1 Introduction

Communities across the Circumpolar North face challenges that often relate back to its history of colonialism, whereby Indigenous groups were forced to accept different ways of living with different values and, for many, a different language. These changes have been imbued with a western influence and an assumption by many that they represent an improvement. But in what ways can we say western ways of living have led to improvements for residents of the North? Do we accept the gaps in services and infrastructure that some areas experience because they are northern?

For decades we have reviewed statistics that show northern and Indigenous communities scoring amongst the lowest in terms of national socioeconomic indicators. Different actions have been taken to try to alter these statistics, some with less success than others. The question becomes one of accepting poorer health outcomes and life expectancy as natural and innate. This raises the concern of believing that poor health outcomes are an individuals’ responsibility to cope. When the water supply, is of such poor quality in colour, smell and taste, that you think it is unhealthy to drink, the alternatives are limited. The northern reality is that bottled water is more expensive than sugary drinks such as soda and juice concentrates, and when income is low, families do what is possible, even if the effect may have other health implications such as poor oral care. Many would not accept this standard and yet for many northern residents it is a fact of life. Importantly, this is not a chosen way of living; it is a systematic imposition on people less visible and further away from decision-making bodies and funding agencies given their eye are in the rural, northern location.

As health professionals, and as nurses we care for individuals but we must consider each person in their surrounding and in society, in order to understand what influences each situation. Dating back to Florence Nightingale (1959) we know that hygiene affects each person’s ability to heal and to prevent illnesses. We know that the houses need fresh air, clean water, discharge of sewage, hygienic standard, and light to prevent illness and disease. Sadly, we see that many poor health outcomes are the direct result of not fulfilling these basic standards even with the extensive knowledge and resources we have today.

For health professionals working under challenging conditions in remote and rural areas, it is important to remember that the basic principles of nursing and health care, as described by Henderson (1997), need to guide professional conduct in meeting each individual patient. However, each individual is part of a society with his or her family, with their values, and their views of the world. Health professionals’ aim of providing holistic care should consider the social and physical environment each person lives in and understand the patient and their family as a partnership. Initiatives from professionals can be counter-productive if they do not consider that each person might have suggestions of healing practices that benefit both the individual and their family.

The articles on this theme confirm that remote and northern communities do have unique challenges. Many of these challenges are historically linked to years of oppression and making people feeling inferior to people in positions of power who had and perhaps still have values that contradict those of northerners.

Health professionals are in a privileged role of seeing and meeting individuals where they live and have the opportunity to understand the impact on peoples’ circumstances; without clean and sufficient water supply, for example, one can anticipate complex and long-term health problems to follow. Each of these theme’s chapters show both the challenges, but also successful and ongoing initiatives for improving people’s health where they live. The proper respect owed to residents of remote and rural communities, including their resilience and success in such harsh climatic conditions is critical. These articles are all context specific, but with knowledge and learning applicable across the Circumpolar North and beyond. The challenges around safe and clean water and adequate food supply is directly connected to health related outcomes, both physically and mentally. These chapters highlight different strength-based approaches; they can be read individually, but read as a whole the reader will see inter-connectedness, to the relationship with Indigenous people’s history and health. An overarching theme is that a collaborative approach is the best means by which to deal with health and other issues in the North.

Oral health is sadly still problematic when it comes to untreated dental carries and sever periodontitis in the northern regions. Oral health issues cause discomfort and are closely connected to other health issues as shown in the article, Oral Health and Health Promotion in Northern and Indigenous Communities by Sisko and Eino Honkala. However, statistics show that different countries and regions have been successful in dealing with those problems. Community development and empowerment draws on existing resources in the community to ensure authentic partnership and ownership in solutions.

Oral health is also closely connected to Food Security in Greenland, by Gert Mulvad. Food is not only about nutrition, but has huge cultural importance as coming together as family and friends are essential to building social connections. Mulvad explains how the traditional Greenlandic diet is mainly based on marine mammals, birds, fish, and land-based animals, but that there has been a drastic change in recent times to a more western diet. This means that most food is now imported and processed. This has impacted not only health outcomes in terms of nutrition, but also the social aspects of preparing and eating meals. The advice from the Greenlandic Board of Food and Environment referred to by Bjerregaard and Mulvard (2012) is to promote traditional foods, especially fish, but especially to prepare and enjoy meals together as a family. In this way, the food should continue to have its place in cultural, business and social conditions.

Clean water is often taken for granted, but the article, Indigenous Water Poverty: Impacts Beyond Physical Health, by Lalita Bharadwaj and Lori Bradford, shows that even in Canada, a water wealthy nation, safe drinking water supplies are not dependable for many Indigenous communities. Bharadwaj and Bradford show through a community based PAR (participatory action research) project what inadequate water supplies mean for communities, including their effects on personal hygiene and the inability to meet basic household needs. Further, water also has spiritual meaning and its inadequacy leads to loss of cultural practices related to the water as well as restricts good health in the holistic sense. The article concludes that Canada as a nation should remedy these inequities and reconcile ways of knowing, valuing and managing water.

Giving birth is a natural and often a happy occasion for women. Ideally, it happens in secure surroundings with support from a competent health care professional such as a midwife and with family nearby, who have an understanding and appreciation of relevant ceremonies and traditional birth practices. The chapter on Indigenous Birth by Angela Bowen and Carrie Pratt explores the state of Indigenous birth in Canada and the impact on the mother and society. Indigenous women living in the north may feel particularly vulnerable during childbirth as they often must leave their homes and families due to the lack of access to birthing units in their own communities. The article stresses that there is an urgent need to find ways to support culturally safe birth experiences for women whether it takes place in their home community, in a rural setting or in an urban centre.

Following, Elizabeth Cooper and S. Michelle Driedger’s Working with Unbounded Communities: A Metis Case Study, helps to explicate the lesson that Indigenous peoples do not exist in homogenous circumstances; rather, within Manitoba, Canada, Metis and First Nations people often live side-by-side, but have unequal access to health services and supports due to differences between federal and provincial fiduciary responsibilities. These different fiduciary responsibilities reproduce health inequities and challenges the uptake of research, policies, programming, and services. Cooper and Driedger explore that issue thoroughly and offer important points to consider for health professionals engage with Metis communities.

Living everyday life with chronic and long-term illness affects the lives of both individuals and their families. Tine Aagaard takes us through an ethnographic field study from Greenland, explores Everyday Life with Chronic Illness: Physical Health or Wellbeing?- how chronic illness needs to be taken into account not only as a medical disease that needs treatment, but also in relation to aspects of everyday life. The Danish model of patient participation might not fit the Greenlandic way of living and dealing with everyday events. Both the patient and the family needs support and for health professionals to discuss their everyday problems connected to living with chronic illness. This requires health professionals to seek the patient’s and family’s knowledge, and to understand the patients’ needs, wishes and resources.  A critical analysis of the disease orientation of health care, as well as the unequal valuation of patients’ knowledge, is highlighted in this chapter.

Tuberculosis (TB) is still a global healthcare problem. The way in which TB prevention and treatment is dealt with in remote Russian communities is described in the article, The Role of Nurses in Preventing Tuberculosis in Russia’s Remote Northern Territories of Residence by Nikolay Diachovsky and Aleksandra Obutova.  The extreme north of Russia has one of the highest incidences of TB and is still a leading cause of death among infectious diseases. Nurses are often the only available health personnel in these areas. This article describes how a Feldsher-Midwife Station, delivering prehospital primary care in remote areas, became a preferred model in Yakutia. The aim was to have a “Village Free from TB” and to prevent and to treat TB in a structured and nurse-led manner.

Community development entails a process of developing strengths-based approaches that can contribute to sustainability in a community. The article Community Development in Canada’s North by Kerry Lynn Durnford, Cathy Bradbury, Susan Starks, Marnie Bell, and Pertice Moffitt describes how to establish working relationships, and use population-based and social determinants approaches to engage in community advocacy for better living conditions. It further discusses how the provision of culturally safe care is an important competency for health professionals working with northern communities. Ongoing education and the understanding of people’s history and culture is essential in order to reduce health disparities.

Overall, this theme demonstrates how northern health professionals must work together with patients and families to improve community health, living conditions, and address health disparities in a collaborative rather than hierarchical manner.