Inuit infants die at well over three times the rate of other Canadian babies, according to a massive new study published Monday in the Canadian Medical Association Journal.
And as if to underscore the tough situation facing aboriginal children in Canada's North, a second study in the same journal found that 70 per cent of Inuit preschoolers live in homes where there isn't always enough food.
"Inuit children in Nunavut are faced with health challenges that are more severe than those in Southern Canada due to the socio-economic conditions facing the entire territory," said Dr. Isaac Sobol, the territory's chief public officer of health.
To study the Inuit infant mortality rate, University of Montreal researcher Dr. Zhong-Cheng Luo looked at all four million births in Canada between 1990 and 2000. He then broke out those that occurred in 53 predominantly Inuit communities in the Arctic, from Labrador in the east the Mackenzie Delta in the west.
After comparing those births with deaths in the first year of life, Luo found the mortality rate for Inuit infants was 16.5 per thousand live births - a rate not seen in Southern Canada since 1971 and 3.6 times the Canadian average of 4.6 deaths.
Luo's data are at least a decade old, but more recent information isn't encouraging.
"If you look at the trends over time, you do not see any improvement," he said.
The lowest rate was in the Inuvialuit region in the Northwest Territories, at 13.4 deaths per thousand births. The highest rate was in the Nunavik region of northern Quebec, where 18.1 babies out of every thousand die before their first birthday.
The study also found a high rate of stillbirths, at 1.7 times the Canadian average.
Luo said many of the deaths are preventable.
Inuit mothers and pregnant women have high smoking and drinking rates. As well, emphasizing the importance of measures such as placing infants on their backs to sleep could reduce the incidence of Sudden Infant Death Syndrome, now seven times more common among the Inuit.
But Luo said poverty, overcrowding and generally poor living conditions in the North are likely taking their toll.
"Improving socio-economic indicators is of fundamental importance," he said. "That's the root cause. Infant mortality is a mirror of socio-economic conditions."
Sobol said that there is a midwifery program in the two Nunavut regions that do not have a hospital. He said smoking and drinking among pregnant and new mothers is a problem that community nurses have been trying to deal with for a long time.
Similar issues surfaced in the second study.
Grace Egeland of McGill University surveyed 388 households in 16 Nunavut communities in 2007 and 2008. She found that 41 per cent of children between age three and five lived in homes where they either had no food for an entire day or where their parents couldn't afford to feed them at least part of the time. Two-thirds of the parents said there were times when they ran out of food and couldn't afford to buy more.
In all, she concluded that 70 per cent of Nunavut's Inuit children sometimes don't have enough to eat.
"We had an anticipation that we had a problem with the food security issue, but I didn't realize the extent of it," said Egeland.
Consequences range from poorer overall health to lower school achievement, she said. Paradoxically, one of those consequences is higher rates of obesity.
"It's easier to eat a lot of high-energy, nutrient-poor foods," said Egeland. "We find that obesity seems to track with food insecurity in developed countries."
Egeland pointed out some households may not be spending grocery money wisely. Cigarettes are expensive, and soft drink consumption in the North is about three times Southern Canada's rate.
Still, she said measures such as higher income support, food banks and milk programs could go a long way toward keeping young bellies full.
Sobol said food security is a complex issue in Nunavut.
"This problem is multi-faceted, involving issues such as poverty, rapid cultural change and education, and has had a profound influence on the health of Inuit in Nunavut."
Nunavut funds a variety of food security programs, such as school breakfasts, said Sobol. Other programs such as "Drop the Pop," which encourages people to consume fewer soft drinks, occur across the North.
"Food security is a public health issue,"said Egeland. "I'm hoping this leads to a really good assessment of health and health policy.
"Inuit are Canadians too, so let's look after each other."