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Children’s health in Greenland; Interdisciplinary efforts necessary

Children’s health in Greenland; Interdisciplinary efforts necessary. Reykjavik, June 2, 2005. Henning Sloth Pedersen, MD, PhD. Experiences. Primary and secundary health care in Greenland in 18 years Associated professor, Institute of Public Health, University of Aarhus, Denmark

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Children’s health in Greenland; Interdisciplinary efforts necessary

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  1. Children’s health in Greenland; Interdisciplinary efforts necessary Reykjavik, June 2, 2005. Henning Sloth Pedersen, MD, PhD

  2. Experiences • Primary and secundary health care in Greenland in 18 years • Associated professor, Institute of Public Health, University of Aarhus, Denmark • Mentor at James Cook University, Townsville, Australien, in Indigenous and Remote Area Health • Advisor at WHO, Environmental and Occupational Health Impact Assessment and Surveillance • Advisory Board for EU’s 7th frame programme for Environmental Research Nuuk

  3. The Future of Children and Youth in the Arctic 1992-2001 Norway Sweden Finland Denmark Iceland Canada USA Russia

  4. Infant mortalityno of death per 1,000

  5. Tuberculosis among children (1992-2001), 0-24 years old

  6. Age of mother2002, 940 births

  7. Teen mothers • Increased rates of lower birth weights • Pre-eclampsia (intoxication) • Social problems more common (education, housing, single, income….)

  8. Other health problems • Weight problems increasing rapidly • Diabetes type 2 seen among children • Infections in general more prevalent (lung, ear) • Serious dental problems • Smoking prevalent (8% of 11 years old, and 65% of 15-19 years smoke cigarettes regularly) • Allergi rapidly increasing

  9. Contaminantspercent > safety threshold

  10. Better health parameters • Less cancer • Less congenital disorders • Less drug abuse • Less alcohol abuse • Less fatal injuries • Solvent abuse as Nordic countries (high in USA)

  11. Self assessment of healthpercent, 11 years old, bad/not good

  12. Never hungry to bed or in schoolpercent, in social class,11-17 years old, 2002

  13. Education • 60% of those leaving elementary school are not able to continue education

  14. No. of police reports of violenceper 10,000 inhabitants

  15. No. of police reports of sexual crimeper 10,000 inhabitants

  16. Summary of health characteristics • Typical for ”Indigenous health”, caused of rapid transition of the society. • Indigenous Peoples: 6,000 tribes; 300,000,000 individuals. • Same pattern among certain ”ethnic minorities”.

  17. Pregnancy programme • 1,000 birth anually in Greenland • 100-120 more in Nuuk now, mainly because of history of complicated delivery before • In Nuuk: 6 midwifes (before 3) • 1 midwife – supervisor for labour assistents outside Nuuk • 1 midwife – contact for patients outside Nuuk

  18. Pregnancy programme • As soon as possible: need for social help? • Guidance and close control of risk patients • BMI>27 or blood glucose increased: control for diabetes • Help to quit smoking (almost 50% quit smoking in pregnancy)

  19. Initiatives in the health sector • Smoking prevalence decrease, but not among children • Alcohol consumption decrease, but no major problem among children • Sexual abuse of children programme • Drink water, quit soda pops • Food and life style guide for children • Lunch in the schools (probably)

  20. Haemophilus influenza meningitisNo of cases

  21. Risk factors and diseases Diabetes Fertility Diet Obesity Infections We treat symptoms and diseases, and have research Projects monitering risk factors.

  22. Risk factors and diseases Pollution Unemployment Diabetes Fertility Diet Obesity Infections Violence Housing • factors outside the health sector’s traditional domaine • influence health

  23. Risk factors and diseases Pollution Unemployment Diabetes Fertility Diet Obesity Infections Violence Housing The generator:Social gap, culture, education Health parameters and other parameters have common cause

  24. Cindy Kiro, Maori from New Zealand • “It is now widely accepted that the major determinants of health are outside the direct influence of the health sector.”

  25. Health care expenditureper capita on average 1985-95

  26. Miscaring of children

  27. Miscaring of children

  28. SECTORIALISM Health sector THE FAMILY Education Social sector Abuse, violence, miscaring, mental disorders, asocial behaviour Inequality, family fragmentation, immorality

  29. INTERDISCIPLINARITY Health sector THE FAMILY Social sector Education Abuse, violence, miscaring, mental disorders, asocial behaviour Inequality, family fragmentation, immorality

  30. SECTORIALISM Short-term Not necessary to understand and involve culture Treating symptoms Monitoring risk factors Specialist runned Sectors in competition with each other ”Not my problem” The family passive Tell what to do INTERDISCIPLARITY Long-term Necessary to understand and involve culture Treating causes Monitoring causal factors Holistic runned Sectors support each other ”How can I help” The family integrated Teach how to do

  31. Children’s health in Greenland;interdisciplinary efforts necessary • Give a man a fish, and he will have food for that day. • Learn him to fish, and he will have food forever (Ksuan-Tsu)

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