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Adapting to the effects of climate change on Inuit health.

https://arctichealth.org/en/permalink/ahliterature104452
Source
Am J Public Health. 2014 Jun;104 Suppl 3:e9-17
Publication Type
Article
Date
Jun-2014
decision-making in an Inuit context. (Am J Public Health. 2014;104:e9–e17. doi: 10.2105/AJPH.2013.301724) James D. Ford, PhD, Ashlee Cunsolo Willox, PhD, Susan Chatwood, MSc, Christopher Furgal, PhD, Sherilee Harper, PhD, Ian Mauro, PhD, and Tristan Pearce, PhD THE CANADIAN ARCTIC IS widely regarded
  1 document  
Author
James D Ford
Ashlee Cunsolo Willox
Susan Chatwood
Christopher Furgal
Sherilee Harper
Ian Mauro
Tristan Pearce
Author Affiliation
James D. Ford is with the Department of Geography, McGill University, Montreal, Quebec. Ashlee Cunsolo Willox is with the Department of Community Health, Cape Breton University, Sydney, Nova Scotia. Susan Chatwood is with the Institute for Circumpolar Health Research, Yellowknife, Northwest Territories. Christopher Furgal is with the Department of Indigenous Environmental Studies, Trent University, Peterborough, Ontario. Sherilee Harper is with the Department of Population Medicine, University of Guelph, Ontario. Ian Mauro is with the Department of Geography, University of Winnipeg, Manitoba. Tristan Pearce is with the University of the Sunshine Coast, Maroochydor, Queensland, Australia.
Source
Am J Public Health. 2014 Jun;104 Suppl 3:e9-17
Date
Jun-2014
Language
English
Geographic Location
Canada
Publication Type
Article
File Size
924997
Keywords
Adaptation, Psychological
Arctic Regions
Canada
Climate change
Food Supply
Health status
Humans
Inuits
Vulnerable Populations
Abstract
Climate change will have far-reaching implications for Inuit health. Focusing on adaptation offers a proactive approach for managing climate-related health risks-one that views Inuit populations as active agents in planning and responding at household, community, and regional levels. Adaptation can direct attention to the root causes of climate vulnerability and emphasize the importance of traditional knowledge regarding environmental change and adaptive strategies. An evidence base on adaptation options and processes for Inuit regions is currently lacking, however, thus constraining climate policy development. In this article, we tackled this deficit, drawing upon our understanding of the determinants of health vulnerability to climate change in Canada to propose key considerations for adaptation decision-making in an Inuit context.
Notes
Cites: Med J Aust. 2009 Jan 5;190(1):4-519119999
Cites: Med Anthropol Q. 2013 Mar;27(1):63-8323674323
Cites: Br J Nutr. 2010 Mar;103(5):749-5919840421
Cites: CMAJ. 2010 Feb 23;182(3):243-820100848
Cites: Can J Public Health. 2010 Jan-Feb;101(1):25-720364533
Cites: BMC Med Educ. 2010;10:3120429949
Cites: Philos Trans A Math Phys Eng Sci. 2011 Jan 13;369(1934):196-21621115520
Cites: CMAJ. 2011 Feb 8;183(2):209-1421041430
Cites: Philos Trans A Math Phys Eng Sci. 2011 May 13;369(1942):1866-8221464077
Cites: Am J Public Health. 2011 May;101(5):804-1321421953
Cites: Am J Public Health. 2011 May;101(5):814-2121490335
Cites: Health Aff (Millwood). 2011 May;30(5):924-3021555476
Cites: Am J Community Psychol. 2011 Dec;48(3-4):426-3821387118
Cites: BMJ. 2003 Aug 23;327(7412):419-2212933728
Cites: Int J Circumpolar Health. 2005 Dec;64(5):478-8616440610
Cites: Int J Circumpolar Health. 2005 Dec;64(5):487-9716440611
Cites: CMAJ. 2006 Sep 12;175(6):60216966664
Cites: Environ Health Perspect. 2006 Dec;114(12):1930-417185287
Cites: Environ Health Perspect. 2006 Dec;114(12):1964-7017185292
Cites: Int J Circumpolar Health. 2006 Dec;65(5):416-3117319086
Cites: Emerg Infect Dis. 2008 Jan;14(1):18-2418258072
Cites: Emerg Infect Dis. 2008 Jan;14(1):25-3318258073
Cites: Can J Public Health. 2008 Jan-Feb;99(1):17-2118435384
Cites: Soc Sci Med. 2008 Nov;67(9):1423-3318676079
Cites: Am J Prev Med. 2008 Nov;35(5):401-218929963
Cites: Am J Prev Med. 2008 Nov;35(5):468-7818929973
Cites: Am J Prev Med. 2008 Nov;35(5):501-718929976
Cites: Health Place. 2009 Jun;15(2):403-1118760954
Cites: J Occup Environ Med. 2009 Jan;51(1):4-1219136868
Cites: Int J Circumpolar Health. 2009 Feb;68(1):84-9119331244
Cites: Lancet. 2009 May 16;373(9676):1663-519447242
Cites: Lancet. 2009 May 16;373(9676):1693-73319447250
Cites: Med J Aust. 2009 May 18;190(10):567-7219450204
Cites: Ambio. 2009 Jul;38(5):290-219714962
Cites: Soc Sci Med. 2009 Oct;69(8):1194-20319700231
Cites: Ecohealth. 2011 Mar;8(1):93-10821785890
Cites: Environ Health Perspect. 2012 Feb;120(2):171-921997387
Cites: Epidemiol Infect. 2011 Nov;139(11):1774-8321134324
Cites: Int J Circumpolar Health. 2012;71(0):1-822584509
Cites: Soc Sci Med. 2012 Aug;75(3):538-4722595069
Cites: Am J Public Health. 2012 Jul;102(7):1260-622594718
Cites: Am J Public Health. 2012 Jul;102(7):1246-922594729
Cites: Nature. 2012 Jun 7;486(7401):52-822678279
Cites: Ecohealth. 2012 Mar;9(1):89-10122526749
Cites: J Epidemiol Community Health. 2012 Sep;66(9):759-6022766781
Cites: Proc Natl Acad Sci U S A. 2012 Sep 11;109(37):E2415-2322869707
Cites: Ambio. 2012 Dec;41(8):808-2222829324
Cites: Lancet. 2009 Dec 19;374(9707):2123-519942278
PubMed ID
24754615 View in PubMed
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Approaching Etuaptmumk - introducing a consensus-based mixed method for health services research.

https://arctichealth.org/en/permalink/ahliterature263112
Source
Int J Circumpolar Health. 2015;74:27438
Publication Type
Article
Date
2015
perspectives and reach consensus on the question at hand. Further utilization and critical evaluation of this mixed methodology with indigenous knowledge are required. Keywords: health systems stewardship; indigenous values; mixed methods *Correspondence to: Susan Chatwood, Institute for Circumpolar Health
  1 document  
Author
Susan Chatwood
Francois Paulette
Ross Baker
Astrid Eriksen
Ketil Lenert Hansen
Heidi Eriksen
Vanessa Hiratsuka
Josée Lavoie
Wendy Lou
Ian Mauro
James Orbinski
Nathalie Pabrum
Hanna Retallack
Adalsteinn Brown
Source
Int J Circumpolar Health. 2015;74:27438
Date
2015
Language
English
Publication Type
Article
File Size
532688
Keywords
Cold Climate
Consensus
Health Services Research/methods
Health Services, Indigenous/organization & administration
Humans
Population Groups/ethnology
Program Evaluation
Quality Control
Abstract
With the recognized need for health systems' improvements in the circumpolar and indigenous context, there has been a call to expand the research agenda across all sectors influencing wellness and to recognize academic and indigenous knowledge through the research process. Despite being recognized as a distinct body of knowledge in international forums and across indigenous groups, examples of methods and theories based on indigenous knowledge are not well documented in academic texts or peer-reviewed literature on health systems. This paper describes the use of a consensus-based, mixed method with indigenous knowledge by an experienced group of researchers and indigenous knowledge holders who collaborated on a study that explored indigenous values underlying health systems stewardship. The method is built on the principles of Etuaptmumk or two-eyed seeing, which aim to respond to and resolve the inherent conflicts between indigenous ways of knowing and the scientific inquiry that informs the evidence base in health care. Mixed methods' frameworks appear to provide a framing suitable for research questions that require data from indigenous knowledge sources and western knowledge. The nominal consensus method, as a western paradigm, was found to be responsive to embedding of indigenous knowledge and allowed space to express multiple perspectives and reach consensus on the question at hand. Further utilization and critical evaluation of this mixed methodology with indigenous knowledge are required.
PubMed ID
26004427 View in PubMed
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Assessing health care in Canada's North: what can we learn from national and regional surveys?

https://arctichealth.org/en/permalink/ahliterature264982
Source
Int J Circumpolar Health. 2015;74:28436
Publication Type
Article
Date
2015
  1 document  
Author
T Kue Young
Carmina Ng
Susan Chatwood
Source
Int J Circumpolar Health. 2015;74:28436
Date
2015
Language
English
Geographic Location
Canada
Publication Type
Article
File Size
975329
Keywords
Adolescent
Adult
Canada
Child
Child, Preschool
Female
Health Care Surveys/methods
Humans
Male
Northwest Territories
Population Groups/statistics & numerical data
Sensitivity and specificity
Young Adult
Abstract
Health surveys are a rich source of information on a variety of health issues, including health care.
This article compares various national and regional surveys in terms of their geographical coverage with respect to the Canadian North, especially their Aboriginal population, and the comparability of the survey contents relating to health care.
Three surveys were selected as providing some information on health care, with separate estimates for the North and its Aboriginal populations. They are the Canadian Community Health Survey (CCHS), Aboriginal Peoples Survey (APS) and the First Nations Regional Health Survey (RHS).
Different surveys focus on different categories of Aboriginal people, and no single survey has covered all categories of Aboriginal people in the North consistently. RHS is targeted at the on-reserve First Nations population only. APS and CCHS sample the off-reserve First Nations population as well as Métis and Inuit. To achieve adequate sample size for North-South comparisons and comparisons among Aboriginal groups within the North, several cycles of the biennial/annual CCHS can be merged, producing a large data set with consistent coverage of topics using comparable questions. The content areas of the 3 surveys can be broadly categorized as health status, health determinants and health care. Substantial variation exists across surveys in the domains covered. There are also changes over time in terms of definitions, questions and even basic concepts. The available health care content of the 3 surveys focus on access to different types of health services, contact with different categories of health professionals, unmet health needs and the use of preventive services. Many important dimensions of health care are not covered. Not all these basic indicators are available for the North or its Aboriginal populations.
A comprehensive survey of health care in the North with sufficient sample size to provide reliable estimates for its subpopulations - urban and remote, Aboriginal and non-Aboriginal, and First Nations, Inuit and Métis - would provide useful information to decision-makers and service providers. Analytical studies can also be conducted to investigate the correlations and interactions among health status, health determinants and health care and assess whether such relationships differ among the different population groups.
PubMed ID
26214103 View in PubMed
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Building on Primary Care Reforms and Indigenous Self-Determination in the Northwest Territories: Physician Accountability and Performance in Context.

https://arctichealth.org/en/permalink/ahliterature295372
Source
Healthc Pap. 2018 Apr; 17(4):70-76
Publication Type
Journal Article
Date
Apr-2018
Author
Susan Chatwood
Author Affiliation
Scientific Director, Institute for Circumpolar Health Research, Associate Professor, School of Public Health, University of Alberta, Associate Professor, Institute of Health Policy Management and Evaluation, University of Toronto, Yellowknife, NT.
Source
Healthc Pap. 2018 Apr; 17(4):70-76
Date
Apr-2018
Language
English
Publication Type
Journal Article
Abstract
This commentary responds to Marchildon and Sherar's (2018) paper, "Doctors and Canadian Medicare: Improving Accountability and Performance," in which they explore questions around governance and physician accountability in Canada. This response situates the issues raised in a northern context by sharing experiences with primary care reform in the Northwest Territories and exploring the implications these changes have had for physician accountability and reported system improvements. Physician leadership and accountability are further explored in the northern context, where health systems for Indigenous communities include multiple jurisdictions and transitions in governance advance the self-government, land claims and treaty rights of Indigenous peoples.
PubMed ID
30291713 View in PubMed
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Building on Primary Care Reforms and Indigenous Self-Determination in the Northwest Territories: Physician Accountability and Performance in Context.

https://arctichealth.org/en/permalink/ahliterature300178
Source
Healthc Pap. 2018 04; 17(4):70-76
Publication Type
Journal Article
Comment
Date
04-2018
Author
Susan Chatwood
Author Affiliation
Scientific Director, Institute for Circumpolar Health Research, Associate Professor, School of Public Health, University of Alberta, Associate Professor, Institute of Health Policy Management and Evaluation, University of Toronto, Yellowknife, NT.
Source
Healthc Pap. 2018 04; 17(4):70-76
Date
04-2018
Language
English
Publication Type
Journal Article
Comment
Keywords
Canada
Medicare
Northwest Territories
Primary Health Care
Social Responsibility
United States
Abstract
This commentary responds to Marchildon and Sherar's (2018) paper, "Doctors and Canadian Medicare: Improving Accountability and Performance," in which they explore questions around governance and physician accountability in Canada. This response situates the issues raised in a northern context by sharing experiences with primary care reform in the Northwest Territories and exploring the implications these changes have had for physician accountability and reported system improvements. Physician leadership and accountability are further explored in the northern context, where health systems for Indigenous communities include multiple jurisdictions and transitions in governance advance the self-government, land claims and treaty rights of Indigenous peoples.
Notes
CommentOn: Healthc Pap. 2018 Apr;17(4):14-26 PMID 30291706
PubMed ID
30291713 View in PubMed
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The Canadian Society for Circumpolar Health is pleased to have played a role in facilitating this special issue on participatory methods in northern regions. Foreword.

https://arctichealth.org/en/permalink/ahliterature120751
Source
Int J Circumpolar Health. 2012;71
Publication Type
Article
Date
2012
Author
Susan Chatwood
Author Affiliation
Canadian Society for Circumpolar. Susan.chatwood@ichr.ca
Source
Int J Circumpolar Health. 2012;71
Date
2012
Language
English
Publication Type
Article
Keywords
Canada
Cold Climate
Community-Based Participatory Research
Health Services, Indigenous
Humans
Societies, Medical - organization & administration
PubMed ID
22973563 View in PubMed
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Circumpolar health collaborations: a description of players and a call for further dialogue.

https://arctichealth.org/en/permalink/ahliterature129813
Source
Int J Circumpolar Health. 2011;70(5):576-83
Publication Type
Article
Date
2011

Community-based adaptation research in the Canadian Arctic.

https://arctichealth.org/en/permalink/ahliterature276482
Source
Wiley Interdiscip Rev Clim Change. 2016 Mar-Apr;7(2):175-191
Publication Type
Article
Date
2016
Overview Community-based adaptation research in the Canadian Arctic James D. Ford,1* Ellie Stephenson,1 Ashlee Cunsolo Willox,2 Victoria Edge,3 Khosrow Farahbakhsh,4 Christopher Furgal,5 Sherilee Harper,3 Susan Chatwood,6 Ian Mauro,7 Tristan Pearce,8 Stephanie Austin,1 Anna Bunce,1 Alejandra
  1 document  
Author
James D Ford
Ellie Stephenson
Ashlee Cunsolo Willox
Victoria Edge
Khosrow Farahbakhsh
Christopher Furgal
Sherilee Harper
Susan Chatwood
Ian Mauro
Tristan Pearce
Stephanie Austin
Anna Bunce
Alejandra Bussalleu
Jahir Diaz
Kaitlyn Finner
Allan Gordon
Catherine Huet
Knut Kitching
Marie-Pierre Lardeau
Graham McDowell
Ellen McDonald
Lesya Nakoneczny
Mya Sherman
Source
Wiley Interdiscip Rev Clim Change. 2016 Mar-Apr;7(2):175-191
Date
2016
Language
English
Geographic Location
Canada
Publication Type
Article
File Size
191611
Keywords
Arctic Regions
Climate change
Adaptation
Communities
Traditional knowledge
Abstract
Community-based adaptation (CBA) has emerged over the last decade as an approach to empowering communities to plan for and cope with the impacts of climate change. While such approaches have been widely advocated, few have critically examined the tensions and challenges that CBA brings. Responding to this gap, this article critically examines the use of CBA approaches with Inuit communities in Canada. We suggest that CBA holds significant promise to make adaptation research more democratic and responsive to local needs, providing a basis for developing locally appropriate adaptations based on local/indigenous and Western knowledge. Yet, we argue that CBA is not a panacea, and its common portrayal as such obscures its limitations, nuances, and challenges. Indeed, if uncritically adopted, CBA can potentially lead to maladaptation, may be inappropriate in some instances, can legitimize outside intervention and control, and may further marginalize communities. We identify responsibilities for researchers engaging in CBA work to manage these challenges, emphasizing the centrality of how knowledge is generated, the need for project flexibility and openness to change, and the importance of ensuring partnerships between researchers and communities are transparent. Researchers also need to be realistic about what CBA can achieve, and should not assume that research has a positive role to play in community adaptation just because it utilizes participatory approaches. WIREs Clim Change 2016, 7:175-191. doi: 10.1002/wcc.376 For further resources related to this article, please visit the WIREs website.
PubMed ID
27668014 View in PubMed
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Community food program use in Inuvik, Northwest Territories.

https://arctichealth.org/en/permalink/ahliterature265833
Source
BMC Public Health. 2013;13:970
Publication Type
Article
Date
2013
  1 document  
Author
James D Ford
Marie-Pierre Lardeau
Hilary Blackett
Susan Chatwood
Denise Kurszewski
Source
BMC Public Health. 2013;13:970
Date
2013
Language
English
Geographic Location
Canada
Publication Type
Article
File Size
2244463
Keywords
Adult
Arctic Regions
Data Collection - statistics & numerical data
Female
Food Assistance - organization & administration - statistics & numerical data - utilization
Food Supply - statistics & numerical data
Humans
Male
Middle Aged
Nunavut
Population Groups - statistics & numerical data
Residence Characteristics - statistics & numerical data
Socioeconomic Factors
Unemployment
Abstract
Community food programs (CFPs) provide an important safety-net for highly food insecure community members in the larger settlements of the Canadian Arctic. This study identifies who is using CFPs and why, drawing upon a case study from Inuvik, Northwest Territories. This work is compared with a similar study from Iqaluit, Nunavut, allowing the development of an Arctic-wide understanding of CFP use - a neglected topic in the northern food security literature.
Photovoice workshops (n=7), a modified USDA food security survey and open ended interviews with CFP users (n=54) in Inuvik.
Users of CFPs in Inuvik are more likely to be housing insecure, female, middle aged (35-64), unemployed, Aboriginal, and lack a high school education. Participants are primarily chronic users, and depend on CFPs for regular food access.
This work indicates the presence of chronically food insecure groups who have not benefited from the economic development and job opportunities offered in larger regional centers of the Canadian Arctic, and for whom traditional kinship-based food sharing networks have been unable to fully meet their dietary needs. While CFPs do not address the underlying causes of food insecurity, they provide an important service for communities undergoing rapid change, and need greater focus in food policy herein.
Notes
Cites: J Nutr. 2012 Mar;142(3):541-722323760
Cites: Soc Sci Med. 2012 Sep;75(6):1067-7722703884
Cites: Int J Circumpolar Health. 2012;71. doi: 10.3402/ijch.v71i0.1858022973565
Cites: BMC Public Health. 2012;12:46422720722
Cites: Ambio. 2012 Dec;41(8):808-2222829324
Cites: J Nutr. 2010 Jul;140(7):1311-620444949
Cites: Rural Remote Health. 2010 Apr-Jun;10(2):136520568906
Cites: Rural Remote Health. 2010 Apr-Jun;10(2):137020568912
Cites: Can J Public Health. 2010 May-Jun;101(3):196-20120737808
Cites: Int J Circumpolar Health. 2010 Sep;69(4):322-3220719104
Cites: J Hum Nutr Diet. 2010 Oct;23 Suppl 1:5-1721158957
Cites: J Hum Nutr Diet. 2010 Oct;23 Suppl 1:51-821158962
Cites: J Hum Nutr Diet. 2010 Oct;23 Suppl 1:110-421158969
Cites: J Hum Nutr Diet. 2010 Oct;23 Suppl 1:120-721158971
Cites: CMAJ. 2011 Feb 8;183(2):209-1421041430
Cites: J Nutr. 2004 Jun;134(6):1447-5315173410
Cites: CMAJ. 1998 May 5;158(9):1143-99597965
Cites: Lancet. 2006 Jun 17;367(9527):2029-3116782494
Cites: CMAJ. 2006 Sep 12;175(6):60216966664
Cites: Int J Circumpolar Health. 2006 Sep;65(4):331-4017131971
Cites: Int J Circumpolar Health. 2006 Dec;65(5):416-3117319086
Cites: Int J Circumpolar Health. 2007 Sep;66(4):308-1918018844
Cites: Soc Sci Med. 2008 Mar;66(6):1393-40518191883
Cites: Can J Public Health. 2008 Mar-Apr;99(2):95-718457280
Cites: Soc Sci Med. 2008 Nov;67(9):1423-3318676079
Cites: Health Place. 2009 Jun;15(2):403-1118760954
Cites: Public Health Nutr. 2009 Aug;12(8):1150-619105863
Cites: Int J Circumpolar Health. 2009 Dec;68(5):471-8720044965
Cites: Br J Nutr. 2010 Mar;103(5):749-5919840421
Cites: CMAJ. 2010 Feb 23;182(3):243-820100848
Cites: Geogr J. 2011;177(1):44-6121560272
Cites: Ecohealth. 2010 Sep;7(3):361-7320680394
Cites: Rural Remote Health. 2011;11(2):168021702639
Cites: J Nutr. 2011 Sep;141(9):1746-5321753059
Cites: Int J Circumpolar Health. 2011 Sep;70(4):373-8321878183
Cites: Int J Circumpolar Health. 2011;70(5):488-9722005728
Cites: Int J Circumpolar Health. 2011;70(5):520-3122152596
Cites: Int J Circumpolar Health. 2011;70(5):444-622208993
PubMed ID
24139485 View in PubMed
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Community wellbeing and infrastructure in the Arctic. Workshop report.

https://arctichealth.org/en/permalink/ahliterature301464
Source
The Danish Centre for Environmental Assessment, Department of Planning and Development, Aalborg University. 30 pages.
Publication Type
Conference/Meeting Material
Date
October 2016
COMMUNITY WELLBEING AND INFRASTRUCTURE IN THE ARCTIC WORKSHOP REPORT NUUK, OCTOBER 2016 Title: Community Wellbeing and Infrastructure in the Arctic Authors: Anne Merrild Hansen, Aslı Tepecik Diş, Susan Chatwood, Gwen Holdmann, Trevor Lantz, Linda Chamberlain, Ross
  1 document  
Author
Anne Merrild Hansen
Asli Tepecik Dis
Susan Chatwood
Gwen Holdmann
Trevor Lantz
Linda Chamberlain
Ross Virginia
Source
The Danish Centre for Environmental Assessment, Department of Planning and Development, Aalborg University. 30 pages.
Date
October 2016
Language
English
Publication Type
Conference/Meeting Material
File Size
2695561
Keywords
Arctic Regions
Community wellbeing
Health inequity
Health services
Abstract
Arctic peoples are presently experiencing significant environmental, social, and economic impacts caused by changes in climate, resource use, and globalization. The Arctic is confronted by critical policy challenges related to issues of community health and wellbeing, energy resources, environmental protection, sustainable use of the Arctic Ocean, infrastructure, indigenous rights, and regional governance. To address some of the key challenges in relation to health and infrastructure and develop policy recommendations to promote community wellbeing in the Arctic, a full-day workshop on wellbeing in the Arctic communities was held in Nuuk, Greenland, on 3 October 2016.
A working group on health and infrastructure, associated with the Fulbright Arctic Initiative, initiated the workshop. The workshop was arranged in collaboration with NORDREGIO,1 Stockholm, Sweden, AAU Arctic,2 at Aalborg University, Denmark, and the Arctic Oil and Gas Research Centre,3 at Ilisimatusarfik (University of Greenland), with financial support from the Nordic-Arctic Collaboration Programme of the Nordic Council of Ministers.
In this report, we provide background and context for wellbeing in the Arctic, we then introduce the Fulbright Arctic Initiative (FAI) programme, and the health and infrastructure working group.
The workshop is the focus of the report and we describe the workshop organisation, share preliminary results, and conclusions. Finally we provide direction for future work.
Notes
ISBN: 978-87-91404-94-8
Documents

nunamed-workshop-report.pdf

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33 records – page 1 of 4.