Health and care

Half marathon, 18 August 2019 in Kulusuk, Ammassalik district. Greenland has five health regions, each with a single regional hospital. The national health service has staff at around 70 locations, and a total of 55 healthcare stations are distributed around the country. The settlements’ access to public health services is limited compared to the towns.
JONATHAN NACKSTRAND/AFP/RITZAU SCANPIX, 2019

In Greenland, a newborn boy can expect to live for 68.3 years, while a newborn girl can expect to live for 73.0 years. However, the average life expectancy for men in settlements is two years less than for men living in towns, while there is no difference between the average life expectancy of women in towns and settlements. Public health in Greenland is monitored through repeated population surveys carried out since 1992 by the National Institute of Public Health on behalf of the Self-Government. Most recently, the survey was conducted in 2018, and here 60 % of people aged 15 and above rated their own health as ‘good’ or ‘really good’ and 89 % stated that they have a good quality of life.

The 2007 United Nations Declaration on the Rights of Indigenous Peoples has led to important debates about basic health rights among indigenous peoples, including the people of Greenland. In continuation of this, there is an increased awareness of the importance of health research in the Arctic that contributes knowledge that helps promote well-being and health, rather than solely pointing out health problems. Healthcare research and practice in Greenland have only, to a limited extent, included knowledge of fundamental values and health perceptions in Greenlandic culture. However, such social and cultural determinants of health are now increasingly being recognised and included.

The population of older people is increasing, and although the majority of older people want to stay in their own homes as long as possible, some, due to the lack of nursing homes and homes for the elderly in the settlements, have to leave their native place to receive proper care.

The health sector

Doctor Heidi Noasen (right) at work on the medical hotline at Queen Ingrid’s Hospital in Nuuk, together with her colleague, doctor Kristina Roed. Public health in Greenland is monitored through population surveys carried out since 1992 by the National Institute of Public Health on behalf of the Self-Government. The latest survey was conducted in 2018.
CHRISTIAN SØLBECK, 2020

The Greenland health sector has staff at around 70 locations. There are currently approximately 120 medical positions, of which about 60 are permanent staff, and there are about 300 nurse positions, of which about 200 are permanent staff. There are approximately 30 dentists, 15 of whom are permanent staff.

The health area has been a Greenlandic area of responsibility since 1992, when the area was taken over from Denmark. In 2011, the health sector became regionalised, meaning that 16 health districts with their own district medical officer and hospital were centralised into a total of five health regions with one regional hospital in each region. The five towns with regional hospitals are Ilulissat (Region Avannaa), Aasiaat (Region Disko), Sisimiut (Region Qeqqa), Qaqortoq (Region Kujataa), and Nuuk has Queen Ingrid’s Hospital, which is both a regional hospital for Region Sermersooq and national hospital for all of Greenland. The regional hospitals have doctors who have a broad education and expertise, including surgical experience. They are able to deal with certain emergency situations that require surgical intervention such as Caesarean section or an appendectomy. About 60 % of the population lives in one of the five largest towns and thus belongs to a regional hospital.

In the other 11 towns with a hospital, the hospitals now serve as either large or small health centres with limited medical care. However, the hospital in Tasiilaq on the east coast also serves as a regional hospital since the population on the east coast is often prevented from reaching the regional hospital in Nuuk due to extreme weather conditions and long transport time.

All disciplines and health regions in the country use telemedicine, but the extent to which it is used varies. However, telephone and fax machine is still needed in those places where the Internet is too unstable and the connection too bad. Online meetings and videoconferencing are also widely used as part of the telemedicine solutions.

Public health has been monitored through regular population surveys conducted by the National Institute of Public Health on behalf of the Self-Government since 1992. The latest survey was conducted in 2018.
HTTPS://WWW.SDU.DK/DA/SIF/RAPPORTER/2019/BEFOLKNINGSUNDERSOEGELSEN_I_GROENLAND

Births

With the health reform in 2011, it was decided that births should take place in the regional hospitals and not locally in the nearest hospital. Being a place of birth requires special level of preparedness, and based on the perinatal guidelines, there are currently major challenges associated with retaining births, even in regional hospitals outside of Nuuk. Many citizens are sad that they cannot give birth in their hometown, since births are an event that brings together the family and brings joy in the local community. The women have free choice of hospital, and can therefore choose to give birth at Queen Ingrid’s Hospital in Nuuk instead of the regional hospital in the health region where she lives. It is not possible to give birth in the settlements and in towns without a regional hospital. Women who come from places other than the five towns where there are regional hospitals must, therefore, travel to and stay in the town where they are due to give birth a few weeks before the birth.

Access to health services and medical care in settlements

Access to health services and medical care is very limited in the settlements compared to the towns. The settlements have healthcare stations staffed by one or more settlement healthcare workers, depending on the number of inhabitants. The aim is for the consultation to be staffed by a trained settlement healthcare worker, but this is not always possible, meaning that there are quite a few unskilled healthcare workers. In the largest settlements, one nurse is often the standard. There are a total of 55 healthcare stations distributed around the country. Virtually all of these are equipped with a telemedical device, which allows telemedical consultation to be accessed by the larger hospitals or specialists.

Recruitment of healthcare workers

Recruitment of healthcare workers is a general challenge in many places, and this is very much the case in Greenland. The challenge is particularly related to three circumstances: increased medical specialisation, lack of trained healthcare workers and competition for staff resources. The growing specialisation of both medical and care staff makes it difficult for small communities such as the ones in Greenland where people with broad competences are needed more given that the population base is limited. Furthermore, the Greenland health sector has a very high staff turnover. There are about 1,400 salaried employees in the health sector, and approximately 950 of these are permanent employees. Despite this, around 1,400 recruitments were made in 2019.

Every year, 14 nursing students are admitted to the University of Greenland, just over half of whom complete the education programme. By 2020, a total of 182 nurses had been trained in Greenland. However, this is far from enough to meet the need. To become a doctor in Greenland, you have to travel to Denmark or another country to get a medical education. Experience from the Greenlandic Houses in Denmark shows that only about half of the medical students from Greenland complete their medical studies, and of them only about half move back to Greenland once they graduate.

Citizens’ perspective on the health sector

If you ask the citizens, they do not always feel well enough informed about the possibilities and limitations of the services provided where they live. The expectations of citizens and the service that is offered locally do not always match. Citizens say that they want to be able to speak Greenlandic when in contact the health sector. This is challenged by the fact that the majority of doctors and nurses in the Greenlandic health sector have either a Danish or other background and do not speak Greenlandic. Therefore, an interpreter is often needed in the meeting between citizens and the health sector, which involves a wide range of common challenges, e.g. misunderstandings when dispensing medicine and providing information about examination results. The linguistic barriers also cover significant cultural differences between the health workers and the citizens, which may lead to misunderstandings and an awkward dialogue.

Social and health challenges

Tags on housing block in Nuuk. In Nuuk, there was a 33 % over-representation of reported offences in the period 2014‑2018, and the crime rate was consequently 33 % higher than would be expected, given the size of the population. Kommuneqarfik Sermersooq and the Greenland Police are working together on early intervention to prevent patterns of criminal behaviour among children and young people from escalating.
MARTIN LEHMANN/RITZAU SCANPIX, 2019

Over the past 100 years, Greenland has undergone an epidemiological transition in the health area, which means that the threat of infectious diseases has gradually been taken over by an increase in lifestyle diseases. Today, most people die from cancer and cardiovascular disease, whereas the third most frequent cause of death is suicide. The increase in lifestyle diseases is attributed to changes linked to marked changes in lifestyle towards more sedentary lifestyle and a dietary pattern that has changed from primarily comprising of marine mammals and fish to comprising much more of imported meat and carbohydrates. In addition, there is an increasing intake of sugary drinks as well as fast food.

Overweight, smoking and a harmful consumption of alcohol and cannabis constitute the three biggest challenges to public health. While overweight and smoking are well known factors (diet, smoking, alcohol and exercise) with consequences for the individual’s health, the public health consequences of alcohol and cannabis are predominantly social and the reason why some children have a difficult childhood.

Since 2007, Greenland has been working to improve public health through the national public health programmes Inuuneritta I, II and III. In the first two public health programmes, particular focus was placed on risk factors for lifestyle diseases. With the current public health programme, which runs from 2020 to 2030, focus is on the good life for children and on developing health promoting initiatives in close partnerships with municipalities and in dialogue with citizens.

Since the mid-1990s, population surveys in Greenland have shown that especially generations born in the 1970s and 1980s have been burdened throughout their upbringing by alcoholism and violence in their home as well as by a high incidence of sexual abuse. Of these generations, as many as upwards of 70 % have grown up with alcohol problems in their home. However, over the past 20 years, there has been some improvement, and for the generations born in 1995 and later, 37 % have grown up with alcohol problems in their childhood.

For the generations born in the 1970s and 1980s, almost 40 % have suffered sexual abuse before the age of 18. In this area too, there has been an improvement, although it remains a serious social and health challenge. For the generations born in 1995 and later, the incidence of sexual abuse before the age of 18 has fallen to 20 %. In 2018, Naalakkersuisut launched a strategy against sexual abuse for the period 2018‑2022, Killiliisa – Let’s set boundaries. The overall objective of the strategy is to reduce the number of cases of sexual abuse over the next five years so that it does not occur at all among 15 to 29-year olds, and from 2022 onwards, the intention is to achieve year groups who do not experience abuse at all.

Despite the positive development, numbers remain high, and the consequences of growing up with physical abuse and alcohol problems in the home have an impact well into adolescent and adult life. The high incidence of alcohol problems, violence and abuse during childhood is a major cause of distress and suicide among young people in Greenland.

Suicide

The suicide rate in Greenland is one of the highest in the world. Over the past 40 years, it has remained unchanged with an average of 100 suicides per 100,000 people. Although the overall incidence remains unchanged, a development can be seen where more young people under the age of 18 die by suicide. Overall, it is especially young men aged 20‑24 who die by their own hand, with an average suicide rate of more than 400 suicides per 100,000 person years. Compared with the 1970s, a demographic shift has also taken place. The highest suicide rates are now found in East Greenland and Northwest Greenland, while a decrease has occurred in the towns on the west coast and especially in Nuuk, where back in the 1970s the first significant increases in the incidence of suicides were seen. The high incidence means that the majority of citizens have lost close relations and family members to suicide.

Social services and support

A total of 4,642 people over the age of 18 received public benefits in 2019. This corresponds to an annual expense of more than DKK 74 million. The 4,642 people who received public benefits make up just over 10 % of the total population aged over 18. In 2019, Statistics Greenland described 4 % of citizens as economically disadvantaged, measured as having a disposable income below 50 % of the median income (excluding students and residents at social institutions). The figure varies from town to settlement with an average of 3 % economically disadvantaged citizens in the towns and 8 % in the settlements. There is also a large variation between the towns: In Tasiilaq, the proportion of economically disadvantaged citizens is at 11 %, while Qeqertarsuaq has the lowest proportion of economically disadvantaged citizens at 1 %.

Children in day-care facilities

In 2020, 3,672 children were enrolled in public preschool day-care facility, and they were distributed among 165 municipal day-care institutions nationwide. This corresponds to 75.2 % of all children in the age group 0‑5 years in Greenland being enrolled in a preschool day-care facility. The proportion of enrolled children varies from town to town. Thus, 90 % of 0‑5 year olds in Paamiut and Maniitsoq are enrolled in a preschool day-care facility, while less than 50 % in Upernavik and almost 60 % in Qaanaaq and Tasiilaq are enrolled. A daycare facility is available in all towns, while not all settlements have municipal preschool day-care facilities.

Children placed outside the home

Based on statistics from the five municipalities, in 2019, just over 300 children and young people under the age of 18 had been placed in foster families. In addition, close to 300 children and young people under the age of 18 were placed in one of the country’s 22, 24-hour institutions. Overall, around 600 children and young people, corresponding to 4.5 %, were placed with people other than their parents.

The elderly population

The population of elderly people is increasing and will present a significant challenge in the health and social services area in the coming years. The trend shows that, compared with the past, the elderly in the municipal senior citizens’ centres are to a greater degree being medicated, undergo rehabilitation and have other extensive needs for help which help drive up the healthcare costs. Among the elderly over the age of 55, in 2018, 77 % could be categorized as chronically ill (includes diabetes, obesity, high blood pressure, etc.).

The majority of elderly people want to stay in their own home for as long as possible, but the lack of senior citizens’ centres and homes for the elderly in the settlements means that some elderly people have to leave family, their native area and local environment to move to a home possibly in another town or settlement that is better suited to their needs.

Crime

The amount of dangerous crime committed against people is generally high. The number of reports of violence and sexual assault increased significantly in 2020 and, in both cases, is well above the level of the rest of the Unity of the Realm measured per capita. The Greenland Police has noted that the large increase in 2020 may be related to the campaign ‘Report sexual assaults – we will help you’ launched in early 2020.

In 2020, there were 89.6 reports of violations of the Criminal Code per 1,000 inhabitants. This figure is twice as high as corresponding reports in Denmark and ten times as high as corresponding reports in the Faroe Islands. It would be better to compare with other Arctic Inuit communities, but it has not been possible to find comparable figures. The figure has risen in recent years and was at 62 reports per 1,000 inhabitants in 2018. In particular the number of homicide and violent crimes as well as sex offences have increased steadily over the past five years. 748 sex offences were reported in 2020, which corresponds to 13.1 per 1,000 inhabitants. That is 13 times higher than the corresponding figure both in Denmark and the Faroe Islands.

The scale of offences against property, which includes shoplifting and burglary, has conversely declined and almost halved since 2016. In 2020, there were 8.1 burglary reports per 1,000 inhabitants. In comparison, the figure in the same period was 6.6 in Denmark and 0.5 in the Faroe Islands. Youth crime poses a particular problem since the level of crime among 15- to 17-year-olds is steadily increasing.

Further reading

Read more about Society and business in Greenland

  • Christina Viskum Lykten Larsen

    (b. 1980) Ph.D. and MSc. in Sociology. Senior Researcher and Head of Health in Greenland, National Institute of Public Health, University of Southern Denmark, and Adjunct Senior Researcher at the Greenland Center for Health Research, Institute of Health and Nature, University of Greenland.

  • Ingelise Olesen

    (b. 1961) Midwife and MA in Health Promotion and Education. Research Coordinator at Health in Greenland, National Institute of Public Health, University of Southern Denmark, Institute of Health and Nature, University of Greenland.