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AMAP Greenland and the Faroe Islands 1997-2001

8 Conclusions and recommendations

8.1 General conclusions

Contaminants of anthropogenic origin are spread globally including the Arctic. The combination of environmental conditions and biomagnification in the marine and fresh water food webs result in accumulation of certain persistent contaminants in traditional food of Arctic peoples, as a consequence some Arctic population groups are much more highly exposed through the diet than most populations in the temperate zone. The social, cultural, spiritual and physical health of Arctic Indigenous Peoples depends on the collection and consumption of country food. It is unlikely that market foods currently available can provide the nutritional equivalent of traditional food. It is difficult in a scientific way to compare the benefits and risks of consuming traditional food. It is, however, important as dietary intakes are changing across the Arctic due to social pressures, perceived threats of contaminants, the availability of traditional food, and the availability and acceptability of store-bought foods.

Food is the major exposure route for contaminants in the Arctic, therefor uniform methodologies for dietary surveys applied across the circumpolar region would greatly assist risk assessment. In addition to dietary intake, recent studies have shown that uptake, metabolism, and excretion of xenobiotics are under genetic influence. Also life-style factors e.g. smoking and body mass index (BMI) influence the body burden.

The concentrations of some POPs in breast milk have raised concern among mothers in the Arctic. The substantial benefits of breast feeding justify the development of programmes to inform mothers how adjustments within their traditional diets can significantly reduce contaminant levels in their milk without compromising nutritional value.

Epidemiological evidence on the adverse effect of POPs and methyl mercury is emerging. The high exposure levels found in some Arctic communities are suspected to have negative influence on human health, based on the weight of all available evidence within and outside the Arctic, there is reason for concern and a need to continue to reduce human exposure

Progress in molecular biology has provided tools to identify biomarkers of contaminant effects in human samples. Implementation of the human effect programme combined with continued monitoring of exposure (including new contaminants of concern) would allow identification of early effects at the molecular level and serve as a warning system to signal increases in exposure to levels where overt signs of poisoning may appear. The new methodologies can integrate epidemiological and mechanistic biomarker effect studies to make it possible to estimate the effects of current exposure levels of the actual mixture of contaminants, possible interactions, and the modifying effects of nutrients and life-style factors, the combined effect.

8.2 General Recommendations.

The Human Health Expert Group recommends:

To continue the process of monitoring of contaminants.The Human Health Effect Programme should be more extensively applied. Uniform methods should be applied for the objective assessment of diets and estimation of exposure and studies on nutrient content of traditional food items should be included.

To continue support of studies of contaminant related effects on human reproduction and fetal and child development, immune and hormone status, and cancer.

To apply communication and consultation approaches that enhances the development of local information and advice to Indigenous Peoples concerning benefits of traditional food, contaminant exposures and effects.

To strengthen international efforts to control the production, use, and emissions to the environment of persistent organic pollutants and mercury.

To ratify and implement the Stockholm convention on Persistent Organic Pollutants and the protocols on POPs and heavy metals in the UNECE Convention on Long-range Transboundary Air Pollution (LRTAP) and support the UNEP Global Mercury Assessment.

To support a global assessment of the linkages between health and the environment.

8.3 Specific conclusions

8.3.1 Conclusions from the AMAP, HH Programme in Greenland

The AMAP, Human Health, monitoring programme has been extended to cover all geographic regions of Greenland. The geographical survey has revealed that the highest human blood levels of POPs in particular of PCB to be found in East Greenland, with close to 100 % in excess of the Canadian blood-guidelines for PCB-aroclor1260 for both men, women of fertile age, and pregnant women.

Exposures to methyl mercury are more geographically uniform. In several areas close to 100% of the samples exceeds the blood concentration corresponding to the strict US- EPA guideline and a considerable part also exceeds the WHO guideline.

Selenium intake through the diet is high among Greenlanders, however, there is at the moment no information on a protective effect against POP‘s. and methyl mercury.

It has so far not been possible to assess time trends in POPs exposure, due to a too short observation period. There are no indications of declined exposures to methyl mercury., whereas the blood levels of lead are continuing to decrease

New data on contaminant concentrations in animals used for food, in combination with improved dietary surveys have made exposure estimates possible with identification of species and organs with the highest contributions to human exposure. On a country wide basis seal blubber followed by whale blubber are the predominant sources of POPs whereas seal meat is the main source of methyl mercury. However in areas where polar bear is consumed that can be a major additional source of POPs.

To evaluate potential health effects of contaminants preliminary tests of effect-biomarkers carried out with blood serum from Greenlanders have indicated an association to the exposure level of POP‘s measured as blood-lipid concentrations. Further investigation is needed to estimate the clinical relevance of these findings.

It is known that POP‘s negatively influences the immune system. As the exposure to POP‘s in some Greenlandic districts are among the highest ever measured it is reasonable to expect an influence on the immune status in these populations. As POP‘s are only one of several influential factors causality is difficult to establish in these small populations

There is no epidemiological evidence from Greenland to correlate pregnancy outcomes, neonatal mortality, or prevalence of infectious diseases to POP exposure.

No overt health effects of endocrine disrupting POP‘s have so far been confirmed. As the exposure level is very high in some communities, in excess of e.g. Canadian guidelines and that the possible effects should be viewed in a perspective of several generations the present situation warrants public health measures to be taken in order to reduce the exposure without jeopardising the nutritional values of the traditional diet

8.3.2 Recommendations for Greenland

It is therefor recommended that the Monitoring, Assessment and Human Effects Biomarker Programmes should be continued in Greenland to follow the temporal changes in the contaminant situation and to uncover any possible overt health effects at the clinical or subclinical levels.

It is furthermore recommended that dietary and other lifestyle advice should be established with the aim to reduce contaminant exposure among pregnant and fertile women taking the high nutritional value of certain traditional food items into consideration and at the same time assuring a sufficiently high nutritional value of the total diet.

8.3.3 Conclusions and Recommendations from The Faroe Islands.

Exposure to methylmercury and organochlorine compounds has been high in the Faroe Islands due to frequent ingestion of pilot whale meat and blubber.

Cognitive deficits and other adverse effects have been demonstrated in children with prenatal exposure to these compounds in the Faroes.

In August, 1998 the Faroese authorities issued an advisory that women, who plan to become pregnant within three months, pregnant women, and nursing women should abstain from eating pilot whale meat.

Furthermore, the best way to protect foetuses against the potential harmful effects of PCBs and other organochlorine compunds, is if girls and women do not eat blubber until they have given birth to their children.

The results from a dietary survey among pregnant women in 2000 – 2001 has revealed a dramatic reduction in whale meat and blubber intake.

Blood analyses showed a decrease corresponding to more than one order of magnitude in regard to mercury exposure. However, possibly because of their stability in the body, the PCB levels were still high and must be considered to be a continued potential health problem in the Faroese community. The reasons for the persistent high PCB concentrations are not fully understood, and further research is needed to elucidate this phenomenon.

Because of the advantages of conducting epidemiological studies in the Faroes and because of the continuing exposure to organochlorine compounds, research should be continued to explore the health consequences of the increased exposure levels.

8.4 Main Conclusion

The main conclusion of the Human Health Programme in AMAP phase 2 is that we are even more certain than before that the current human exposure at the prevailing levels and mixtures of contaminants influences the health of Arctic populations in a negative way. Subtle effects have been demonstrated to be present at a sub-clinical level. In consideration of the potential effects on future generations, efforts to reduce the entry of persistent substances into the ecosystems of the world should be accelerated. Furthermore, the process initiated through the AMAP under phase 1 and 2 should be continued and expanded to involve all relevant disciplines with the goal of pursuing a more holistic assessment of the health of the Arctic Peoples. 

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