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Open Access Highly Accessed Research article

Acculturation and self-rated health among Arctic indigenous peoples: a population-based cross-sectional study

Bent-Martin Eliassen1*, Tonje Braaten2, Marita Melhus1, Ketil Lenert Hansen1 and Ann Ragnhild Broderstad13

Author Affiliations

1 Department of Community Medicine, Centre for Sami Health Research, University of Tromsø, Tromsø, N-9037, Norway

2 Department of Community Medicine, University of Tromsø, Tromsø, N-9037, Norway

3 Department of Medicine, University Hospital of Northern Norway, Harstad, N-9480, Norway

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BMC Public Health 2012, 12:948  doi:10.1186/1471-2458-12-948

Published: 5 November 2012

Abstract

Background

Acculturation is for indigenous peoples related to the process of colonisation over centuries as well as the on-going social transition experienced in the Arctic today. Changing living conditions and lifestyle affect health in numerous ways in Arctic indigenous populations. Self-rated health (SRH) is a relevant variable in primary health care and in general public health assessments and monitoring. Exploring the relationship between acculturation and SRH in indigenous populations having experienced great societal and cultural change is thus of great importance.

Methods

The principal method in the Survey of Living Conditions in the Arctic (SLiCA) was standardised face-to-face interviews using a questionnaire. Very high overall participation rates of 83% were obtained in Greenland and Alaska, whilst a more conventional rate of 57% was achieved in Norway. Acculturation was conceptualised as certain traditional subsistence activities being of lesser importance for people’s ethnic identity, and poorer spoken indigenous language ability (SILA). Acculturation was included in six separate gender- and country-specific ordinal logistic regressions to assess qualitative effects on SRH.

Results

Multivariable analyses showed that acculturation significantly predicted poorer SRH in Greenland. An increased subsistence score gave an OR of 2.32 (P<0.001) for reporting poorer SRH among Greenlandic men, while an increased score for Greenlandic women generated an OR of 1.71 (P=0.01). Poorer SILA generated an OR of 1.59 in men (p=0.03). In Alaska, no evidence of acculturation effects was detected among Iñupiaq men. Among Iñupiaq women, an increased subsistence score represented an increased odds of 73% (p=0.026) for reporting poorer SRH. No significant effects of acculturation on SRH were detected in Norway.

Conclusions

This study shows that aggregate acculturation is a strong risk factor for poorer SRH among the Kalaallit of Greenland and female Iñupiat of Alaska, but our cross-sectional study design does not allow any conclusion with regard to causality. Limitations with regard to wording, categorisations, assumed cultural differences in the conceptualisation of SRH, and confounding effects of health care use, SES and discrimination, make it difficult to appropriately assess how strong this effect is though.

Keywords:
Self-rated health; Acculturation; Kalaallit; Iñupiat; Sami; Inuit; Indigenous peoples; Living conditions; SLiCA