1. Arctic Healthcare:
How is Healthcare Delivered to the Most Remote Regions of the World?
Hope Watson, College of Public Health, Kinesiology
The Arctic and Its Peoples
Telemedicine and eHealth
Infant Mortality and Maternal Health
Pipaluk
Challenges in Arctic Healthcare Delivery:
• Geography
• Population Density
• Transportation Infrastructure
• Language Barrier
• Medical Staff Turnover
• Health Stigmas and Cultural Differences
• Low Budget for Preventative Healthcare
• Food Security
Solutions for Equal Access and Quality
In the case of any complicated pregnancy in Greenland, the
expecting mother must be flown from her home to the Southern
Capital, Nuuk, to receive care from a physician able to oversee
the complications. This process involves Mothers likely have to
stay until the baby is delivered, which may mean being away from
their home settlement and family. This protocol was implemented
to reduce infant mortality gap between Greenland and Denmark.
The protocol initiative is due to the legal obligation under Self
Rule, where Denmark must provide equal access and quality of
care to Greenlandic people.
Health Inequalities
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Centralizing Care Facilities
Applications for Non-remote Geographies
The Arctic faces many similar clinical issues that are prevalent in other regions of the world, but are magnified due
to infrastructural and social challenges. Arctic regions have begun utilizing creative approaches to reducing these
problems; the solutions have potential to replicated elsewhere. Particularly, mental health issues have become the
largest epidemic in the past decade without enough healthcare personnel to meet demands. Effective
telemedicine and technology based phone application approaches that allow a professional to oversee multiple
patients real time.
Mental Health
A Pipaluk, literally translating to “sweet little thing” in Greenlandic , is a
multifunctional medical equipment machine. The Pipaluk machine is in every
location in Greenland and many other Arctic areas with more than 50 citizens. The
machine serves as: otoscope, tooth camera, EKG, scope (pulse, BP, saturation),
digital and video camera, stethoscope, spirometer, and scanner. Many health care
facilities in the Arctic do not have X-Rays or MRIs, so procedures must be regularly
outsourced to other facilities.
Currently in many Arctic regions receiving
proper care entails either the patient or the
doctor travelling once or twice per year. Lack of
specialist care is marked by health inequalities
in very high rates of chronic Otis media (causing
deafness), tuberculosis, and suicide. The main
goal of telemedicine is to have specialists
available at all times. One of the next steps
Greenland is looking to make is the ability to for
Danish surgeons to perform surgeries in Nuuk
utilizing surgical robots. All Arctic regions current
require vast distances of travel when medical
issues need to be outsourced. For nationalized
healthcare systems the transportation cost is
absorbed by the state and be up to 15% of
healthcare expenditures in remote regions.
Chukotka (Russia) and
Greenland have the highest rates
of suicide anywhere else in the
world. Rapid infrastructure and
lifestyle changes occurred in the
Arctic following WWII, where in
many areas roads had not
previously existed. Societies
transitioned from a hunting and
bartering society to a wage
earning society
One of the major barriers for equal access to
care is disproportionate amounts of money
spent on Northern and Southern populations,
where underfunding is prevalent in both
Denmark/Greenland and Russia/Chukotka
(exact measures unknown). The other
geographical areas see the inflating costs due to
travel cost and health care personnel dispersion
required for care. Reallocating nationalized
health care budgets and special funding for
indigenous populations and reducing
transportation costs creates potential to close
both the underfunding and inflation gap while
providing equal access and quality of care.
Health Expenditures ’05-’09
There are 11 main groups of indigenous peoples in Arctic regions, comprising approximately 1.73
million people. The Arctic is home to the lowest population densities in the world, even as low as
0.36/sq. mi in ice free areas.
Russia is home to about 80% of indigenous people (1.4 million), but this is
likely an unreported value due to lack of census and health surveillance.
Among youth aged 15-17:
• Among 32% a family member had
committed suicide.
• Among 18% a boy/girlfriend or good
friend had committed suicide.
• Among 18% a friend from school
had committed suicide.
• 42% knew ‘someone else’ who had
committed suicide
International Journal of
Circumpolar Health, 2015
Most of the housing in Arctic areas, particularly Greenland,
was government built as part of modernization in a post
WWII society. This has forced centralization on many of
the I on many of the indigenous Inuit people there.
Although this trend continues to make healthcare delivery
easier, it comes at a cultural cost of displacing people from
their homes and the land they are originally from.
A typical government
built house in Greenland.
Indigenous Arctic peoples have long been affected disproportionately by
disease. The early 1700s marked the first large smallpox waves on the
virgin soil populations. Modernly, Arctic people suffer the highest global
rates of Tuberculosis and large STI rates. They also suffer greater rates
of smoking and drinking addiction. Artic peoples usually suffer higher
rates of cancer, but research also shows special protective genetics for
certain cancers.
Average cost of
one-way flight
from Quaannaq
to Nuuk: $2,300.
0%
20%
40%
60%
80%
100%
Alaska Canada Greenland Norway, Sweden,
Finland
Russia
Percent Indigenous Persons by Region