Political importance of Political importance of Arctic RussiaArctic Russia

A 2/3 of Russian territory is A 2/3 of Russian territory is represented by permafrost represented by permafrost landslands

11 11 million inhabitants of million inhabitants of Russian population are resident Russian population are resident of the arctic region of Russiaof the arctic region of Russia

20% of Russian GNP is 20% of Russian GNP is provided by the economy of provided by the economy of arctic region arctic region

The The 20012001-2003-2003 AMAP Arctic AMAP Arctic Health Survey in RussiaHealth Survey in Russia

There were There were 18 18 nativenative communitiescommunities in in the selected the selected study areas.study areas.

The followed-up The followed-up

cohorts ofcohorts of indigenous indigenous minorities of minorities of the Norththe North::

407 mother-407 mother-child pairs child pairs

1514 adults1514 adults

0

200

400

600

800

1000

1200

UellenCoastal

communities

Ryrkaipiy Lamutskoye Ust-Belaya

Serum concentrations of total PCBs and total DDTs in maternal blood of pregnant indugenous women of

Chukotka, ng/g in lipids (means)

Sum PCB's

Sum DDT

Internationally approved package of Internationally approved package of recommendations on health risks recommendations on health risks

reduction derived from the 2001-03 reduction derived from the 2001-03 Russian Arctic Health SurveyRussian Arctic Health Survey

Nutritional advicesNutritional advices Training of local health workers and Training of local health workers and

community volunteers community volunteers Health services improvementHealth services improvement Financial, organizational and technical Financial, organizational and technical

assistance to support Human Health Risk assistance to support Human Health Risk Reduction Campaign.Reduction Campaign.

Levels of implementation

The 2003-2007 Action Plan based on AMAP recommendations

Regional level - 2 arctic counties (Chukotka, Nenets AO)

Community level - 6 heavily contaminated indigenous communities were selected

Individual level - family planning program for 1870 indigenous women at age of fertility

Selection and training of Selection and training of communicators communicators

Demands:Demands: trustworthiness, creditabilitytrustworthiness, creditability sympathetic insightsympathetic insight expert knowledgeexpert knowledge commitmentcommitment sinceritysincerity

Field training of indigenous volunteers engaged in clean-up operations in native communities of Cukotka Peninsula

On spot analysis for POPs

On spot analysis for POPs

Community cleaning-up

Printed brochure on health risk reduction

The 2010 Interim Evaluation of Implemented

Action Plan Human exposure to 6 persistent

priority contaminants Incidence rates of diseases

potentially associated with exposure to PTS in question (immune deficiency, malignancies, pregnancy miscarriage, birth defects, diabetes, mental retardation)

Temporal trends in the Temporal trends in the human exposure to POPs human exposure to POPs

(adult males) (adult males)

Annual incidence rates of Annual incidence rates of diseases potentially associated diseases potentially associated with the exposure to POPs in with the exposure to POPs in

indigenous populationindigenous population

Temporal trend of annual incidence Temporal trend of annual incidence rates of diseases associated with the rates of diseases associated with the

exposure to POPs in the cohort of exposure to POPs in the cohort of children, new cases per 1000children, new cases per 1000

-15

-10

-5

0

5

10

15

1 2 3 4 5 6 7 8C

2003 2004 2005 2006 2007 2008 2009 2010

Intensity of Tsunami Occured in the South-

East Pacific Region

27,000 victims and16,000 have been missing due to the 2011 tsunami

Estimated Cumulative Temporal Trend of Intensity of Washouts

due to Natural Catastrophes

Ocean currents:A Pathway of POPs Transfer from Tropics to the Arctic

Major Flyways of Migrating Birds into the

Arctic

Ocean currents in the main Salmon stock in subarctic

area

Questions from AMAP:Questions from AMAP:What is the lesson to be What is the lesson to be learnt? What should be learnt? What should be

done next?done next?

A Suggested Regional A Suggested Regional Model for Healthy Arctic Model for Healthy Arctic

CommunityCommunity Public health practice adjusted Public health practice adjusted to Russian arctic circumstances to Russian arctic circumstances is particularly important to is particularly important to indigenous health. indigenous health.

A new model for healthy arctic A new model for healthy arctic communities has been recently communities has been recently suggested and is being suggested and is being discussed at national level.discussed at national level.

A suggested national A suggested national model for healthy arctic model for healthy arctic

communitycommunity This model is primarily This model is primarily

addressing developmental addressing developmental goals while enhancing the goals while enhancing the abilities that will allow us to abilities that will allow us to achieve measurable and achieve measurable and sustainable results in the sustainable results in the implementation of Good Arctic implementation of Good Arctic Health Care Practice concept. Health Care Practice concept.

Educational needsEducational needs

An obstacle is that existing An obstacle is that existing educational and training educational and training programs for public health programs for public health professionals are not adequately professionals are not adequately reflect specificity of both the reflect specificity of both the arctic environmental risk factors arctic environmental risk factors and lifestyle, social and economic and lifestyle, social and economic status of indigenous peoplesstatus of indigenous peoples..

Educational needsEducational needs

Identifying critical gaps and broad Identifying critical gaps and broad level principles for Indigenous health level principles for Indigenous health curricula within training programs curricula within training programs and to respond with innovative and to respond with innovative teaching modules.  teaching modules.  

Increasing the number of indigenous Increasing the number of indigenous public health graduates by teaching public health graduates by teaching public health using a community public health using a community based approach;based approach;

Educational needsEducational needs Identifying the priority arctic health risk Identifying the priority arctic health risk

factors and specifying the public health factors and specifying the public health policy and practice needs to deliver policy and practice needs to deliver comprehensive education for the comprehensive education for the professionals are to serve in the arctic professionals are to serve in the arctic indigenous communities; indigenous communities;

Increasing the rate of indigenous Increasing the rate of indigenous graduates nationally awarded a MPH graduates nationally awarded a MPH degree; degree;

   Establishment of a national network of Establishment of a national network of

indigenous public health professionals; indigenous public health professionals;

Health Care needsHealth Care needs Prioritization of health care in the arctic Prioritization of health care in the arctic

communities as primary goal of local communities as primary goal of local policy.policy.

Selection of the best values in health Selection of the best values in health care providers and treatment. Quality of care providers and treatment. Quality of health services benchmarking.health services benchmarking.

Securing a universal access to health Securing a universal access to health carecare

Encouraging arctic people of taking Encouraging arctic people of taking personal responsibilities for their own personal responsibilities for their own health and for others by helping them to health and for others by helping them to obtain health promoting services . obtain health promoting services .

Do we need to set up Do we need to set up another paradigm in health another paradigm in health

policy for arctic policy for arctic communities communities

It is essential to enable arctic It is essential to enable arctic indigenous communities to indigenous communities to feel themselves as an feel themselves as an important constituent of important constituent of Good Arctic Health Practice Good Arctic Health Practice and to create a sense of and to create a sense of purpose of it. purpose of it.

International dimension of International dimension of Arctic Health Policy Arctic Health Policy

Do we need to achieve the Arctic Do we need to achieve the Arctic Treaty to harmonize environmental Treaty to harmonize environmental and human health policies and to and human health policies and to limit exploration and use of the arctic limit exploration and use of the arctic resources? resources?

The Antarctic Treaty unique The Antarctic Treaty unique experience: what works and what experience: what works and what doesn’t? doesn’t?

Are current environmental exposure Are current environmental exposure limits to be the same as those limits to be the same as those developed for a better climates?developed for a better climates?

Thank you for attention!Thank you for attention!