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Greenland

Public health in Sisimiut

Every year, the health centre in Sisimiut (Holsteinborg) puts on a oneweek campaign to improve the population's health habits. The purpose is the same every time: to get people to understand that a healthy lifestyle protects against disease.

Week 46 of the year is a special week in Sisimiut. The local community centre is seething with activity. This year's health theme is being debated. The hospital's personnel, together with personnel from other institutions, have spent the preceding six weeks preparing the theme, which this year is Self Care. Stalls have been set up in the community centre at which people can discuss food and nutrition, weight problems, hygiene, etc. They can also have their Body Mass Index (BMI) calculated; BMI is a simple measure of whether one is overweight. People can also find out how they themselves can avoid many diseases by changing their lifestyle. Communal meals are laid on at the community centre all week, and recipes are given out.

"We have a tradition for this method of activation," says Ove Rosing Olsen, who is the Chief District Medical Officer in Sisimiut. "Good preparation is essential for getting the health message across and encouraging the right attitude."

The health week is a very popular event. About half the population participate in it. It has become a well-established tradition, and a template has been made for the method, so that it can be used elsewhere in Greenland. The method has two elements: the first is the public information activities and activation of the population and the second is scientific studies of health problems in the area.

During the scientific follow-up, the health centre works together with a research team at the Department for Epidemiological Research at Statens Serum Insitut in Denmark. The problem could be the incidence of the bacterium Helicobacter pylorii, for example, which causes stomach ulcers, or various venereal diseases. Right now, hepatitis is being investigated. On previous occasions it has been human parasites, particularly those affecting children (pinworm, whipworm, roundworm and the different various tapeworms), and allergy. This last study was extended to other towns (Aasiaat and Ilulissat).

One recently completed project was called "Children and Disease". It revealed that children had exhibited symptoms of one or more bronchial infections for 40% of their lifetime.

This is almost a world record. Surprisingly, these bronchial infections occur equally frequently in summer and winter.

The main reasons were found to be smoking in the family, being in a day-care centre, and sleeping together with others in one bedroom. Lastly, it looked as though children that were breast-fed until the age of at least six months had fewer bronchial infections than those breast-fed for a shorter time. In a previous Week 46, there was massive advertising of the project, and participation in the project was enormous - 88% of parents in the town decided to participate.

Everyone at the health centre works together on these projects. There is a campaign newspaper, "Peqqik Sisimiut", which is distributed to all households.

The scientific results are published in both "Ugeskrift for Læger" (the Danish Medical Journal) and international scientific journals. Equally important, the local population gets some feedback written in ordinary, everyday language - for example, the title of the article in the campaign newspaper: "Snotty noses and coughs in children in Sisimiut".

Food and pollution

"How do you inform people about the impact on their food from heavy metals and POPs in a reasonable way?" I ask Ove Rosing.

He replies: "We have not done much yet on the pollution of our food products. Just recently, a couple of us have looked into the eating habits of children and young people and carried out diet studies in the local schools to find out what the situation is and promote the use of traditional foods.

"However, the effect of toxic substances in the environment and our food on people's general health is not a subject of daily discussion among the local population. Nor has there been a week 46 project on the subject."

People are aware of pollution in food products but do not talk much about it. They are generally resigned to the fact that there is not much they can do about that aspect of their lives. They cannot stop eating seal meat. Being told that there are contaminants in seal liver does not stop them from eating seal liver, although they may eat less of it.

"But that must be very much your problem, as head of the health centre," I say, not wanting to leave matters there. "You know how high the impact is and also know that people are not keen on discussing what effect this has on their health."

"The question is, what it pays to do," replies Ove Rosing Olsen. "I quite literally look people deep in the eye. When I take people's blood pressure, I automatically take a look at the small blood vessels in the retina, and I have found almost no changes at the back of the eye. In other populations, e.g. the Danish population, very extensive changes are seen, so there must be a factor here in Greenland that protects blood vessels - perhaps it is the diet. It is unlikely to be anything genetic."

Ove Rosing Olsen also tells me that patients with hepatitis and people that drink a lot do not have the same degree of changes in the liver as in Denmark. In Greenland, practically no cases of cirrhosis of the liver have been seen. And patients with hepatitis B, which is common in Greenland, suffer almost no long-term effects. He does not see much in the way of cardiovascular changes in his patients. He seldom sees the kind of glaring cardiovascular changes that are seen in other countries.

Ove Rosing says, "This leads me to conclude that there are some important protective factors at work here, and I attach great importance to them. I think that part of the explanation lies in the diet." Ove Rosing Olsen uses this for treatment purposes. He almost never uses cholesterol-reducing drugs. They are used very extensively in Denmark. Greenlandic patients with high blood pressure - apart from those with familial hypercholesterolemia - receive dietary advice. They are told to eat seal blubber and beluga blubber. Beluga blubber is the most potent cholesterolreducing agent he knows.

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