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 Greenland by towns (regional centers) and villages (settlements) 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 km 2 –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 times greater (compared to DK) Life expectancy 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 Choose a Healthy Profile