Background
The people of Eeyou Istchee have experienced major changes in their environment and their way of life in the last 60 years. Before the 1960s, children were sent out to residential schools for most of the year, and many families spent a good part of the year on their hunting territories. As services developed, including schools and clinics, people began to spend more time in the communities. At the same time, mining and forestry development started to affect the southernmost Cree bands – Oujé-Bougoumou and Waswanipi. In the 1960s it was discovered that some fish contained high levels of mercury, and people were told to stop eating it. With the start of Hydro development in the 1970s, roads were built in the territory and food and other goods from the south became more and more accessible, while lifestyle changes (e.g., less walking, use of motorized vehicles, office jobs) led to people being less physically active than before. All these changes have had a dramatic effect on health. Some improvements have occurred – for example, far fewer babies and children die of infectious diseases like gastroenteritis and meningitis. But other diseases – such as diabetes and thus also heart disease – have been on the increase.
The introduction of the hydro-electric projects in the region in the 1970s came with new concerns about increasing mercury levels linked to these dams. In the context of the La Grande Project, this led to the 1986 Mercury Agreement between the Grand Council of the Crees (GCC), the government of Quebec and Hydro-Québec; subsequently, the 2001 Mercury Agreement was implemented in the context of the Eastmain-1 project. Mercury is a concern for human health either from the risk of eating contaminated fish or the risk of poor nutrition linked to not eating fish. For this reason, the 2001 Agreement provided significant money to stimulate the fishery, with $8M set aside to study Cree fish consumption patterns and benefits, as well as exposure to mercury and other contaminants. A legal vehicle, the Eeyou Namess Corporation, was set up to plan, approve and manage projects carried out with these funds.
For a time, there was a question within the Public Health Department about how to best respond to the significant mandate set out in the 2001 Mercury Agreement. Surveillance of a population’s health is one of the primary functions within public health, so the mandate itself was never at issue. Rather, the concern was on how to implement such a large mandate in a small Department with many other priorities.
The response evolved through two processes, one involving a quite separate initiative. The latter was a 2002 study carried out in Oujé-Bougoumou (with Nemaska serving as a non-impacted community); it was designed to look at the health impacts of mine tailings on the environment and human health (Dewailly and Nieboer, 2005). In effect, the design of that study addressed many of the objectives of the 2001 Mercury Agreement, and thus was able to serve as a precursor and model for subsequent studies developed under the Mercury Agreement (2001) funds. The other process was a direct, planning consultation with the communities and Cree entities about their needs for and the feasibility of doing such a comprehensive environment-and-health study with the Mercury Agreement funds (Nieboer and VanSpronsen, 2004). This happened in late 2003 and early 2004, and it led directly into the development of the protocol for a study which was accepted by the Eeyou Namess Corporation1 for a pilot study in 2005 in Mistissini.
Objectives
The links between mercury and the other components of the study are as follows: contaminants such as mercury in people’s bodies are thought to come mainly from eating traditional foods, so it was decided to ask people what kinds of traditional foods they eat. Because of the alarming rise in the incidence of diabetes in Eeyou Istchee, questions about store-bought foods and physical activity were also included. A serious consequence of diabetes is heart disease. Since fish and possibly other foods in the traditional Cree diet potentially protect against these diseases, indicators of heart and blood vessel disease were included in the study. Other clinical laboratory tests were also incorporated to permit an examination of links between diet, contaminants, lifestyle issues and health indicators. Testing for diseases spread by game animals and birds (zoonoses) and micro-organisms in traditional sources of water was also added, as well as women’s bone health.
Thus, the main objectives of the Nituuchischaayihtitaau Aschii Environment-and-Health Longitudinal Study in Eeyou Istchee were to: investigate health effects in relation to lifestyle, environmental contaminants exposure, and diet (assess exposure to environmental contaminants and nutrient intake); and investigate the links between wildlife health, quality of aquatic environments and human health.
