Regional Perspectives on Mental Wellness Interventions in Various Settings

• Gert Mulvad MD GP• Member of the Circumpolar Inuit Health

Committee• Greenland Center for Health Research, University

of Greenland• Municipality Board for Family Welfare

Population development 1781-2001. Greenland by towns (regional centers) and villages (settlements)

-

10.000

20.000

30.000

40.000

50.000

60.000

1781

1801

1821

1841

1861

1881

1901

1921

1941

1961

1981

2001

To

tal p

op

ula

tio

n

Villages Towns

Source: Rasmus Ole Rasmussen

Challenges

Greenland faces a series of challenges related to infrastructure, energy and climate:

• Greenland is the world's 13th largest country – Area: 2,175,600 km2 – Population: 56,600

• 47,000 in 18 towns• 9,300 in 60 settlements

– Isolated, sparsely populated areas – Dependence on imports of oil and produce– Annual block grant from Denmark of 3.4 billion DKK, corresponding to 30 %

of Greenland's GDP. – A political priority to work towards independence from Denmark. – A need to develop the business sector.

Health indicators

• Infant mortality 1.5-3 times greater (compared to DK)• Life expectancy 10-20 years less (compared to DK)• Communicable (infectious) diseases• High suicide rate• Substance abuse causes significant health problems• Cardiovascular diseases, diabetes, cancer increasing• Injuries • Domestic violence• Contamination of food• Malnutrition

Cultural values

• Indigenous• Harmony with nature• Soul and body united• Feelings are important• Education from the elders

• Material wealth is shared

• Behaviour is cooperative• Leaders serve the people• To be > to have

• Western

• Domination of nature• Soul and body are divided• Feelings must be rationalized• Education from the

professionals• Materiel wealth is hoarded and

consumed• Behavior is competetive• People serve the leaders• To have > to be

• Indigenous peoples define and understand the circumstances surrounding their life in terms of multifactorial processes, rather than taking a problem-specific approach.

• You can not get or demand a culturally competent health care system from the government (in Denmark), the only way is to build it yourself (in Greenland)

• The health situation among Greenlanders is the end of a historical process that has fostered dependency, loss of identity and marginalization.

• The Greenland health care is a health repairing system:

• ”More repair – better health”

• But just repairing does not change the development of disease

• And more intensive repairing – and use of resources - can be a real threat to public health.

• Progress is needed in some key areas:• Infrastrukturer• Self-determination of health services• Access to a network of community-controlled

primary health care services• Adequate level of resources• The development of appropriate health services

requires the training of indigenous peoples in the health professions, and providing cultural sensitivity training to all health professionals. These are urgent tasks if culturally appropriate health care systems are to be developed.

Self Government• Recognising that the people of Greenland is a people according

to international law with the right of self-determination• Own language• Commen responsibility- Solidarity- Equality.

• Health Promotion:• Cultural and personal feelings. • Self-definition of health and the good life. • Feeling capable of taking care of ones own life.• Identify ressources and way of action.• The goal is mobilising energy to handel the every day life and

the stress situation in life

Responsibility

Atuafitsialaq a new strategy. Education,

Well-being and Social responsibility

The Sports Confederation in Greenland

Social responsibility Arctic Wintergame

Royal Greenland

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