Course Syllabus

 

 

Public Health in The Arctic, Summer 2017

DIS Copenhagen

 

Location: F24-303

Type & Credits: Elective Course - 3 credits

Study Tour: Tromsø - Karasjok

Major Disciplines: Public Health, Pre-Medicine/Health Science

 

Course Description

This course will focus on public health and health care delivery in the Arctic. The main public health challenges and opportunities in the region will be addressed, by examining historical and current health and disease patterns and the organization of healthcare systems in the Arctic. Through the course the students will familiarize themselves with how to deliver health care in one of the coldest, most remote, and sparsely populated regions of the world. The class will focus primarily on Greenland and the Inuit population, but also include some comparative insights from Arctic Scandinavia (the destination of the study tour) and the North American Arctic (Canada, Alaska). The course will take an interdisciplinary approach and draw concepts, theory and research from the fields of public health science and epidemiology.

 

Expected learning outcomes

After successfully completing this course students will be able to explain and discuss the health transition that indigenous people in the Arctic have gone through, assess existing and future challenges in health and health care delivery in the Arctic, and discuss possible solutions.

 Specifically students will be able to

• Explain main demographic characteristics of the peoples of the Arctic.
• Explain the organization of major circumpolar health networks and organization of healthcare systems including disease surveillance, national registers, health promotion and disease prevention.
• Explain and discuss how determinants of health affect health and disease in the Arctic.
• Explain and discuss disease patterns in Arctic populations and their relative burden to public health
• Analyze and compare the different geographical Arctic regions: Greenland, Scandinavian Arctic and North American Arctic to assess differences and similarities in health and disease patterns, organization of health care systems, etc.

Instructors

	Sascha Wilk Michelsen, course coordinator, study tour leader M.D. (University of Copenhagen, 2007). PhD: Host Immunity to Tuberculosis in Greenland (2016). Pediatric resident, Department of Pediatrics, Hvidovre Hospital/Rigshospitalet (2015-present). Researcher at the Department of Epidemiology Research – Section for Greenland Research at Statens Serum Institut. Lived and worked in Greenland as an M.D. and researcher in 2008-2009, 2010, 2012, 2013, and 2015. Worked as a general physician in Mo i Rana, Northern Norway in 2011. Co-organized summer schools on International Health and Global Health Challenge, at University of Copenhagen during medical school. With DIS since 2015.
	Anders Koch M.D. (University of Copenhagen, 1991). PhD: A longitudinal community based study of respiratory tract infections in Greenlandic children: disease burden and risk factors (2000). MPH: Chronic suppurative otitis media in children in Greenland: frequency, risk factors and disease burden (2009). Specialist in clinical infectious diseases and tropical medicine. Staff specialist at the Department of Infectious Diseases, Rigshospitalet (2015-present), and researcher at the Department of Epidemiology Research – Section for Greenland Research at Statens Serum Institut (1994-present) - head of section since 2001. Chairman of the Danish Greenlandic Society for Circumpolar Health and President of the International Union for Circumpolar Health (IUH). Lived and worked in Greenland as an M.D. and a researcher. With DIS since 2016.
	Christina Viskum Lytken Larsen Cand.scient.soc (University of Copenhagen, 2006). PhD: Gambling and public health in Greenland - a large indigenous population in transition (2014). Researcher at Center for Health Research in Greenland, National Institute of Public Health, University of Southern Denmark, Research Program on Adult Health and Health-related Behaviour (2007-present) and Center Coordinator since 2015. Represents the Government of Greenland on several health issues within the Arctic Council. Lived and worked in Greenland as a researcher. Associate professor affiliated with the University of Greenland. President of the Circumpolar Health Research Network. With DIS since 2016.
	Bolette Søborg M.D. (University of Copenhagen, 1999). PhD: Tuberculosis infection among children in Greenland (2010). Field epidemiologist from the European Programme for Intervention Epidemiology Training (EPIET) (2013). Senior Consultant, Public Health Medicine, Danish Health Autority (2015-present). Researcher at the Department of Epidemiology Research – Section for Greenland Research at Statens Serum Institut (2008-present). Lived and worked in Greenland as a researcher. With DIS since 2016.

Evaluation and Grading

To be eligible for a passing grade in this class all of the assigned work must be completed.
The factors influencing the final grade and the proportional importance of each factor is shown below:

 

Component	Weight
Class and study tour participation	20%
Study tour assignment	15%
Student presentations, The Arctic and its peoples	15%
Lecture based multiple choice exam	20%
Group based exam with presentation of project	30%

A word about grades: We realize that grades are important to you, but try not to let your anxiety about grades deter you from taking intellectual risks and learning just for the joy of learning. Also, we do not grade to punish or reward you just as our grade is not an indication of our evaluation of you as a person. We grade you to give you our honest assessment of your academic performance at this point in time.

Below you can read more about the individual parts

Class participation

This is intended to be an interactive class. Primarily because it provides for a better learning experience, but also because it simply makes classes more fun. In order to participate, students are required to attend all classes, read and prepare before each class and to participate actively in class. Missing classes will be reflected in the participation grade – unless there is a valid reason.

Study Tour Participation

Before the study tour you will be provided with information and links about the academic visits on the tour. During the tour it is important that all students participate and show interest and enthusiasm – whether it’s a course specific or a cultural visit. The more active participation from students the better the learning experience for everyone.

Student presentations, The Arctic and its peoples

Further details will be given during the first day of classes.

Study tour assignment

The assignment will include a) an introduction and questions for a specific visit and b) debrief and reflection on learning outcomes via TUMBLR.

1. You will be divided into smaller groups, and each group will be assigned to prepare a short presentation for a specific visit. The presentation should include a short introduction to the institution and pose relevant questions.
2. TUMBLR: As part of the study tour, each group will upload a post to the TUMBLR account for the Public Health in the Arctic course about the assigned visit. More information is given during study tour orientation.

Lecture based multiple choice exam

The lecture-based exam will consist of multiple-choice questions. The duration of the exam is 45 minutes. A short text, chart or table may be handed out and used in connection with some of the questions in the exam.

Group Project

The class will be divided into groups of 3-5 students. A set of papers/relevant reading on a number of selected key topics relevant to public health and research in the Arctic will be provided. Each group is required to read, discuss, and review one set of literature on a specific topic, present their findings, derive relevant key messages and one essential take home message. The topics and the literature will be handed out during the first week. A 4-person group will be required to do a 20-minute presentation, including no-more than 20 slides. All students within the group are required to present. Grades will be assigned individually.

 

Workload

This is a very intensive course, and in just three weeks, you will receive three credits. In order to merit this you should expect a high workload. You should expect to use on average 2-3 hours preparing for each day of classes.

Study tour to Arctic Scandinavia, Northern Norway

This program will include a study tour to Tromsø and Karasjok in Arctic Scandinavia, Norway. You will travel with your classmates and DIS faculty and staff. The study tour is an important part of the program, as we take the classroom on the road and see how theory presented in the classroom is translated to practice in the field. There will be academic visits to various relevant sites in Northern Norway, as well as cultural visits and sightseeing. Attendance and active participation in all activities are required on the study tour.

Expectations for study tour

• Participate in all activities
• Engage in discussions, ask questions, and contribute to achieving the learning outcomes
• Respect the destination, the speakers, DIS staff, and your fellow classmates
• Represent yourself, your home university and DIS in a positive light

While on tour DIS will provide transportation to/from the destination(s), accommodation, approx. 2 meals per day and entrances, guides, and visits relevant to your area of study or the destination. You will receive a more detailed itinerary prior to departure.

Travel policies: You are required to travel with your group to the destination. If you wish to deviate from the group travel plans on the way back, you need approval from the program director and the study tours office.   

The tour is scheduled with departure Sunday June 18 and return to Copenhagen Friday June 23.

Teaching methods

Different teaching formats may be used. The course will be a mix of lectures, interactive lectures, class discussions, group work, and student presentations. A part of the course will be based on debating issues, and students are expected to engage actively in oral presentations, discussions, group work and exercises.

Policies

Attendance

You are expected to attend all DIS classes and activities when scheduled, and we will actively monitor attendance. Absences will jeopardize your grade and your standing at DIS. Excused absences include only serious illness and participation in religious holidays.
You must always notify your instructors about an absence a reasonable time in advance.

If you miss multiple classes the Director of Academic Support, and the Director of Student Affairs will be notified and they will follow-up with you to make sure that all is well. In the case of multiple absences you will need to provide a doctor’s note.

Class room etiquette

A good learning environment requires that everyone is present, prepared, and participating. Out of respect for both faculty and fellow students we expect you to be on time and to participate in the full duration of the class.

Laptops and phones in class: You may use your laptop for note‐taking or fact‐checking. Usage of laptops or phones not related to the class is unacceptable, and will reduce your participation grade significantly.

Academic Honesty: Plagiarism and Violating the Rules of an Assignment

DIS expects that students abide by the highest standards of intellectual honesty in all academic work. DIS assumes that all students do their own work and credit all work or thought taken from others. Academic dishonesty will result in a final course grade of “F” and can result in dismissal. The student’s home universities will be notified. DIS reserves the right to request that written student assignments be turned in electronic form for submission to plagiarism detection software. See the Academic Handbook on DIS Forum for more information, or ask your instructor if you have questions.

Disability and resource statement

Any student who has a need for accommodation based on the impact of a disability should contact the Office of Academic Support to coordinate this.  In order to receive accommodations, students should inform the instructor of approved DIS accommodations within the first week of classes.

Practical information

Field studies in Copenhagen

A number of field studies are being planned. Relevant institutions working with the Arctic region and Arctic health will be visited. Examples are: The Center for Health Research in Greenland at The National Institute of Public Health, Section for Epidemiology Research in Greenland, Statens Serum Institut, The Arctic Institute, The Danish National Museum, The North Atlantic House, The House of Knud Rasmussen, or The Nordic Council of Ministers. Further information regarding actual visits will be provided as the dates approach. Please note that the field studies are part of the course and exam questions related to field studies are possible.

Office Hours and Contacts

The instructors have no set office hours, but you may contact them or the program assistant, Victoria Stepanova, with any DIS questions or to schedule an appointment.

DIS Science & Health contact info

Victoria Stepanova, Science and Health Programs Assistant, vs@dis.dk
Louise Iversen, Assistant Program Director, Science & Health Programs, lbi@dis.dk
Lisbeth Borbye, Director of Science & Health Programs, lbo@dis.dk
Science & Health Office: Vestergade 10-B12

DIS Canvas

Canvas is a web-based system that allows you to access course resources and communicate with your classmates and faculty. To access Canvas, you can go to the DIS homepage and click the ‘Canvas’ link on the bottom of the website, or go to: https://canvas.disabroad.org/login/canvas (Links to an external site.). You can also download the Canvas App (By: Instructure) on iPhone and Android smart phones.

Readings

Primary textbook

• Young, TK and Bjerregaard, P (eds.) (2008): Health Transitions in Arctic Populations. University of Toronto Press.

Articles

Mandatory

1. Chateau-Degat ML, Dewailly E, Louchini R et al., Cardiovascular burden and related risk factors among Nunavik (Quebec) Inuit: insights from baseline findings in the circumpolar Inuit health in transition cohort study. Can J Cardiol. 2010 Jun-Jul;26(6):190-6.
2. Chatwood S et al. Approaching a collaborative research agenda for health systems performance in circumpolar regions. Int J Circumpolar Health. 2013; 72: 10.3402/ijch.v72i0.21474.
3. Jeppesen C & Bjerregaard P (2012). Consumption of traditional food and adherence to nutrition recommendations in Greenland. Scan Jl of Public Health,40: 475–481.
4. Jørgensen ME, Borch-Johnsen K, Witte DR, Bjerregaard P. Diabetes in Greenland and its relationship with urbanization. Diabet Med 2012;29:755–760.
5. Ladefoged K, Rendal T, Skifte T, Andersson M, Søborg B, Koch A. (2011). Risk factors for tuberculosis in Greenland: Case-control study. Int J Tuberc Lung Dis 15(1):44–49
6. Michelsen SW, Soborg B, Koch A, et al. The effectiveness of BCG vaccination in preventing Mycobacterium tuberculosis infection and disease in Greenland.  Thorax. 2014 Sep;69(9):851-6. doi: 10.1136/thoraxjnl-2014-205688. Epub 2014 Jun 26.
7. Moltke I, Fumagalli M, Korneliussen TS, Crawford JE, Bjerregaard P, Jørgensen ME, Grarup N, Gulløv HC, Linneberg A, Pedersen O, Hansen T, Nielsen R, Albrechtsen A. Uncovering the genetic history of the present-day Greenlandic population. Am J Hum Genet. 2015 Jan 8;96(1):54-69. doi: 10.1016/j.ajhg.2014.11.012. Epub 2014 Dec 31.
8. Niclasen B, Mulvad G (2010). Health care and health care delivery in Greenland. Int J of Circumpolar Health 69:5 2010
9. Raghavan M, DeGiorgio M, Albrechtsen A, Gilbert MT, Nielsen R, Willerslev E. The genetic prehistory of the New World Arctic. Science. 2014 Aug 29;345(6200):1255832. doi: 10.1126/science.1255832
10. Rasmus SM, Charles B, Mohatt GV (2014). Creating Qungasvik (a Yup'ik intervention "toolbox"): case examples from a community-developed and culturally-driven intervention. Am J Community Psychol. 2014 Sep;54(1-2):140-52.
11. Riva M, Larsen CV, Bjerregaard P.  Household crowding and psychosocial health among Inuit in Greenland.  Int J Public Health. 2014 Oct;59(5):739-48. doi: 10.1007/s00038-014-0599-x
12. Ruiz-Castell M, Muckle G, Dewailly É, Jacobson JL, Jacobson SW, Ayotte P, Riva M (2015). Household crowding and food insecurity among Inuit families with school-aged children in the Canadian Arctic. Am J Public Health Mar;105(3):e122-32.
13. Sainani and Popat, Understanding Study Design (2011).  American Academy of Physical Medicine and Rehabilitation, Vol 3:573-7.
14. SDWG (Arctic Council). Sharing Hope. Circumpolar Perspectives on Promising Practices for Promoting Mental Wellness and Resilience. Please access here.
15. Young TK, Revich B, Soininen L (2015).  Suicide in circumpolar regions: an introduction and overview. Int J Circumpolar Health:74:27349. doi: 10.3402/ijch.v74.27349 

Additional

1. Akande VO, Hendriks AM, Ruiter RA, Kremers SP.Determinants of dietary behavior and physical activity among Canadian Inuit: a systematic review.  Int J Behav Nutr Phys Act. 2015 Jun 24;12:84. doi: 10.1186/s12966-015-0252-y.
2. Bjerregaard P, Dahl-Petersen IK (2011). How well does social variation mirror secular change in prevalence of cardiovascular risk factors in a country in transition? Am J Hum Biol. Nov-Dec;23(6):774-9. doi: 10.1002/ajhb.21209. Epub 2011 Sep 19.
3. Bjerregaard P, Young TK, Dewailly E, Sven OE Ebbesson SOE (2004). Review Article: Indigenous health in the Arctic: an overview of the circumpolar Inuit population. Scand J Public Health 32(5): 390–395
4. Friborg J, Koch A, Stenz F, Wohlfahrt J & Melbye M.  A Population-Based Registry Study of Infant Mortality in the Arctic: Greenland and Denmark, 1973–1997.Am J Public Health. 2004 March; 94(3): 452–457.
5. Fumagalli M et al. Greenlandic Inuit show genetic signatures of diet and climate adaptation. Science 2015 Sep 18;349(6254):1343-7. doi: 10.1126/science.aab2319.
6. Larsen CV, Curtis T, Bjerregaard P (2013). Gambling behavior and problem gambling reflecting social transition and traumatic childhood events among Greenland Inuit: a cross-sectional study in a large indigenous population undergoing rapid change. J Gambl Stud:29(4):733-48.
7. Larsen CV, Curtis T, Bjerregaard P (2013). Harmful alcohol use and frequent use of marijuana among lifetime problem gamblers and the prevalence of cross-addictive behaviour among Greenland Inuit: evidence from the cross-sectional Inuit health in transition Greenland survey 2006–2010. Int J Circumpolar Health:72: 19551 - http://dx.doi.org/10.3402/ijch.v72i0.19551 
8. Niclasen B, Mulvad G (2010). Health care and health care delivery in Greenland. Int J of Circumpolar Health 69:5 2010
9. Niclasen BV and Bjerregaard P (2007). Child health in Greenland. Scan J of Public Health; 35: 313-322.