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This Week in The Lancet

  • Volume 377 1719 (2011)
  • May 21, 2011

Climate Change

Climate change, diseased fish and food insecurity: What this means to the Ouje-Bougoumou community

Thursday, November 4th, 2010

by Benita Y. Tam
University of Toronto, Canada

Traditional foods are vital to cultural identity and the health of Aboriginal peoples [1]. Personal identity, cultural values, skills and spirituality are all associated with the traditional lifestyle in obtaining wild game meat and fish [2]. A decline in a traditional food source may not only impact the physical health of an Aboriginal community, but it may also affect the representation of their culture. Leaders of Cree communities believe harvesting (e.g. hunting, fishing and trapping) to be integral for their cultural and social health [3]. In a Cree community of the eastern James Bay region, a decline in harvesting and bush activity due to hydroelectric development has been found to be related to greater social and health issues [4]. Aboriginal elders may observe the loss of healthy fish with greater significance and value: they may associate this loss with the loss of a traditional method or the loss of the connection between fish and the First Nations. Thus, a loss of a traditional food source such as fishing may have significant health implications on Aboriginal communities.

Aboriginal members of the Ouje-Bougoumou community in the James Bay region, Quebec, Canada have subsisted on fish for a long time from nearby lakes. As a community member reported:

They like eating fish. I know that. My friends from Chibougamau will ask me, did you go fishing? Can I have a few? [5]

However, in 1999, a documentary revealed the reality of the fish in several lakes of the Ouje-Bougoumou region [6]. It showed elder Albert Mianscum catching fish, and each one he caught was plagued with physical deformities, such as red sores and missing fins and eyes [5, 6]. As a community member reported in an interview several years later:

You got to see the fish, how ugly they look. Their eyes are popping out. Red, red eyeballs. [7]

The physical deformities were later confirmed to be caused by a fish disease called furunculosis [8]. For Albert Mianscum, and like so many other community members, this was a serious concern as fish was a main source of food for him and his family [5]. Many of the community members of Ouje-Bougoumou believe that the onset of furunculosis was caused by the runoff of nearby mines [5]. Another study found that a combination of stress factors, i.e. climate change and mining contaminants, could have induced the susceptibility of certain fish species to furunculosis [7]. As climate change and contaminants are “affecting the traditional food systems” in the Arctic [9]; the unhealthy contaminated fish of the James Bay region may be further exacerbated by climate change.

Climate change has been associated to food security issues particularly in Northern Aboriginal communities due to the impact on traditional harvesting activities and financial insecurity [1, 10]. With a growing population of diseased fish in the James Bay region, climate change may further devastate the fish population, putting Aboriginal community members at risk to health issues such as food insecurity.

Food security

Food security refers to the adequate access, availability, supply, and utilization of food; also known as the four pillars to food security [2]. Education and knowledge on the health benefits of consuming healthy foods has been established to be other influential components of food security. This term is well defined by the World Food Summit in 1996 (obtained in [2]):

Food security exists when all people, at all times, have physical and economic access to sufficient, safe, and nutritious food to meet their dietary needs and food preferences for an active and healthy life.

Food insecurity may presumably be the opposite of this definition; where people do not have physical access and/or economic means to a sufficient amount of safe and nutritious food that would provide them a healthy lifestyle. Food insecurity is a condition that can adversely affect the health and well-being of individuals, households, and communities [2]. Harmful consequences of food insecurity include social, physical, and nutritional detriments. A number of studies reveal that those suffering from food insecurity consume an inadequate amount of nutrients on a daily basis [2]. Subsequently, poorer quality dietary intake may lead to many health problems including obesity, heart disease, and type 2 diabetes [11].

Rates of food insecurity for Aboriginal Canadian households are much higher than those of Non-Aboriginal households [2]. A study surveyed three rural Aboriginal communities and compared the rates of food insecurity between the children and adults within the same household [2]. Results show that in the same household, food insecurity rates for children were much higher than their counterparts [2]. Conversely, food insecurity rates for children were lower than their counterparts when examining western households located in southern Canada [2].

Since game fish is one of the main foods for many Aboriginal members in the Ouje-Bougoumou community [7], a decline in healthy fish due to contamination and climate change may be detrimental to their overall diet. A decline in access to healthy fish in Ouje-Bougoumou may force community members to consume more store bought foods. Simultaneously, availability of readily consumable foods, e.g. canned foods, has been increasing in the region, with a potential adverse influence on the food choices of community members. The cost of store bought food is also an issue. Substituting game fish in one’s diet can indeed create financial strain for households because a diet based on traditional foods obtained through catching, hunting, and fishing is typically less costly than its sold counterpart. This financial strain can in turn lead to greater food insecurity because it can seriously limit food choices. The decrease in available traditional foods (partly attributable of climate change) coupled with inflated food costs and limited availability in Northern Quebec may be detrimental to the overall health status of Aboriginal members of the Ouje-Bougoumou community. Already, obesity and diabetes mellitus are increasingly prevalent in Canadian Aboriginal communities [12]. Furthermore, in light of the results discussed above, the increasing population of diseased fish can be expected to be especially detrimental for the Ouje-Bougougmou children.

Aboriginal children may be vulnerable to living an unhealthy lifestyle at an early age. Just in the past decade, the rate of diabetes occurring in Aboriginal children has skyrocketed [13]. The prevalence of diseased fish may incite adults to feed their families with bought food rather than with traditional foods. A high caloric diet may chronically debilitate the well-being of the child, causing her, for example, to be at a much greater risk for lifestyle debilitating diseases such as diabetes. With the impacts of climate change, harvesting activities may be less practiced. The transmission of traditional ecological knowledge (TEK) may be truncated between the two current generations due to the decline in healthy fish and the increased reliance on a Western lifestyle, leading to greater physical inactivity. “The adoption of a more sedentary lifestyle often accompanies the transition to a modern diet” [12]. And as it has been found, physical inactivity is a risk factor to type 2 diabetes mellitus [12].

Conclusion

Food insecurity is only one aspect of how climate change may impact the Ouje-Bougoumou community. As climate change is a complex issue, detrimental impacts that many Aboriginal communities face are multifaceted. Climate change does not solely affect the fish population; climate change affects the land and resources that many Aboriginal communities depend on [1, 10]. Thus, not only is their food source affected, but also their homes, lifestyle and possibly their sense of traditional purpose. All of these in turn can have repercussions not only on their physical health, but also on their social, mental, and emotional well-being.

Acknowledgements

Special thanks to William A. Gough and  Leonard Tsuji for their support and assistance.

References

  1. Furgal, C. and Seguin, J. Climate Change, Health, and Vulnerability in Canadian Northern Aboriginal Communities. Environmental Health Perspectives 2006; 114-12: 1964-1970.
  2. Power, E. M. Conceptualizing food security for Aboriginal people in Canada. Canadian Journal of Public Health. 2008; March-April: 95-97.
  3. Ohmagari, K. and Berkes, F. Transmission of Indigenous Knowledge and Bush Skills among the Western James Bay Cree Women of Subarctic Canada. Human Ecology 1997; 25-2: 197-222.
  4. Niezen, R. Power and dignity: The social consequences of hydro-electric development for the James Bay Cree. Canadian Review of Sociology and Anthropology 1993; 30: 510-529.
  5. Tam, B. A Climate Change Impact Assessment on the Spread of Furunculosis in the Ouje-Bougoumou Region. Master’s Thesis. University of Toronto. 2010. Available from: https://tspace.library.utoronto.ca/handle/1807/17227
  6. CBC. Albert’s fish part 1. 2001. Documentary on Canadian Broadcasting Company’s Maamuitaau Program. 1999.
  7. Tam, B, Gough, W, and Tsuji, L. The Impact of Warming on the Appearance of Furunculosis in the fish of the James Bay region, Quebec, Canada. Regional Environmental Change. 2010. DOI:10.1007/s10113-010-0122-8.
  8. Penn, A. Memorandum: Report of furunculosis in fish from Obatagamau Lake. November 24 2000.
  9. Lambden, J., Receveur, O. and Kuhnlein, H. Traditional food attributes must be included in studies of food security in the Canadian Arctic. International Journal of Circumpolar Health 2007; 66-4: 308-319.
  10. Ford, J.D. Vulnerability of Inuit food systems to food insecurity as a consequence of climate change: a case study from Igloolik, Nunavut. Regional Environmental Change 2009; 9: 83-100.
  11. Health Canada. A statistical profile on the health of First Nations in Canada. Ottawa: First Nations and Inuit Health Branch. 2003 [cited December 1, 2006]. Available from: http://www.hc-sc.gc.ca/fnih-spni/pubs/gen/stats_profil_e.html.
  12. Young, T. K., Reading, J., Elias, B., and O’Neil, J.D. Type 2 diabetes mellitus in Canada’s First Nations: Status of an epidemic in progress. Canadian Medical Association 2000; 163-3: 561-566.
  13. Couture, J. Children in basic need of better quality of life. Windspeaker 2008; August: 8.

A Healthy Planet?

Tuesday, June 30th, 2009

In today’s podcast Erica and John speak to Mustafa Abbas. Mustafa told us all about being the coordinator of Medsin’s Healthy Planet Campaign (sign the pledge) as well as being the new Vice President for Branches. He also was one of the authors on the fantastic (and enormous) report that was published recently in The Lancet on the links between climate change and health – a busy chap! So we’re really pleased that he managed to squeeze us in for a chat…listen in here.

A fresh look at air pollution

Friday, January 23rd, 2009

Kate Leyland writes about the effect of air pollution on health, an article inspired by her recent intercalated year in Pharmacology completing a lab project on the effect of diesel exhaust particulate on the cardiovascular system.

Each year we take approximately 10 million breaths.  Breathing contaminated air allows toxic substances to enter the body and produce harmful effects. Clean air is therefore a fundamental precondition of health. Worldwide, the World Health Organisation reports that air pollution is responsible for an estimated 2 million premature deaths per year.(1)  Understanding the nature and magnitude of the effects of air pollutants on health is essential for developing policies to reduce their harm. After highlighting some causes and consequences of air pollution, I will explain why it is such an important global health problem, and discuss some measures for tackling it.

Air pollution contains a mixture of noxious gases, volatile organic liquids, and particulate matter. Pollutants cause pathology by different mechanisms. In the respiratory system for example: sulphur dioxide causes broncho-constriction; nitrogen dioxide damages the epithelium lining of the airways; and ozone decreases lung cell function. Combinations of pollutants can have additive or synergistic effects. In the cardiovascular system, carbon monoxide decreases the oxygen carrying capacity of blood, whereas diesel exhaust particulate impairs vascular function.(2)  It is thought that particles in air pollution do not just affect the lungs, however the mechanism for their impact on other organs is yet to be fully elucidated. The traditional view is that inhaled pollutants provoke an inflammatory response in the lung, which causes release of prothrombotic and inflammatory cytokines into the circulation.(3)  These inflammatory mediators result in pathological mechanisms such as thrombosis. Newer hypotheses incorporate evidence that inhaled particles can translocate across the alveolar wall, to enter the systemic circulation and cause direct systemic effects.(4)

Whether acute or chronic, exposure to air pollution is associated with adverse health effects. Acute exposure can cause symptoms including headache, nausea, and irritation of the eyes, nose, and throat. It can also increase prevalence of upper respiratory tract infections, such as bronchitis and pneumonia, and aggravate existing respiratory conditions, such as asthma and emphysema. There are clear associations between daily increases in air pollution and certain health outcomes, such as evidence of increased hospital admissions and premature deaths due to acute respiratory attacks.(5)  Epidemiological evidence shows that chronically high levels of air pollution may promote lung cancer(6), and myocardial infarction.(7)  Newer evidence suggests that long-term air pollution exposure may also result in damage to the brain, nerves(8), liver(9), and kidneys.(10)

Although some pollutants are naturally produced, we are responsible for a large proportion of them. Fossil fuel combustion is a major source. Power stations, factories, vehicles, offices and even our homes contribute to air pollution. Age, general health, lifestyle factors, and location influence susceptibility to the health effects of air pollution. In developed countries, people in lower socioeconomic groups are likely to live in areas, such as near main roads, where they are exposed to greater quantities of air pollution at higher concentrations. Their health is also likely to be compromised already, due to factors such as poor nutrition and lack of access to good quality medical care. As a result, they have a disproportionate disease burden compared to people in higher socioeconomic groups. The burden is even greater for people in developing countries, who bear more than half of the global ill health arising from air pollution.(1)  A large proportion of this air pollution is created by growing numbers of vehicles, often poorly maintained, which use low quality fuel and burn it inefficiently.

Recognizing air pollution as an important global health issue is fundamental to tackling it. Solving the problem also requires action from public authorities at local, national, and international levels. Health, housing, energy, and transport initiatives can all play a role in reducing air pollution. In certain parts of the world, regulations and measures have been introduced to achieve this. For example, since 2005, a 20 km bus rapid-transit system has been operating in Mexico City. It transports 263,000 people per day and exposes them to fifty percent less carbon monoxide, benzene, and particulate matter than older buses.(11)  Despite such schemes, air pollution is still a major cause of morbidity and mortality. In addition to government legislation leading to reduced air pollution levels, many people making small changes, such as using public transport instead of driving private vehicles, can make a difference.

The World Health Organisation estimates that a quarter of the world’s population is exposed to unhealthy concentrations of air pollutants.(1) Air pollution has a variety of sources, with different health consequences. Acute or chronic exposure is harmful, and the concentration of pollutants also influences the extent of damage. Measures have been taken to reduce the global health burden of air pollution, but there is considerable room for improvement. Perhaps a fresh outlook is needed to fuel future progress.

Kate Leyland is a medical student at the University of Edinburgh, Scotland.

K.A.Leyland@sms.ed.ac.uk

References

(1) Air quality and health. August 2008; http://www.who.int/mediacentre/factsheets/fs313/en/index.html [accessed Sep 6]

(2) Air pollution and health. October 2002; http://www.ncbi.nlm.nih.gov/pubmed/12401268 [accessed Sep 6]

(3) Seaton, A., Soutar, A., Crawford, V., Elton, R., McNerlan, S., Cherrie, J., Watt, M., Agius, R., and Stout, R. (1999a). Particulate air pollution and the blood. Thorax 54 (11), 1027-1032

(4) Nemmar, A., Hoet, P. H., Vanquickenborne, B., Dinsdale, D., Thomeer, M., Hoylaerts, M. F., Vanbilloen, H., Mortelmans, L., and Nemery, B. (2002). Passage of inhaled particles into the blood circulation in humans. Circulation 105(4), 411-414

(5) Air pollution and daily hospital admissions in metropolitan Los Angeles. May 2000; http://www.ncbi.nlm.nih.gov/pubmed/10811569 [accessed Sep 6]

(6) Air pollution increases lung cancer risk. March 2004; http://www.pulmonaryreviews.com/mar04/pr_mar04_pollutionlung.html [accessed Sep 6]

(7) Air pollution and cardiovascular injury. August 2008; http://content.onlinejacc.org/cgi/content/full/j.jacc.2008.05.029v1 [accessed Sep 6]

(8) Long-term air pollution exposure is associated with neuroinflammation, an altered innate immune response, disruption of the blood-brain barrier, ultrafine particulate deposition, and accumulation of amyloid beta-42 and alpha-synuclein in children and young adults. March 2008; http://www.ncbi.nlm.nih.gov/pubmed/18349428?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum [accessed Sep 6]

(9) Noninvasive assessment of liver detoxification capacity of children, observed in children from heavily polluted industrial and clean control areas, together with assessments of air pollution and chloro-organic body burden. April 2004; http://www.ncbi.nlm.nih.gov/pubmed/15037995?ordinalpos=13&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum [accessed Sep 6]

(10) Health and environment. May 2008; http://www.epa.gov/air/lead/health.html [accessed Sep 6]

(11) The Benefits and Costs of a Bus Rapid Transit System in Mexico City. May 2008; http://www.epa.gov/integenv/pdf/mexico/Metrobus%20Mexico%20Phase%20III.pdf [accessed Sep 6]

The effect of climate change on the spread of infectious diseases

Friday, December 5th, 2008

Zaid Hussain Khan writes on one of the specific impacts climate change will have on public health. 

Global warming or more specifically the ‘greenhouse effect’ refers to the trapping of solar heat by greenhouses gases such as methane, resulting in increased global temperatures. (1) Emission of greenhouse gases has increased significantly since the industrial revolution (2) and is largely anthropogenic, that is, caused by human activity. For example, growing demand for energy has amplified concentrations of CO2, a major greenhouse gas, in the atmosphere from the burning of fossil fuels. With increased concentrations of greenhouse gases, global temperatures have risen and continue to rise; this has lead scientists to fear, rightly, the long term effects of such climate change. One of the major effects forecasted is an increase in the incidence of infectious diseases. (3) A key factor affecting the spread of infectious disease is climatic conditions, (4) as many infectious diseases rely on vector organisms for transmission. (5) These organisms are sensitive to environmental changes and therefore may be affected by global warming. (more…)

What doctors and medical students can do to help combat climate change

Tuesday, December 4th, 2007

 Sarah Walpole discusses what the medical community can do and also interviews the right honourable Hilary Benn MP, Secretary of State for the UK’s Department for the Environment, Food and Rural Affairs

Climate change is, and will increasingly be, the cause of major and widespread health problems. These include trauma following natural disasters, malnutrition where crop yields are reduced, and infection due to the spread of diseases and disease vectors.

Scientists have found that there is a “tipping point” at which major destabilisation will occur, with catastrophic effects, such as major natural disasters. To avoid reaching the tipping point and prevent the major health consequences, global emissions must peak and begin to fall by 2015 (1) which is no easy target. (more…)

Profile: Hugh Montgomery

Thursday, November 29th, 2007

hugh-montgomery.png  Professor Hugh Montgomery is an intensive care consultant at University College Hospital London and directs the Institute of Human Health and Performance at University College London, but the way he sees it, the biggest threat to health is something that won’t be touched by these medical endeavours as Sarah Walpole finds out

This year, Professor Hugh Montgomery will be giving the Royal Institution Christmas lectures, which are about the body and the physiology of survival. “It’s theatre as much as lecturing”, and Hugh says that it may well be “the most difficult thing [he's] done”.

It’s not Hugh’s first delve into the world of entertainment though, as a film that he wrote is currently being produced for Hollywood. When given the opportunity to write a piece for the big screen, Hugh wrote this medical thriller, “Reputation and Control”, in six weeks. He has also written two novels for families (“The Voyage of the Arctic Term” and “Cloudsailors“). His latest is ‘The Genie in the Bottle- about which more later. (more…)

The International Physicians for the Prevention of Nuclear War view on climate change

Wednesday, November 7th, 2007

Sarah Walpole interviews Alex Rosen for his organisation’s views on climate change

alexrosencolor.JPGAlex Rosen

Alex Rosen is a Paediatrician working in Germany, and a member of International Physicians for the Prevention of Nuclear War (IPPNW), an organisation which is committed to bringing a public health perspective to the debate surrounding nuclear war. IPPNW recognises the detrimental health effects of nuclear war, and is committed to preventing nuclear war and abolishing nuclear weapons.

Dr Rosen explains that IPPNW sees resource use and climate change as root causes of conflict, and argues strongly that doctors have an important role in addressing environmental issues to protect health.

(more…)