‘Changing Climate, Changing Health, Changing Stories’ Profile: Using an EcoHealth Approach to Explore Impacts of Climate Change on Inuit Health
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- Harper, S.L., Edge, V.L., Cunsolo Willox, A. et al. EcoHealth (2012) 9: 89. doi:10.1007/s10393-012-0762-x
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Global climate change and its impact on public health exemplify the challenge of managing complexity and uncertainty in health research. The Canadian North is currently experiencing dramatic shifts in climate, resulting in environmental changes which impact Inuit livelihoods, cultural practices, and health. For researchers investigating potential climate change impacts on Inuit health, it has become clear that comprehensive and meaningful research outcomes depend on taking a systemic and transdisciplinary approach that engages local citizens in project design, data collection, and analysis. While it is increasingly recognised that using approaches that embrace complexity is a necessity in public health, mobilizing such approaches from theory into practice can be challenging. In 2009, the Rigolet Inuit Community Government in Rigolet, Nunatsiavut, Canada partnered with a transdisciplinary team of researchers, health practitioners, and community storytelling facilitators to create the Changing Climate, Changing Health, Changing Stories project, aimed at developing a multi-media participatory, community-run methodological strategy to gather locally appropriate and meaningful data to explore climate–health relationships. The goal of this profile paper is to describe how an EcoHealth approach guided by principles of transdisciplinarity, community participation, and social equity was used to plan and implement this climate–health research project. An overview of the project, including project development, research methods, project outcomes to date, and challenges encountered, is presented. Though introduced in this one case study, the processes, methods, and lessons learned are broadly applicable to researchers and communities interested in implementing EcoHealth approaches in community-based research.
KeywordsEcoHealthIndigenousclimate changehealthcommunity-based researchdigital storytelling
Global climate change and its subsequent impacts on public health exemplify the challenge of managing complexity and uncertainty in health research. Identified as the biggest health threat of the twenty-first century (Costello et al. 2009), impacts of climate change on human health include direct impacts on morbidity and mortality due to increased temperature and extreme events, indirect effects via waterborne, foodborne, and vectorborne diseases, and impacts on mental health and wellbeing due to the displacement of people and loss of livelihood (McMichael et al. 2008; Costello et al. 2009). In particular, it is expected that these health-related climate change impacts will be experienced by Indigenous populations and peoples who remain directly reliant upon local ecosystems for livelihoods, culture, and well-being. For example, the Canadian North is currently experiencing rapid changes in climate (Nickels et al. 2005; Christensen et al. 2007), and even subtle resultant environmental changes can dramatically impact the livelihoods, cultural practices, and health of Inuit who live there (Furgal and Seguin 2006).
Researchers investigating climate change impacts on health recognise that comprehensive and meaningful research outcomes depend on taking a more systemic and transdisciplinary approach (Wilcox and Kueffer 2008). Furthermore, engaging local citizens in project design, data collection, and analysis (ITK 2006) is required to more broadly comprehend the complexities and interrelationships between climate change and health, and to inform adaptation policy (McMichael and Wilcox 2009).
A List of Working Definitions Used by the Changing Climate, Changing Health, Changing Stories Team in Rigolet, Nunatsiavut, Canada
Research and development approaches guided by six principles: (1) systems thinking, (2) transdisciplinary research, (3) participation, (4) sustainability, (5) gender and social equity, and (6) knowledge to action
Concepts, ideas, events, or processes that:
• Are comprised of a large number of interacting elements
• Are comprised of elements that individually do not address the problem/issue
• Emerge from a number of controlling processes or systems, not from a random association between a large number of interrelated elements
• Are comprised of systems that are self-organised
Studying complex issues require:
• Sets of individual research questions, which together address a problem/issue
• Embracing uncertainty
• Understanding the issue/problem from a variety of operational and philosophical perspectives
• Considering several elements to understand the topic, but not too many to enhance understanding and communication. According to Einstein, it should be “as simple as possible, but no simpler”
Research that transcends disciplinary boundaries, combines multiple perspectives and disciplines working together as a cohesive unit, and integrates many tools and methods to generate new frameworks, concepts, ideas, and information.
Participation in research
Stakeholders—including, but not limited to government, bi-laterals, multilaterals, non-governmental organizations, community-based organizations, and community members—actively participating in all phases of research design, implementation, interpretation, evaluation, and action, which enhances the research process, resulting action, and the sustainability of the project. Participation includes Participatory Action Research
Social equity in research
Research that considers and addresses unfair or unequal differences between groups (e.g. social, economic, class, age, or gender groups) in terms of gender (e.g. roles and responsibilities), power (decision making, access to resources), and trade-offs (who benefits)
The cognitive and social skills that allow individuals to access, understand, and use information to maintain good health. Health literacy encompasses basic/functional, communicative/interactive, and critical health literacy
Changing Climate, Changing Health, Changing Stories Project
Community Profile: Rigolet, Nunatsiavut, Canada
Health Statistics for Those Living in the Four Canadian Inuit Regions Compared to the National Average from 1999 to 2003 (ITK 2010)
Proportion of low birth weight* (%)
Life expectancy at birth† (years)
Infant mortality per 1,000 births‡
Perinatal mortality per 1,000 births**
Age-standardised mortality per 100,000††
Respiratory disease age-standardised mortality per 100,000‡‡
Suicide and self-inflicted injury age-standardised mortality per 100,000***
Climate change and its effects are a growing concern in Nunatsiavut, with reports from residents and scientists alike indicating that recent years have been characterised by higher atmospheric temperatures, increased intensity and frequency of storms, delayed ice formation and earlier break-up, and changes in rainfall patterns (Furgal and Seguin 2006; Alley et al. 2007; Cunsolo Willox et al. 2011; Harper et al. 2011; Stroeve et al. 2011). In an exploratory survey in 2009, Rigolet residents reported changes in temperature, precipitation, ice, wildlife and vegetation, water systems, and overall weather predictability. The majority of community members reported that these climatic and environmental changes were of concern (66 of 75 [88%] respondents), and resulted in changes to lifestyle (46 of 75 [61%] respondents) and health (57 of 75 [76%] respondents).
In January 2009, the Rigolet Inuit Community Government partnered with a team of researchers, public health practitioners, and community storytelling facilitators to examine if any climate change impacts on local health had been observed. Specifically, the Changing Climate, Changing Health, Changing Stories project aimed to develop and use participatory, community-run methodological strategies to explore climate–health relationships. Funding was provided directly to the community by Health Canada’s First Nations and Inuit Health Branch, with complementary funding from the Nasivvik Centre for Inuit Health and Changing Environments, and the Nunatsiavut Government.
Project Activities and Data Collection
Oral traditions and cultural stories are vital to research exploring past changes and experiences, as well as how these changes were perceived (Smith 1999; Chamberlin 2003; Denzin and Lincoln 2008). Inuit culture, language, and stories are based on an oral tradition. These stories are place-based and contain local knowledge and history—information that cannot be gathered through purely quantitative measurement. Therefore, the project team identified the use of digital storytelling as an innovative approach to data collection, particularly within an Indigenous context (Cunsolo Willox et al. 2012, forthcoming).
Digital storytelling is the process of illustrating personal narratives and experiences through various multi-media techniques (Lambert 2006; Gubrium 2009). The Rigolet community storytelling facilitators tailored a digital storytelling process to meet the local needs and culture of the community. Participants created their own digital stories in week-long workshops facilitated by three locally trained community members. Workshops provided participants with the opportunity to discuss observed climatic changes, as well as perceived impacts of these changes on physical, mental, and emotional health. Participants were also trained in photography skills, digital photo editing, and video-editing. Personal stories were written and/or recited, and then recorded, before being illustrated with video clips, photographs, art work, text, audio, and music, to create a 3–5 min first-person narrative video.
To date, 37 stories have been created in nine workshops, with five of those workshops taking place in the community, one in the school for grades 7–9, and two in cabins on the land. Six additional stories were created by Elder and youth pairs who participated in the project’s Elder and Youth UKausiga (‘My Word’) Camp, which brought together Elders and youth from all Nunatsiavut communities. The digital format allowed these stories to be shared via the internet (YouTube™, community websites, and listservs), social media (Facebook© and blogs), community DVDs, academic conferences, and community story nights.
When using digital storytelling as a data collection method, the digital stories are the data. Thus, the data emerge directly from the participants, with minimal interference from the researchers. In other qualitative methods, the researcher commonly identifies which questions to ask and frames the direction of the interview. Where digital storytelling is the data collection method, however, it is the participants, not the researchers, who have the power to decide what information is important, relevant, and appropriate for the research topic. Thus, this process provided unique and culturally valid data that were meaningful to participants and representative of their lived experiences (Cunsolo Willox et al. 2012, forthcoming). Analysis of digital storytelling data is similar to other forms of qualitative data analysis: the media are analysed and coded for pre-determined and emergent themes and trends, as well as for place-based and cultural symbols and meanings. The suite of digital stories helped explain complex climate–health relationships from multiple perspectives, showing how various people view and make meaning of different events. The digital storytelling process exemplified the value of the participatory aspect of EcoHealth methodology in collecting complex data, as well as a reversal of the traditional power structure between researcher and participant.
Other Research Methods
While digital storytelling was the central data collection method, other complementary qualitative research methods were also used. In-depth interviews were conducted from November 2009 to October 2010 (n = 87) in a conversational format (Kvale 1996) to promote an open dialogue and encourage participants to explore attitudes, feelings, and behaviours associated with climate change impacts on land, wildlife, vegetation, and human health. In conjunction with the digital storytelling workshops, a series of seven focus groups were facilitated by Rigolet community members using concept mapping, photos, and digital stories to stimulate and enhance discussions. In November 2009, a population survey was conducted to gain a broader understanding of community perceptions and observations of climate change (n = 75). A second survey was conducted in August and October 2010, which gathered data on the bio-psycho-social costs of ecosystem disturbance caused by climate change (n = 112). Three PhotoVoice workshops were held, where participants received training in photographic skills and took pictures to document health-related climate change impacts. Participants shared these photos, stories, themes, and experiences in a group setting, and then created narratives to accompany their photographs, representing their experiences, perceptions, and observations of the relationship between climate change and health.
The wide spectrum of activities provided community members with multiple opportunities to engage and provide direction in the research project and resulted in high participation and response rates. For instance, there have been 10 story-nights with high attendance, two community surveys and 87 in-depth interviews with high response rates (75, 96, and 100% response rates, respectively), and active social media sites. This participation allowed a more thorough examination of complex climate–health relationships from a variety of perspectives, which fit well within our EcoHealth approach.
The digital storytelling data collected and the stories created were unique and emergent from local norms and culture, and contained information and ideas that could not have been captured through interviews alone. Research results include exploration of climatic and environmental change observations, the impacts of climate change on mental, emotional, and place-based health, youth and elder observations and perceptions of climate change, the socio-economic impacts of climate change, and the potentials and opportunities of using digital storytelling as a research method. Research results were continually shared, discussed, and validated with community members to ensure accuracy and authenticity of results via regular community story nights, presentations at large community events, DVDs delivered to each household, a Facebook© group, posters, and household flyers. To share research results with the academic community, researchers and community members are working collaboratively on articles and have a number of scholarly manuscripts at various stages in the peer-review process. As well, to-date, research results have been shared through 34 presentations at academic conferences by community leaders, university students, and health professionals. This active collaboration was fundamental in our EcoHealth approach; rather than being passive sources of data, community members helped generate new knowledge (Forget and Lebel 2001) and have become leaders in climate–health work in the Nunatsiavut region.
Training Provided to Develop and Enhance Skills for Community Storytelling Facilitators in Rigolet, Nunatsiavut, Canada
Professional novelist and journalist
Professional writing skills: grant writing; letter and email writing; writing for the media; and media relations
University learning specialist
Presentation skills: oral presentations; poster presentation; and PowerPoint©
Professional media arts technician
Digital video and photo editing skills
Digital photography skills: composition; lighting; and digital camera options
Professional documentary film director
Mentorship in documentary film
Research skills: research design; data collection; and writing
Not-for-profit storytelling organization
Facilitation and digital storytelling techniques were introduced
Nunatsiavut Government mental health specialists
Listening and responding to difficult stories; client referral; self-care; and ethics and responsibilities related to facilitating the storytelling process
The digital stories were also viewed as culturally relevant public health campaigns. The stories and discussion that these media generated promoted health and health literacy in two ways. First, some organisations, such as the Nunatsiavut Government, have expressed interest in utilizing stories with specific health messages in public health campaigns. Through this approach, the digital storytelling process and resulting media could improve people’s access to health information and their capacity to use it effectively, thereby improving health literacy (Nutbeam 1998a, b, 2000). Therefore, digital storytelling could be used as a tool for promoting social change and awareness, and modifying behaviour through information dissemination (Lambert 2006). Second, digital storytelling is an effective strategy for enhancing community health through culture preservation and promotion. The digital stories created, the discussions the stories generated, and the gathering of individuals to speak about important issues, were reported by participants as a way of preserving and promoting their language, cultures, and ways of life (Cunsolo Willox et al. 2012, forthcoming). Therefore, the research process itself helped promote community health; the research methods and results within our EcoHealth approach became interventions themselves.
Looking Forward and ‘Scaling-up’
In general, the scaling-up of EcoHealth projects tends to be challenging because of the extent of community involvement and locally specific context of EcoHealth projects (Charron 2012). To meet this challenge, the project advisory team was comprised of local, regional, provincial, and federal members to ensure that all research results and successful programs could be incorporated into wider policies and programs. This partnership has enabled the community of Rigolet to recently launch the ‘My Word:’ Storytelling and Digital Media Lab (www.rigolet.ca), the first Northern centre in the world dedicated to using digital media and storytelling to share information about Inuit culture, history, and lifestyle through personal narrative. Rigolet now hosts a fully equipped media lab and can welcome individuals from other Northern communities to use digital media to create stories and archive knowledge and experiences. The ‘My Word’ team also has a travelling media lab, which will allow trained community facilitators to travel to other communities with all needed equipment to facilitate workshops and provide training and research services. This media lab will encourage the sharing of oral stories within and between communities across the North, thereby facilitating the strengthening of networks across this vast and remote area.
Lessons Learned: EcoHealth Theory and Practice
Many of the challenges encountered were similar to those faced by other EcoHealth researchers, including how to effectively move EcoHealth theory into action, how to access funding and efficiently utilise limited resources to investigate broad and complex problems, and how to maintain clarity of vision and purpose with diverse project partners. We believe that four elements contributed to the success of this project, which was measured by a sense of pride in the community, an extensive qualitative climate–health database, the emergence of local project champions, far-reaching support, exciting momentum, and long-term commitments. First, a common fundamental belief in the project’s purpose, approach, and future potential was shared between researchers, practitioners, and community members. Second, instead of focusing on overcoming challenges and barriers, the project team focused on and built the project around strengths and opportunities (Brown 2007). This focus allowed the project team to avoid an interventionist approach and escape the pitfall of enumerating problems and trying to ‘fix’ people and communities and contributed to the success of the project (Sullivan et al. 2001). Third, listening was integral to project success. Considering the varied backgrounds of the project team, active listening allowed the team to relate to and gain an understanding of one another’s thoughts, priorities, beliefs, and vision. Finally, while resources and funds from outside the community were required for this project, the unique funding structure allowed community members to control the project finances, including administrative oversight and accountability. This research funding model is exemplary for EcoHealth research. Funding agencies are encouraged to enable and promote research that genuinely engages communities by providing financial support directly to communities, thereby showing respect and recognition of their abilities in addressing their local priorities and research gaps.
Approaches to research that embrace complexity, such as EcoHealth, are gaining momentum in the research community; however, mobilizing these approaches can be challenging. The Changing Climate, Changing Health, Changing Stories project can be used as an example of Indigenous community-based research that mobilised EcoHealth principles of transdisciplinarity, community participation, and social equity to examine the impacts of climate change on Inuit health. The community worked as part of a transdisciplinary team to develop data collection techniques to gather data that were mutually meaningful, useful, and beneficial to researchers and community members. These methods resulted in media that also served as educational pieces and learning opportunities for other Inuit communities, government representatives, and policy makers. The EcoHealth approach built trust and meaningful relationships between stakeholders, promoted positive community perspectives of research, respected community expertise, ensured cultural appropriateness, provided tangible community benefits (Sullivan et al. 2001), and strengthened partnerships, networks, and institutions (Forget and Lebel 2001). We believe that this project has left lasting individual and collective capacity development, resources, knowledge, skills, and infrastructure in the community of Rigolet, and will change the way that future research will be conducted in the community and in the region. This project stands as a successful example of meaningful engagement with an Indigenous community. The lessons learned, experiences shared, and approaches used can extend globally to inform other EcoHealth projects.
We would like to thank the community of Rigolet for their ongoing strong support for the project and for sharing their knowledge and stories. We would also like to thank Michelle Kinney, John Lampe, Gail Turner, Gwen Watts, and Michele Wood from the Nunatsiavut Government for their continued support. Thanks also to Carol Brice-Bennett and Gwen Elliott from Labrador Grenfell Health for their support in this project. Particular thanks to the Rigolet My Word team members: Marilyn Baikie, Sarah Blake, Libby Dean, Candice Elson, Liane Langstaff, Kathryn Marsilio, Joanna McDonald, Dan Michelin, Carlene Palliser, Joelene Pardy, Tanya Pottle, Ashley Shiwak, Inez Shiwak, Charlotte Wolfrey, Dina Wolfrey, and Andra Zommers. Thanks to Marilyn Baikie and Charlotte Wolfrey for editing the manuscript and to Joanna McDonald and Adam Bonnycastle for assistance in creating Fig. 1. Financial support was provided by the Climate Change and Health Adaptation in Northern First Nations and Inuit Communities program through Health Canada’s First Nations and Inuit Health Branch, the Nasivvik Centre for Inuit Health and Changing Environments, and the Nunatsiavut Department of Health and Social Development as well as the Canadian Institutes for Health Research (Vanier Canada Graduate Scholarship to Sherilee Harper) and the Social Sciences and Humanities Research Council (J-Armond Bombardier Canada Graduate Scholarship to Ashlee Cunsolo Willox).