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AMAP Greenland and the Faroe Islands 1997-2001

2 Sociocultural environment, lifestyle, and health in Greenland

By Peter Bjerregaard

The population of Greenland was 56,124 in 2000. Of these, 49,369 (88%) were born in Greenland, which is the official proxy measure for Greenlandic (Inuit) etnicity. However, in recent years an increasing number of ethnic Danes have been born in Greenland while a similarly increasing number of ethnic Greenlanders have been born in Denmark¹. A study from the 1990s estimated that 97% of those born in Greenland considered themselves to be Greenlanders while 9% of those not born in Greenland considered themselves as Greenlanders and 17% as both Greenlander and Dane. The use of definition criteria (place of birth, identity or ethnicity of parents/grandparents) must be chosen according to the circumstances.

The population pyramid for the indigenous population is relatively broad based until the age group 30-34 (figure 2.1). Around 1970 the very high fertility rates decreased rapidly which, in combination with relatively few women of childbearing age resulted in small birth cohorts. After the dramatic decrease, the size of the birth cohorts increased steadily from 1974 to 1995 but is now once more on the decrease.

The population composition of the non-indigenous (Danish) population is very different. Men make up 70% of the non-indigenous population, and 79% of these are in the age group 25-59 compared with only 50% among the Greenlanders.

2.1 Settlement structure

The majority of the population (92%) lives on the South and central West coast; 6% live on the East coast, and 1.5% live in the extreme North (See map of Greenland, page 14). Furthermore, 81% live in small towns with population sizes ranging from 500 to 13,500, the remainder in villages with 50-500 inhabitants, and a few hundred people live scattered especially in the south. The non-indigenous population is concentrated in the towns.

The population is not scattered evenly all over the inhabited part of the country. Two thirds of the population live in four by Greenlandic standards relatively densely populated areas: 13,500 (24%) in the capital, Nuuk, 10,500 (19%) in the Disko Bay area, 8,000 (15%) in South Greenland, and 5,000 (9%) in Sisimiut on the central west coast.

Although Greenland is a very large island, 85% of its area is permanently covered with ice, and all settlements are situated on the coast, most often on the outer coast directly facing the open sea or very close. In the south there is some agriculture, but reindeer herding has never really been successful. A few mines have been open from time to time, and there are ongoing prospecting activities for hydrocarbons and minerals such as zinc, uranium, gold, and iron, but there are currently (2002) no active mines.

2.2 Language, culture and Economy

Greenlandic and Danish are both official languages of Greenland. Greenlandic is the mother tongue of the vast majority of the indigenous population, among whom 57% indicate to speak Danish reasonably well. Although Greenlandic is widespread as the first language, the presence of a large occupationally active contingent of Danes, who usually have no command of Greenlandic, has resulted in much of the administration taking place in Danish. Primary education takes place in Greenlandic but college and university level education takes place in Danish – and often outside Greenland. Thus a fluent command of Danish (and good command of English) are necessary in order to obtain a higher education.

The Danish/Norwegian colonization of West Greenland started in 1721, and what today is termed the traditional Greenlandic culture is a mixture of Inuit and European culture. The traditional occupation of the Greenlanders until the early 20th century was the hunting of marine mammals (seal, whales, walrus). During the 20^th century hunting was increasingly supplanted by fishing, first from small dinghies but later from large sea-going vessels using the most modern equipment. The Greenlandic culture today is still very much centered around traditional Greenlandic food (kalaalimernit), which is understood as the flesh and organs of marine mammals and fish often eaten raw, frozen or dried. Seal meat, for instance, is usually ascribed several positive physical as well as cultural qualities, and asking a person whether he or she likes seal meat is equivalent to asking whether he or she considers himself/herself to be a true Greenlander.

The economy of Greenland is based on transfer of funds from Denmark and on fishing, especially for shrimp. Until the beginning of the 20^th century, seal hunting was the major trade in Greenland. After 1920, fishing and related industries became the main trades. After 1950, when Greenland opened up and was modernized, business and commerce changed. The service sector in particular has developed considerably. The educational level is high and the housing conditions have improved markedly but housing density is still much higher than, e.g. in Denmark.

Traditional sealing and whaling still plays an important role in the life of people especially in Northwest, North, and East Greenland although it is not the dominant industry in economic terms. Leisure time hunting and fishing is a very common activity.

2.3 Lifestyle

Information about the diet has been collected in several population surveys including a specific dietary survey. The consumption of marine mammals and fish is high but the young and the population in towns eat considerably less than the elderly and the population in the villages. Seal is the most often consumed traditional food item followed by fish. On average, 20% of the Greenlanders eat seal 4 times a week or more often while 17% eat fish similarly often. Traditional food is valued higher than imported food; the highest preference is given to muktuk (whale skin), dried cod, guillemot, and blackberries. Almost all value traditional food as important for health and less than one percent (in 1993-94) restricted their consumption of marine mammals or fish because of fear of contaminants.

A sedentary lifestyle is becoming increasingly common among the Greenlanders. In the villages, only 7% are self-reported sedentary while this increased to 23% among the well-educated residents of the capital, Nuuk. Overweight is an increasing problem among the Greenlanders; 35% and 33% of men and women, respectively, are overweight (BMI 25.0-29.9) and 16% and 22% are obese (BMI=> 30).

The consumption of alcohol and tobacco has increased considerably during the lat 30-40 years but is now stagnant. The consumption of alcohol is now equivalent to ca. 13 litres of pure alcohol per year in the adult population, which is at the same (high) level as in Denmark. Alcohol is, however, often consumed in binges and the impact of alcohol on social and family life is marked. Among those born after 1960, more than 50% state that they experienced alcohol related problems in their parental home.

According to import statistics, the average consumption of cigarettes increased from 5 cigarettes per day in 1955-59 to 9 in 1990-94. Recent population surveys estimate the proportion of cigarette smokers to be 70-80% among both men and women compared with 40% in Denmark, but the proportions of heavy smokers are similar in the two countries. Young people start smoking very early, often well before the age of 15, and the lowest smoking prevalence is found among the elderly.

2.4 Disease pattern

The disease pattern in Greenland is primarily known from mortality statistics, statistics on notifiable diseases, and population surveys. Life expectancy at birth is considerably lower both among men (60.8 years) and women (67.5 years) than in, for instance Denmark (73.6 and 78.6 years). Infant mortality is high (18.3 per 1000 live births) compared with Denmark (4.2 per 1000) as well as Alaska Natives (8.7). The causes of death show a different pattern from that of many European countries. Mortality from acute infections is still relatively high but among the young the most frequent causes of death are suicides and accidents (67% of deaths among the 15-44 year old), while later in life cardiovascular diseases and cancer account for the majority of deaths (58% of deaths among those above 45 years of age). Lung cancer and other tobacco related diseases are common causes of death and ill-health. The general picture of mortality trends during the last 30 years is that of a slightly increasing total mortality caused by the combination of a substantial decrease in infant and child mortality from infections (diarrhoea, measles, hepatitis, meningitis, and acute respiratory infections), neonatal deaths and, also in adults, from accidents, but an increased mortality in adults from lung cancer, suicides and homicides. This mortality transition is in keeping with the change of the Greenlandic society from material poverty to a society with increased material wealth but characterized by substance abuse and lack of spiritual health.

During the 19^th and 20^th centuries tuberculosis was one of the most important diseases and causes of death in Greenland. The incidence decreased dramatically during the 1950s due to the combination of improved housing conditions, case finding and treatment, and BCG vaccination. In the early 1990s, however, the incidence of tuberculosis was still considerably higher in Greenland (89 per 100,000) compared with Denmark (8 per 100,000). Reactivation and spread of the disease occurs repeatedly, especially in remote communities with poor housing and sanitary conditions.

The general disease pattern is not as well described as the mortality. There is no computerized registration hospital diagnoses let alone of reasons for visits to the out-patient clinics. Information about the major health problems in Greenland must be pieced together from a few studies of contacts with the health care services, some studies on specific diseases, and a few population surveys.

Selfrated health status decreases with age, slowly until the age of 40-50, more rapidly afterwards. Women rate their health poorer then men, and there are pronounced socioeconomic differences. About 75% of adult Greenlanders have been bothered by one or more symptoms during the two weeks before participating in a health survey, most often by pain in the arms or legs, fatigue, headache, or common cold. Only few of these had contacted the health services. About 60% of adult Greenlanders state that they suffer from a longstanding illness, most often a musculoskeletal disease. While this self reported disease pattern is quite similar to what has been found in health interview surveys in Denmark, Greenlanders use prescription drugs considerably less often than the general population of Denmark.

2.5 Health care

Greenland is divided into 18 municipalities of varying size; 16 of these presently has a small hospital or health post manned by at least one physician, nurses, health aides etc. Queen Ingrid’s Hospital in Nuuk is not only the hospital for the municipality but the central hospital for the whole country. It has 130 beds and specialists in general and orthopedic surgery, obstetrics and gynecology, internal medicine, psychiatry, dermatology, anesthesiology, radiology and dentistry. Specialists from Queen Ingrid’s Hospital and from Denmark visit the health districts on “the Coast” regularly but usually not more than a couple of times each year. Patients with diseases that cannot be treated at Queen Ingrid’s Hospital are transferred to Denmark.

Each town on “the Coast” has a small hospital staffed with 1-4 general practitioners. There is usually an out-patient clinic, emergency unit, maternity unit, operating theatre, x-ray facilities, a laboratory and a number of beds depending on the size of the municipality. There are also one or more dental clinics at the hospital or at the school. In villages with more than 300 inhabitants there is a nursing station, in smaller villages a health aide and in small villages with less than 70 inhabitants an untrained person authorized to dispense certain drugs after consultation with the physicians. The physicians visit the villages regularly but due to shortage of staff and poor weather conditions it is not always possible to make these visits as often as needed. Probably only few villages are visited on a monthly basis. Most health professionals in Greenland are Danes working on short time assignments i.e. a couple of months or a couple of years but quite a few have settled permanently in Greenland.

Notes
1. Place of birth refers to the place of residence of the mother. Children born at the Copenhagen University Hospital (Rigshospitalet) for medical reasons are thus registered as born in Greenland if the permanent address of the mother is in Greenland.

2.6 References

Bjerregaard P, Curtis T, Senderovitz F, Christensen U, Pars T. Levevilkår, livsstil og helbred i Grønland. København: DIKE, 1995. 155 s.

Bjerregaard P, Young TK. The Circumpolar Inuit: health of a population in transition. København: Munksgaard, 1998. 287 s.

Government of Greenland. This is Greenland 2000-2001. Copenhagen, Greenland Resources 2000.

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