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By Joe Sarcone
According to the World Health Organization (WHO) chronic diseases such as heart disease, cancer and diabetes are the leading cause of mortality in the world. Out of the 36 million people who died from chronic disease in 2008, nine million were under age 60 and 90 per cent of these premature deaths occurred in low and middle-income countries. While rates of some chronic disease have declined in Western populations, chronic diseases are a growing cause of mortality and morbidity among vulnerable populations. The Centre for Aboriginal Health Research at the University of Victoria states that the aboriginal people of Canada experience higher rates of chronic disease in comparison to the population overall and that this is true of indigenous peoples around the world.
Although some types of cancer are less likely to occur in indigenous populations, indigenous people are significantly more likely to have cancers that have a poor prognosis, usually diagnosed with cancer at a later stage, less likely to receive adequate treatment, and are more likely to die from cancers than other population groups (Australian Institute of Health and Welfare).
Consider this example from Alaska. According to the Alaska Native Epidemiology Center cancer is the leading cause of death among Alaska Native people. Prior to the mid 1900’s, cancer was considered a rare disease among Alaska Native people, but since that time, cancer incidence has increased dramatically. Cancer incidence rates are high among Alaska Native people and many types of cancer exceed the rates of cancer in the US white population.
There are more than 600 former military sites and an estimated 6,000 abandoned mine sites scattered throughout rural Alaska. Many of these contaminated sites are proximate to the more than 200 rural and remote Alaska Native villages. Alaska Native people practice customary and traditional use of the land for hunting, fishing and gathering or subsistence. Subsistence is a crucial social and cultural determinant of health.
Although the patterns of Alaska Native cancer incidence are largely explained by the higher prevalence of risk factors such as tobacco use, many Alaska Native people believe that increased cancer incidence is the result of exposure to contaminants from sources such as former military sites and abandoned mine sites. This is especially true for exposure to contaminants through ingestion of contaminated subsistence resources.
In most instances, human toxicology bears out a low level cancer risk associated with exposure to environmental contaminants despite what people may perceive as harm. However, we must address the perception of harm with indigenous populations. In indigenous communities human toxicology reaches right through community networks of obligation to deal directly with each individual living there. For example, what is the excess cancer risk to an individual of a certain age and weight, eating so many ounces of a food contaminated with a certain level of chemical over a lifetime? The outcome is a measure of the chance of morbidity or mortality for an exposed individual.
In traditional cultures the premature death of a hunter, linguist, story teller, healer or weaver represents more than the loss of the individual. It is the irreversible loss to the culture of traditional life. In this sense, the adverse effects of a chemical on a human being is urgently supplanted by the cultural toxicology on a way of being.
Human toxicology does not directly address concerns of irreversible cultural loss. Even as an indigenous population may assert that they are experiencing a high incidence of cancer due to exposure to an environmental contaminant, the public health practitioner will apply human toxicology and epidemiology to diminish environmental contaminant concerns and advise the people to stop smoking. The remaining perception of cancer linked to contaminant exposure resulting in cultural loss is devastating. Left unaddressed, this omission can come back to the government in unintended and costly ways.
Father Michael Oleska who has taught courses in cross-cultural communication for 35 years in the University of Alaska system has said that communication across cultures is approximate and imperfect and that when there is a miscommunication it is always the non-dominant culture that suffers the consequences. How can public health practitioners apply toxicology in a way that acknowledges and addresses overarching cultural loss and suffering?
Consider the following example. The National Collaborating Center for Aboriginal Health (NCCAH) at the University of Northern British Columbia identifies culture as a determinant of health that is intricately tied to traditional foods. “Not only are traditional foods valued from cultural, spiritual and health perspectives, but the activities involved in their acquisition and distribution allow for the practice of cultural values such as sharing and cooperation. Among Alaska Native peoples, traditional food consumption is associated with other measures of culture such as speaking a Native language, using traditional medicine and participating in traditional events.”
The literature describing the health benefits of customary and traditional subsistence diets is extensive. Traditional diets tend to contribute to beneficial fat profiles important for cardiovascular health, tend to be lower in carbohydrates, including simple sugars, an important consideration in conditions such as obesity and diabetes, and are rich in micronutrients.
Traditional subsistence food insecurity can result from many factors including concern over contaminants in the foods. In a 2004 report by the Tribal Association for Solid Waste Management and Emergency Response 34 percent of tribes surveyed changed how much traditional foods they ate because of concerns about a contaminated site and 30 percent have had a subsistence activity stop all together because of concerns about contaminated sites. The NCCAH cites that where there are issues of food insecurity traditional diets and associated physical activities have been replaced with patterns of consumption that increase the risk of developing chronic disease.
Cultural toxicology can address health burdens in indigenous populations by taking on concerns about contaminants in subsistence foods and providing information that allows people to make decisions that promote good nutrition, protect against chronic disease, maintain food security, and ensure cultural integrity.
One way this has been accomplished with Alaska Native communities is through onsite key informant interviews on the customary and traditional use of areas impacted by contaminants. Summaries of the interviews, approved by the communities, are shared with federal, state, tribal and non-profit agencies. These organizations have consistently stepped up to address community concerns elicited in the interviews in ways that contribute to informed decisions by communities and individuals on the use of traditional subsistence resources. The extent to which health burden in the communities is alleviated by these actions remains to be measured but the connection to improved health is strongly inferred. There is more work to be done here.
Joe Sarcone, MSPH has worked in public health at the interface of indigenous people and the federal government throughout 30 years of public service. He works at the U.S. Department of Health and Human Services.