and S.W. Sconlon, Intercultural Communication, Cambridge MA: Blackwell (1995), p.145
  29. Kaliss, Tony, What Was The ‘Other’ That Came On Columbus’s Ships?: An interpretation of the writing about the interaction between Northern Native peoples in Canada and the United States and the ‘other’, Journal of Indigenous Studies 3(2); Gabriel Dumont Institute of Native Studies and Applied Research, Saskatoon, Saskatchewan, 1997; p. 37
  30. Professor C.A.Bowers, University of Oregon; retrieved March 19, 2007 from: http://cabowers.net/pdf/Evolution_Constructivist.pdf
  31. R. Sconlon and S.W. Sconlon, Intercultural Communication, p.145
  Ibid.
  32. A.L. Jenkins, T.W. Gyorkos, K.N. Culman, B.J. Ward, G.S. Pekeles, E.L. Mills,
 “An overview of factors influencing the health of Canadian Inuit infants,” International Journal of Circumpolar Health 62:1 2003; p.17
  33. Tester, F. & Kulchyski, P. 1994. Tammarniit: Inuit relocation in the eastern Arctic, 1939-63. Vancouver, University of British Columbia Press
  34. Sara Arnatsiaq, Makivik, QIA team up to investigate dog slaughter, Nunatsiaq News July 12, 2002; retrieved march 22, 2007 from: http://www.nunatsiaq.com/archives/nunavut020712/news/nunavik/20712_1.html
  35. J. Thompson, “Convict blames sanatorium stay for life of crime”, Nunatsiaq News, March 16, 2007, p.1
  36. Aboriginal Health in Canada, p.202
  37. Ibid.
  38. http://www.fhs.mcmaster.ca/history/chedoke.htm
  39. J. Thompson, “Convict blames sanatorium stay for life of crime”, Nunatsiaq News, March 16, 2007, p.1
  40. Aboriginal Health in Canada, p.204
  41. ZZ-names of respondents; Kowesa, Ulrike, h.tait, itk, p. bird, etc?
  42. Development of a First Nations Health Reporting Framework, Prepared by the Assembly of First Nations and Social Development, March, 2005, page 19
  43. The role that a framework can play in foregrounding certain issues and hiding others is noted by Kaliss and Fridere: “I agree with Fridere’s statement, in his 1983 book, Native People in Canada: Contemporary Conflicts [page 294], that “The nature of the analytical framework through which Native-White relations are viewed largely determines what solutions can be put forward.” In Kaliss, Tony, What Was The ‘Other’ That Came On Columbus’s Ships?: An interpreatation of the writing about the interaction between Northern Native peoples in Canada and the United States and the ‘other’, Gabriel Dumont Institute of Native Studies and Applied Research, Saskatoon, Saskatchewan, 1997. p. 28
  44. Canadian Institutes of Health Research, Health Research Needs North of 60: Northern Town Hall Meetings, September 2001 (published January 25, 2002), p.12
  45. Allen, Kristiann, The Mental Health of Indigenous Peoples (Culture & Mental Health Research Unit, Report No.10), Division of Social and Trans-cultural Psychiatry, McGill University, Montreal, 2001, p.140
  46. Pauktuutit Inuit Women of Canada, Arnait: The Views of Inuit Women on Contemporary Issues, 1991, p.10
  47. interviewed in A. Rojas, Iglumi Isumatait: A Reinterpretation of the Position of Inuit Women, unpublished thesis, Trent University, June 2001, p.83
  48. Oakes, Jill & Riewe, Rick, Culture, Economy & Ecology: Case Studies in the Circumpolar Region, The Cider Press, Milbrooke, Ontario, 1997, p.80
  49. Pauktuutit Inuit Women of Canada, The Inuit Way, 2006, p. 22
  50.  Pauktuutit Inuit Women of Canada, The Inuit Way, 2006, p. 16-20
  51. Arctic Council Sustainable Development Working Group, Analysis of Arctic Children and Youth Health Indicators, August 2005, p.91
  52. Gerard Duhaime, Edmund  Searles, Peter J. Usher, Heather Myers & Pierre Frechette, Social Cohesion and Living Conditions in the Canadian Arctic: From Theory to Measurement, Kluwer Academic Publishers, Netherlands, December, 2002, page 301,303
  53. Minutes of Steering Committee Meeting SLiCA-Canada, SLiCA, Iqualuit, Nunavut, April 18-19, 2000, page 7
  54. Frank James Tester & The Kinngait Harvest Society, Iglutaq (in my room): THE IMPLICATIONS OF HOMELESSNESS FOR INUIT; A Case Study of Housing and Homelessness in Kinngait, Nunavut Territory, April, 2006, p.72
  55. Joanasie Akumalik, personal communication, January, 2007
  56. Pauktuutit Inuit Women of Canada, Inuit women’s health: overview and policy issues, March, 2000, p.4
  57. Callaghan, M. et al (2002) Women and Housing in Canada: Barriers to Equality. Retrieved March 23, 2007, from http://www.equalityrights.org/cera/docs/CERAWomenHous.htm.
  58. Government of Nunavut and Nunavut Tunngavik Inc., Nunavut’s Ten Year Housing Action Plan, September 2004, P.8
  59. Frank James Tester & The Kinngait Harvest Society, Iglutaq (in my room): THE IMPLICATIONS OF HOMELESSNESS FOR INUIT; A Case Study of Housing and Homelessness in Kinngait, Nunavut Territory, April, 2006, p.41
  60. Pauktuutit Inuit Women of Canada, Inuit Women: The Housing Crisis and Violence (1986), p.9.
  61. Pauktuutit, The Nuluaq Project Research Report: Applying Inuit Cultural Approaches in the Prevention of Family Violence and Abuse, Pauktuutit Inuit Women of Canada, retrieved March 27, 2007 from: http://www.pauktuutit.ca/nuluaq/default.asp?pg=1066
  62. J. Bell, (editorial), GN must save Qimaavik, Nunatsiaq News, October 6, 2006, retrieved on March 27, 2007, from http://www.nunatsiaq.com/archives/61027/opinionEditorial/editorial.html
  63. Pauktuutit, National Strategy To Prevent Abuse In Inuit Communities, Pauktuutit Inuit Women of Canada, retrieved March 27, 2007, from: http://www.pauktuutit.ca/nuluaq/pdf/AbusePreventionStrategy2006_e.pdf
  64. Pauktuutit, The Nuluaq Project: Interview with Network Partner, Pauktuutit Inuit Women of Canada, retrieved March 27, 2007, from: http://www.pauktuutit.ca/nuluaq/default.asp?pg=1033
  65. Pauktuutit, The Nuluaq Project Research Report: Applying Inuit Cultural Approaches in the Prevention of Family Violence and Abuse, Pauktuutit Inuit Women of Canada, retrieved March 27, 2007 from: http://www.pauktuutit.ca/nuluaq/default.asp?pg=1066
  66. Archibald, Linda & Grey, Roda, Evaluation of Models of Health Care Delivery in Inuit Regions, Inuit Tapiriit Kanatami, Ottawa, 2004, page 13
  67. Archibald, Linda & Grey, Roda, Evaluation of Models of Health Care Delivery in Inuit Regions, Inuit Tapiriit Kanatami, Ottawa, 2004, page 13
  68. Archibald, Linda & Grey, Roda, Evaluation of Models of Health Care Delivery in Inuit Regions, Inuit Tapiriit Kanatami, Ottawa, 2004, page 3
  69. Thanks to Frank Tester for telling us this story, the details of which he ferreted out from the National Archives in Ottawa; the story will be printed in full in: Tester, F. & Kulchyski, P. (in press). Kiumajuk (Talking Back): Game Management, Community Development and Inuit Rights in the Eastern Arctic. Vancouver. University of British Columbia Press.
  70. Poppel, Birger, Jack Kruse, Gérard Duhaime, Larissa Abryutina. 2007. Survey of Living Conditions in the Arctic: SLiCA Results. Anchorage: Institute of Social and Economic Research, University of Alaska Anchorage. P. 13. Retrieved March 27, 2007 from: web at www.arcticlivingconditions.org
  71. Reimer, Gwen D., Female Consciousness: An interpretation of interviews with Inuit women, Inuit Studies 20 (2), 1996, p.90
  72. Reimer, Gwen D., Female Consciousness: An interpretation of interviews with Inuit women, Inuit Studies 20 (2), 1996, p.91-2
  73. R.A. Shweder & E.J. Bourne, Does the concept of the person vary cross-culturally?, Essay from the book Culture Theory, Cambridge University Press, 1984, pp194-195
  74. NSDC, Inuit Qaujimajatuqangit as a planning and organizational tool, Igloolik, Nunavut, 2000
  75. NSDC, Inuit Qaujimajatuqangit as a planning and organizational tool, Igloolik, Nunavut, 2000
  Annie  Quirke, personal communication, July 2001
  76. Oakes, Jill & Riewe, Rick, Culture, Economy & Ecology: Case Studies in the Circumpolar Region, The Cider Press, Milbrooke, Ontario, 1997, p. 126
  77. Oakes, Jill & Riewe, Rick, Culture, Economy & Ecology: Case Studies in the Circumpolar Region, The Cider Press, Milbrooke, Ontario, 1997, p.110
  78. Nunavik Educational Task Force, Silatunirmut: The Pathway to Wisdom, Lachine, Quebec: Makivik Corporation; 1992, p15, 55
  79. J. O’Neil, “The Politics of Health in the Fourth World: a Northern Example,” in K.Coates and W. Morrison (eds) Interpreting Canada’s North, Toronto: Copp Clark, 1989, p.285
  80. Inuit healing in contemporary Inuit society, March 31, 2004, report by Pauktuutit Inuit Women of Canada; retrieved March 21, 2007 from: http://www.pauktuutit.ca/pdf/publications/abuse/AHFNuluaqInuitHealing_e.pdf
  81. p. 9,  Inuit healing in contemporary Inuit society, March 31, 2004, report by Pauktuutit Inuit Women of Canada; retrieved March 21, 2007 from: http://www.pauktuutit.ca/pdf/publications/abuse/AHFNuluaqInuitHealing_e.pdf
  82. p. 11, Inuit healing in contemporary Inuit society, March 31, 2004, report by Pauktuutit Inuit Women of Canada; retrieved March 21, 2007 from: http://www.pauktuutit.ca/pdf/publications/abuse/AHFNuluaqInuitHealing_e.pdf
  83. p. 12, Inuit healing in contemporary Inuit society, March 31, 2004, report by Pauktuutit Inuit Women of Canada; retrieved March 21, 2007 from: http://www.pauktuutit.ca/pdf/publications/abuse/AHFNuluaqInuitHealing_e.pdf
  84. J. Bennett and S. Rowley (eds) Uqalurait: An Oral History of Nunavut, Montreal: McGill-Queen’s University Press, p.209-220
  85. p. 16, Inuit healing in contemporary Inuit society, March 31, 2004, report by Pauktuutit Inuit Women of Canada; retrieved March 21, 2007 from: http://www.pauktuutit.ca/pdf/publications/abuse/AHFNuluaqInuitHealing_e.pdf
  86. p.5, Inuit healing in contemporary Inuit society, March 31, 2004, report by Pauktuutit Inuit Women of Canada; retrieved March 21, 2007 from: http://www.pauktuutit.ca/pdf/publications/abuse/AHFNuluaqInuitHealing_e.pdf
  87. Archibald, Linda & Grey, Roda, Evaluation of Models of Health Care Delivery in Inuit Regions, Inuit Tapiriit Kanatami, Ottawa, 2004,p.31
  88. Inuit Women and Access to Health Service: Analysis of Survey Results from Pauktuutit Inuit Women of Canada 2000 AGM Health Survey, Pauktuutit Inuit Women of Canada and P.Bird, November 2000, p.13
  89. Ross M, Aboriginal women’s health: cultural values, belief, and practices, Journal of the Society of Obstetricians and Gynecologists of Canada, 1997;17:987-91
  90. Ibid.
  91. Archibald, Linda & Grey, Roda, Evaluation of Models of Health Care Delivery in Inuit Regions, Inuit Tapiriit Kanatami, Ottawa, 2004, p.36
  92. Pauktuutit Inuit Women of Canada, Keepers of Light: Inuit Women’s Action Plan, October 1, 2006, p. 11
  93. Janet Smylie, A Guide for Health Professionals Working with Aboriginal Peoples: Aboriginal Health Resources, Journal of the Society of Obstetricians and Gynecologists of Canada, March, 2001, p.3; “Unfortunately the Quebec government has recently passed legislation requiring all new midwives to successfully complete a three year training program outside Povungituk, which is available in French only.  This will severely limit the number of potential new Inuit midwives.”
  94. Information from the National Inuit Midwife Strategy, Pauktuutit Inuit Women of Canada; retrieved from: http://www.pauktuutit.ca/pdf/publications/pauktuutit/MidwiferyPoster_e.pdf
  95. Madeleine Dion Stout, Gregory D. Kipling, & Roberta Stout, Aboriginal Women’s Health Research Synthesis Project, Prepared for the Centres of Excellence for Women’s Health Research Synthesis Group, May, 2001, page 22
  96. Reimer, Gwen D., Female Consciouness: An interpretation of interviews with Inuit women, Inuit Studies 20 (2), 1996, p.83
  97. Pauktuutit Inuit Women of Canada, Inuit women’s health: overview and policy issues, March, 2000, p.4
  98. Poppel, Birger, Jack Kruse, Gérard Duhaime, Larissa Abryutina. 2007. Survey of Living Conditions in the Arctic: SLiCA Results. Anchorage: Institute of Social and Economic Research, University of Alaska Anchorage. Retrieved March 27, 2007 from: web at www.arcticlivingconditions.org
  99. J.S. Matthiasson, Living on the Land: Change Among the Inuit of Baffin Island, Peterborough: Broadview Press, p.159
  100. Poppel, Birger, Jack Kruse, Gérard Duhaime, Larissa Abryutina. 2007. Survey of Living Conditions in the Arctic: SLiCA Results. Anchorage: Institute of Social and Economic Research, University of Alaska Anchorage. Retrieved March 27, 2007 from: web at www.arcticlivingconditions.org
  101. Hing Man Chan, Karen Fediuk, Sue Hamilton, Laura Rostas, Amy Caughey, Harriet Kuhnlein, Grace Egeland & Eric Loring, Food Security in Nunavut, Canada: Barriers and Recommendations, International Journal of Circumpolar Health 65:5, 2006, page 417
  102. Gerard Duhaime, Edmund  Searles, Peter J. Usher, Heather Myers & Pierre Frechette, Social Cohesion and Living Conditions in the Canadian Arctic: From Theory to Measurement, Kluwer Academic Publishers, Netherlands, December, 2002, page 307
 103. list adapted from Table 2.5 in Kuhnlein, H., Chan, L., Egeland, G., Receveur. O, "Canadian Arctic Indigenous Peoples, Traditional Food Systems, and POPs", in Downie, D., Fenge, T., (eds), Northern Lights Against POPs: Combatting Toxic Threats in the Arctic, McGill-Queen's University Press, 2003
  104. Kuhnlein, H., Chan, L., Egeland, G., & Receveur, O., “Canadian Arctic Indigenous Peoples, Traditional Food Systems, and POPs” , in Downie, D., Fenge, T., (eds), Northern Lights Against POPs: Combatting Toxic Threats in the Arctic, McGill-Queen's University Press, 2003, p. 27
  105. Hing Man Chan, Karen Fediuk, Sue Hamilton, Laura Rostas, Amy Caughey, Harriet Kuhnlein, Grace Egeland & Eric Loring, Food Security in Nunavut, Canada: Barriers and Recommendations, International Journal of Circumpolar Health 65:5, 2006, page 427
  106. Archibald, Linda & Grey, Roda, Evaluation of Models of Health Care Delivery in Inuit Regions, Inuit Tapiriit Kanatami, Ottawa, 2004, p.12
  107. J. Lambden, O. Receveur, J.  Marshall, H.V. Kuhnlein, “Traditional and Market Food Access in Arctic Canada is Affected by Economic Factors, International Journal of Circumpolar Health 65:4 2006; p.339
  108. Nancy K. McGrath-Hann, Dana M. Greene, Ronald J. Tavernier, Abel Bult-Ito, Diet and Mental Health in the Arctic: Is Diet an Important Risk Factor For Mental Health in Circumpolar Peoples?, International Journal of Circumpolar Health 62:3, 2003, page 235
  109. Hing Man Chan, Karen Fediuk, Sue Hamilton, Laura Rostas, Amy Caughey, Harriet Kuhnlein, Grace Egeland & Eric Loring, Food Security in Nunavut, Canada: Barriers and Recommendations, International Journal of Circumpolar Health 65:5, 2006, page 417
  110. Ibid.
  111. Pauktuutit Inuit Women of Canada, Inuit women’s health: overview and policy issues, March, 2000, p.4
  112. J. Lambden, O. Receveur, J.  Marshall, H.V. Kuhnlein, “Traditional and Market Food Access in Arctic Canada is Affected by Economic Factors, International Journal of Circumpolar Health 65:4 2006; p.332
 113.  “Trans fat levels high in North, scientist says”, CBC, December 14, 2006; retreived March 10, 2007 from http://www.cbc.ca/health/story/2006/12/14/north-fats.html?ref=rss
  114. Shearer,R., & Han, S., Canadian Research and POPs: The Northern Contaminants Program”, in Downie, D., Fenge, T., (eds), Northern Lights Against POPs: Combatting Toxic Threats in the Arctic, McGill-Queen's University Press, 2003, p.42
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