18 Family Health and Local Capacity Building in a Developing Community in Greenland, seen from a Health Promotion Perspective

This discussion paper is based on papers and reports from the population surveys on health and health prevention program. The discussion is about possible change in the society seen from health promotion perspective.

The population surveys on health in Greenland provide an insight into the incidence and distribution of different risk factors for disease among the adult population. The studies allow for the follow-up of morbidity and health over time and can be used to measure the development of public health in Greenland and thus constitute an important platform for prevention initiatives. Currently, four population surveys from 1993-1994, 1999-2001, 2005-2010, and 2014 have been conducted. In August 2017, the fifth population survey was initiated. (Christina Viskum Lytken Larsen)

Health Prevention Program is often seen as a top/down or a program coming from outside. Cultural and personal feelings. Self-definition of health and the good life. Feeling capable of taking care of one’s own life, is keywords in a Health Promotion program. Identify resources and way of action. The goal is mobilizing energy to handle the everyday life and the stress situation in life.

Family values and the health and wellness of children and youth are the priorities for Inuit Health Steering Committee. Individuals must take responsibility for their own health, Families must take responsibility for ensuring the health and wellness of their children and Communities must take ownership over responses to emerging crises and rely less on external support.

Over the past few decades, Greenland has witnessed acceleration in development. The population in the settlements has lower educational possibilities than that of the population in the towns and cities, and there are fewer jobs for people with an education in the settlements. But there are several others areas where life in the settlements and in the towns differs: living accommodations, infrastructure and access to healthcare. Among the children of school age, there are huge disparities between city and settlement. Un-healthy lifestyle is more apparent in settlements. Child mortality is higher in the settlements than in the cities, but mortality in comparison to social strata has not yet been researched. As a result of this development, the traditional family structure, norms, and value systems have been impacted. Studies have also identified a number of serious social and psychological problems in Greenlanders that stem from this development. However, there is now an increasing focus in the Greenlandic society on social, health and schools, which points towards a better welfare in Greenland. Against this background, this chapter argues that family values, and the health of children and youth must be prioritized to ensure the healthy development of future generations. In response, I argue that an increased investment in children’s education; social services; resources and increased training for new families; language; public health; and research can help to achieve this goal.

The family has always been the basis for childhood. It is necessary to maintain the family perspective in a community in transition. The well-being of a family depends on: cultural and personal feelings; self-definition of health and the good life; feeling capable of taking care of one’s own life; identifying resources and way of action; and mobilizing energy to handle the everyday life and the stressful situations in life.

In the coming year, the Government of Greenland is planning to renew the daycare area through working with “the good daycare”. The good daycare will focus on food, play and exercise, hygiene and indoor air quality, and a close relationship with parents. The Government will involve local resource people, parents, and professionals in the development process. Here, social and healthcare assistants work in close collaboration with educators so that children develop well, both in educational, health and socially. This municipality regulation on public schools reflect significant changes in the perception of children and learning. Whereas previously, children were unable to take part in shaping their own lives; they will be able to engage in equitable interaction with adults earlier. The Greenlandic school provides a significant opportunity for improved welfare through the learning process. From family planning to having children until the child finishes elementary school, the focus will be on general perceptions of health, looking at determinants including early childhood development, education, material resources, housing, social exclusion, personal security, tradition, culture and language. The good school must have the necessary resources and the necessary educational and professional instruments, along with a focus on the family to create a much closer collaboration between health care, social services and the school system.

Second, strengthening welfare workers’ and schoolteachers’ capacity and emphasizing a close collaboration between the health, social, and educational systems can lay the groundwork for better welfare for families in Greenland and ensure that children experience healthy educational, social, and physical development. This can be achieved through better education and training, and measures to secure better salaries for these workers in the community. In turn, a good school must have the necessary resources, and the educational and professional instruments to provide quality education. Families must not become objects being thrown between systems; they must be active partners. This requires close personal contact between professionals. In addition, while recreation should be a shared responsibility in the communities, there must be public funding, both to ensure professionalism in the various recreational areas and to support voluntary initiatives.

Third, throughout the world, so many children have grown up in families with violence and with experience of neglect and sexual abuse. It is a global social issue and unfortunately a very common problem so we all need help to find solutions. Unfortunately, there is a tendency for the media to focus on children who are victims of neglect and sexual abuse, which often shifts the agenda to a treatment-oriented approach. All parents love their children and want to care for them. However, some need help with building their own capacity to take on the role as mother or father. In turn, the public services for pregnant women must be strengthened through an increased focus on care. Adequately caring for one’s children is not always something that comes on its own. The healthcare system can better train young families and inform them about the care of the child and preparation for childbirth. As part of fostering the development of the child, education on how to be a new family should be prioritized as well. Increased communication and cooperation between new families and social services to ensure a safe environment for the new life must be established when needed and a focus on care and well-being is important. In addition, there needs to be a focus on food, play and exercise, hygiene and indoor air quality and a close relationship with parents during early child development.

Fourth, there is an increasing gap in the area of knowledge and language. Greenland is also part of the global community, where communication and knowledge are key factors for continued development. Increased knowledge for the individual is also the means to address increasing social inequality. Greenlandic is naturally the first language. It is the language that gives identity and ensures daily communication. But the global community and the historic ties to Denmark makes it necessary to be fully trilingual; Greenlandic, Danish and English education must be planned accordingly. Knowledge and communication are the future for us all, and children are the best positioned to naturally acquire these skills. This development must be planned for the future and with due regard to the past. Social inequality is one of the biggest threats to health and wellbeing.

Fifth, the municipality has recently broadly endorsed the draft for a Greenlandic Public Health Program which is based on a popular debate. The focus is on health in everyday life and in all sectors of society. It is a program based on better knowledge about health in the Greenlandic population. A knowledge that will improve the chances of enjoying a good, long life free from disease and discomfort. “Health promotion” are the key words in the Public Health Program.

Finally, social research and research on mental health with a focus on children and families’ social and emotional development should be supported and followed up by increased educational research and development in these areas.

These are problems that people in Greenland have shared with other Inuit and other Indigenous peoples who have lived through similar societal changes. In response, we must find the necessary resources in the community for this targeted approach, where the strategy is development rather than a treatment. A treatment community is the most expensive solution. This is recognized both in the social, health and school services. The big challenge is to ensure grassroots support. This is necessary because the family and children’s well-being is a prerequisite for a positive future for Greenland.

References

Health aspects of colonization and the post-colonial period in Greenland 1721 to 2014. P Bjerregaard, CVL Larsen – Journal of Northern Studies, 2016 – diva-portal.org

Colonial times … ? Finn Lynge, ARCTIC SOCIAL SCIENCES – Prospects for the International Polar Year 2007-2008 Era and Beyond Keynote presentations and other highlights from the Sixth International Congress of Arctic Social Sciences (ICASS VI) Nuuk, Greenland August 22-26, 2008

Three lifestyle-related issues of major significance for public health among the Inuit in contemporary Greenland: a review of adverse childhood conditions, obesity, and smoking in a period of social transition. P Bjerregaard , CVL Larsen – Public Health Reviews201839:5

Midtvejsevaluering af Inuuneritta II: Gennemført i 2017 (Danish) C Ingemann, CVL Larsen – 2018 – forskningsdatabasen.dk Befolkningsundersøgelsen i Grønland 2014 (Danish) Peter Bjerregaard, Inger Katrine Dahl-Petersen. https://www.sdu.dk/da/sif/publikationer/2016/befolkningsundersoegelsen_i_groenland_2014

http://www.inuitcircumpolar.com/icc-canada-health-reports.html