Acculturation and self-rated health among Arctic indigenous peoples: a population-based cross-sectional study

Eliassen et al. BMC Public Health 2012, 12:948 http://www.biomedcentral.com/1471-2458/12/948 RESEARCH ARTICLE Open Access Acculturation and self-rated health among Arctic indigenous peoples: a population-based cross-sectional study Bent-Martin Eliassen1*, Tonje Braaten2, Marita Melhus1, Ketil Lenert Hansen1 and Ann Ragnhild Broderstad1,3 Abstract Background: Acculturation is for indigenous peoples related to the process of colonisation over centuries as well as the on-going social transition experienced in the Arctic today. Changing living conditions and lifestyle affect health in numerous ways in Arctic indigenous populations. Self-rated health (SRH) is a relevant variable in primary health care and in general public health assessments and monitoring. Exploring the relationship between acculturation and SRH in indigenous populations having experienced great societal and cultural change is thus of great importance. Methods: The principal method in the Survey of Living Conditions in the Arctic (SLiCA) was standardised face-to-face interviews using a questionnaire. Very high overall participation rates of 83% were obtained in Greenland and Alaska, whilst a more conventional rate of 57% was achieved in Norway. Acculturation was conceptualised as certain traditional subsistence activities being of lesser importance for people’s ethnic identity, and poorer spoken indigenous language ability (SILA). Acculturation was included in six separate gender- and country-specific ordinal logistic regressions to assess qualitative effects on SRH. Results: Multivariable analyses showed that acculturation significantly predicted poorer SRH in Greenland. An increased subsistence score gave an OR of 2.32 (P<0.001) for reporting poorer SRH among Greenlandic men, while an increased score for Greenlandic women generated an OR of 1.71 (P=0.01). Poorer SILA generated an OR of 1.59 in men (p=0.03). In Alaska, no evidence of acculturation effects was detected among Iñupiaq men. Among Iñupiaq women, an increased subsistence score represented an increased odds of 73% (p=0.026) for reporting poorer SRH. No significant effects of acculturation on SRH were detected in Norway. Conclusions: This study shows that aggregate acculturation is a strong risk factor for poorer SRH among the Kalaallit of Greenland and female Iñupiat of Alaska, but our cross-sectional study design does not allow any conclusion with regard to causality. Limitations with regard to wording, categorisations, assumed cultural differences in the conceptualisation of SRH, and confounding effects of health care use, SES and discrimination, make it difficult to appropriately assess how strong this effect is though. Keywords: Self-rated health, Acculturation, Kalaallit, Iñupiat, Sami, Inuit, Indigenous peoples, Living conditions, SLiCA * Correspondence: 1 Department of Community Medicine, Centre for Sami Health Research, University of Tromsø, Tromsø N-9037, Norway Full list of author information is available at the end of the article © 2012 Eliassen et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Eliassen et al. BMC Public Health 2012, 12:948 http://www.biomedcentral.com/1471-2458/12/948 Background Acculturation is for indigenous peoples [1] related to the process of colonisation over centuries [2]. Being one of the most cited definitions [3], Redfield, Linton and Herskovits [4] define acculturation as “those phenomena which result when groups of individuals having different cultures come into continuous first-hand contact, with subsequent changes in the original culture patterns of either or both groups” (p. 149). In health research the concept of acculturation has usually been applied to assess the health effects resulting from contact between people belonging to different ethnic groups; but the concept has also shown to be useful when exploring health implications among people subjected to rapid modernization and subsequent social and cultural change [5]. Within Alaska there are some 47.000 Inuit [6]. Approximately 30% of these are Iñupiat [6-8] inhabiting the northern and western coasts as far south as Norton Sound [6]. Greenland is home to about 57.000 people, of which approximately 90% are Kalaallit (Greenlanders). The majority of Greenland’s population is situated on the south-central west coast. Only 3500 live on the east coast and less than 1000 are located in the far north. Kalaallisut (the Greenlandic language) is closely related to the Iñupiaq language spoken by Iñupiat in Alaska [9]. The traditional Sami settlement area (Sápmi) in Norway stretches from Finnmark in the north to Engerdal in Hedmark County in the south. No reliable or updated demographic record on the Sami exists. Though suffering from grave deficiencies, estimates of the total number of Sami in Norway usually vary between 40.000 and 50.000 [10]. The Iñupiat, Kalaallit and the Sami share a common, though independently unique, history of colonialism and have throughout history been victims of state and church driven forced assimilation [11-14]. Forced assimilation has resulted in loss or extensive change of traditional practices, native languages, and norms and beliefs [2]. As part of this process, concentration of the populations in large settlements provided most circumpolar indigenous peoples with schooling, health care, housing, water, sanitation, and imported foods and consumer products [14-16]. The post-World War II years in the Arctic were characterised by an intensification of social and cultural change [14]. In Greenland, Alaska, and Norway an increasing urbanisation has taken place [14] and mining, industrial fishing and the discovery of oil transformed – to a varying degree – the economies [17]. In 2005 only 17% of the Greenlandic population lived in villages [9]. In the post-war period in Norway and Alaska, outmigration from rural to urban areas has also been considerable [18,19]. Today the transition from hunting and small scale fishing to a mixed cash/harvest economy is seen all across the Arctic [16]. Subsistence Page 2 of 11 and traditional foods is still a significant contributor to cultural identity and social cohesion among the Inuit and Sami [14,20,21], but unemployment is a problem in many Inuit communities which affects subsistence as this requires costly equipment such as guns, ammunition, snowmobile, and petrol [14,22-24]. The role of subsistence is also affected by access to the resources traditionally harvested being reduced by climate change, pollution, and an increasing number of regulations and import bans [16,20,22,23,25]. Changes in living conditions and lifestyle following this development affect health in numerous ways [16]. The life expectancy of the Inuit and (...truncated)