Foodborne, waterborne, and zoonotic disease in the Canadian North

October 31, 2016

Dr. Sherilee Harper and Dr. Ashlee Cunsolo look at the need for integrated environment and health surveillance for foodborne, waterborne, and zoonotic diseases in the Canadian North

Foodborne, waterborne, and zoonotic disease is a major public health priority in the Circumpolar North, especially considering rapid climatic and environmental changes experienced in this region. Recent research by The University of Gelph uncovered the highest rates of self-reported enteric illness (i.e. diarrhea and vomiting) reported in the world to be the Canadian North. Infectious diarrhea and vomiting can be caused by contaminated drinking water (i.e. waterborne disease), contaminated food (i.e. foodborne disease), contact with animals (i.e. pets, wildlife), or person-to-person contact. To reduce the high rates of diarrhea and vomiting in Northern Canada, we must identify the pathogens causing illness to understand what are responsible for illness and how people contract the illness.

Endemic levels and outbreaks of enteric illness transmitted by contaminated food and water contribute to considerable morbidity, mortality, and economic costs, in particular among high risk populations, including Indigenous populations living in remote communities across the North, including in the Canadian Arctic. Given the high prevalence of enteric illnesses, the impacts on individuals and communities, and the economic burden to the health system, environmental and public health practitioners continue to prioritise surveillance approaches to monitor the burden of illness, detect and control outbreaks, and evaluate control measures. Indeed, surveillance systems that monitor enteric illness provide critical data to inform the prioritisation of public health actions, program planning, interventions, and research for disease prevention and health promotion. In the context of Indigenous health, there has been a strong and repeated call for enhanced public health surveillance that uses novel approaches, incorporates new types of data, and integrates environmental data.

People, Animals, Water, and Sustenance: Establishing the PAWS Project

Responding to the call for integrated surveillance systems, in 2014 representatives from the Government of Nunavut, health practitioners, policy makers, and researchers came together to create the People, Animals, Water, and Sustenance (PAWS) project. The goal of this project is to design and implement a participatory, community-based surveillance system to understand, respond to, and reduce the burden of foodborne and waterborne enteric pathogens in Iqaluit, Nunavut, Canada. This information will be important to help understand why rates of diarrhea and vomiting in Northern communities appear to be high. Northern collaborators are actively contributing to all phases of the research design, data collection, analysis, interpretation, and results dissemination process.

Community-Based & Community-Led Data-Gathering: Working Together to Set Priorities

Community, health professional, and government stakeholder participation is an essential component of the PAWS project, which forms the basis on which the transdisciplinary team of community leaders, veterinarians, epidemiologists, health scientists, and social scientists forms its data-gathering approaches. Indeed, through ongoing consultation and feedback from partners such as the Department of Health, Iqaluit Public Health, Nunavut Research Institute, and the Public Health Agency of Canada, community stakeholders and policy makers identified the priority pathogens to study and measure, and it was determined that Cryptosporidium and Giardia posed the most serious concern for the community and for the Territory. Furthermore, these partners identified key suspected environmental sources of infection: house, guard, and sled dogs; water gathered from various rivers around Iqaluit where untreated drinking water is collected; and clams gathered from various locations in the Iqaluit harbor. Currently, these sources are being tested using microbiological and source attribution techniques.

Additionally, it was also identified that in order to fully understand the relationships among people, food, water, and pets in the community, and to provide culturally-appropriate contextual understanding to the epidemiological testing and findings, it was essential to work with Inuit knowledge holders in the community to understand the physical, mental, emotional, and spiritual connections that people have with the land, food, dogs, and water. As a result, in-depth iterative qualitative interviews were conducted with 10 Inuit community members, representing a diverse cross-section of the community. These interviews were structured around 3 main themes: the historical, contemporary, physical, mental, emotional, and spiritual connections people had with food, water, and dogs. Each of the interviews were conducted conversationally, in peoples’ homes, over 3 separate time periods, allowing for in-depth consideration, reflection, and discussion of each of the themes. This qualitative research not only provides rich, powerful, and poignant narratives of Inuit knowledge, wisdom, and lived experience, but also ensures that the quantitative research findings can be interpreted and understood within a larger socio-cultural context.

Knowledge-to-Action: Mobilising PAWS Research for Evidence-Based Decision-Making

On-going and meaningful collaboration with Indigenous stakeholders, health professionals, and Indigenous organisations is essential to develop and evaluate a culturally acceptable and effective knowledge translation program to reduce foodborne, waterborne, and zoonotic enteric illness. The PAWS project is end-user driven; as such, moving research results to action at individual, household, community, and government levels is an explicit objective. This research has important implications for healthcare provision policies, procedures, and planning. In the North, enteric-illness related decisions are typically based on the best available information from Southern, non-Indigenous locales, which might not be applicable in Indigenous communities. The PAWS research will provide a baseline understanding of the unique epidemiology of enteric illness in Northern Indigenous communities. This information is critical to developing new or enhancing existing public health planning, programming, and policy to effectively reduce the high reported burden of enteric illness.

Project Team