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Towards the Limits – Climate Change Aspects of Life and Health in Northern Sweden: studies of tularemia and regional experiences of changes in the environment
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Clinical Microbiology. (Arcum)
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Indigenous peoples with traditional lifestyles worldwide are considered particularly vulnerable to climate change effects. Large climate change impacts on the spread of infectious vector-borne diseases are expected as a health outcome. The most rapid climate changes are occurring in the Arctic regions, and as a part of this region northernmost Sweden might experience early effects. In this thesis, climate change effects on the lives of Sami reindeer herders are described and 30 years of weather changes are quantified. Epidemiology of the climate sensitive human infection tularemia is assessed, baseline serologic prevalence of tularemia is investigated and the disease burden is quantified across inhabitants in the region.

Methods

Perceptions and experiences of climate change effects among the indigenous Sami reindeer herders of northern Sweden were investigated through qualitative analyses of fourteen interviews. The results were then combined with instrumental weather data from ten meteorological stations in a mixed-methods design to further illustrate climate change effects in this region. In two following studies, tularemia ecology and epidemiology were investigated. A total of 4,792 reported cases of tularemia between 1984 and 2012 were analysed and correlated to ecological regions and presence of inland water using geographical mapping. The status of tularemia in the Swedish Arctic region was further investigated through risk factor analyses of a 2012 regional outbreak and a cross-sectional serological survey to estimate the burden of disease including unreported cases.

Results

The reindeer herders described how the winters of northern Sweden have changed since the 1970s – warmer winters with shorter snow season and cold periods, and earlier spring. The adverse effects on the reindeer herders through the obstruction of their work, the stress induced and the threat to their lifestyle was demonstrated, forcing the reindeer herders towards the limit of resilience. Weather data supported the observations of winter changes; some stations displayed a more than two full months shorter snow cover season and winter temperatures increased significantly, most pronounced in the lowest temperatures. During the same time period a near tenfold increase in national incidence of tularemia was observed in Sweden (from 0.26 to 2.47/100,000 p<0.001) with a clear overrepresentation of cases in the north versus the south (4.52 vs. 0.56/100,000 p<0.001). The incidence was positively correlated with the presence of inland water (p<0.001) and higher than expected in the alpine and boreal ecologic regions (p<0.001). In the outbreak investigation a dose-response relationship to water was identified; distance from residence to water – less than 100 m, mOR 2.86 (95% CI 1.79–4.57) and 100 to 500 m, mOR 1.63 (95% CI 1.08–2.46). The prevalence of tularemia antibodies in the two northernmost counties was 2.9% corresponding to a 16 times higher number of cases than reported indicating that the reported numbers represent only a minute fraction of the true tularemia.

Conclusions

The extensive winter changes pose a threat to reindeer herding in this region. Tularemia is increasing in Sweden, it has a strong correlation to water and northern ecoregions, and unreported tularemia cases are quite common.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2016. , 50 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1840
Keyword [en]
Climate change, public health, Indigenous peoples, Sami, reindeer herding, resilience, tularemia, mixed-methods, infectious disease, seroprevalence, ELISA, outbreak investigation, risk factor, ecology, Francisella tularensis
National Category
Medical and Health Sciences
Research subject
Epidemiology; Public health
Identifiers
URN: urn:nbn:se:umu:diva-126949ISBN: 978-91-7601-552-0OAI: oai:DiVA.org:umu-126949DiVA: diva2:1039580
Public defence
2016-11-18, Sal A, 9tr, by 1D,, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-10-26 Created: 2016-10-24 Last updated: 2016-11-10Bibliographically approved
List of papers
1. Facing the limit of resilience: perceptions of climate change among reindeer herding Sami in Sweden
Open this publication in new window or tab >>Facing the limit of resilience: perceptions of climate change among reindeer herding Sami in Sweden
2011 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, no 8417, 11- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Arctic area is a part of the globe where the increase in global temperature has had the earliest noticeable effect and indigenous peoples, including the Swedish reindeer herding Sami, are amongst the first to be affected by these changes.

OBJECTIVE: To explore the experiences and perceptions of climate change among Swedish reindeer herding Sami.

STUDY DESIGN: In-depth interviews with 14 Swedish reindeer herding Sami were performed, with purposive sampling. The interviews focused on the herders experiences of climate change, observed consequences and thoughts about this. The interviews were analysed using content analysis.

RESULTS: ONE CORE THEME EMERGED FROM THE INTERVIEWS: facing the limit of resilience. Swedish reindeer-herding Sami perceive climate change as yet another stressor in their daily struggle. They have experienced severe and more rapidly shifting, unstable weather with associated changes in vegetation and alterations in the freeze-thaw cycle, all of which affect reindeer herding. The forecasts about climate change from authorities and scientists have contributed to stress and anxiety. Other societal developments have lead to decreased flexibility that obstructs adaptation. Some adaptive strategies are discordant with the traditional life of reindeer herding, and there is a fear among the Sami of being the last generation practising traditional reindeer herding.

CONCLUSIONS: The study illustrates the vulnerable situation of the reindeer herders and that climate change impact may have serious consequences for the trade and their overall way of life. Decision makers on all levels, both in Sweden and internationally, need improved insights into these complex issues to be able to make adequate decisions about adaptive climate change strategies.

Place, publisher, year, edition, pages
Häggeby: Co-Action publishing, 2011
Keyword
climate change, indigenous peoples, Sami, reindeer herding, perception, resilience
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-49406 (URN)10.3402/gha.v4i0.8417 (DOI)22043218 (PubMedID)
Available from: 2011-11-11 Created: 2011-11-11 Last updated: 2016-10-24Bibliographically approved
2. In the light of change: A mixed methods investigation of climate perceptions and the instrumental record in northern  Sweden
Open this publication in new window or tab >>In the light of change: A mixed methods investigation of climate perceptions and the instrumental record in northern  Sweden
(English)Article in journal (Refereed) Submitted
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-126961 (URN)
Available from: 2016-10-24 Created: 2016-10-24 Last updated: 2016-10-24
3. Epidemiology and Ecology of Tularemia in Sweden, 1984-2012
Open this publication in new window or tab >>Epidemiology and Ecology of Tularemia in Sweden, 1984-2012
Show others...
2015 (English)In: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 21, no 1, 32-39 p.Article in journal (Refereed) Published
Abstract [en]

The zoonotic disease tularemia is endemic in large areas of the Northern Hemisphere, but research is lacking on patterns of spatial distribution and connections with ecologic factors. To describe the spatial epidemiology of and identify ecologic risk factors for tularemia incidence in Sweden, we analyzed surveillance data collected over 29 years (1984-2012). A total of 4,830 cases were notified, of which 3,524 met all study inclusion criteria. From the first to the second half of the study period, mean incidence increased 10-fold, from 0.26/100,000 persons during 1984-1998 to 2.47/100,000 persons during 1999 2012 (p<0.001). The incidence of tularemia was higher than expected in the boreal and alpine ecologic regions (p<0.001), and incidence was positively correlated with the presence of lakes and rivers (p<0.001). These results provide a comprehensive epidemiologic description of tularemia in Sweden and illustrate that incidence is higher in locations near lakes and rivers.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-99774 (URN)10.3201/eid2101.140916 (DOI)000347503700005 ()
Available from: 2015-02-18 Created: 2015-02-12 Last updated: 2016-10-24Bibliographically approved
4. Tularemia in northern Sweden - sero-prevalence and a case-control study of risk factors
Open this publication in new window or tab >>Tularemia in northern Sweden - sero-prevalence and a case-control study of risk factors
Show others...
(English)Article in journal (Refereed) Submitted
National Category
Infectious Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-126960 (URN)
Available from: 2016-10-24 Created: 2016-10-24 Last updated: 2016-10-24

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