The 2015 Human Health Assessment Report has continued the historical line from the
former reports (1–3), including new knowledge, missing links and information from
each report, drawing attention to the most recent knowledge and perspectives for future
research. The separate chapters in this special issue reveal details on monitoring,
known health effects, relations to climate change and, not least, the difficult communication
challenges to reach policymakers, public health authorities and the people of the
Arctic.
The Arctic Monitoring and Assessment Programme (AMAP), Phase 1, started in 1991 to
implement components of the Arctic Environmental Protection Strategy (AEPS) as adopted
at that time by Ministers of the eight Arctic countries. The main task was to prepare
an assessment of the state of the Arctic environment with respect to defined pollution
issues. On the basis of this, AMAP designed and implemented a monitoring programme,
and conducted its first assessment. The monitoring programme was largely based on
adaptation of ongoing national and international activities, initiating new monitoring
and research work only where necessary. The first AMAP assessment was presented in
1998, entitled “Arctic Pollution Issues: A State of the Arctic Environment Report”
(1). The first AMAP assessment was a compilation of current knowledge about the Arctic
region and a statement of the prevailing conditions in the area. The report had a
broad and holistic perspective, with human health as a separate chapter. The report
would have been impossible without the generous offer from Health Canada to analyse
blood samples from all eight Arctic countries, providing the very first quality assured
comparison of persistent organic pollutants (POPs) and metals in human biological
materials at the circumpolar level. This basic biomonitoring programme was thoroughly
discussed by Odland and Nieboer (4). Even though programmes implemented in scarcely
populated areas provide special challenges, different programmes have been introduced
in several regions and countries. It was concluded in the health chapter of the 1998
report that several groups of people in the Arctic are highly exposed to environmental
contaminants. It was also concluded that variation in human exposure depends on a
combination of (a) varying environmental concentrations of contaminants, (b) local
physical and biological pathways which make the contaminants available and (c) the
local dietary habits of the people. The overall report concluded that the current
understanding of transport processes and the ability to quantify them was inadequate.
In particular, the determination of transport processes and their relative importance
or magnitude within and between compartments (air, land, water, ice, sediments and
biota) is essential. One important recommendation was the well-known benefits of breast
milk and traditional food against the suspected but not yet fully understood effects
of contaminants. The importance of good and reliable biomonitoring programmes was
also addressed. A special part of the 1998 report was the description of health status
and living conditions of population groups living in the Arctic. This overview has
been developed into a comprehensive set of circumpolar health indicators published
by Young and Bjerregaard (5).
The 2002 report (2) went deeper into health effects, introducing case studies in different
geographical areas. It focused upon the combined effects of “multiple environmental
stressors”. Evidence from analyses of banked blood samples from Norway (non-Arctic
donors) demonstrated an exponential increase in polybrominated diphenyl ethers since
1977. Progress was made in studies on the interactive effects of current levels of
mixtures of POPs in the traditional diet. Also, information on concentrations found
in various organs of species used for food had improved. These findings improved the
basis for dietary advice aiming at reducing exposure (2).
The success of carefully developed public health strategies was demonstrated in the
Faroe Islands where interventions related to consumption of pilot whale meat resulted
in an 80% reduction in mean mercury body burdens. New methodologies were found for
integration of epidemiological and mechanistic biomarker effect studies on human samples
making it possible to estimate the effects of current exposure levels, the possible
interactions and the modifying effects of nutrients (combined effects).
The 2009 report demonstrated an important advance in our understanding (3). Several
of the ongoing mother/child cohorts provided results of effect studies, the epidemiologic
design was improved and the basic molecular research was in rapid development. Risk
communication and risk management were on the public health agenda. Human adaptation
to climate change became part of the discussion, and several new substances emerged
as contaminants of potential concern. Especially, recent data for Arctic Russia were
described, indicating elevated levels of oxychlordane and polychlorinated biphenyls
in indigenous coastal peoples from Chukotka. These levels were linked to consumption
of marine mammals by these coastal peoples. Dichlorodiphenyldichloroethylene, the
major metabolite of the pesticide dichlorodiphenyltrichloroethane (DDT), was now found
at the highest concentration in Arctic Russia. This indicates that the likely source
is recent use of DDT in Russian agriculture or as a pesticide in northern communities.
Mercury levels were declining in many populations across the Arctic; however, Inuit
people still had blood mercury levels 3 to 10 times higher than populations who consume
imported foods. This finding was especially prominent in Greenland and parts of Arctic
Canada. A decreasing proportion of Inuit women of childbearing age exceeded guidelines
for blood mercury. Dietary changes due to social, cultural and economic changes, as
well as people's responses to risk management recommendations in the Arctic, are likely
to be the reasons for these decreases in human body burdens. A number of health effects,
at molecular level, as well as in clinical studies, are now described and presented
to public health authorities. This leaves a big challenge for the policymakers and
public health workers. Risk communication must be carried out with great care and
must be sensitive to cultural preferences at a community level. The AMAP Human Health
Assessment Group has clearly stated that it cannot provide specific public health
advice in local and regional situations, but can evaluate the circumpolar impacts
of efforts by local health authorities to develop and disseminate advice.
This special issue will give you a thorough update of all aspects of human health
in the Arctic, with focus on contaminant levels, health effects, future needs and
how we can communicate our difficult scientific language to common people and health
authorities. The authors are all members of the AMAP, Human Health Assessment Group.
There are still many “black holes” in our assessment, and our ongoing and planned
cohorts are open for new possibilities in Arctic health studies and public health
advice. The basic aim is to provide knowledge for health promotion for all Arctic
people.
The papers have been thoroughly peer reviewed following the guidelines of the journal
and the AMAP. We are also happy to include a short paper on reproductive health in
Yakutia, in addition to the papers based on the AMAP report. All papers stand on their
own feet and can be read separately. We wish you a very interesting reading.
Jon Øyvind Odland
Department of Community MedicineFaculty of Health SciencesUiT The Arctic University
of NorwayTromsø, NorwayEmail: jon.oyvind.odland@uit.no
Shawn Donaldson
Health Canada, OttawaON, Canada
Alexey Dudarev
Northwest Public Health Research CenterSt. Petersburg, Russia
Anders Carlsen
Den Danske MiljøstyrelsenCopenhagen, Denmark