Arctic Yearbook - Arctic Pandemics:COVID-19 and Other Pandemic Experiences and Lessons Learned

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Arctic Yearbook Special Issue: Arctic Pandemics

Spence, J., H. Exner-Pirot, & A. Petrov (eds.). (2023). Arctic Pandemics: COVID-19 and Other Pandemic Experiences and Lessons Learned. Akureyri, Iceland: Arctic Portal. Available from https://www.arcticyearbook.com

ISSN 2298–2418

This is an open access volume distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY NC-4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

Cover Image Credit

Amber Webb

Guest Editors

Jennifer Spence| jennifer_spence@hks.harvard.edu

Heather Exner-Pirot | exnerpirot@gmail.com

Andrey Petrov | andrey.petrov@uni.edu

Editorial Board

Anastasia Emelyanova, Postdoctoral Researcher, Thule Institute, University of Oulu

Heather Exner-Pirot (co-chair), Senior Fellow, Macdonald-Laurier Institute

Selma Ford, Program Director, Gordon Foundation

Lassi Heininen, Editor, Arctic Yearbook and Professor Emeritus, University of Lapland

Solveig Jore, Senior Researcher, Norwegian Institute of Public Health

Christina Storm Mienna, Associate Professor, Umeå University

Embla Eir Oddsóttir, Director, Icelandic Arctic Cooperation Network

Andrey Petrov (co-chair), Professor, University of Northern Iowa

Norma Shorty, Instructor, Yukon University

Jennifer Spence (co-chair), Senior Fellow, Belfer Center Arctic Initiative, Harvard University

Eydís Kr Sveinbjarnardóttir, Associate Professor, University of Iceland

About Arctic Yearbook

The Arctic Yearbook is the outcome of the Northern Research Forum (NRF) and UArctic joint Thematic Network (TN) on Geopolitics and Security. The TN also organizes the annual Calotte Academy.

The Arctic Yearbook seeks to be the preeminent repository of critical analysis on the Arctic region, with a mandate to inform observers about the state of Arctic politics, governance and security. It is an international and interdisciplinary peer-reviewed publication, published online at [https://arcticyearbook.com] to ensure wide distribution and accessibility to a variety of stakeholders and observers.

Arctic Yearbook material is obtained through a combination of invited contributions and an open call for papers. For more information on contributing to the Arctic Yearbook, or participating in the TN on Geopolitics and Security, contact the Editor, Lassi Heininen.

Acknowledgments

The Arctic Yearbook would like to acknowledge the Arctic Portal [https://arcticportal.org] for their generous technical support, especially Ævar Karl Karlsson; Sai Sneha Vankata Krishnan and Sarah Seabrook Kendall for their assistance with copy editing; and our many colleagues who provided peer review for the scholarly articles in this volume.

Section I: State of Knowledge

Arctic Pandemics: COVID-19 & other pandemic experiences & lessons learned Preface 1 Anne Zink Introduction 4 Jennifer Spence, Heather Exner-Pirot & Andrey Petrov
The COVID-19 pandemic in the Arctic: An overview of dynamics from 2020 to 2022 7 Andrey N. Petrov, Sweta Tiwari, Michele Devlin, Mark Welford, Nikolay Golosov, John DeGroote, Tatiana Degai & Stanislav Ksenofontov The state of research focused on COVID-19 in the Arctic: A meta-analysis 21 Jennifer Spence & Sai Sneha Venkata Krishnan
II: Arctic Responses from Alaska to Murmansk Community responses to the COVID-19 pandemic in Inuit Nunaat 35 Robyn Long, Selma Ford, and John Crump Understanding the COVID-19 pandemic gendered policy responses in Alaska through the prism of a holistic wellness concept 56 Laura F. Goodfield, Anissa S. Ozbek, Riya Bhushan, Sophie M. Rosenthal, Alicia Glassman & Marya Rozanova-Smith Biocultural perspectives of pandemics and post-pandemic population health in Alaska 72 Taylor P. van Doren, Ryan A. Brown & Ron Heintz Taming Coronavirus: Siberian Yup’ik COVID-19 strategies on St.Lawrence Island, Savoonga USA 101 Anita Parlow Indigenous approaches to public health: Lessons learned from Yukon First Nation responses to the COVID-19 pandemic 106 Council of Yukon First Nations, Math’ieya Alatini, Kari Johnston, Alison Perrin, Rhiannon Klein, Kiri Staples & Kristeen McTavish Storytelling through uncertainty: How a Yukon entrepreneur podcast helped chronicle the COVID-19 experience ............................................................................................................................ 127 Sonia Wesche, Kari Johnston, Christy Huey, Mark Andrachuk, Felix Arndt & Jiamin Jiang “Dinjii Zhuh (Gwich’in) perspectives of epidemics: Contemporary Indigenous concepts of survival, community, strength, & COVID-19 in the Northwest Territories, Canada”................. 131 Crystal Gail Fraser (she/her)
Section

Section III: Arctic Impacts and

Assessing pandemic risk through a lens of vulnerability and resilience: A case of the Northwest Territories, Canada 134 Sweta Tiwari, Andrey N. Petrov, Michele Devlin, Mark Welford, Nikolay Golosov, John DeGroote, Tatiana Degai & Stanislav Ksenofontov Understanding the Power of Community During COVID-19 ........................................................ 157 Gwen Healey Akearok Challenging dominant narratives to enable effective responses to pandemics and other crises in rural and island communities ................................................................................................................. 161 Thomas Fisher & Theona Morrison Pre-travel testing of travelers to Greenland during the COVID-19 pandemic – formation of a screening program .................................................................................................................................... 180 Anders Koch, Mie Møller & Åse Bengaard Andersen Social life and use of an Arctic city centre during the COVID-19 pandemic ................................ 185 David Chapman, Jennie Sjöholm, Sandra Zetterkvist & Agneta Larsson Local newspaper as a solution seeking actor in Northernmost Finland during the COVID-19 pandemic ................................................................................................................................................... 201 Kati Parkkinen, Ulla Timlin & Arja Rautio Voluntary work in the shadow of COVID-19: Experiences from a Norwegian-Russian border region in the Arctic .................................................................................................................................. 205 Vigdis Nygaard & Larissa Riabova
Innovation The impacts of COVID-19 on Yukon’s frontline healthcare workers 211 Liris P.R. Smith, Mark R. Christopher & Michelle D. Leach The health experience of the COVID-19 pandemic among the Sámi in Sweden: A cross-sectional comparative study 238 Lena Maria Nilsson, Miguel San Sebastian & Jon Petter A Stoor The COVID - 19 pandemic and regional economic resilience in Northern Finland, Norway, and Sweden – bouncing back or not? 251 Jaakko Simonen, Mikko Moilanen, Jemina Kotila, Joona Lohtander, Lars Westin, Anders Hersinger, Stein Østbye, Tapio Riepponen & Rauli Svento Fishing in the time of COVID: Assessing risk in the Bristol Bay commercial salmon fishery and the societal benefits of social science research .................................................................................... 275 Davin Holen, E. Lance Howe & Guangqing Chi What do COVID-19 stimulus measures delivered in the Arctic region tell us about the prospects for a nature-based economy? ................................................................................................................. 278 Elena F. Tracy Gendered Impacts of COVID-19: Designing a COVID-19 Gender Impacts and Policy Responses Indicators Framework for Arctic Communities .............................................................. 282 Marya Rozanova-Smith, Andrey N. Petrov & Charlene Aqpik Apok
Professional educators in the Circumpolar North: A model for the digital competence of future teachers 301 Satu-Maarit Korte, Minna Körkkö, Gregor Maxwell, Mhairi C. Beaton, Pigga Keskitalo, Miia Hast, Outi KyröÄmmälä & Sanna Mommo Arctic research in the COVID-19 pandemic era: lessons learned & looking ahead in Nunavut, Canada ....................................................................................................................................................... 315 Sappho Z. Gilbert, Jade B. Owen & Jamal Shirley Potential role of international environmental law and One-Health Approach to protect the Arctic Indigenous Peoples from climate-sensitive zoonotic diseases .......................................................... 319 Hitomi Kimura Tested by wildfires, floods and pandemic: Are there limits to adaptability in the Arctic? ........... 336 Daria Burnasheva & Mariia Osipova

Preface

We had landed in Dillingham, Alaska in the spring of 2020. Located 331 miles from Anchorage, the flight had been smooth, but the tension was high. Countries had closed their borders; cities were shut down and the world grappled w ith understanding and responding to a worldwide pandemic for the first time in most peoples’ memories. The salmon, on their own schedule, prepared to make their mass migration to Bristol Bay, spawning to begin the next generation. This annual migration has sustained the land, the people, and the fish for thousands of years. Not only was the salmon migration going to happen regardless of policies, politics, or pandemics, it was the economic life force and cultural fabric of Alaska Native communities, who have lived, played and worked for as long as the stories have been told. It was also a critical source of food for the world. But throughout history, with the migration of fish had also come disease. During the 1918 pandemic, the great influenza outbreak, or “Great Death” as it has been commonly referred to, the flow of infected people following fish had been the primary means that disease was introduced into communities. The results were devastating.

The experience of Arctic communities during the COVID-19 pandemic was one where lived experience along with an understanding of the land and unique geography were intertwined into the response; where the crucible of necessity and austere conditions forged creative and resilient solutions; and where lessons learned from history, and carefully handed down from generation to generation, echoed their way through every layer of preparation, response, and recovery.

Stories of previous trauma experienced by many Alaska Native communities during the response to the 1918 pandemic have endured. The history of these communities was not housed in books

as much as it lived in the stories, made the foundation and was built into the walls of the communities . The hospital was initially constructed as an orphanage as parents, grandparents, aunties, and uncles were taken by that deadly disease. The ceiling kept out the rain and snow, but its walls echoed a great sadness of the past. And during COVID-19, the caregivers worked to not only heal ailments of the present, and prevent another pandemic, but also to heal the past

One of the local leaders, Chief Tom Tilden of Curyung Tribe shared some of the stories his grandmother told of leaving her community for a year during the Great Death, only to return to a village devastated by disease where only dogs and small children had survived. He had been told these stories and he planned to learn from them and keep his community safe. Charged with the care of his people, he was not about to allow this new unknown virus that had shut down New York, was already devastating the Navajo Nation, and had been slowly creeping across the country, make its way to his community.

Communities lost a generation, language, and culture. The 1918 pandemic was not a single event. It was a seismic s hift, and its destruction, amplified by systemic inequities, are echoed in the disparate health outcomes of Alaska Native people.

However, the lessons of the past created the strength and resilience of today. Alaska Native People, like so many Indigenous Peoples of the Artic, overcame tremendous odds, and the lessons learned forge a path for all for the challenges that lay ahead.

This special issue of the Arctic Yearbook contains a time capsule of these truths and stories. It highlights the innovations, partnerships, and knowledge gained. Together, this research reflects the knowledge of this great illness and the amazing resilience of individuals, families and communities that have lived to tell about it. They highlight the importance of sovereignty, the strength that comes from Indigenous ways, as well as paint a path of health and wellness that can be a guiding light towards future readiness or better yet, prevention of disease.

These papers chronicle our experiences, our discoveries and the lessons w e collectively learned. My sincere hope is that what will be remembered is great strength, rather than great death. Across the Arctic, communities came together, used traditional ways of knowing and braided them with modern science and technology, ultimately creating uniquely resilient, s overeign, strength-based responses in some of the most remote and challenging conditions.

As Johanna Coghill, a community health practitioner in Nenana, said, “we are making new stories.” As she remembered epidemics of past generations and incorporated the ways communities cared for each other, using existing infrastructure for immunizations to distribute vaccinations and test kits, she continued, “It’s one of those things we’ll talk about 100 years from now.”

The learning curve for humankind across the globe was steep. But there is great beauty in the understanding that continues to emerge. When the value of community and Indigenous ways of being that have existed for thousands of years were recognized, honored, and brought to the forefront of governmental responses, people thrived The ancient truths, carefully handed from one elder to the next, from one generation to the next, contain wisdom and power that transcend the relative blip in time of modern medical advances.

Arctic Yearbook 2023 Special Issue: Arctic Pandemics Zink 2

How we remember and recover from this pandemic will be as important as how we initially responded. This special issue of the Arctic Yearbook is like a packaged gift for current and future health practitioners, policy makers, elders, and leaders to come.

A dear friend and mentor once shared with me knowledge that an elder had imparted to her. She asked, “What are you doing with the lessons you've learned? This is not your knowledge to keep.” So, to the authors, researchers and publis hers, thank you for sharing these lessons. The gift you give to those who will come after us, as we all understand, is not your knowledge to keep. And to the readers, please accept and enjoy this precious gift.

Arctic Yearbook 2023 Special Issue: Arctic Pandemics Preface 3

Lest we forget…

The idea for this special issue of the Arctic Yearbook started with the beginning of the COVID19 pandemic. As we all tried to come to terms with the magnitude of this event, we realized that the pandemic was global, but the experiences and impacts in the Arctic would be distinct.

Early on, we recognized that understanding the impacts of the COVID-19 pandemic in the Arctic would require a broad lens. We needed to consider the health impacts of the pandemic, but we also wanted to understand the social, cultural, and economic implications. We wanted to assess the impacts of the virus, but we also needed to examine the impacts of the various risk management measures put in place in response to its spread.

We knew that the COVID-19 pandemic needed to be understood in context – in relationship to past (and future) pandemics, colonial injustices, existing infrastructure deficits, current and future impacts of climate change, and other distinct features of the region. We knew that communities in the Arctic would face unique challenges, but this would also be an opportunity to observe and learn from their resilience in the face of extensive and rapid change.

We were humbled to be able to draw together a strong editorial board from across the Arctic region to guide the creation of this special issue and mobilize their networks to encourage a variety of relevant, high-quality contributions. We are also particularly thankful to the Arctic Yearbook for their willingness and commitment to support this effort. It is through their innovative and flexible approach that we were able to invite a diversity of contributions (including academic peer reviewed articles, case studies, commentaries, and any other form of contribution people chose to submit) and make this collection accessible as an open-source volume. We wanted to reach and inspire dialogue between experts and knowledge holders, and we knew we could only be so successful with this project because many people believed that it was important.

Introduction
Jennifer Spence, Heather Exner-Pirot, and Andrey Petrov are the editors of this special issue of the Arctic Yearbook

The result is a collection of 15 peer reviewed articles and 11 shorter contributions that cover an impressive range of issues and experiences. We are particularly proud that this volume places an emphasis on Indigenous and community-based experiences and issues with pandemics. Our editorial board agreed that this was a critical aspect of the project and we are pleased that the final product respects this vision.

The contributions are organized into three sections: 1) state of knowledge, 2) Arctic responses from Alaska to Murmansk, and 3) Arctic impacts and innovations. It was not easy to separate these diverse contributions into distinct categories. In many cases, the placement of an article in one section over another is somewhat arbitrary. Many of the articles take a holistic approach in the scope of their research, analysis, and findings, which is perhaps another common (and valuable) feature of Arcticrelated research. It was not our intention to force our authors into silos and we encourage community leaders, policymakers, researchers and other readers to review and take note of the important connections between the sections.

At the heart of all the articles in this volume is a desire to share the experiences and circumstances of Arctic communities with COVID-19 and other pandemics. This collection is grounded in a desire to expose what pandemics generally and COVID-19 specifically tell us about the unique strengths and vulnerabilities of Arctic communities. This special journal issue is an effort to remember and learn from Arctic experiences with COVID-19 and other pandemics in order to inform our responses to future pandemics and other regional and global shocks that we can expect to face in the future.

As COVID-19 increasingly is seen as a thing of the past that people prefer to move on from, it is critical that knowledge holders, researchers, and policymakers continue to dedicate time, effort and resources to learning from these experiences and ensuring that it informs our future actions. We hope that this volume is a useful contribution to this effort.

Arctic Yearbook 2023 Special Issue: Arctic Pandemics Introduction 5

Section I: State of Knowledge

The COVID-19 pandemic in the Arctic: An overview of dynamics from 2020 to 2022

Since February 2020, the COVID-19 pandemic has been unfolding in the Arctic, placing many communities at risk due to their remoteness, limited healthcare options, underlying health issues, and other compounding factors. This paper assimilates diverse sources of COVID-19 data in the Arctic from 2020-2022 and provides a preliminary analysis at the regional (subnational) level. The results suggest that the COVID-19 pandemic outcomes to date (infections, mortality, and case-fatality ratios) were highly variable, but mortality generally remained below respective national levels. The Arctic has persevered through COVID-19 with less dire consequences despite the region’s preexisting vulnerabilities. Based on the varying trends and magnitude of the pandemic, we classify Arctic regions into several groups.

As of October 1, 2022, the Arctic has experienced about 2.4 million confirmed cases and over 29,000 deaths from COVID-19. These outcomes are not uniform across the Arctic region and are greatly influenced by Northern Russia, given its sizable Arctic populations. Greenland, the Faroe Islands, Iceland, Northern Canada, and Northern Norway reported just under 60 cumulative deaths per 100,000 population, while Alaska, Northern Russia, and Northern Sweden had over 180 deaths per 100,000. This study summarizes the COVID-19 epidemiological outcomes in the Arctic by its regions from February 2020 to October 2022, with a goal of shedding

Andrey N. Petrov, ARCTICenter and Department of Geography, University of Northern Iowa, USA; Sweta Tiwari, ARCTICenter and Department of Geography, University of Northern Iowa, USA; Michele Devlin, ARCTICenter, University of Northern Iowa and United States Army War College, USA; Mark Welford, Department of Geography, University of Northern Iowa, USA; Nikolay Golosov, Department of Geography, Pennsylvania State University, USA; John DeGroote, Department of Geography, University of Northern Iowa, USA; Tatiana Degai, ARCTICenter, University of Northern Iowa, USA and Department of Anthropology, University of Victoria, Canada; Stanislav Ksenofontov, ARCTICenter and Department of Geography, University of Northern Iowa, USA.

Andrey N. Petrov, Sweta Tiwari, Michele Devlin, Mark Welford, Nikolay Golosov, John DeGroote, Tatiana Degai & Stanislav Ksenofontov

more light on the factors that determine the pandemic’s spatiotemporal dynamics in the Arctic. The COVID-19 epidemiological variability across the Arctic, to a large extent, is explained by geographical isolation, the effectiveness of COVID-19 public health prevention measures, the nature of the health care system, and varying vaccination rates, among other reasons.

Lessons learned by examining the patterns of COVID-19 spread and pandemic outcomes, such as mortality and morbidity their relationships with underlying public health conditions and healthcare resources, as well as socioeconomic characteristics, prevention and mitigation policies, and experiences of the Indigenous Peoples can inform responses to current and future pandemics.

Introduction

COVID-19 (or formally SARS-CoV-2) has, since December 1, 2019, advanced rapidly around the world (Ciotti et al., 2020; Kapitisinis, 2020; MacIntyre, 2020). In fact, SARS-CoV-2 is the fifth pandemic to affect the world since the 1918 flu outbreak, known as “Spanish flu.” The others are the 1957 Asian flu, 1968 Hong Kong flu, and 2009 Swine flu. The February 1918 to April 1920 pandemic infected ~500 million and killed between 17-50 million including large numbers of Arctic inhabitants. The 1957-1958 flu infected in-excess of 100 million and killed ~1.1 million, the 1968 flu killed 1 million, and the 2009 flu killed in-excess of 200,000 (Barro et al., 2020; Kilbourne, 2006; Simonsen et al., 2013).

Although pandemic morbidities have declined over the last 100 years, intense globalization has accelerated the spread of these pandemics. Over the course of the COVID-19 pandemic to date (2020-2022) positive cases totalled over 660 million and 6.7 million people perished due to the disease (JHCRC, 2023) and many were left permanently compromised. In other cases, infected individuals barely noticed their infection yet were infectious (JHCRC, 2023; Liu et al., 2020). Research from China, Italy, and Singapore suggested that early morbidity from SARS-CoV-2 was elevated among those individuals suffering from hypertension, diabetes, heart disease, cancer, dementia, or with a medical record of strokes (Singh et al., 2020). Past evidence from China and Italy suggests ~20% of all COVID-19 sufferers who visited hospitals or were hospitalized will suffer subsequent heart disease, while 40-60% of those individuals infected with SARS-CoV between 2002-2004 and who survived continue to suffer heart problems (Bansal 2020). Stringent public health policies and subsequent mass vaccination campaigns conducted in 2021-2022 around the world have slowed down the pandemic (Watson et al., 2022), although the outbreaks continue to persist (JHCRC, 2023).

The Arctic is considered particularly vulnerable to pandemics due to factors such as limited infrastructure and healthcare options, remoteness, difficult socioeconomic conditions, and painful histories of colonization and neglect from central governments in the past (Huot et al., 2019; Petrov et. al, 2021a; Adams & Dorough, 2022). Arctic populations are characterized by high rates of comorbidities including hypertension, diabetes, and heart disease (Erber et al. 2010; Murphy et al. 1997, Arctic Council, 2020) as well as health disparities (Chatwood et al., 2012). In turn, many observers have pointed out that the COVID-19 pandemic has also exacerbated the existing socioeconomic and health vulnerabilities of Arctic residents (Markova et al., 2021, Lemieux et al., 2020, Jaakko et al., 2021, Cook & Johannsdottir, 2021, Men & Tarasuk, 2021 and Golubeva et al., 2022). At the same time, Arctic communities possess capacities that contribute to their resilience to the pandemic, most notably through control over implementing anti-pandemic measures and Indigenous knowledge and practices. In particular, reliance on Indigenous knowledge, generational wisdom, leadership, self-determination, and rapid vaccination have been instrumental in reducing the potential impacts of the COVID-19 pandemic in some Arctic jurisdictions, including Alaska, Northern Canada, and Greenland (Petrov et. al, 2021a; Richardson and Crawford, 2020; Fleury & Chatwood 2022).

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Petrov, Tiwari, Devlin, Welford, Golosov, DeGroote, Degai & Ksenofontov

COVID-19 was first recorded in the Arctic in February of 2020, and by January 1, 2023 there have been 2,677,457 positive COVID-19 cases and 29,492 deaths. Past analysis indicates that the pandemic’s dynamics varied among Arctic regions, with some areas more affected than others (Petrov et al., 2020, 2021b; Tiwari et al;., 2022). There are some indications that while infections, mortality, and case-fatality ratios were highly variable, mortality generally remained below respective national levels (Petrov et al., 2021a).

This paper examines COVID-19 data in the Arctic from February 2020 to September 2022 and provides a preliminary analysis at the regional (subnational) level with a goal to shed more light on the pandemic’s spatiotemporal dynamics and outcomes in the Arctic. We used the ARCTICCOVID (ARCTICenter, 2023) dataset for COVID-19 cases and deaths for 52 subnational political units within ten Arctic regions: Alaska, Faroe Islands, Iceland, Greenland, Northern Canada, Northern Norway, Northern Russia, and Northern Sweden.

Dataset and methods

This study utilized data on COVID-19 positive cases and fatalities collected at the subnational (regional, county) level for 52 regions in eight Arctic countries (Figure 1). This follows the Arctic boundaries used in the Arctic Human Development Report (Einarsson et al., 2004) that were revised by Jungsberg et al. (2019).

The data was collected by the project team through the pandemic (Petrov et al., 2020, 2021a) by acquiring daily case and death information from a variety of global, national and regional sources (John Hopkins University Coronavirus Resource Center (https://coronavirus.jhu.edu/map.html), the Public Health Agency of Sweden (https://www.folkhalsomyndigheten.se/), the National Institute for Health and Welfare of Finland (https://thl.fi), the Government of the Russian Federation (https://стопкоронавирус.рф), and Verdens Gang (Norway) - https://vg.no). The data were extracted at 17:00 GMT each day, stored, and published daily on the Arctic COVID-19 dashboard (https://arctic.uni.edu/arctic-covid-19). The temporal coverage extends from February 21, 2020 (the first documented case in the Arctic) to the present. However, for the purposes of this study, we focused on COVID-19 dynamics between February 2020 and September 2022. The data after October 1, 2022 were not included due to changes in data availability as some jurisdictions discontinued regular COVID-19 reporting. We used the ArcticVAX (2021) tracker to obtain information on vaccination trends for the same period.

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The COVID-19 pandemic in the Arctic: An overview of dynamics from 2020 to 2022

Figure 1. Study area Variables and definitions

Key epidemiological variables were analysed and are defined here. Confirmed cases are individuals detected with SARS-CoV-2 nucleic acid or antigen in their clinical specimen (ECDC, 2020) Daily increase is the number of cases confirmed within 24 hours after the previous reporting. Incidence rate represents a cumulative number of confirmed cases per 100,000 residents in a given period of time. Confirmed deaths are the number of deaths resulting from a clinical illness due to COVID-19 infection (ECDC, 2020). Mortality rate is the number of confirmed deaths attributable to COVID19 infection per 100,000 residents in a given period of time. Case Fatality Ratio, or CFR, is the total number of deaths divided by the total number of confirmed cases at a given point in time. Given that data are from diverse sources and multiple jurisdictions, the specific definitions used by the reporting agencies may inevitably vary and have to be interpreted with some caution.

Results

Pandemic outcomes

The analysis of the key pandemic variables (positive COVID-19 cases and deaths (totals), cases and deaths per 100,000 and CFR) indicates that the pandemic had a severe impact on many Arctic regions, although the levels of morbidity and mortality varied considerably. The Arctic as a whole had 20,234.1 positive cases and 234.8 deaths per 100,000 (as of September 1, 2022). A number of regions had elevated case load (e.g., Iceland, Faroe Islands, Alaska) partially because of small population numbers. In contrast, Northern Canada, Norway, and Russia had relatively low incident rates, although the reasons for that may vary (from low levels of infection to underreporting). At the same time, the highest mortality indicators are found in Northern Russia (283.8 per 100,000),

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Petrov, Tiwari, Devlin, Welford, Golosov, DeGroote, Degai & Ksenofontov

Northern Sweden (191.7) and Alaska (188.8). These figures likely reflect public health policy, healthcare, and vaccination campaign challenges in these regions. High mortality also corresponds with the elevated CFR in these countries. If in the Arctic as a whole the CFR stood at 1.2%, in Northern Russia it was 1.7%, in Northern Sweden it was 0.7%, and in Alaska it was 0.5%. It is notable, however, that in all Arctic regions (with the sole exception of Russia) the mortality and CFR were below the national levels of the respective countries. For example, in Alaska mortality was 188.8 per 100,000 versus 324.0 in the U.S. and the CFR was 0.5% versus 1.1% (Table 1). Therefore, most Arctic jurisdictions experienced a less severe COVID-19 pandemic than more southern regions of the same Arctic states.

Table 1. Key COVID-19 pandemic outcomes by Arctic region and county (Data on Sep 1, 2022)

Source: ARCTICenter (2023).

Spatiotemporal dynamics of the COVID-19 pandemic

Figure 2 shows the cumulative number of confirmed COVID-19 cases in the Arctic from February 2020 until October 1, 2022. As can be easily seen, the pandemic has gone through several “waves” (surges in incidents of the infection followed by a substantial decrease sustained over a certain period (Zhang et al., 2021)). Often these waves are given a label derived from a predominant strain of SARS-CoV-2 at the time of its occurrence, although multiple strains co-existed throughout every wave. Overall, the pandemic started relatively late in many Arctic regions, and the first wave did not occur until summer 2020 (Petrov et al., 2020). A delayed start may have been related to the remoteness of Arctic regions, as well as the strict preventive policies implemented in some jurisdictions. In the first year of the pandemic, new COVID-19 cases peaked again around midDecember 2020 (“second wave” (Petrov et al., 2021b)) and then decreased in the early months of 2021. The second and the third (“Delta”) waves were well-pronounced, with the “Delta” wave clearly detectable in October-December of 2021 (Tiwari et al., 2022). This was immediately followed by the fourth, “Omicron,” wave in the early 2022, which dwarfed previous infection rates

The COVID-19 pandemic in the Arctic: An overview of dynamics from 2020 to 2022

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Country/Territory Cases (cumulative) Deaths (cumulative) Cases (per 100,000) Deaths (per 100 000) CFR (%) Arctic 2,474,606 28,721 20234.1 234.8 1.2 Iceland 204,717 213 56220.2 58.5 0.1 Greenland 11,971 21 21367.2 37.5 0.2 Faroe Islands 34,658 28 71464.2 57.7 0.1 Denmark 3,092,530 6,934 53391.3 119.7 0.2 Alaska 292,819 1,338 41319.6 188.8 0.5 USA 96,527,639 1,072,520 29162.2 324.0 1.1 Northern Finland 126,970 n/a 15972.7 n/a n/a Finland 1,266,917 5,690 22865.6 102.7 0.4 Northern Canada 19,881 59 14405.1 42.7 0.3 Canada 4,176,359 44,043 11065.5 116.7 1.1 Northern Norway 89,932 113 18339.3 23.0 0.1 Norway 1,460,246 3,980 26877.3 73.3 0.3 Northern Sweden 108,881 796 26223.8 191.7 0.7 Sweden 2,569,152 19,873 25439.0 196.8 0.8 Northern Russia 1,584,777 26,153 17199.5 283.8 1.7 Russia 19,578,730 384,441 13416.1 263.4 2.0

(Figure 3). The Omicron wave brought major outbreaks to the Faroe Islands and Iceland, which previously had very few COVID-19 instances. This wave receded by summer of 2022, but positive cases increased again in the fall after many COVID-19 healthcare measures were relaxed. A rise in infections in fall of 2022 clearly indicates that the COVID-19 pandemic in the Arctic was continuing.

Cumulative COVID-19 cases and fatalities per 100,000 for each region of the Arctic are demonstrated in Figure 3. The dynamics of COVID-19 deaths likely reflect a differential timing of pandemic onset, difference in anti-COVID policies, and variable success of vaccination campaigns. For example, due to strict public health measures, early in the pandemic COVID-19-related deaths were low with the exception of Sweden, which also posted dramatic early CFRs (Figure 4). Each subsequent wave brought about a spike in death rates. For instance, during the Delta wave of 2021 in the Arctic, there was an increase of 205.8 percent in cases and 334.8 percent in deaths compared to the previous year. At the same time the Omicron wave of infections in early 2022 did not lead to a distinct increase in mortality. The CFR actually declined in all jurisdiction within a few months after introduction of COVID in the given jurisdiction, except for Northern Russia, where CFR did not decline until the start of 2022. In 2020-2022, the Arctic’s cumulative CFR was 1.2%, which is relatively high compared to the global and European ratios (Alrasheedi, 2023, JHCRC, 2023), but mostly influenced by the high CFR in Russia with other Arctic regions experiencing CFRs under 1%.

Northern Russia, due to its large population size, has been a driving force behind Arctic COVID19 cases and fatality trends. Although detected infections per 100,000 in Northern Russia were lower than in some other Arctic regions, the cumulative mortality and CFR were higher, especially later in the pandemic (Figure 3). Northern Russia was one of only a few Arctic jurisdictions with

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Petrov, Tiwari, Devlin, Welford, Golosov, DeGroote, Degai & Ksenofontov Figure 2. Cumulative Confirmed COVID-19 Cases and Pandemic Waves in the Arctic (February 20, 2020-October 1, 2022)

both COVID-19 mobility and fatalities rates higher than in the southern parts of the country. For most Arctic states, the northern regions exhibited lower rates than the national figures (Petrov et al., 2021a).

Alaska experienced similar waves as the rest of the Arctic. The initial COVID-19 spike took place in summer of 2020 (prompted by summer travel and fisheries) with a big wave in the fall. In late 2021, confirmed COVID-19 incidents per 100,000 precipitously increased marking the very pronounced Delta and Omicron waves. During that period, Alaska COVID-19 indicators were more than twice as high as the Arctic as a whole. The growth in infections slowed in March, but rose again in summer of 2022.

Northern Sweden is a very interesting region in respect to the COVID-19 dynamics given its initially relaxed approach to public health emergency policies (Kamerlin & Kasson, 2020). Sweden, including its northern parts, demonstrated rapid growth in COVID-19 cases and deaths very early in the pandemic (spring 2020). Notably, CFR in this period was nearly 9% and CFR five to eight times higher than elsewhere in the Arctic. Both reported infections and fatalities per 100,000 in Northern Sweden were also high during 2021, but in the fall of 2021, the region experienced only a modest increase in new confirmed cases and deaths, seemingly avoiding a distinct Delta wave. Still the Omicron wave in early 2022 was well pronounced.

Greenland, Iceland, and the Faroe Islands reported relatively few positive COVID-19 cases and deaths throughout the pandemic. Iceland went through a short period of growth and decline in new cases between mid-July and October of 2021 followed by a rapid increase in the cases from November onward. Meanwhile Greenland, after mid-July 2021, experienced an upward trend in new cases that further accelerated in late fall and spring of 2022 constituting an outbreak associated with the Omicron wave. A similarly drastic rise was observed in the Faroe Islands. Although both Greenland and the Faroe Islands had very low COVID-19-related mortality during the earlier stages of the pandemic, they saw an increase in the number of deaths in November of 2021.

Northern Norway and Northern Finland had few reported infections and deaths for the first eighteen months of the pandemic. Following a gradual increase starting in spring 2021, new cases quickly rose from November 2021 to March 2022 constituting the Delta and Omicron waves. In Finland elevated daily positive cases extended until June. The number of deaths also grew in this period. Northern Canada had a relatively mild pandemic until summer 2021, when infections started to climb during multi-spike Delta and Omicron waves. Still, Northern Canada, along with Northern Norway and Finland, remain the least pandemic-affected Arctic regions (Figures 3).

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The COVID-19 pandemic in the Arctic: An overview of dynamics from 2020 to 2022
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Petrov, Tiwari, Devlin, Welford, Golosov, DeGroote, Degai & Ksenofontov Figure 3. Cumulative cases per 100,00 (top); Cumulative deaths (Bottom) per 100,000, (February 20, 2020-October 1, 2022)

Spatiotemporal dynamics of vaccination in the Arctic

As of September 2022, nearly 70% of Arctic residents were fully vaccinated (as defined by a given jurisdiction). The Arctic presents a globally interesting case for examining the spatiotemporal dynamics of COVID-19 vaccination implementation. In fact, some Arctic regions were among the first places in the world where vaccines were broadly distributed and used (Petrov et al., 2021nature, Figure 5). In particular, Alaska and northern Canada started vaccination campaigns as early as December 2020. Northern Canada reached a 50% mark of fully vaccinated population by May of 2021. Although other Arctic jurisdictions started vaccinations later, most of them rapidly increased vaccination rates and attained a 60-70% attainment level by fall of 2021 (Figure 5). The exceptions were Alaska and Northern Russia. In Alaska, despite the December 2020 start, the vaccine uptake was lagging in the subsequent months. In Northern Russia the vaccination campaign was slow and conducted with limited success due in part, to higher vaccine hesitancy (Lazarus et al., 2023) and resistance (Roshchina et al., 2022).

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The COVID-19 pandemic in the Arctic: An overview of dynamics from 2020 to 2022 Figure 4. Case Fatality Ratio (CFR)

Discussion and conclusions

Overall dynamics: patterns and regional differences

The COVID-19 pandemic in the Arctic is not over: a rise in reported infections in fall of 2022 indicates it very clearly. Although the general course of the pandemic in the Arctic was similar to global and national trends, the COVID-19 pandemic in the Arctic exhibited several important and distinct characteristics. First of all, the onset of the pandemic in most regions was delayed. In part this was due to the remoteness of Arctic communities, and in part because of the stringent antiCOVID measures instituted in most jurisdictions. Remoteness is thought to initially help in delaying the beginning of the pandemic, and thus, to secure more time for preparation for its eventual arrival. On the other hand, when infections and morbidity rise, distant locations of Arctic communities may become an impediment (the “curse of remoteness, Petrov et al., 2021a) for delivering timely high-quality healthcare. This delayed onset, with subsequent major outbreaks, were evident in the Faroe Islands, Greenland, Iceland, and many other Arctic regions. Thus, even though the arrival of a pandemic appears to be inevitable, remote communities can be better prepared for dealing with the disease with careful planning. Notably, mortality and CFR in most northern localities (with the exception of Russia) were considerably below the levels found in more central, southern regions of the same Arctic states. In addition to a delayed onset, factors like strict enforcement of anti-pandemic polices, rapid vaccinating campaigns, ability to exercise selfdetermination in healthcare, and the engagement of Indigenous knowledge contributed to this outcome (Petrov et al., 2023).

There have been studies that identified typologies of Arctic regions based on COVID-19 trends (Petrov, et al. 2022, Tiwari et al., 2022). Tiwari et al (2022) suggested distinguishing four regional types of pandemic dynamics in the Arctic: the first type is characterized by drastic spikes and lows in the

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Petrov, Tiwari, Devlin, Welford, Golosov, DeGroote, Degai & Ksenofontov Figure 5. Fully vaccinated individuals by Arctic region (%)

daily positive cases. This type of dynamic is observed in Greenland, Iceland, the Faroe Islands, Northern Norway, Northern Finland, and Northern Canada, which were relatively unaffected by the pandemic until late 2021 largely due to strict quarantine measures and subsequent vaccination and battled major surges of infections and deaths during the Delta and Omicron waves. Alaska’s represents a separate type, with relatively similar early dynamic, but with a very large outbreak of COVID-19 later in the pandemic (fall 2021-spring 2022), when most anti-COVID restrictions and mandates were ended. Northern Sweden and Northern Russia could be recognized as two additional types of the COVID-19 dynamics. In Northern Sweden a protracted wave was associated with less strict preventive policies in 2020 that determined high infection and mortality rates throughout year one, which subsequently reduced due to tightening measures. Northern Sweden generally avoided the Delta wave, but experienced an Omicron wave in winter-spring 2022. Finally, Northern Russia’s trend was characterized by persistently high daily cases and deaths. The pandemic appears to be more severe in the Russian Arctic than elsewhere in the Arctic or in Russia, potentially reflecting the inconsistent and top-down anti-COIVID policies, limited healthcare capacities, and poor availability and/or uptake of vaccines in remote communities (Åslund, 2020).

Lessons learned

As mentioned, many Arctic jurisdictions experienced a less severe COVID-19 pandemic than southern regions of the same states despite greater socioeconomic, infrastructure, and health vulnerabilities in Arctic communities. This is an important notion that may have implications for public health policies. The availability of additional sources of resilience associated with Indigenous knowledge, cultures, and practices may have plaid a major role in the pandemic outcomes. In most notable cases, the Arctic Indigenous communities were able to capitalize on multigenerational memories of the past epidemics, engage Indigenous knowledge and practices, and exercise selfdetermination in order to combat the pandemic (ITK, 2020; Foxworth et al., 2021; Petrov et al., 2023). For example, Indigenous communities in Alaska and Northern Canada instituted very strict quarantines and other preventive measures, utilized the knowledge of the land to practice isolation and healing, implemented their own priorities in administering western and traditional healthcare (such as focusing on elders, culturally-appropriate treatment, spiritual healing, etc.), and exercised control over vaccination campaigns and other healthcare activities thus asserting their sovereignty in public health affairs. Exercising self-determination, in part or in full, appears to be a factor of pandemic severity among Indigenous communities. Consequently, a strong consideration should be given to recognizing and investing in the Indigenous Peoples’ capacity to manage their own healthcare (in the Arctic and elsewhere in the world) as a key policy to ensure preparedness for combating this and future pandemics.

Acknowledgements

This research is supported by NSF PLR #2034886.

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The COVID-19 pandemic in the Arctic: An overview of dynamics from 2020 to 2022

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The state of research focused on COVID-19 in the Arctic: A meta-analysis

The Arctic region faces unique risks and challenges as a result of both the COVID-19 pandemic and the actions taken to respond to it. Arctic communities have distinct health, social and economic needs and circumstances that were more pronounced during this pandemic. Research offers an important opportunity to understand the region’s unique conditions and characteristics for pandemic management. Only by systematically examining its impacts can public officials, community leaders, medical professionals and other decision-makers have the knowledge needed to decrease further harm due to COVID-19 and leverage this opportunity to support the resilience of Arctic communities. This article contributes to this knowledge building effort by surveying the literature (peer reviewed and grey) that explicitly focuses on COVID-19 in the Arctic between 2020 and 2022. We analyze this emerging body of work with a focus on identifying overarching trends (time, countries studied, scale of analysis, specific populations). We also map the themes and topics considered in this literature with a focus on highlighting topics that are prominent and those that are conspicuously underrepresented. This analysis seeks to inform our understanding of, and response to, the pandemic and other global shocks in the short-, medium- and longer-term.

Introduction

On 11 March 2020, the World Health Organization (WHO) declared the spread of novel coronavirus (COVID-19) to be a global pandemic (WHO, 2020b). In the following months, this infectious disease spread rapidly and reached all regions of the globe at a pace unprecedented in human history. The COVID-19 pandemic represents a rapid global shock that has severely disruptive consequences (OECD, 2011). However, while the presence of COVID-19 has been pervasive, people’s experiences with the pandemic have been diverse. As a consequence, there is an emerging literature that explores the varying impacts of the pandemic on different countries, industries, socioeconomic statuses, age groups, genders, etc. This research is critical not only to understand the differentiated impacts of the pandemic, but to examine the broader systemic and

Jennifer Spence, Senior Fellow, Belfer Center Arctic Initiative, Harvard Kennedy School Sai Sneha Venkata Krishnan, Researcher, Belfer Center Arctic Initiative, Harvard Kennedy School Jennifer Spence & Sai Sneha Venkata Krishnan

structural biases within our societies. Lessons and insights learned from the pandemic offer an opportunity to inform our actions to effectively break down barriers and build resilience.

In June 2020, a preliminary assessment of the impacts of COVID-19 in the Arctic and the actions taken to respond to the pandemic was released by the Arctic Council (2020) in a briefing document prepared for Senior Arctic OfficialsClick or tap here to enter text.. This report, released early in the pandemic, was produced using available material and data; however, given the short timeframe, gaps in information, and the evolving circumstances, the report recommended that additional research would be needed.

Research to examine the experiences of Arctic residents and communities with COVID-19 offers an important opportunity to understand the region’s unique conditions and characteristics for pandemic management. It also helps in advancing our understanding of the specific impacts and lessons learned from the spread of COVID-19 and related public health responses in the Arctic. This article surveys this new literature focused on COVID-19 in the Arctic. Through this form of meta-analysis, we contribute to building our region-specific knowledge by examining where research is taking place and the common themes and issues that have been explored regarding COVID-19 in the Arctic.

The goal of this article is to raise awareness among researchers and decision-makers and deepen their understanding of the responses to and impacts of COVID-19 in the Arctic. This analysis provides the Arctic research community with opportunities to examine common themes and identify research synergies. It also highlights areas with limited research and invites experts and knowledge holders to reflect on why these gaps exist and to what extent this analysis could inform future research priorities. Furthermore, we aim to provide an overview of this emerging literature for decision-makers – those responsible for future policy actions in the Arctic at every scale. We seek to demonstrate that research related to COVID-19 in the Arctic provides decision-makers with important resources that can contribute to evidence-based actions that advance the resilience of Arctic communities in the face of a pandemic and other major shocks, including climate change, geopolitical crises, and massive socio-economic pressures.

This article begins by providing an overview of the methodology used to conduct a meta-analysis of the literature focused on COVID-19 in the Arctic. We then present key findings from this analysis. We begin by analyzing the overarching trends in this emerging literature over time, geography, scale of analysis, and key populations. We subsequently examine the issues and themes identified in this literature using three broad categories: pandemic spread and public health responses, pandemic consequences, and lessons for the future

Methodology

There are different types of meta-analysis that serve different purposes and, by extension, depend on different methodological approaches (Levitt, 2018) This research project aims to provide a descriptive overview of an emerging body of literature that focuses on the impacts of COVID-19 in the Arctic. Data collection and analysis procedures for this form of meta-analysis were designed with this aim in mind. Data collection involved a broad search of source materials. Google Scholar was used to create an initial list of source materials published between January 2020 and December 2022. Search teams used were: “COVID-19”, “pandemic”, and “Arctic”. As we intended to include all relevant materials, this search included all publications with these search terms anywhere in the article and included any type of publication included in the Google Scholar database (peer reviewed, grey, citations). The search was limited to English language search results. We recognize that the search engine, search terms, focus on English search results, and a manual review of the dataset would not capture all the work that contributes to this emerging body of literature or produce a comprehensive dataset. Additional research will improve our understanding of this literature, but

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the findings presented in this preliminary survey of the literature confirms the value of efforts to examine and understand research taking place in this space.

The Google Scholar search produced 17,100 sources. An initial review of these sources, based on titles, removed a substantial number of duplicates. A second phase of review culled sources using the title and abstract (if available) to exclude sources based on their relevance. In particular, we excluded sources where COVID-19 was not a core component of the article. This included source materials that only mentioned COVID-19 in passing or peripherally. Additionally, we excluded articles that did not differentiate Arctic and non-Arctic regions within the countries being studied. Given the purpose of this meta-analysis and the emerging nature of this body of literature, we decided not to limit the dataset to peer-reviewed sources. However, we did exclude sources that provided no substantiated information or analysis (e.g. editorials, commentaries, project descriptions, etc.). After this initial filtering, the dataset included 171 sources. We then conducted a more comprehensive assessment of these sources and excluded an additional 52 sources based on specific criteria, which included 1) not substantially focused on COVID-19 (26), 2) not substantially focused on the Arctic (16), and 3) not able to locate the publication for analysis (10). The resulting dataset includes 114 sources.

The data analysis procedures associated with this review were similarly designed to align with the goals of this research. We focussed on mapping the source materials into broad categories and specific topics of study. This enabled us to observe patterns in this emerging literature. We did not attempt to analyze the findings in the source materials or assess their quality.

We adopted a hybrid approach to structuring our mapping and categorization of the source materials. The initial structure used to classify source materials was based on the broad categories and specific topics/issues introduced in the Arctic Council assessment report (2020). This initial analytical structure was a useful guide for the meta-analysis because it was developed at the beginning of the pandemic by over 50 Arctic experts with a diverse range of expertise and interests. These Arctic experts developed this initial frame with the intention of articulating the types of information and knowledge that could be important to guide research and policy making. The categories and topics identified in this report are outline in Table 1.

Category Topic

Existing Public Health Actions and Activities Across the Circumpolar Arctic

Available epidemiological data

Infectious disease monitoring and assessment

Patient care

Public health information sharing, awareness, and education

Risk management and mitigation

Consequences of Pandemic and Public Health Responses

Physical well-being and mental health

Regional and local economies by sector/industry

Social and cultural environments

Vulnerable persons

Knowledge production Mobility

Enabling public infrastructure

The state of research focused on COVID-19 in the Arctic: A meta-analysis

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Table 1: Arctic Council COVID-19 Assessment Report categories and topics (2020)

In addition to mapping articles using these predefined categories and topics, we remained open to including additional categories and topics that emerged from the dataset. Using this flexible approach, we included one additional category, “Lessons for the future”, and seven new topics. In the pandemic spread and responses category, we included the topics: access to relevant health data and community and culturally grounded responses. In the category of pandemic consequences, we identified five new topics: environment/climate, food security/sovereignty, community-level impacts, political impacts, and geopolitical impacts In analyzing the dataset, we also made the decision to move the topic of enabling infrastructure to the pandemic spread and responses and lessons for the future categories because we found that the literature was primarily focused on to what extent the physical and social infrastructure was sufficient to support pandemic responses rather than providing commentary on the consequences of the pandemic. The final list of categories and topics used for this meta-analysis is presented in Table 2.

Table 2: Categories and topics used for analysis

Category

Topic

Pandemic Spread and Responses Available epidemiological data

NEW: Access to relevant of health data

Infectious disease monitoring and assessment

Patient care

Public health information sharing, awareness, and education

Risk management and mitigation

NEW: community and culturally grounded responses

Enabling public infrastructure [moved from pandemic consequences]

Pandemic Consequences

Impacts on physical well-being and mental health

Impacts on regional and local economies by sector/industry

Impacts on social and cultural environments

Impacts on vulnerable persons

Impacts on knowledge production

Impacts on mobility

NEW: impact on environment/climate

NEW: impact on food security/sovereignty

NEW: community-level impacts

NEW: political impacts

NEW: geopolitical impacts

Lessons for the Future

Enabling public infrastructure [moved from pandemic consequences]

Other

Source materials were analyzed for their inclusion in all relevant categories and topics. For example, one source might include content relevant to the pandemic spread and responses category and the pandemic consequences category. Similarly, a source could cover multiple topics, such as risk management and mitigation, impact on regional and local economies, and impacts on mobility. In addition to these categories and topics, the source material was analyzed for the countries covered (Canada, Kingdom of Denmark, Finland, Iceland, Norway, Russia, Sweden, United States), the scale of analysis (local, sub-national, national, sub-regional, pan-Arctic, global), and specific population lenses (Indigenous Peoples, vulnerable persons, gender).

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Findings: Overarching trends

The dataset of 114 sources provides us with some rich insights regarding the emerging literature focused on COVID-19 in the Arctic.1 We will start by reviewing some of the overarching observations about this body of work and then examine specific findings regarding the themes and issues addressed.

Research over time

The articles analyzed were published from January 2020 to December 2022. Figure 1 demonstrates that researchers interested in studying COVID-19 in the Arctic responded quickly. Two grey literature products were released almost immediately after the pandemic was confirmed in March 2020 – one article focused on the impact of travel restrictions in Norway on Arctic research (Vogel, 2020), and one policy brief focused on Inuit Nunangat that emphasized the importance of Northern research related to the pandemic and Inuit perspectives and experiences (Penney & Johnson-Castle, 2020). Furthermore, the first peer reviewed article was published shortly after in April 2020 and considered the impacts of COVID-19, public health responses, and travel bans on the relationship between Greenland and Denmark (Grydehøj et al., 2020).

Articles

Figure 1: Number of articles published from January 2020 to December 2022

The number of publications grew throughout 2020 and again in 2021 with publications peaking in the summer of 2021. Following mid-2021, we observe a decline in the literature being published in this space. In fact, publications from 2022 make up only 24% of the total dataset whereas 2021 saw approximately 50% of sources published. While this decline in publications is perhaps consistent with general “pandemic fatigue” observed globally (World Health Organization, 2020a), the timing of this decline seems premature to build a solid base of knowledge in this field. It should be of concern for those who recognize the importance of short-, medium- and longer-term research and analysis of such an important global event, especially in the Arctic.

Arctic State coverage

This meta-analysis provides us with useful insights about the geographic areas that have been the focus of study in this literature. What stands out in Figure 2 is that the Russian Arctic (33%) followed by Norway (25%) and Canada (25%) are the most studied in the dataset. Whereas, Iceland has been least studied in this literature (11%). It is difficult to come to any conclusions about why we observe these variations in the geographic areas studied. The strong presence of the Russian Arctic in this literature at the very least indicates a clear interest by researchers in understanding the unique conditions, characteristics, and consequences of pandemic management in the Russian Arctic, especially when you consider that data collection was conducted in English. However, the

1 More detailed information about the dataset is available upon request by contacting Jennifer Spence.

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The state of research focused on COVID-19 in the Arctic: A meta-analysis

weaker showing of Iceland in this dataset may not fairly represent the production of relevant research and may be more an indication that “Arctic” is not an appropriate search term for identifying Arctic-relevant research related to the pandemic in Iceland.

centred) and sub-regional (i.e. various sub-groupings of Arctic states) scales of analysis took up similar shares at 16% and 17%, and national- and global-level studies that substantively considered the Arctic were lowest at 9% and 12% respectively.

This analysis is further nuanced when we combine the Arctic state coverage with the scale of analysis used (Figure 3). We observe three interesting findings. First, 55% of sources that included the Russian Arctic used the sub-national level as the unit of analysis, and on the flipside, 44% of the research done at the sub-national level focuses on the Russian Arctic. This finding reinforces the research interest and capacity that is dedicated to studying the Russian Arctic. It also suggests that the specific context and experience of the Russian Arctic during the pandemic is seen as an important area of research. Next, we observe that 32% of all source materials that included the Canadian Arctic focused on a local scale of analysis, and 56% of the local-level research involved communities in the Canadian Arctic. No solid conclusions can be made about the reasons for this result. This finding may be driven by the types of research interests that are relevant in the Canadian Arctic, but it also may provide evidence that the community-based research approaches that have been championed in the Canadian North are taking hold. Lastly, it is interesting to observe that none of the publications in the dataset adopted the Nordic region as a unit for analysis. The absence of this form of sub-regional research is notable given the potential common experience, and opportunities for comparison and shared lessons learned. It is also interesting because of the

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existence of Nordic research funding programs that could easily enable this form of sub-regional collaboration if there was interest.

Figure 3: Articles by country across scales (local to global) Population lenses

Finally, we analyzed the dataset using specific population lenses that are relevant in the Arctic context: Indigenous Peoples, vulnerable persons, and gender. Our first finding is that 37% of publications in the dataset focused on or provided an Indigenous perspective on the impacts of the pandemic in the Arctic. 38% of these publications include a focus on the Canadian Arctic and 57% of the publications that study the Canadian Arctic incorporate Indigenous issues and/or perspectives. Also notable, 90% of the publications that focused on the Canadian Arctic at the local level include Indigenous perspectives and experiences. This finding is particularly interesting when we recall that Canada had the largest share of locally focused research, which may provide some insights on the types of research related to the pandemic that are more relevant to Arctic Indigenous Peoples in Canada.

Research related to the impact of the pandemic on vulnerable populations was identified in only 16% of the literature. These publications covered a broad range of issues, including older populations, mental health, remote communities, food security, and human rights. No one Arctic state stands out as being the focus of this research, rather the scale of analysis is more interesting

Half of the articles focused on vulnerable populations adopted a sub-national level of analysis, which again is likely appropriate given the level at which public health responses are most actively managed. Pan-Arctic studies represented 28% of the publications that highlighted the experiences of vulnerable populations. This observation may provide guidance regarding an area where future Arctic-focused research could be valuable.

Lastly, work incorporating a gender lens or issues into research related to COVID-19 in the Arctic was notably low in the dataset. Some consideration of gender was included in only 6% of publications and in none of these was gender a primary focus. This emphasizes the importance of projects, such as Understanding the Gendered Impacts of COVID-19 in the Arctic (George

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9 9 2 1 5 8 3 8 1 2 12 11 3 21 3 4 6 10 1 9 1 3 8 4 15 3 7 31 33 0 10 20 30 40 50 60 70 80 Local Sub-National National Global Sub-Regional Pan-Arctic Canada Norway Russia United States Other

Washington University, n.d.), that dedicate specific attention to important area of research. Initiatives like this will hopefully share analyses that will help to fill this gap in the literature.

Findings: Themes and issues

The broad categories (pandemic spread and responses, pandemic consequences, lessons for the future) used to structure this meta-analysis provide a frame to analyze the dataset and present relevant themes that are covered in the literature. 45% of publications include a focus on understanding pandemic spread and responses, articles that analyzed the pandemic consequences represent 68% of the dataset, and 40% of the articles incorporate lessons for the future. Figure 4 provides us with an overview of the prominence of publications in each of these categories over time. We observe that, while the largest number of articles focused on understanding COVID-19 spread and responses were published in 2021, this category represented the largest share of articles (52%) in 2020. We also observe that research related to the consequences of the pandemic assumes the largest share in all years and follows a similar trend.

As outlined in the methodology section, we subsequently included a third category for analyzing the publications. We were interested in capturing those source materials that offered lessons for the future. We thought it could be useful to acknowledge the portion of this emerging literature that provides insights for researchers and practitioners that could inform further action. What we observe is that 40% of the dataset (with a relatively consistent proportion of publication each year) provide some future-oriented insights.

There are two additional observations worth noting about the placement of these source materials into these higher-level categories. A notable percentage of articles in all three categories include Indigenous issues and/or perspectives. Articles in the pandemic response category had the highest share of articles (50%), while the pandemic consequences and lessons for future categories included 36% and 40% of articles respectively. This helps to substantiate the narrative that Indigenous Peoples hold a prominent position in the Arctic and emphasizes that research that includes Indigenous perspectives and interests is treated as a priority. A second observation is that sub-national analyses make up the largest share of all of these categories, and they also form the most consistent share of each (pandemic response 41%, pandemic consequences 41%, lessons for the future 32%). The reasons for, and consequences of, this finding are beyond the scope of this article; however, considering the strength and diversity of research at this scale and others warrants further consideration.

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Figure 4: Number of articles by category from 2020-2022
17 23 11 20 39 19 14 19 13 0 5 10 15 20 25 30 35 40 45 2020 2021 2022 Pandemic Response Pandemic Consequences Lessons for future

Pandemic spread and response

As previously mentioned, the topics identified to classify the literature were initially drawn from the Arctic Council’s assessment report (2020) released early in the pandemic. In our analysis of the dataset, we identified two additional topics: access to relevant health data and community and culturally grounded responses. We also included the topic of enabling public infrastructure in this category rather than in the pandemic consequences category because it was a more appropriate fit given the focus of the publications analyzed.

In classifying the source materials, it is perhaps not surprising to observe in Figure 5 that the largest number of articles focus on risk management and mitigation (36%). It is also interesting that close to 80% of publications in this topic area were released in 2020 and 2021 and only 20% had this focus in 2022. These articles covered a broad range of topics (e.g. public health measures, travel bans, food security, fisheries, etc.). This literature provides important insights about the unique characteristics of pandemic management in different Arctic contexts and informative accounts of the context-specific experience of implementing risk management measures in the Arctic.

Figure 5: Topics under Pandemic Spread and Response

The topic of enabling infrastructure also received a significant amount of attention in the publications studied (30%). In Penny and Johnson-Castle’s (2020) early analysis of the risks of COVID-19 in the Inuit Nunangat, they signalled that the pandemic would make the infrastructure gaps faced by Inuit “even starker” (p.3). The subsequent publications in this dataset confirm the diversity of issues related to physical and social infrastructure risks and challenges. Articles covered a range of topics: health-related equipment and supplies, housing, internet connectivity, food supply chains, emergency response, and access to social services. In many ways, the pandemic provided concrete and vivid illustrations of the infrastructure gaps that Arctic communities have raised concerns about for decades (Arctic Council, 2020; Nunavut Tunngavik, 2020)

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Risk management and mitigation 41 Enabling public infrastructure 34 Community developed responses 28 Infectious disease monitoring and assessment 19 Patient care 18 Public health information sharing 17 Epidemiological data 10 Access to relevant health data 9

The newly added topic of community and culturally grounded responses also held a prominent place in the literature (25%). This topic included a diverse range of issues and experiences that provided an interesting counterpoint to the infrastructure challenges articulated above. In addition to emphasizing the importance of community-driven responses to the pandemic, articles highlighted the strength and resilience of Arctic communities in the face of the pandemic, such as the importance of country foods and food sharing systems, on-the-land initiatives, and social and cultural support systems.

Of equal importance in this analysis are the topics that received limited attention. Experts in the initial Arctic Council report emphasized the critical importance of reliable, high quality epidemiological data to understand the spread of COVID-19 in the Arctic and respond to and mitigate health risks. They also acknowledged that this type of data is often not easily accessible in many Arctic jurisdictions (2020). The University of Northern Iowa Arctic COVID-19 project provides an interesting example of efforts to collect and analyze Arctic-specific data about COVID-19 cases and deaths using accessible data sources (University of Northern Iowa, n.d.). It illustrates the value of dedicated efforts to collect, organize and analyze data that can strengthen our understanding of the Arctic context and inform appropriate responses. However, the limited number of publications identified under this topic (13%) and under the newly added collection of health data topic (8%) suggests that there is much more work that can be done to empirically assess the spread of COVID-19, the pandemic response, and the pandemic consequences in the Arctic.

Pandemic consequences

In the category pandemic consequences, we also started with the topics identified in the Arctic Council report, and as previously mentioned, incorporated five new topics based on issues identified in the source material: environment/climate, food security/sovereignty, community-level impacts, political impacts, and geopolitical impacts

Figure 6: Topics under Pandemic Consequences

In Figure 6, we observe not surprisingly that the topic of impacts on health (43%) was strongly represented in this category. What is perhaps most interesting about articles included under this

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Health 49 Economy 39 Mobility 38 Environment 33 Knowledge production 29 Social and cultural 16 Research 15 Community-level 14 Geopolitcal 14 Politics 8 Food security/so v 10

topic is the rich diversity of issues that have been connected to health. Several publications considered different Arctic factors that might facilitate or impede the spread of COVID-19 (e.g. weather and climatic conditions, health delivery systems, the size and remoteness of communities, digital service delivery, etc.). Similarly, the types of issues connected to health impacts was notably diverse, including mental health, Indigenous Knowledge, economies, food, and education.

The impact of the pandemic on Arctic economies also consumed a substantial amount of attention (34%). The most prominent sub-topic was the pandemic’s impact on various Arctic industries with tourism, energy, extractive industries, and fisheries receiving the most attention. A smaller collection of articles examined the impact on labour markets, and others provided analyses of the broader economic impacts of the pandemic. These sub-topics provide some important insights about aspects of Arctic economies that are being studied; however, it also invites a consideration of the gaps in what has been studied and where more research might be valuable.

The newly added topic whose prevalence in the literature is perhaps the most surprising is the impact of the pandemic on the Arctic environment and climate (29%) – from increases in ozone and sea ice to decreases in black carbon and aerosol emissions. Researchers seem keen to study the environmental impacts of a massive disruption in human activity, and the Arctic region seems to be a focal point for this research. Moving forward, it will be interesting to see to what extent the scientific findings from this period might be integrated into and considered in longer term climate and environmental research. In a somewhat different vein, research also emerged about how COVID-19 public health measures (e.g. masks, gloves, and other personal protective equipment) contributed to increased marine plastic pollution in the region.

Lessons for the Future

The final category that we added to classify and analyze the source material was those publications that provided some future-oriented advice or commentary. 40% of all articles include some form of lessons for the future. This category captures a diverse range of contributions in terms of the focus and purpose of the lessons that were shared. 80% of the publications touched upon risk management and mitigation, community and culturally grounded responses, or enabling public infrastructure. Earlier publications provided lessons learned for the immediate management of the pandemic (public health responses, community-specific approaches, travel bans, etc.) or proposed critical research that should be undertaken to understand the pandemic (collection of health and environmental data, experiences of communities, effectiveness of risk management measures).

As the pandemic progressed, lessons regarding the vulnerabilities that the pandemic exposed emerged, and increasing consideration was given to how to improve the resilience of Arctic communities for future pandemics or other major shocks. More than 40% of the articles covering consequences on health, research and education, environment, and tourism offered lessons for future pandemics. However, there was limited insights on the impacts on social and cultural environments, labor markets, tourism, and geopolitics. This suggests that there is a need for additional literature in these areas to strengthen Arctic resilience.

Some articles identified the experience with the pandemic as an opportunity to expose existing gaps and promote appropriate action (connectivity, health infrastructure, transportation, and food systems). A few articles argued that the COVID-19 pandemic demonstrated an urgent need to respond to permafrost thaw and improve Arctic resilience. Others identified the pandemic as an opportunity to challenge the status quo and introduce innovation (scientific research, education, green transition, community capacity development). Many of these articles focused on digital transformation of research and education and large Arctic projects.

For the purposes of this analysis, we did not catalogue or critically examine the lessons that were presented; however, our preliminary analysis suggests that the literature focused on COVID-19 in the Arctic may offer a valuable resource to inform future research and action. It provides

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information and knowledge that the research and policy communities could draw on to systematically assess pandemic responses and the pandemic consequences, learn from these experiences, and consider how this knowledge will guide and inform future work.

Conclusion

Over the space of three years, we have observed the emergence of a new literature that contributes to our knowledge and understanding of COVID-19 in the Arctic. Our analysis of this literature confirms that a global pandemic cannot be fully understood in the absence of context. This literature shows us how the unique experiences of the Arctic inform our understanding of the spread of COVID-19 and associated public health responses. We observe that risk management and mitigation measures, like isolation, travel bans and vaccination programs, are experienced very differently in Tuktoyaktuk, Canada than Toronto, Canada. The ability to monitor and assess the spread of COVID-19 and access quality care for infected persons is different in Kautikeino, Norway than Oslo, Norway. However, this literature does more than document the unique experiences of Arctic communities with globally and nationally organized public health responses or highlight the constraints or limitations of these responses when applied in Arctic contexts. This literature provides important knowledge about responses and experiences across the Arctic that could be valuable for communities in the Arctic as we prepare and respond to COVID-19, future pandemics, and other global shocks. This literature also brings to light the urgency of identifying the potential risks of future pandemics associated with rising temperatures, thawing permafrost, and other climate change related factors that may challenge the resilience of Arctic communities.

This literature is equally rich for highlighting what COVID-19 reveals (or in some cases confirms) about the Arctic. COVID-19 exposed the existing vulnerabilities of many Arctic communities, including health infrastructure, internet connectivity, housing, and social services. This emerging literature also provides powerful evidence of efforts in the Arctic to focus on and prioritize Indigenous Knowledge and experiences, and it captures the unique strengths and resilience of Arctic communities to develop pandemic responses that are appropriate to their contexts and their needs.

On 5 May 2023, the WHO Director-General declared that COVID-19 is now an “ongoing health issue which no longer constitutes a public health emergency of international concern” (World Health Organization, 2023) and its presence has received dwindling time and attention in the mainstream media for months. Perhaps more concerning, we observe a similar decline in publications in our dataset related to COVID-19 in the Arctic. While COVID-19 continues to spread and some public health measures are still in force, it has largely taken a backseat to other crises and concerns. However, the opportunities to understand and learn from the unique characteristics and experiences of the Arctic with this pandemic have not been exhausted. We hope that this meta-analysis not only deepens understanding about this body of work and fosters connections between researchers doing work in the space, but also exposes gaps in the existing literature, and inspires further research.

Acknowledgements

We would like to thank Researcher Vic Hogg at the Belfer Center Arctic Initiative, Harvard Kennedy School for their role in supporting this research project in its early stages.

References

Arctic Council. (2020). COVID-19 in the Arctic: briefing document for senior arctic officials.

https://oaarchive.arctic-council.org/handle/11374/2473

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George Washington University. (n.d.). Understanding the Gendered Impacts of COVID-19 in the Arctic Impacts of COVID-19 in the Arctic Grydehøj, A., Kelman, I., & Su, P. (2020). Island Geographies of Separation and Cohesion: The Coronavirus (COVID-19) Pandemic and the Geopolitics of Kalaallit Nunaat (Greenland). Tijdschrift Voor Economische En Sociale Geografie, 111(3), 288–301.

https://doi.org/10.1111/tesg.12423

Levitt, H. M. (2018). How to conduct a qualitative meta-analysis: Tailoring methods to enhance methodological integrity. Psychotherapy Research, 28(3), 367–378.

https://doi.org/10.1080/10503307.2018.1447708

Nunavut Tunngavik. (2020). Nunavut’s Infrastructure Gap.

https://www.tunngavik.com/files/2020/10/2020.10.20Nunavuts_Infrastructure_Gap_Report_vf.pdf

OECD. (2011). Future Global Shocks: Improving Risk Governance, OECD Reviews of Risk Management Policies. https://doi.org/https://doi.org/10.1787/9789264114586-en

Penney, J., & Johnson-Castle, P. (2020). COVID-19 and Inuit Nunangat: Research, responsibility and infrastructure inequality. https://yellowheadinstitute.org/wp-content/uploads/2020/03/covid19-inuit-nunangat-brief.pdf

University of Northern Iowa. (n.d.). Arctic COVID-19. Retrieved February 6, 2023, from https://arcticcovid.uni.edu/homepage

Vogel, G. (2020, March 16). Coronavirus concerns force Arctic mission to cancel research flights. Science. https://www.science.org/content/article/coronavirus-concerns-force-arcticresearch-mission-cancel-flights

World Health Organization. (2020a). Pandemic fatigue: Reinvigorating the public to prevent COVID-19 https://apps.who.int/iris/handle/10665/335820

World Health Organization. (2020b, March 11). WHO Director-General’s opening remarks at the media briefing on COVID-19. https://www.who.int/director-general/speeches/detail/who-directorgeneral-s-opening-remarks-at-the-media-briefing-on-covid-19 11-march-2020

World Health Organization. (2023, May 5) Statement on the fifteenth meeting of the IHR (2005) Emergency Committee on the COVID-19 pandemic. https://www.who.int/news/item/05-05-2023statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic

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Section II: Arctic Responses from Alaska to Murmansk

Community responses to the COVID-19 pandemic in Inuit Nunaat

This paper examines how the COVID-19 pandemic has simultaneously heightened the vulnerability of Inuit communities as well as amplified collective resilience. First, we address the intersection of existing challenges to Inuit health, well-being, and social and cultural environments with the pandemic. By situating these issues within the long-standing inequities facing Inuit communities, we discuss how the pandemic has exacerbated negative outcomes at the individual, community and cultural levels. We then outline themes of Inuit-led responses to enhance collective well-being during the COVID-19 pandemic. Particular attention is given to responses that address overlapping issues, for example, mental health, infrastructure, and food security. We draw upon a variety of sources of information to highlight culturally grounded responses, including Inuit government agencies and corporations, nonprofit organizations, news outlets, interviews with community leaders, and partners of the Inuit Circumpolar Council. The examples provided exemplify pathways that Inuit institutions and organizations draw upon for organizing and sharing resources. Thereafter we discuss how amplifying Inuit ingenuity does not minimize the ongoing impact of social and political inequities, but rather underscores the evolving ability of Inuit institutions to respond to wide-scale social and health challenges. In conclusion, we provide insights and policy recommendations that advance Inuit communities’ management and responses to pandemics.

Robyn Long, MSW, Seven Directions: A Center for Indigenous Public Health, University of Washington; Selma Ford, Health Officer - Inuit Circumpolar Council – Canada; John Crump, Senior Policy Advisor, Inuit Circumpolar Council – Canada Robyn Long, Selma Ford, and John Crump

Introduction

Inuit communities have been largely successful in protecting residents from COVID-19 infections and mortality while also developing culturally grounded strategies to buffer the social, economic, and mental health impacts of the pandemic. These achievements are particularly noteworthy in light of the longstanding social inequities and infrastructure deficits facing communities. In this paper, we situate the COVID-19 pandemic within the historical trauma of past pandemics and continuing inequities, including housing, water and technology deficits, food insecurity, and challenges to mental health and well-being. Thereafter, we draw attention to Inuit initiatives during the pandemic, including community-wide protective measures, vaccination efforts, and locally-driven responses to health and well-being. Finally, we discuss policy steps that are necessary to advance Inuit health, including centering Inuit self-determination, addressing infrastructure inequities, and strengthening Inuit food sovereignty initiatives. This paper draws upon examples from across Inuit Nunaat, the homeland of approximately 180,000 Inuit spanning Canada, Greenland, the U.S.A. (Alaska), and Russia (Chukotka) (see Figure 1: Map of Inuit Nunaat). The Inuit Circumpolar Council (ICC) represents the rights and interests of Inuit in all these areas at the international level. Interviews and many of the reports cited in this paper were provided by ICC’s country offices and contacts. Where firsthand information from the offices was limited, most notably in the case of Chukotka, we drew upon government reports, scientific manuscripts, and local news sources.

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Long, Ford & Crump Figure 1: Map of Inuit Nunaat

The impact of past pandemics in Inuit Nunaat

The innovative and resourceful nature of Inuit culture is why collective loss and historical trauma from past pandemics frame the way many communities understand the threat of COVID-19 The influenza pandemic of 1918 devastated many communities. In Brevig Mission, Alaska, the disease killed 90% of the residents and in Nunatsiavut, Canada it claimed the lives of more than 30% of residents in the region (Higgins, 2007). It was particularly deadly in Okak and Hebron, where it led to the death of 77% and 86% of residents respectively (Inuit Tapiriit Kanatami [ITK], 2020c). This profound loss resulted in the entire community of Hebron being dismantled and relocated. Survivors have shared that a sense of depression haunted the community long after the pandemic had ended (Higgins, 2007). Tuberculosis (TB) has been an ongoing threat to the health and stability of Inuit communities for more than a century. The TB mortality rate among Inuit in Canada doubled between 1938 and 1953, while it dropped by 78% for the general population during the same period (Tester et al., 2001). Treatment for TB required Inuit to be relocated to southern Canada where they stayed in sanatoria for months or years. In the 1960s, an estimated 50% of Inuit in Canada had spent time in sanatoria (ITK, 2020c). This separation was socially and emotionally difficult given historical traumas of colonization’s forced confinement and separation of Inuit families. Further, Inuit who passed away in the sanatoria were often buried in cemeteries without their family members’ knowledge. In some cases, it could be years until a family learned that a loved one died. The Canadian federal government has apologized for the mistreatment of Inuit and currently funds a program to support family members in locating their loved ones’ graves (LeTourneau, 2019). TB remains a perpetual threat to Inuit; TB rates among Inuit in Canada are 300 times the Canadian-born non-Indigenous population (KiddellMonroe et al., 2020)

Inuit leaders have referenced this shared history as a central reason communities were quick to implement protective measures against COVID-19. In an interview about community responses to COVID-19, Minnie Grey, Chair of ICC’s Circumpolar Inuit Health Steering Committee (CIHSC) and Executive Director of the Nunavik Regional Board of Health and Social Services (NRBHSS), reflected:

Our people suffered so much historically from foreign illnesses that were new to them. I remember hearing stories from my mother and grandmother of the days when people were all dying around them from illness that were all so new to them. And I think we have learned from those times that the protection of our most vulnerable is very important, such as our Elders and those with low immune systems. (Inuit Circumpolar Council [ICC], 2020c)

While the memory of loss from past pandemics remains present, the similarities between those diseases and COVID-19 is also clear – they are all highly infectious and require far-reaching public health responses grounded in culturally relevant approaches. It is within this historical backdrop and collective experience that Inuit approached the COVID-19 pandemic.

Contextualizing the COVID-19 pandemic

Longstanding inequities facing communities have rendered Inuit more vulnerable to COVID-19 and other impacts of the pandemic than the general population. Such inequities include the lack

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Community responses to the COVID-19 pandemic in Inuit Nunaat

of transit and access to medical infrastructure, shortage of adequate housing and access to clean water, pre existing food insecurities, and disproportionate levels of mental challenges. These are illustrated in Figure 2: Inuit vulnerabilities to the COVID pandemic and discussed in detail below.

Infrastructure challenges

At the start of the COVID-19 pandemic, Inuit communities and agencies called attention to heightened risk of virus transmission given widespread infrastructure challenges (ICC, 2020b also Arctic Council, 2020; ITK, 2020c)

Most Inuit communities across Inuit Nunaat are reachable only by fly in/fly out (FIFO) on small aircrafts and lack basic healthcare facilities. For example, among Inuit communities in Canada, there are only two hospitals with a combined capcity of 86 patients with no options for long-term in-patient care (ITK, 2020c). Similarly in Alaska, patients needing serious care, including respirators, must be flown to regional medical facilities (Sambo Dorough, 2020). In Greenland, a third of the Inuit population live outside Nuuk, which is the only place a ventilator is available (Indigenous Peoples Major Group for Sustainable Development, 2021) This infrastructure deficit means transporting patients in need of rapid medical care is a challenge and limits swift public health responses including rapid testing

Most Inuit communities rely on limited road, marine, and air infrastructure for food and water deliveries. Water infrastructure is particularly troublesome during pandemics. There are 117 Inuit communities in Alaska, Canada, and Greenland without access to piped drinking water and sewer systems (ITK, 2020a). Historically, these substandard water and sanitation systems have rendered Inuit more vulnerable to the spread of infectious diseases, such as influenza and pneumonia, and more in need of hospitalization (Hennessy et al., 2008). Coupled with inadequate water supplies, communities are burdened with high costs of cleaning supplies. The COVID-19 pandemic has further exposed how inadequate water infrastructure can restrict proper hygiene practices and increase the risk of virus transmission. Janice Grey, who served as Deputy Mayor of the village Aupaluk in Nunavik during the COVID-19 pandemic, shared that it was a challenge for the municipality to ask residents to conserve water while at the same time telling them to increase hand washing and cleaning (J. Grey, ICC Interview, 2022).

Inuit communities also experience the most significant housing deficits when compared to nonIndigenous communities. In Canada, more than 40% of Inuit live in overcrowded housing compared to only 2% of the general population due to a housing crisis exacerbated by climate change (ITK, 2019). Inuit in Alaska, Greenland, and Chukotka face a similar housing crisis. At the start of the pandemic, Inuit agencies stressed that it would not be feasible for all Inuit to follow public health isolation recommendations, rendering it difficult to mitigate local COVID-

Long, Ford & Crump

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19 transmission (ICC, 2020b). Speaking of the first COVID-19 outbreak in Nunavik, Minnie Grey noted that it was a cluster of 13 infected people within one household and public health authorities were quick to support them and effectively limited transmission to the rest of the community (ICC, 2020c). Community wide infrastructure deficits mean there was also a lack of public facilities where those infected with COVID can isolate (ITK, 2020c). Inuit across all regions were fearful that overcrowding would be a source of transmission and loved ones would get sick. Interviews with Inuit youth reveal they were particularly scared of the virus spreading within their community and infecting Elders due to limited healthcare infrastructure and overcrowding (Thomas et al., 2022).

Broadband connectivity is a longstanding issue for Inuit communities, which Inuit Tapiriit Kanatani (ITK), Canada’s national Inuit organization, and others have labeled the “digital divide”. In a report detailing this inequity, ITK found that only 68% of Inuit living within Inuit Nunangat (the Inuit homeland in Canada) have access to internet compared to 94% of the general Canadian population (ITK, 2021b). This infrastructure gap is a result of insufficient federal investments and the high costs of services through private providers. Inuit households that do have internet access generally do not have enough speed to support video conferencing or downloads, which severely hampers online learning, remote employment options, and telehealth service delivery.

Economic & food security

Inuit agencies and governments raised economic and food security as an immediate concern when business and travel restrictions from the COVID-19 pandemic went into effect. For example, across Inuit Nunangat, most projects requiring material (e.g., construction) are dependent on sealift carriers to bring in supplies from southern Canada (Stoney, 2021). This meant that business closures in southern Canada stalled the import of materials and delayed construction projects. Further, Inuit communities rely on seasonal labor. Travel restrictions during the pandemic meant only essential workers were permitted to visit Inuit communities, impacting the availability of short-term laborers for local businesses (Stoney, 2021). In Greenland, the majority of income is generated through tourism and fishing – both of which came to a halt during closures (CIHSC, 2020) As a result of such closures, unemployment during the pandemic was at historic highs across Inuit Nunaat (Arctic Council, 2020a).

The Arctic Council (2020) reports that pandemic related closures impacted the already vulnerable availability, affordability, and quality of foods in Inuit communities. Prior to the pandemic, for example, Inuit in Canada paid two to three times more for market foods than the general population due to high transportation costs (Pakseresht et al., 2014). Unemployment increases coupled with high food costs severely threaten families’ food security. ITK has documented that Inuit food insecurity also increased because of the pandemic’s disruptions to supply chains (ITK, 2020c). In Alaska, Ravn Airlines’ bankruptcy and flight cancellations abruptly stopped travel and food shipments to dozens of villages (Johnson et al., 2021). Simultaneously, rising fuel costs and unemployment limited traditional harvesting opportunities for Inuit hunters who must travel by car or snowmobile. Combined with the impacts of climate change such as reduced sea ice, hunters were already faced with longer travel distances and higher fuel costs. Traditionally, Inuit hunters share harvests with other community members; thus, their inability to harvest impacts their family as well as the broader community (ICC, 2020a)

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responses to the COVID-19 pandemic in Inuit Nunaat

Mental, social, and cultural well-being

Early in the pandemic, Inuit organizations and leaders predicted the pandemic would exacerbate mental health challenges for Inuit (Arctic Council, 2020a). Inuit well-being is deeply relational and within the context of cultural, familial and communal systems. As illustrated in Figure 2, which was developed during the 2021 ICC Inuit Health Summit, these systems have been continuously challenged and torn apart by historical and intergenerational trauma from colonization, including the forced separation of families and placement of children in residential schools, attempted erasure of language and culture, and breakdown of traditional political structures. As a result, there is a prevalence of mental health challenges, including suicide, across Inuit Nunaat. The summit in which the illustration was developed brought together (virtually) youth from across Inuit Nunaat. At this summit, youth talked about the importance of being connected to culture as a source of protection that promotes mental wellness. The image depicts the forces that impact mental wellness and shows that a root cause of many mental health issues is colonialism. Graphic recordings were done in real time to capture and highlight discussions regarding the important connection between mental wellness and culture. In Canada, for example, the suicide rate among Inuit adults is four times higher than for the general population, with the highest rates among Inuit males aged 15 to 24 (Kumar & Tjepkema, 2019). Similar realities face Inuit in other regions. In Alaska, suicide rates in Iñupiaq and Yup’ik communities have been as high as 90/100,000 people (Allen et al., 2011) – a stark contrast to the general U.S. rate of 13/100,000 (Suicide, 2022), meaning they are more than six times likely to die by suicide than the general population. These pre-existing challenges are central when discussing the impact of the COVID-19 pandemic on Inuit mental health and well-being.

Figure 3: ICC Inuit Health Summit Inuit Mental Wellness & Connection to Culture

Similar to past pandemics, the COVID-19 pandemic altered family and community relations once again by requiring youth to physically distance themselves from Elders, which became a source of distress for many families (Arctic Council, 2020). Research has shown that youth broadly have been particularly vulnerable to negative mental health outcomes during the pandemic (D’Amico et al., 2020; Meherali et al., 2021). Increased social isolation due to educational and extracurricular activities closures and heightened insecurity due to unemployment have threatened to exacerbate existing symptoms of depression and anxiety

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among Inuit youth (Thomas et al., 2022). Families with new and young children were also deeply impacted. Trine Abelsen, M.D., based in Nuuk, Greenland, shared that social distancing was a challenge for most in the community. Further, she was pregnant when the pandemic started and explained it “was a time when you needed your loved ones. It was so hard not to have them there to share in the joy or daily moments” (Abelsen, ICC Interview, December 8, 2022)

Prior to the pandemic, Inuit also faced barriers to accessing mental health services due to geographic isolation and limited telecommunications infrastructure for telehealth services. Most mental health providers worked on a fly-in, fly-out (FIFO) system. Research with FIFO providers serving Inuit Nunangat during the COVID-19 pandemic highlights challenges during restrictions, including not being able to feasibly provide in-person services due to the required quarantine measures (i.e., two weeks before and after traveling to a community) (Roberts et al., 2021). Providers aiming to switch to remote services faced barriers, most notably poor internet connectivity, and some indicated that teleservices were most effective with established clients (Roberts et al., 2021)

Globally, the pandemic has been associated with increases in poor mental health, including rising levels of clinical distress among the general population (Xiong et al., 2021). In Canada, selfreported rates of fair/poor mental health are higher among Indigenous peoples versus nonIndigenous Canadians (38% to 23% respectively), including higher rates of moderate to severe anxiety (Arriagada, et al., 2020). While Inuit specific data are not consistently available across the region, local and provincial governments have noted increases in mental health challenges and substance misuse. The connection between mental health, past pandemics, and infrastructure deficits was effectively encapsulated by former ICC Chair Dalee Sambo Dorough in a press release regarding COVID-19:

Inuit across our homelands are working to maintain our traditional culture under very trying circumstances. We are used to living together in groups. Social distancing is a foreign concept and our past experiences with such an advisory were triggered by devastating illnesses such as tuberculosis (TB), measles, and polio. This is why we must adapt. The issues we have been working to overcome for decades, such as overcrowded housing, lack of proper sewage and potable water systems, high rates of TB, and poor broadband connectivity become starkly evident during a pandemic, and increase the risks of spreading the disease. (ICC, 2020b)

Responses to COVID-19: Protecting Inuit well-being

At the start of the pandemic, Inuit communities established local emergency response teams, with whom mayors and other government leaders had weekly calls. In Nunavik the Regional Emergency Preparedness Society was set up to coordinate closely with the Nunavik Regional Board of Health and Social Services (NRBHSS) on measures such as isolation guidelines and travel restrictions (CIHSC, 2020). Further, these response teams maintained regular contact with one another, which enabled isolated communities to receive emerging information on the virus. During an interview, Janice Grey, recounted from her time as Deputy Mayor of Aupaluk that these regular check-ins were critical for villages to check in on COVID-19 rates and standardize messaging on protective measures (Grey, ICC Interview, 2022). The National Inuit Committee on Health (NICoH), ICC, ITK, the National Inuit Youth Council, and Pauktuutit (an

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Community responses to the COVID-19 pandemic in Inuit Nunaat

organization representing Inuit women) supported information sharing and regular pandemic updates among Inuit communities across Canada. Similarly, ICC Alaska facilitated COVID-19 meetings and communications among communities from the Yukon-Kuskokwim region to the North Slope. These forums were an important foundation for Inuit to understand the pandemic’s impact, as well as to advocate for local solutions ranging from protective measures and vaccination campaigns to well-being initiatives

Community-wide protective measures

Regardless of what national or federal governments employed, Inuit governments at all levels implemented protective measures including travel restrictions and tracking everyone coming in/out of their communities. Across the Arctic, some of the strictest measures implemented were in Greenland. This included prohibiting all entry to the island, suspending internal travel, and mandatory lockdowns and quarantines for areas affected by COVID-19 (Tiwari et al., 2022). When Greenland did begin to open back up in mid-2020, they required pre-flight testing and quarantine in combination with testing after arrival (Greenland Health Authority, 2022). In Nunavut, Canada, a territory-wide lockdown meant that non-residents were not permitted to enter communities and there was a mandatory two-week quarantine period in a hub outside the region for residents returning (Vilches et al., 2022). An emergency order issued in 2020 for Alaska’s North Slope Borough called for caution while traveling in the context of Iñupiat values of caring for one another. The order, entitled Think before you travel, opened with the statement, “You are your brother’s keeper. That is how life has always been up here on the North Slope. Think before you travel. Every time you go, you are making a critical health decision for yourself, your family, your friends, your co-workers – and your elders. Listen to them. Seek their counsel.” (Office of the Mayor, 2020).

Alongside travel restrictions, other non-pharmaceutical interventions (NPIs; e.g., mask wearing, social distancing, business and school closures) were effective in limiting the spread of COVID19. In a September 2020 meeting, representatives from all ICC country offices shared that measures such as restrictions on events and gatherings, mandatory handwashing in public, and mask wearing had been essential in keeping cases and mortality minimal (CIHSC, 2020). Communities were also creative in overcoming infrastructure challenges during the pandemic. In response to immediate pandemic needs, they stockpiled protective equipment and tests so they were less dependent on deliveries (Arctic Council, 2020a). In Chukotka, clinics purchased oxygen and respiratory equipment, which were not previously available, and designated a special ambulance for patients with COVID-19 symptoms (CIHSC, 2020). The Government of Nunavut tackled communities’ isolation by implementing a local pilot project to reduce their reliance on charter flights (Government of Nunavut, 2022b). This initiative ensured communities had ongoing air service that was not disrupted by COVID-19 closures from outside airline companies and, due to its success, was extended multiple times. Proactive testing and monitoring to reduce transmission ranged from community wide, as in Chukotka, to close contact settings, such as daycares and Elder’s homes in Nunavut (CIHSC, 2020, Government of Nunavut, 2022a)

Addressing the lack of adequate water and sewage infrastructure was an immediate public health priority across Inuit Nunaat. Within the first week of the pandemic in Canada, Nunavut Tunngavik Inc., the land claims organization representing Inuit from that territory, began funding local municipalities to ensure there were daily water deliveries to households so residents could

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maintain proper hygiene and cleaning practices. This involved hiring additional drivers and extending hours (Nunavut Tunngavik Inc., 2020). In many regions, such as Aupaluk Nunavik, water comes from a local lake and the municipality had to hire people to clear snow so they could withdraw water (J. Grey, ICC Interview, 2022). An additional benefit of these initiatives was hiring residents who had been unemployed due to pandemic-related closures.

The NRBHSS underscores that these public health strategies and NPIs in Nunavik were critical in preventing community transmission of COVID-19 for the first 18 months of the pandemic, (NRBHSS, 2022). Similarly, modeling COVID-19 transmission outbreaks in Nunavut shows that without NPIs the outbreak in November 2020 would have been 4.7 times higher and 13.5% of the total population would have become infected with COVID-19 prior to the availability of vaccines (Vilches et al., 2022). More broadly, epidemiological trends show that, particularly at the start of the pandemic, confirmed cases and mortality rates across Indigenous communities in the Arctic were better than their southern counterparts in the same countries (Petrov et al., 2021). This success was a benefit of communities’ isolation and local and regional leadership that enacted protective measures. While these strategies could not prevent the virus from entering entirely, they did provide a window of time for clinics to prepare and residents to get vaccinated.

Vaccination efforts

Despite some historical vaccine hesitancy rooted in systematic medical mistreatment, Inuit were some of the first to begin vaccination efforts. This success is largely due to communities having sovereignty over when and how vaccines were rolled out. Further, communications about vaccines emphasized their safety, as well as the need to protect communities. In Alaska, campaigns grounded in Tribal cultural values and messaging were found to have increased vaccination rates (Tiwari et al., 2022). In Canada, the Qikiqtani Inuit Association (QIA) created a series of resources including videos, in English and Inuktitut, that addressed vaccine concerns and their importance in protecting loved ones (QIA, 2020)

The remoteness of communities and lack of freezer storage facilities posed a barrier to widescale vaccination efforts in Inuit Nunangat. Local governments set up short vaccination “blitzes”, two to five day clinics in each community, to address this challenge (Nunatsiaq News, 2022). In many places, these clinics promoted incentives to draw people in for the short timeframe. In Nunavut, youth were eligible to receive a $100 gift card and adults were eligible to receive one of five $2,000 cash prizes (Brown, 2021; The Canadian Press, 2021). Local officials have emphasized that the cost of these incentives was small compared to the need to achieve herd immunity. Inuit governments were also strategic in which communities received vaccines first. In Greenland, residents in Nuuk were offered the vaccine first since it was predicted an outbreak would occur in a larger town before villages, where clinics would require more resources (McGwin, 2021).

Funding advocacy

Inuit agencies and governments have long advocated for financial resources to support Inuit led solutions to food security (ICC, 2020a). These efforts were critical during the pandemic as economic assistance was needed to support those impacted by unemployment. For example, the Canada Recovery Benefit, a federal program, provided $500 CAD a week to individuals whose income was reduced by 50% or more because of the pandemic. While this direct economic assistance was a critical lifeline for many families, only an estimated 44% of Indigenous peoples experiencing economic hardship during the pandemic reported accessing federal programs

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Community responses to the COVID-19 pandemic in Inuit Nunaat

(Arriagada, et al., 2020) Inuit were active in highlighting the need for funding streams that local governments and agencies could direct to communities. These efforts were successful in Canada, where the federal government committed $8 million to the four Inuit land claims organizations to support initiatives such as food voucher programs, nutritional education initiatives, meal delivery services, and community harvester programs . This funding enabled Inuit communities to respond to local needs quickly and effectively throughout the pandemic and funded many of the initiatives discussed below.

Community-driven initiatives

As soon as pandemic related closures began increasing unemployment rates, Inuit communities and governments embarked on a number of initiatives to address food insecurity (Arctic Council, 2020a) Food hampers, grocery cards, and elder and school food programs became widespread across Inuit Nunaat (Mashford-Pringle et al., 2021; QIA, 2020). Isolation kit programs also became an important means to support households with food during illness or required isolation (Lochead, 2021; Nunavut Tunngavik Inc., 2022). Kits also included cleaning supplies, infant items, and games for children. In Canada, the four land claim organizations supplied households with cleaning supplies free of charge during the height of the pandemic. Nearly every Inuit community across Canada started programs that offered grocery vouchers to elders. Communities also reported hiring residents to deliver groceries – which both ensured food could be dropped off at residents’ homes and provided a source of income to many individuals (NRBHSS, 2022).

“This is such a big part of our life, being out on the land. Land is a healer. We’re providing families and people in the communities [with] gas and food vouchers who want to take their families on the land. This is a big part of mental wellness.”

Funding for harvester programs was important in addressing a multitude of negative impacts from COVID-19 and upholding Inuit customs. For example, each hunters and trappers association in Nunavut received up to $40,000 to harvest and distribute food to communities (Government of Nunavut, 2020). The Nunatsiavut COVID-19 Marine Harvesters Support Program provided 50 liters of gasoline to families each week. The program also allowed families owning a boat to harvest on behalf of a family approved for emergency relief (Nunatsiavut Government, 2020). Similarly funded initiatives across Canada became central to community health and well-being during the pandemic.

Support for harvester programs is a holistic approach to supporting Inuit food-security. A connection to land and water is central to Inuit Qaujimajatuqangit (IQ), a term with roots in Nunavut that is increasingly more widely used to describe Inuit societal values. Further, food sharing is a long-standing Inuit tradition and central to cultural well-being. The ability of harvesters to return to their subsistence lifestyles and provide for their communities promotes positive mental health, which had decreased as a result of pandemic related unemployment. In Chukotka, preventative measures at the start of the pandemic were implemented to ensure that hunting and fishing could continue (CIHSC, 2020)

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In addition to promoting health, the harvesting, preservation, and sharing of country foods is central to transmission of IQ between generations. During harvests, for example, Elders share knowledge about the many uses of country foods including nutritional, medicinal, clothing, and housing – all of which is grounded in learning “how to be within one’s environment” (ICC, 2020a). The importance of programs addressing food security and Inuit values has received increased attention during the pandemic, as illustrated in the Community Highlight: Inukjuak, Nunavik.

Community Highlight: Inukjuak, Nunavik

In the Hudson Bay region of Nunavik, 84% of Inuit are food insecure and pay 48% more for groceries than residents in Southern Quebec. Sirivik*, a local nonprofit addressing food security through Inuit values, became a lifeline for many families when the COVID-19 pandemic began. Sirivik’s programs range from operating a food centre and community kitchen to youth programming such as on the land workshops and cooking skills activities. The team quickly responded to the community’s shifting needs during the pandemic with programs to:

• Deliver hot meals to Elders four days a week;

• Distribute weekly food boxes to over 100 homes for an average of 500 recipients; and

• Provide daily food boxes to individuals under quarantine.

During the pandemic, they also continued their Ulluriat program, hiring local hunters to take youth on the land to hunt and engaging elders to provide guidance on country food preparation. Sirivik’s ability to rapidly mobilize and provide stable essential food support demonstrates the immense benefit of having permanent local specialized food security resources.

The above information was provided by the Nunavik Regional Board of Health and Social Services (NRBHSS)

* The name Sirivik is from an Inuktitut expression for gratitude and excitement before sharing a meal. Learn more about their programs at https://sirivik.ca/

The provision of health information and services such as healing gatherings in Inuktitut has been important in bringing communities together and addressing trauma. Nunavut Tunngavik Incorporated, for example, collaborated with regional organizations to support events for youth, families and Elders (CIHSC, 2020). Inuit government and organization websites and social media outlets consistently posted information on closures, infection rates, support programs, and vaccines in Inuktitut, Inuktut Qaliujaaqpait (a writing system with Roman orthography), and English. Further, ITK created a COVID-19 booklet for children in all three versions (ITK, 2020b). The Alaska Public Interest Research Group helped community members to translate COVID-19 information into Iñupiaq and Yup’ik. The mother-daughter duo leading Iñupiaq translations noted that some new words had to be introduced to the language (Bissett, 2021) Mental health public service announcements and YouTube videos were offered by a variety of youth leaders, including Crystal Martin-Lapenskie, former President of the National Inuit Youth Council in Canada, who recorded in Inuktitut and English (Bell, 2020). In Nunavik, the government health board ensured that social services, including youth protection and women’s shelters, were considered essential so they could be maintained through the pandemic and expanded communications to increase awareness about their availability (ICC, 2020c)

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Community responses to the COVID-19 pandemic in Inuit Nunaat

Programs centering around Inuit culture and values have been essential in supporting well-being and mental health. Pandemic related closures meant the many traditional events, such as celebrations of life, had to be cancelled, postponed, or dramatically altered. Embrace Life Council, an Inuit nonprofit in Nunavut, offered a range of programs that could be done while in isolation or social distancing including compiling traditional sealskin, beaded earring home kits, and social media contests such as building snow sculptures or writing Inuktitut words in the snow (Embrace Life Council, 2020). In Alaska, an Inuit music group Pamyua and local radio station KYUK teamed up to leverage technology to share music and dancing online when CamaI, the annual Alaska Native festival, was cancelled due to the pandemic (Eurich, 2020). Janice Grey, from Nunavik, Canada, reflected that these types of activities, as well as small gestures by residents, were central to “stave off the loneliness and keep the community spirit going” since the physical distancing had caused many to feel isolated from their support networks (J. Grey, ICC Interview, 2022). At the 2021 ICC Inuit Health Summit, participants engaged in an important discussion on suicide prevention centered in Inuit values of being connected to one another (Figure 4).

As the pandemic continued, and isolation increased during the Delta and Omicron waves, many communities found safe ways to convene in person. The Inuvialuit Regional Corporation, in the western Canadian Arctic, for example, launched a Community Elder Workers program to hire residents to visit Elders and assist them with household tasks. The program also aimed to combat the isolation Elders experienced with increased COVID-19 regulations (Inuvialuit Regional Corporation, 2021). In 2020 and 2021, a program in Nunavik called Nurrait (Inuktitut for “baby caribou”) brought more than 300 youth in 14 villages outside for workouts or workshops grounded in Inuit knowledge or skills. One participant, Joshua Nathan Kettler, shared that the program boosted his self-esteem and that it was far better than what he usually did after school (spend time online) since "you're going out on the land, finding your own culture." (Grant, 2022)

Communities in Alaska’s North Slope initiated a “Walk for Hope and Healing” as a safe way for people to reconnect in person after vaccines were widely available in the spring of 2022. More than 50 people joined the event in Utqiagvik under the larger Healthy Ways Project that included family activities, potlucks, and storytelling, and community talks (Naiden, 2022).

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Long, Ford & Crump Figure 4: ICC Inuit Health Summit suicide prevention strategies

A theme in all Inuit conversations about the pandemic was the difficulty of being separated from family members. Inuit wellbeing is rooted in social connectedness and closeness with family. As highlighted above, community initiatives that strengthened these bonds supported Inuit through the pandemic. In a research study on Inuit youth well-being during COVID-19, participants reported that strong community cohesion and collaboration improved their wellness (Thomas et al., 2022). In particular, they indicated feeling that everyone was “doing their part” to keep their community safe. Also, they noted that being part of food distributions, outdoor sports, and land gatherings fostered emotional support during times of isolation and closures.

Discussion & policy recommendations

Finding Ways to Stay Connected

During the COVID-19 pandemic, Inuit found new ways to remain connected to one another. Janice Grey reflected that in her village, Aupaluk, this took many forms rooted in traditional Inuit values, especially sharing. People were baking bannock for one another and hunters were delivering fish to neighbors. Ms. Grey shared that she would put cloth pouches on her dogs so they could deliver little things to her mother’s house. “The cultural practice of sharing was keeping us connected”, she explained, “We were sharing in food. We were sharing in memes. We were talking on the phone. We took for granted older ways of communication. We started getting little handwritten cards from nieces and nephews.” (J. Grey, ICC Interview, 2022).

The swift, decisive action of Inuit governments and communities was successful in protecting the majority of residents from COVID-19. Despite the wide scale infrastructure and healthcare access inequities, COVID-19 infection and mortality rates in many parts of Inuit Nunangat were far lower than the general populations in their respective countries – particularly at the start of the pandemic. There have been important distinctions between countries that are central to preparing for future pandemics. Petrov et al. (2021) note that regions where Inuit hold a greater amount of territorial sovereignty, such as Canada and Greenland, had limited outbreaks of COVID-19 due to the strong preventative measures. Conversely, regions where pandemic policies and closures were less locally driven, such as in Alaska and Russia, had higher rates of COVID-19 cases and mortality (Petrov et al., 2021). However, the impacts from these rates were often lessened by successful vaccination efforts. For example, many Alaskan Native communities had more than 50% of residents vaccinated by April 1, 2021 (ARCTICenter, 2021). Tiwari et al. (2022) attribute these pandemic related successes to the three-pronged public health approach employed by Inuit. This includes: 1) delaying the arrival of the virus through protective measures and culturally specific messaging; 2) preparing for the pandemic through vaccine campaigns and building up the healthcare system; and 3) responding to outbreaks through Indigenous selfdetermination and knowledge combined with available healthcare resources.

The successes and lessons learned by Inuit are central to preparing for future pandemics, or other wide-scale emergencies such as natural disasters. The pandemic has also highlighted the need to quickly address three aspects that will ensure Inuit positive health and well-being: 1) centering Inuit knowledge and self-determination; 2) correcting infrastructure inequities; and 3) strengthening Inuit food sovereignty initiatives. These are elaborated on below.

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responses to the COVID-19 pandemic

Centre Inuit self-determination

Advancing Inuit self-determination is paramount to ensuring positive health and well-being. Selfdetermination encompasses the autonomy to manage areas critical to culture, society and livelihoods, including land and governing institutions. Another important aspect of selfdetermination is the right to participate in and influence decision-making at all levels that impact Inuit within a province or nation (Wilson & Per, 2019). As previously noted, the right and territorial autonomy of Inuit communities to establish public health protocols was central to effective strategies that limited the spread and impact of COVID-19 (Lancet, 2020; Petrov et al., 2021). As Minnie Grey noted, the sovereignty of Inuit today versus in the past has been a positive force in shaping public health responses:

We are very fortunate as Inuit today that we are able to be involved in ensuring that our people are cared for, and that we have our public health authorities in place to transfer knowledge to our population. Inuit involvement in decision-making pertaining to managing the pandemic has been really key (ICC, 2020c)

Similarly, in Greenland, Trine Abelson, M.D., reflected that the locally implemented restrictions were important in delaying COVID-19 outbreaks until people were able to get vaccinated. (Abelsen, ICC Interview, December 8, 2022).

The right of Indigenous peoples to self-determination is enshrined in the United Nations Declaration on the Rights of Indigenous Peoples. Federal and provincial governments must make legal commitments to the rights of Inuit – and to all Indigenous peoples – to ensure this right and help facilitate the creation of Inuit led health policies and programs. Self-determination is a prerequisite for all other human rights and shapes how other policies should be implemented.

Address Infrastructure Inequities

Inuit agencies have been vocal in advocating for equitable health, housing, water, and technology infrastructure. The COVID-19 pandemic has exposed how communities are further vulnerable to poor health outcomes because of longstanding infrastructure deficits. The 2022 ICC Declaration of the 14th Assembly underscored that it is essential for federal governments across Inuit Nunaat to collaborate closely with Inuit to close the infrastructure gap (ICC, 2022). Below are three areas that rendered Inuit more vulnerable to poorer health and well-being during the pandemic that should be urgently addressed.

1) Housing: Inuit have long advocated for funding to remedy the acute housing crisis. Alleviating overcrowded households is central to reducing the spread of diseases and improving mental wellbeing. In Canada, Inuit-led advocacy efforts were recently successful in attaining a three-fold increase in federal funding for housing. The federal government’s seven-year budget, released in 2022, includes $845 million for housing improvements across Inuit Nunangat (ITK, 2022)

2) Water: Inuit do not have the same access to clean water and sanitation as the general populations in their respective countries. Further, Inuit communities without access to piped water bear the financial burden of having water hauled to homes and they are at higher risk of a multitude of disease including respiratory tract, skin, and gastrointestinal (Hennessy et al., 2008; ITK, 2020a; Thomas et al., 2016). Upholding the right to clean water is critical to promoting health and human rights.

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In August 2021, ICC and ITK presented a joint submission to the United Nations Rapporteur on the human rights to safe drinking water and sanitation to document challenges to clean drinking water in Inuit Nunaat. The submission outlines recommendations to address this challenge, including a) calling on federal governments to make Inuit specific investments in water and sanitation; b) emphasizing the Arctic Council’s role in leveraging collaboration across the region; c) requesting the Government of Canada to extend the policy on eliminating long-term boil water advisories for First Nations communities to include Inuit communities; and d) asking state and academic institutions to prioritize investments in Inuit-led research on water and sanitation (ITK, 2021c).

3) Internet: It is essential for governments to invest in the implementation of national broadband or fiber networks to reach Inuit communities. ITK has published a detailed assessment of broadband gaps and opportunities across Inuit Nunangat, including the potential benefits and drawbacks of fiber versus satellite based on Arctic environments and weather (ITK, 2021b). The report underscores that many Arctic nations, including Finland, Sweden, and Norway, provide high-capacity broadband connectivity to remote communities, noting similar efforts are feasible for other regions in the Arctic. Such connectivity is critical to promote access to information, including options for online learning in the event of future pandemics. Reliable, high-speed internet is also critical for the implementation of successful telehealth services in Inuit Nunaat

While federal funding is critical to addressing these infrastructure inequities, there is also a need to create pathways for communities to generate local solutions to these issues. Communities must be leading the design and implementation of such projects, as well as receiving training for maintaining infrastructure.

Strengthen Inuit food sovereignty initiatives

In addition to improving transportation and housing infrastructure, Inuit agencies have worked to achieve investments in public infrastructure that uphold food sovereignty. ICC defines food security as “the natural right of all Inuit to be part of the ecosystem, to access food and to caretake, protect and respect all of life, land, water, and air. It allows for all Inuit to obtain, process, store, and consume sufficient amounts of healthy, nutritious, and preferred food,” (ICC, 2020, pg. 17). ICC further notes that food sovereignty is a critical dimension of food security, which assures Inuit the right to determine their own harvesting, fishing, land, and water policies. ITK (2021a) has outlined a detailed strategy for advancing Inuit food security, including:

1) reducing Inuit poverty and addressing the high cost of living in the region;

2) implementing school programs to support the most vulnerable families;

3) investing in local food production options that support country food preparation;

4) supporting harvesting and sharing networks; and

5) addressing infrastructure deficits, such as storage facilities and supply chains.

While the pandemic has shined a spotlight on food insecurity, it has long been a challenge for Inuit due to rising costs of living and social inequities. It is also an increasing concern as impacts from climate change alter wildlife migration patterns, limit access to traditional hunting territories, and intensify weather patterns and decrease hunting safety.

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Community responses to the COVID-19 pandemic in Inuit Nunaat

Conclusion

The Arctic Council’s Sustainable Development Working Group noted that COVID-19 would be a “stress test on public infrastructure and highlight areas where vulnerabilities must be examined and addressed” (Arctic Council, 2020b, p.8). As discussed in this paper, Inuit were indeed vulnerable to the virus due to widespread infrastructure deficits alongside social and economic inequities. Based on experience from past pandemics, Inuit adapted quickly to the uncertain and emerging situation that COVID-19 presented. Throughout the pandemic, Inuit communities and institutions called attention to the importance of locally driven solutions. There were tangible successes, including protective measures to limit virus outbreaks, effective vaccine campaigns, and holistic approaches to food insecurity and mental well-being. These achievements demonstrate that self-determination is the foundation for preparing for future pandemics. Concrete commitments to supporting Inuit self-determination mean federal governments must act on longstanding inequities through partnerships that are guided by Inuit leadership. Such strategies are critical to reducing future pandemic vulnerabilities and can also create opportunities to immediately and effectively promote Inuit health and mental well-being.

Acknowledgements

The authors are grateful to staff in the Inuit Circumpolar Council country offices and the Circumpolar Inuit Health Steering Committee for their leadership during the pandemic, and for supporting this paper by sharing reports, updates and for facilitating interviews with community leaders.

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1

Understanding the COVID-19 pandemic gendered policy responses in Alaska through the prism of a holistic wellness concept

The Arctic has historically been vulnerable when met with emergencies, and the COVID-19 pandemic has been no exception. The geographic remoteness of many Arctic communities, along with insufficient social infrastructures, elevates the importance of nuanced subnational and local regulations for this region. In focusing on gendered policy responses to the pandemic, this paper examines Alaska's legislation and administrative measures through a gender lens, focusing on one of its at-risk demographics: women.

With analysis of Alaska's policy compendiums, the paper provides a classification of policies by their responsiveness to women's needs. Through the prism of the United Nations Development Programme/United Nations Women's methodology and the Substance Abuse and Mental Health Services Administration’s holistic wellness framework, this study seeks to improve understanding and informed decision-making to better reflect and address women's needs in crisis and recovery from a holistic perspective.

1 This research is supported by the U.S. National Science Foundation (award PLR #2137410).

Laura F. Goodfield (Student, Department of Epidemiology, Milken Institute School of Public Health, George Washington University, USA; Department of Surgery, Massachusetts General Hospital, Boston, USA), Anissa S. Ozbek (Student, The Elliott School of International Affairs, The George Washington University, USA), Riya Bhushan (Student, The Elliott School of International Affairs, The George Washington University, USA), Sophie M. Rosenthal (Student, The Elliott School of International Affairs, The George Washington University, USA), Alicia Glassman (Student, The Elliott School of International Affairs, The George Washington University, USA), Marya Rozanova-Smith (Research Professor, Department of Geography, Columbian College of Arts and Sciences, The George Washington University, USA).

Laura F. Goodfield, Anissa S. Ozbek, Riya Bhushan, Sophie M. Rosenthal, Alicia Glassman & Marya Rozanova-Smith

Introduction

Women were disproportionately impacted by the onset of the COVID-19 pandemic. This was seen through higher rates of women’s unemployment, domestic violence, greater health-related risks, and increased burdens of responsibility during lockdown, namely through child/elderly care and household tasks (Azcona et al., 2020). The pre-pandemic gender earnings gap in Alaska was recorded at 28% in 2019 (US Bureau of Labor Statistics, 2023), and, although its severity varied across the state (Figure 1), it placed women at an additional risk for economic instability, which was further exacerbated by the pandemic (National Women’s Law Center, 2023).

Although sex-disaggregated data for change in employment status from 2020-22 remains unavailable from Alaska Department of Labor and Workforce Development, preliminary findings show that ‘the pandemic has hit women harder than men” (Wiebold, 2021, p. 5). In particular, women with children were more likely to be adversely affected by labor inequalities. Women within the 25-to-34-year-old age group, the most common reproductive age for women in Alaska, comprised the majority of unemployment claimants (Alaska Department of Health, 2022). The closure of schools and care facilities left mothers to shoulder additional domestic responsibilities, increasing unpaid care and providing additional context to the gendered impacts women faced in their employment status during the pandemic (Robinson,

The pandemic worsened occupational conditions for women working in female-dominated spheres, such as healthcare, as they experienced increased workloads and stress in addition to heightened COVID-19 contraction risks. Before the pandemic, in 2019, nearly 1 in 4 Alaskan women worked in health care and social assistance (Alaska Department of Labor & Workforce Development, 2021). Overall, women comprised 80% of healthcare support workers, 89% of childcare workers, 87% of registered nurses, 94% of preschool teachers, and 81% of elementary school teachers (Robinson, 2022, p. 9). In addition, women’s overrepresentation in significantlyaffected sectors of the economy, such as the hospitality industry, placed them at heightened risk for economic instability during COVID-19 (Robinson, 2022, p. 5). For example, in 2019, women comprised 79% of restaurant, lounge, and coffee shop workers, 74% of hotel, motel, and resort desk clerks, and 71% of waitstaff (Wiebold, 2021, p. 11)

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2022, p. 6; UN Women, 2020a). Figure 1. Women’s wage as a percent of men’s in Alaska, by borough (Wiebold, 2021). Source: Alaska Department of Labor and Workforce Development.

Women also experienced increased levels of physical violence during the COVID-19 pandemic (UN Women, 2020b). This is an especially relevant issue in Alaska, as the state has held the highest homicide rate in the nation for women killed by men since 2014 (Violence Policy Center, 2021). The 2020 Alaska Victimization Survey revealed that during the first year of the pandemic, “about twice as many women in households with financial or employment difficulties related to the COVID-19 pandemic experienced intimate partner violence, sexual violence, or both” (The Alaska Criminal Justice Comission, 2022). This indicates another pertinent gender inequality of the pandemic.

While longitudinal research is necessary to fully evaluate the gendered impacts of the COVID-19 pandemic and subsequent policy measures, recent studies suggest that overall, the pandemic had detrimental effects on physical (Koh et al., 2021; Shanbehzadeh et al., 2021; Raveendran et al., 2021), mental/emotional (Lades et al., 2020; Shanbehzadeh et al., 2021; World Health Organization, 2022), financial (Findling et al., 2021; Horowitz et al., 2021; Kodjamanova et al., 2022), spiritual (Buchtova et al., 2022; Captari et al., 2022; Coppola et al., 2021) , occupational (Alrawashdeh et al., 2021; Haave et al., 2023; Johnson & Whillans, 2022), social (Borel et al., 2022; Ernst et al., 2022; Luijten et al., 2022; Weissbourd et al., 2021), intellectual (Becker et al., 2021; Kuhfeld et al., 2022), and environmental (Adisa et al., 2022; Ammar et al., 2020; Kourti et al., 2023) aspects of health. Thus, a more holistic approach is essential to address public health challenges for planning subsequent gendered pandemic response and recovery policies.

Methodology

In this study, a relevant theoretical framework for a holistic health approach is adapted from the Substance Abuse and Mental Health Services Administration (SAMHSA), a subsidiary of the US Department of Health and Human Services (HHS) (SAMHSA, 2016). Originally created by Dr. Margaret Swarbrick in her seminal paper “A Wellness Approach,” Eight Dimensions of Wellness (also known as the SAMHSA Wheel) were initially created to encourage recovery amongst individuals dealing with mental/behavioral health issues or substance use (Figure 3) (Swarbrick, 2006) (SAMHSA, 2016). Despite its original focus on this group of individuals, this SAMHSA Wheel framework is able to provide a nuanced view of health and wellbeing, as well as be used in a holistic gendered approach to crisis response.

The SAMHSA model uses the term ‘wellness’ to emphasize that ‘health’ does not solely refer to ‘physical health,’ countering the dominant U.S. medical model, where physical health and overall health are essentially synonymous (White, 2017) This model shares similarities with many North American Indigenous concepts of health and wellness. In Alaska, these holistic practices have long been suppressed and undermined due to colonization; however, their efficacy in creating and maintaining positive health outcomes is becoming increasingly accepted within the Western medical model. The continued development of co-management relationships and health-response cooperation between Alaska Tribal and state authorities, as employed during the COVID-19 pandemic, could be conducive to the widespread adoption of more nuanced approaches to health policy.

In this paper, we will apply the SAMHSA theoretical model to understand gendered policy responses in Alaska during the COVID-19 pandemic from a holistic perspective. This study analyzes policies at the State of Alaska level of governance, as well as the municipal policies of Anchorage, Fairbanks, Juneau, and Nome.

This study is based on secondary data analysis sourced from findings compiled in the Arctic COVID-19 Gender Response Tracker (Rozanova-Smith, 2022), a policy compendium based on a methodology created by the United Nations (UN) Development Programme (UNDP) and UN Women to evaluate global gender responses to the COVID-19 pandemic (UNDP, & UN Women, 2021). Developing the COVID-GEA Tracker, we examined publicly available sources on gendered

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Goodfield, Ozbek, Bhushan, Rosenthal, Glassman & Rozanova-Smith

policy measures for Alaska, including legal databases such as LexisNexis, the Alaska State Legislature website, Alaska city administration websites, government reports, council meeting minutes, press releases, and local newspapers. The criteria for gendered categorization of the COVID-19 policy data were modeled on the COVID-19 Global Gender Response Tracker (UNDP/UN Women’s Tracker), created by the UNDP/UN Women. The UNDP/UN Women’s Tracker divides all COVID-19 policies into four general categories: social protection measures, labor market measures, fiscal and economic measures, and violence against women. COVID-19 policy measures of social protection measures, labor market measures, fiscal and economic measures are subsequently categorized as ‘gendered’ if they meet gender lens criteria of targeting or prioritizing women, or targeting female-dominated sectors of the economy (Figure 2).

responsive policies during the COVID-19 pandemic.

Source: UNDP and UN Women (2020) COVID-19 Global Gender Response Tracker: Methodological note. UN Women, p. 2. Available at: https://data.undp.org/wpcontent/uploads/2020/09/COVID19_Global_Gender_Response_Tracker_Methodological_Note_20092020.pdf

While the UNDP/UN Women’s Tracker exclusively focuses on policies at a national level, the novelty of the COVID-GEA tracker lies in its inclusion of measures implemented by various levels of governance, including regional and municipal (UN Women, 2021). Utilizing the COVID-GEA Tracker's database of Alaska's gendered COVID-19 policy measures, we evaluated the state and municipal government responses through the prism of the SAMHSA Wheel (Figure 3) by categorizing COVID-19 policies based on the dimension(s) of wellness that best correlate to policy contents and their responsiveness to women's needs.

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Though women across social, economic, and cultural backgrounds hold varying needs as they relate to the eight dimensions of wellness, the SAMHSA Wheel presents a general, widely-applicable conceptual framework. Applying a gender perspective, policy measures are categorized primarily as physical health if they target the prevention of disease spread in female dominated-industries through efforts such as vaccinations, mask-wearing, social distancing, and limiting capacities of indoor spaces. Physical health also applies to policies specifically targeting women and women’s health. Emotional health measures prioritize the protection of women’s mental health, for example through counseling support, non-profit funding, and psychiatric programming. Social health measures are aimed at maintaining and increasing connection with other individuals, family members, and the general community in a way that addresses unpaid care or targeted women, for instance through volunteering, events centered around shared interests, and spending time with others. Measures that sought to protect intellectual health primarily focus on broadening educational opportunities for women. Environmental health measures encompass a wide range of determinants, such as access to nature and clean water, further supporting a safe and positive living environment. Environmental health, as it pertains to this paper and dataset, is linked to policies that combated domestic violence, a public health issue in which women are victimized disproportionately. Though domestic violence is an issue that permeates many facets of life, it is first and, perhaps, best, addressed through policy measures that offer a safe living space. While occupational and financial health may seem interchangeable, policies are categorized as financial if the measure seeks to directly infuse cash or remove monetary barriers to services for women or targeted female-dominated sectors. Occupational health, in this context, refers to policies that are meant to help women remain in employment in their chosen industry. Additionally, policies that protect industries with a disproportionate number of female workers fall into this domain of occupational health. Lastly, spiritual health refers to women’s ability to find and keep purpose and meaning in life as well as a sense of balance and peace. Spirituality can also refer to organized religion, beliefs in traditions, community, and beyond (SAMHSA, 2016).

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Goodfield, Ozbek, Bhushan, Rosenthal, Glassman & Rozanova-Smith Figure 3. Eight dimensions of wellness, presented in the SAMHSA Wheel. Source: University of Florida Health. Available at: https://education.health.ufl.edu/community/wheel/

The major methodological novelty in this study is the integrated use of the UNDP/UN Women’s COVID-19 Gender Response methodology and the SAMHSA Wheel’s model (Figure 4) for gendered policy analysis. In the first step of the analysis, policies are categorized based on the UNDP/UN Women gendered policy criteria (whether policies target or prioritize women or target female-dominated sectors) and then analyzed using the SAMHSA’s dimensions of wellness: physical, emotional, intellectual, social, environmental, occupational, financial, and spiritual. For the UNDP/UN Women conceptual framework, the study outlines the necessity for an additional policy category and policy measure type in order to adapt a holistic approach that incorporates the spiritual needs of women into this integrated model (Figure 4).

As an example of applying the integration of the UNDP/UN and SAMHSA models, here we show an analysis of Alaska State’s Elementary and Secondary School Emergency Relief Fund, an initiative

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Figure 4: The integrated conceptual framework of UNDP/UN Women’s COVID-19 Gender Response methodology and SAMHSA Wheel’s model for gendered policy analysis. Note: The outlined boxes at the bottom represent the proposed creation of a new policy category and policy type within the UNDP/UN Women methodology to better incorporate spiritual health in a gendered policy analysis framework.
Social protection Social insurance Social assistance Care services All policy measures Violence against women Other measures Awareness raising campaigns Strengthening of services Integration of VAWG in COVID-19 response plans Collection and use of data Labor market Reduced work time & telework Wage subsidy and ncome replacement for self-employed Activation measures and enterprise development Labor regulatory adjustment Economic financial, and f scal support for businesses and entrepreneurs Loan guarantees Tax deferrals Multiple measures Credit/loan deferral restructuration, or renegotiation Credit lines or additional liquidity by financial institutions Equity injections: public sector Tax cut/exemptions/ credits Environmental health (domestic settings) Emotional health Occupational health Intellectual health Physical health Financial health Social health Dimensions of Wellness Spiritual health C t d of data V o ence aga nst women Measures by Policy Category Measures by Policy Type COVID-19 Gender Response Model Based on UNDP/UN Women's Methodology SAMSHA Model's Methodology Gender Lens Criteria Target or prioritize women Target femaledominated sectors

to help schools safely reopen, practice methods to limit the spread of COVID-19, provide mental health services, and upgrade educational technology (Alaska Department of Education and Early Development, 2021). This policy addresses women's physical health, as implementing public health measures such as masks, contact tracing, and diagnostic and screening in order to reduce COVID19 transmission in a female-dominated industry (see Figure 4). This policy measure is also considered gendered based on the UNDP/UN Women methodology, as women in Alaska make up the majority of educators (Robinson, 2021, p. 9). Following SAMHSA methodology, this measure is categorized as providing women's occupational health support, as teachers are given social assistance in a female-dominated industry. Additional paid hours for engaging in academic support for students outside of regular classroom time, allow them to remain in the field of their choice.

Another example of how policy measures are categorized using the UNDP/UN Women and SAMHSA theoretical framework through a gender lens examines the State of Alaska’s “People First Initiative,” a policy measure that seeks to address domestic violence and sexual assault, missing and murdered Indigenous persons, human/sex trafficking, foster care, and homelessness (Osborne, 2021). Resources are also allocated to provide for staffing additions for nonprofits that deal directly with victims of domestic violence. Based on the UNDP/UN Women methodology, this policy is considered gendered as women in Alaska experience disproportionate rates of domestic violence. Using the SAMHSA wheel, domestic violence prevention falls under the environmental health dimension. While SAMHSA’s definition of environmental health is expansive, covering both domestic and natural environments, its relevance in this study’s analysis pertains to policy measures that involve wellness in the home. This policy is also categorized as serving women's emotional health, as it provides “strengthening of services” to combat violence against women, specifically counseling services (see Figure 4). Lastly, this policy supports women’s occupational health, as women are disproportionately employed in the nonprofit and social services sector, also providing supplementary employee funding through the “strengthening of services” (see Figure 4) (Camarena et al., 2021). Additional hiring under this initiative allows women to gain access to greater economic security through employment in the field of their choice.

Results

In this study, we identified 82 policy measures passed during the COVID-19 pandemic across the state and city levels of governance in Alaska. Among them, only 23 measures were genderresponsive, as defined based on the UNDP/UN Women methodology. Of the 23 identified gendered policies, 11 were adopted on the state level. The remaining 12 measures were implemented on the municipal level of the cities: 5 in Anchorage, 4 in Fairbanks, 2 in Juneau, and 1 in Nome.

The State of Alaska’s policies targeting women’s economic security comprised 56.3% of the state response, with 18.8% directly supporting unpaid care, and 25% addressing violence against women (Figure 5). The policy response at the city level exhibited similar trends in focusing on supporting women’s economic and occupational security (see Figure 6). At the same time, municipal approaches were not consistent across the sample. The largest cities in the study, Anchorage and Fairbanks, differed in their policy priorities: 71.4% of Anchorage’s policies addressed women’s economic security, while 80% of Fairbanks’ policies directly supported unpaid care. State policy approaches to the pandemic (Figure 5) were similar to municipal policy responses (Figure 6) in that both expressed considerable emphasis on targeting women's economic security and supporting unpaid care. The primary focus on these policies demonstrates an apparent lapse in legislation and administrative measures addressing crucial areas of wellness, such as emotional health.

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Based on the SAMHSA methodology, of the 11 gendered policies at the state level, occupational and physical health needs were most prominently addressed (see Figure 7), and occupational health was addressed in 40% of gendered policies (8 total). Physical health appeared in 25% of policies (5 total), and environmental health was represented as 15% of policies addressed violence against women (3 total). Emotional health was addressed in 15% of policies (3 total), and intellectual health was seen in 5% of policies (1 policy). Notably, spiritual, financial, and social health domains do not appear in any policies identified at the state level.

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Figure 5: Breakdown of COVID-19 gender-responsive measures based on UNDP/UN Women Methodology: State of Alaska level of governance. Based on COVID-GEA Tracker data. Figure 6: Breakdown of COVID-19 gender-responsive measures based on UNDP/UN Women methodology: City level of governance. Based on COVID-GEA Tracker data.

Note:

Note: Percentages represent facets of health, not the total number of policies. More than one aspect of health can be addressed per policy.

At the municipal city level, physical health, financial health, and occupational health were the most represented facets of health, while emotional, intellectual, and spiritual health domains were not addressed by policy-makers (see Figure 8).

Anchorage's city-level gendered COVID-19 policy response prioritized a financial health dimension, as this facet was addressed in 50% of their policies (3 total). Physical, social, and occupational health were each addressed in 16.7% of policies (1 each, 3 total). Juneau’s policy response prioritized physical health dimension, as seen in 49.2% of policies (3 total). Social health constituted 26.8% of the total policy response (2 policies). Financial health and occupational health

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Goodfield, Ozbek, Bhushan, Rosenthal, Glassman & Rozanova-Smith Figure 7: Breakdown of Alaska’s state-level COVID-19 gender-responsive measures using the SAMHSA Wheel. Based on COVID-GEA Tracker data. Percentages represent facets of health, not the total number of policies. More than one aspect of health can be addressed per policy. Figure 8: Breakdown of COVID Alaska city level of governance. Based on COVID-GEA Tracker data.

were each seen in 1 policy each, each representing 14.3% of Juneau’s total policy response. Fairbanks had 3 policies classified as gendered, and occupational health was addressed in both, constituting 66.7% of the total response (2 policies), and physical health was addressed in 1 of the policies, representing 33.3% of the health facets addressed. Nome only had 1 identified gendered COVID-19 policy response which focused on occupational health (100%). Violence against women was not addressed at the municipal level in these focal cities, as well as emotional and spiritual dimensions of health were not included in gendered municipal COVID-19 measures.

Discussion

According to a growing volume of literature, women during the pandemic were disproportionately exposed to significant stressors related to increased unpaid care, elevated unemployment rates, and domestic violence, and thus had a higher need for policies that addressed their social and emotional health (UN Women, 2020b). Although further research is needed to support this thesis, the study's findings demonstrate that the gendered policy response to the COVID-19 pandemic was limited in Alaska. It also did not fully address all dimensions of health, seeing as it overwhelmingly prioritized physical, financial, and occupational health.

The study findings further indicate that, although the UNDP/UN Women framework allows for the identification and evaluation of COVID-19 gendered policy responses in a comprehensive manner, it does not explicitly include all eight SAMHSA’s dimensions of health and wellness, and a spiritual health dimension is currently overlooked. Alternatively, while the SAMHSA Wheel framework provides a holistic view of health and wellness, it does not incorporate a gender component. Thus, through the use of the integrated conceptual framework of UNDP/UN Women’s COVID-19 Gender Response methodology and SAMHSA Wheel’s model, this study presents a more comprehensive methodology to evaluate gendered policy response to the COVID19 pandemic in Alaska or other regions in the Arctic and beyond.

A community-centric approach to policy is particularly important in Alaska as the state is home to a diverse Indigenous and non-Indigenous population that adds to the complexity of socioeconomic, cultural, and political environments; this makes a one-size-fits-all policy approach across different levels of governance at different locations rather inadequate. For instance, though gun violence is a prevalent issue within Alaska, with 25% of female homicide victims in Alaska being killed by guns in 2021 (Stremple, 2022; Violence Policy Center, 2021), gun legislation is a crucial political task requiring nuanced regulation particularly for smaller remote communities to accommodate Alaska’s traditional subsistence practices across socio-economic and cultural spheres (Rogerson, 2023).

The co-management model of state-tribal cooperation in Alaska, specifically the collaboration between the Alaska Department of Health and Social Services and the Alaska Native Tribal Health Consortium, demonstrated high efficacy during the pandemic and paved the way for increased trust between the State of Alaska’s government and Indigenous organizations (Petrov et al., 2023; Chhean et al., 2021; Halseth & Murdock, 2020). In the context of this co-management model, SAMHSA Wheel’s more holistic approach in certain aspects can be considered in line with Indigenous concepts and practices of health. The Indigenous Medicine Wheel, used for thousands of years, emphasizes the physical, mental, emotional, and spiritual components of health (Brumley, 2015; Dapice, 2006; Quinless, 2022). In North American Indigenous communities, connection with oneself, others, and the environment are all important in defining health beyond the physical dimension (Healy, 2017; Quinless, 2022). The convergence of Western and Indigenous knowledge systems can support future holistic public health responses and may ultimately lead to greater outcomes for diverse Arctic communities in general and women in particular.

Conclusion

Using the example of the State of Alaska and the cities of Anchorage, Fairbanks, Juneau, and

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Nome, the study examined the COVID-19 pandemic gendered policy responses through the prism of a holistic wellness concept. Given the importance of the holistic approach to policies in crises, like the COVID-19 pandemic, developed in this study, the integrated conceptual framework of UNDP/UN Women's COVID-19 Gender Response methodology and SAMHSA Wheel's model proved useful in identifying and highlighting various aspects of gendered policy responses in Alaska. This integrated framework may also provide a platform for better integrating Western science and Indigenous knowledge by using a more holistic approach to evaluating and responding to the gendered impacts of the COVID-19 pandemic.

Findings from this study demonstrate that the gendered policy response to the COVID-19 pandemic at the state and municipal city levels remained limited in Alaska. These policies also did not fully address all SAMHSA’s dimensions of health, seen as overwhelmingly prioritizing physical, financial, and occupational health over emotional, social, environmental, intellectual, and spiritual. The integrated conceptual framework of UNDP/UN Women's COVID-19 Gender Response methodology and SAMHSA Wheel's wellness concept can be useful to better understand lapses in gender-responsive decision-making. Our analysis of gender policies demonstrated that it remains essential for women’s needs to be taken into consideration while addressing all dimensions of wellness, as defined by SAMHSA model, in the Arctic and beyond.

Limitations and future directions

Our data collection was limited to open-source, publicly available information. The research included an analysis of gendered policy responses at the state and municipal levels of governance in Alaska, with a special focus placed on four focal cities, as data for local levels of governance, like villages, were unavailable or difficult to access. Additionally, at the time of publication, the Alaska Bureau of Labor Statistics was in the process of preparing updated sex-disaggregated data for the entire pandemic period, so it was inaccessible for our study.

In order to have a nuanced understanding of the co-management model of state-tribal cooperation in Alaska and the complex interactions between federal, state, tribal, and local policies addressing women's needs, future research should be done in close collaboration with Indigenous scholars and knowledge holders.

Collecting primary data is vital for understanding the realities and outcomes of crisis-responsegendered policy implementation as well as the rationale behind decision-making priorities in Alaska. Additionally, future research should include other genders to provide a more complete picture on the gendered impacts of the COVID-19 pandemic.

Potential policy recommendations

Strengthening gender-responsive governance amid and beyond the COVID-19 pandemic includes:

● Improving gender-specific COVID-19 data collection and availability

● Integrating the UNDP/UN Women COVID-19 Gender Response Model and SAMHSA Wheel methodologies to ensure the complex and holistic gendered policy responses

● Expanding frameworks like the UNDP/UN Women COVID-19 Gender Response Model to address women’s needs beyond economic and social protection measures

● Mainstreaming considerations of gender within public health policies, post-COVID-19 recovery programs, and political processes

● Prioritizing public health policies based on a holistic concept of health and wellness, such as the SAMHSA Wheel and Indigenous health and wellness models

● Strengthening the co-management model of state-tribal cooperation in Alaska to provide

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an adequate response to women’s needs

● Streamlining Alaskan tribal communities' policy planning approach to adequately respond to Indigenous women's needs, especially in rural communities

● Improving public day-care and childcare facilities by making them more accessible and affordable, especially during crises

● Creating public platforms and forums for the articulation of women's interests.

Acknowledgements

We honor the ancestral stewards of the Indigenous Peoples in Alaska. We acknowledge and respect their knowledge and wisdom.

Our special thanks go to Prof. Andrey Petrov and the two anonymous reviewers for their highly valuable comments and insightful ideas for future research directions.

This research is supported by the U.S. National Science Foundation, Project “Understanding the Gendered Impacts of COVID-19 in the Arctic (COVID-GEA),” award PLR #2137410).

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Biocultural perspectives of pandemics and postpandemic population health in Alaska

Pandemics are recurring events through human history, so it is valuable to analyze and compare determinants, impacts, and consequences of different pandemics. Anthropological perspectives of pandemics recognize that modern population health is the product of biocultural evolution that is driven by human relationships with infectious pathogens that play out differently in locales with different cultural, environmental, and biological ecologies. Health and pandemic experiences in the Arctic are expected to be distinct from those of other regions of the world and should be closely investigated to better understand the dynamics and consequences of pandemics therein. In this paper, we focus on Alaska and its unique experiences with the 1918 influenza pandemic and the COVID-19 pandemic. Through review of these two pandemics, we show that there are similarities across time, such as how coastal communities were hit hardest and interior communities were more likely to escape, and that Alaska Native communities’ ability to maintain agency over their community-centered responses resulted in better protection against novel outbreaks. Additionally, we characterize the ambient social conditions during each pandemic to explore critical relationships between biology, culture, behavior, and health. Finally, in an application of biocultural theory to pandemics, we review and engage with the emerging literature on the impacts of delayed healthcare during the COVID-19 pandemic and theorize about potential population health consequences of delayed care during COVID-19 in Alaska. Current data for Southeast Alaska show that the majority of people in the region experienced delays in healthcare in 2020-21, but more research is required to identify determinants of this phenomenon. Finally, we discuss how a biocultural perspective can help us understand the dynamics of pandemics and can help tailor pandemic preparedness plans that are appropriate for local social and cultural ecologies.

Taylor P van Doren, Postdoctoral Fellow, Sitka Sound Science Center; Ryan A. Brown, Professor and Senior Social Scientist, RAND Corporation; Ron Heintz, Research Director, Sitka Sound Science Center.

Introduction

Pandemics are regularly occurring phenomena through human history, yet they are relatively understudied from social science perspectives when compared with epidemiological (Frost, 1919; Mills, 2004), demographic (Chandra et al., 2018; Noymer & Garenne, 2000), biomedical (Morens et al., 2008), virological (Nelson et al., 2008; Worobey et al., 2014), and historical (Budgell, 2018; Crosby, 1989) points of view (to name a few).1 While there is no single standard definition of “pandemic” across fields (e.g., Doshi, 2011), pandemics are typically novel, acute, and rapidly transmitted infectious diseases that impact more than one country or continent relatively simultaneously (Dimka et al., 2022). A comprehensive understanding of pandemic dynamics and consequences in different geographic and sociocultural contexts requires engagement with the social sciences, especially those that integrate human behavior, culture, population biology, ecology, and historical context. An anthropological lens, particularly an integrative biocultural approach, provides a holistic framework that considers biological and social dynamics that occur at multiple time scales and geographic spaces to affect how humans experience acute infectious disease outbreaks. This approach also takes a comparative approach, a cornerstone of anthropology, in exploring human experiences within specific ecologies to shed light on both the common and idiosyncratic elements of different pandemics.

The Arctic remains one of the least studied regions in the world in terms of pandemic impacts and consequences. Because of its unique and diverse geological, ecological, and sociocultural characteristics, we cannot assume that pandemic experiences in the Arctic are equivalent to those of non-Arctic regions. The Arctic is under immense ecological pressure due to anthropogenic climate change and has been warming more rapidly than any other region of the planet for the last half century, including the tropics (Jacobs et al., 2021; Rantanen et al., 2022). This means that Arctic peoples will face a multitude of stressors on health in the coming years and decades, including novel pathogens (Mora et al., 2022). Thus, Arctic population health, as it is under acute stress from epidemics, pandemics, climate change, and emerging infectious diseases, deserves careful attention from holistic disciplines like anthropology so that public health and community authorities will be prepared for and can work to counteract these changes.

This paper discusses the historical, sociocultural, and ecological contexts of Alaska with respect to its experiences with two major pandemics, the 1918 influenza and COVID-19 pandemics, from a biocultural anthropological perspective. The goal of this discussion is to review current knowledge about each pandemic and compare their characteristics while emphasizing dynamics that are linked with the local physical and sociocultural ecology. Ultimately, we link these dynamics to show that while the proximate determinants of pandemics, such as the nature of a pandemic pathogen and the disease it causes (e.g., H1N1 influenza for the 1918 flu and SARS-CoV-2 for COVID-19), can and often will change, the ultimate determinants of outcomes, such as social inequalities and barriers to accessing medical care, show stability over time (van Doren, 2021).

After presenting what is known about the 1918 flu and COVID-19 in Alaska, we apply a biocultural framework to better understand how consequences of the COVID-19 pandemic can leave a lasting mark on the population health of Alaska. We review the current literature on delayed care and the

1 The papers cited in this sentence are all in reference to the 1918 influenza pandemic, but diverse disciplinary perspectives explore other pandemics of differing etiologies, as well.

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ways that failing to access or seek healthcare during the COVID-19 pandemic could have longterm impacts on population health through individual, social, and intergenerational pathways. Finally, we conclude with a discussion of how fields like public health can draw on existing social science knowledge and interventions to better prepare for a future that inevitably contains emerging infectious diseases and novel pathogens with pandemic potential. These pandemic preparedness plans must draw on our knowledge of the social and ecological drivers of pandemic impacts to better tailor preparation and responses to diverse populations that may be small, isolated, and have limited resources.

Biocultural anthropology, public health, and applications to Alaska

One of the most popular theoretical frameworks for studying human population health in recent years is the biocultural approach, which highlights how the biological and cultural elements of human nature perpetually co-evolve (Goodman & Leatherman, 1998; Wiley & Cullin, 2016). The biocultural approach further highlights how this co-evolution is not homogeneous across populations but plays out differently in distinct socioecologies. Lock (1993, 2017) characterizes these differences as local biologies, which are distinct characteristics of the physical body and more broadly, the population that are consequences of macrosocial socioeconomic and ecological forces. Not only can these local biologies be distinct between and among populations geographically, but they also show unique temporal dynamics (Lock, 2017; Hoke & McDade, 2014). Some prominent scholarship that utilizes biocultural approaches include: the investigation of how socially constructed race becomes embodied as health inequalities (Gravlee, 2009), how urban environments are stressors on human health (Schell, 1997), how stigma affects biology in marginalized populations (Brewis & Wutich, 2019), and how sex and gender dynamics affect health (DuBois et al., 2020).

Biocultural approaches have been applied less often to the study of infectious disease dynamics and their role in shaping human biology, demography, culture, and behavior. One of the earliest applications of biocultural theory to the relationship between humans and pathogens was Livingstone’s (1958) discussion of how the progression of agricultural development in West Africa led to closer and more frequent contact with mosquitoes that carry Plasmodium falciparum, the causal pathogen of malaria. Livingstone’s explanation helped illuminate why the heterozygous genotype for sickle cell anemia, which protects against malaria disease, became prolific in this region (Allison, 1954). Other anthropologists have explored disease patterns in ancient contexts (Armelagos, 1969), the relationship between tuberculosis, demography, and cultural evolution (van Doren, 2022), syphilis in antiquity (Harper et al., 2011), the contexts and drivers of the spread of HIV (Goodreau et al., 2012), and in biocultural and ecosocial drivers of COVID-19 and other re-emerging diseases (Friedler, 2020). Dimka et al. (2022) argue for a more purposeful role of biocultural and biological anthropology in the study of infectious diseases, especially with respect to pandemic studies. Importantly, not all populations are regularly exposed to or are equally susceptible to the same infectious diseases, and the local environment is a critical component to which pathogens regularly circulate and how humans can adapt to the presence of those pathogens. Given the specific conditions faced by populations in the Arctic, we argue that scientists should study pandemics with unique characteristics of the Arctic in mind to help form public health recommendations that will most benefit Arctic populations.

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Knowledge of pandemics in the Arctic can be considerably broadened through social science perspectives like the biocultural framework, due in part to its potential for interdisciplinary engagement. Zuckerman et al. (2022) discuss how the framework for biocultural anthropology exists within a loop of complementary frameworks, including ecosocial theory (e.g., Krieger, 1994), intersectionality (e.g., hooks, 1984), and syndemics (e.g., Singer & Clair, 2003). Ecosocial theory, popularized in the fields of public health and social epidemiology by Nancy Krieger (1994, 1999, 2001, 2005), was specifically operationalized to explain health inequalities, especially while elevating the importance of local environments as determinants of health and health inequalities. This perspective helps push back against assumptions that individual health outcomes are predetermined and innate.

Similar to the interdisciplinary argument made by Zuckerman et al. (2022), van Doren (2022) explores how biocultural anthropology can be more purposefully integrated with theories of demography and epidemiology that investigate the role of infectious diseases in population health and demographic evolution. van Doren (2022) points out that the most prominent iterations of demographic and epidemiological transition theory (that is, explanations for how and why mortality and fertility change led to increases in life expectancy and apparent improvements in population health [Barrett et al., 1998; Harper & Armelagos, 2010; Kirk, 1996; Omran, 1971; Thompson, 1929]) were theorized in reference to Western European and some North American populations. In sum, the most referenced “standard” for how population health has shifted through millennia is substantially biased and does not adequately explain the nature of population health transitions on most of the planet (Defo, 2014; Mercer, 2018; Santosa et al., 2014).

The Arctic itself is, of course, not monolithic. Countries like Norway, Sweden, Finland, and Iceland may fit the traditional epidemiological transition model: the rise of the industrial revolution led to advances in sanitation procedure and the ability to support a growing population with advances in technology and infrastructure; infectious disease mortality fell and proportionate chronic disease mortality rose; and life expectancy increased while population size and density increased (McKeown, 1976; Omran, 1971). The U.S. also broadly fits this model (Omran, 1977). However, the U.S. is only an “Arctic nation” with the inclusion of Alaska. Most of Alaska is rural and sparsely populated, as is most of Northern Canada, Greenland, and Russia. Therefore, traditional models of population health and epidemiological transitions cannot adequately explain the realities of health over time in these regions. Large-scale observations of demographic and health shifts would not be appropriate for most spaces in the Arctic, and small-scale demographic analyses that consider how space and place determine life course experiences would be more appropriate, albeit much more complex in many cases (Raymer et al., 2018). As such, when health and population transitions are discussed in the context of the U.S., Alaska’s inclusion in those discussions is erroneous, and its exclusion does not always result in more careful investigation of its population health within the context of being an Arctic space.

To integrate biocultural perspectives of pandemics with the study of population health and thereby produce more bioculturally-informed, locally grounded public health recommendations it is important to address one of the most long-standing debates in population health surrounding the social determinants of health (Lucyk & McLaren, 2017). Debates about the social determinants of health have centered on whether the ultimate drivers of health inequalities are more rooted in “neo-materialist” dynamics, that is, social structural forces such as poverty and neighborhood

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conditions that affected access to care; or, whether drivers are more often “psychosocial,” for example, the effects of neighborhood safety on psychological stress, leading to stress-linked chronic disease. As with other dichotomies now widely accepted as false, such as nature versus nurture or genes versus environment, we argue that this distinction between neo-materialist and psychosocial pathways to health outcomes is indeed a false dichotomy. Instead, social structural forces are always acting in deeply integrated ways with psychosocial processes. For example, social inequalities are to some extent upheld and justified by cognitive biases, and the unequal distribution of resources leads to undeniably stressful experiences with proven health consequences via biological stress pathways.

For the purposes of studying pandemics through a biocultural lens, this means that we must stay attuned to the overt and subtle ways that larger social structural pathways can affect local pandemic experiences. For example, policies set at the state or federal level may be difficult to enforce or could even be counterproductive when applied to small communities with relatively large Indigenous populations. In turn, this may lead to distrust, confusion, and local division as well as challenges to mental health when Indigenous cultural and subsistence practices are derailed. However, vaccine resources given to local populations, when combined with local systems of collective interest, may make some Indigenous groups positive examples of vaccine uptake; in some cases, Indigenous groups have used this capacity to help vaccinate poor, largely white populations living near and among them.

Overall, this discussion points towards multiple directions in which social scientists, including anthropologists, can contribute to the understanding of pandemics in a diverse and unique space while simultaneously engaging with interdisciplinary theories and approaches. In the rest of this paper, we will focus on establishing the state of health in the Arctic, and what is known about how the 1918 influenza and COVID-19 pandemics progressed in Alaska within the context of Alaska as a diverse Arctic space. We will engage with specific ecological and sociocultural characteristics of Alaska as critical elements of how these two pandemics impacted its people. Finally, we will apply the current knowledge of past and ongoing pandemics to current pressing issues of population health and what this can teach us about how to pursue more holistic pandemic preparedness plans.

Health in the circumpolar north

The circumpolar north is a vast and diverse area with a population of about seven million people, including approximately 1.1 million Indigenous peoples in eight Arctic nations (U.S., Canada, the Kingdom of Denmark, inclusive of Kalaallit Nunaat [Greenland] and Faroe Islands, Iceland, Norway, Sweden, Finland, and Russia) (Young & Bjerregaard, 2019). The Arctic is under severe ecological pressures and is warming four times faster than the rest of the planet (Rantanen et al., 2022). Recent stressors, like the COVID-19 pandemic, have further challenged the health and wellbeing of Arctic populations. The health disparities of circumpolar nations are often overlooked, partly because most regions in the Arctic belong to high-income nations (Chatwood et al., 2012; Krümmel, 2009). Snodgrass (2013) aggregated research on health in Indigenous circumpolar populations compared to those of the high-income nations with which they are generally homogenized (Alaska’s diverse Native population with the continental U.S., for example), and provides a thorough summary of primary measures of interest in population health. For example, life expectancy at birth varies greatly, but seems to be relatively high in Indigenous peoples of

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Scandinavia and relatively low in Siberian peoples (Kozlov et al., 2007; Hassler et al., 2008). Meanwhile, cardiovascular disease has become increasingly more prevalent in all Indigenous circumpolar peoples except the Sami, who are Indigenous to Sápmi (northern Scandinavia) (Château-Degat et al., 2010; Snodgrass et al., 2005).

In this paper, we focus specifically on Alaska due to relative availability of research using historical data for comparison to contemporary experiences, as well as the desire to focus on one specific region for more detailed discussion rather than generalized discussion of the vast and complex circumpolar north. Alaska is geographically, socioculturally, and ecologically diverse, and has a large Indigenous population. Until 1930, Alaska’s Native population was estimated to be over 50% of the total population of the territory, while today 18% of the total population is Native. However, the percentage of individuals who identified themselves as American Indian/Alaska Native (AI/AN) alone or in combination on the 2020 U.S. Census is considerably higher for some regions, especially the Bethel Census Area (88.5% AI/AN), the Northwest Arctic Borough (88.1% AI/AN), and the Kusilvak Census Area (96.9% AI/AN) (U.S. Census Bureau, 2020).

Alaska is the Native homeland of nearly half of the federally recognized AI/AN tribes in the U.S., and they can be meaningfully grouped into eight major (and broad) cultural areas: (1) Athabascan in the interior; (2) Tlingit, Haida, and Tsimshian of Southeast Alaska/North American Pacific Northwest; (3) Siberian Yup’ik of St. Lawrence Island in the Bering Sea; (4) Yup’ik, Cup’ik, and Yupiak of the central west coast; (5) Iñupiaq of the Arctic circle; (6) Alutiiq/Sugpiaq of Kodiak Island, Prince William Sound, and the southern Alaska Peninsula; (7) Unangan of the Aleutian Islands; and (8) Eyak of south central Alaska (Williams, 2009). While these eight broad cultural areas allow for some understanding and comparison, Alaska Native peoples maintain that there are too many cultural regions to number (Williams, 2009), and it is important to emphasize that each of the 229 tribes are complex, with internal differences tied to the land on which they have lived since time immemorial (Roderick, 2010). In this paper, we cannot adequately represent and discuss all facets of Alaska’s diversity, its experiences with the 1918 influenza and COVID-19 pandemics, and the potential points of interest for post-population health. However, we seek to broadly acknowledge what is known about Alaska and its pandemic experiences and open the conversation for more researchers to engage with the dynamics of health, emerging infectious diseases, and historical context in Alaska, especially in ways that are of direct benefit to the knowledge and lived experiences of Alaska Native peoples.

Population health is best conceptualized as the product of many determinants, including ecological and sociocultural determinants (Krieger, 1994, 1999). Alaska is geographically large, with settlements few and far between, where weather is a constant threat to healthcare for rural Alaskans. In Alaska, one of the most important determinants of population health is healthcare access (Allhoff & Goleman, 2020). As stated by Allhoff & Goleman (2020): “It is not just that Alaska is sparsely populated, or that it is huge, it is that it is both” (emphasis added).

Overall, Alaska Native peoples have relatively good health compared to Indigenous peoples of other circumpolar nations (perhaps not as good in general as those in Scandinavia but measurably better than those in Northern Russia), and the main risks to health include dietary changes, low activity levels, high tobacco usage, pollution, and climate change (Snodgrass, 2013). The top seven causes of death in Alaska, excluding COVID-19, are: cancer, heart disease, injuries, cardiovascular disease, chronic obstructive pulmonary disease (COPD), suicide, diabetes, and cirrhosis (Alaska

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Bureau of Vital Statistics, 2011). Systematic reviews from 2009 and 2011 show that for the top seven causes of death (plus three other important causes of death: influenza/pneumonia, sexually transmitted infections [including HIV], and tuberculosis), the common determinants are addiction, environmental exposure, diet/nutrition/exercise, social connectedness, access to clean water, climate change, access to quality healthcare, sexual and reproductive health, and occupational health and safety (Driscoll et al., 2013). Climate change has already caused significant economic and social upheavals in the Arctic (Parkinson & Evengard, 2009), and Indigenous peoples in the Arctic are at highest risk of severe negative outcomes of climate change due to the rapid transitions of the environment and their close relationship with the rapidly changing land (Hess et al., 2008). Many determinants of health are directly and indirectly linked to ongoing climate change in the Arctic, including consequences of severe weather, mental and social stress, loss of traditional lifestyle, newly emerging and re-emerging diseases, decreased access to safe water resources, and diet changes from loss of subsistence foods (Parkinson, 2008; Parkinson & Berner, 2009; Vors & Boyce, 2009).

Additional stressors such as poverty, land dispossession, globalization, and sociocultural transitions challenged the adaptability of Arctic Indigenous peoples in the face of climate change (Ford, 2012). Even so, we cannot ignore the considerable adaptive flexibility of Indigenous Arctic peoples, and some scholarly work has been done specifically to center and elevate Alaska Native agency and traditional ecological knowledge to leverage their strengths to adapt to their changing ecologies and to future pandemic threats (Ford et al., 2014, 2015; Wexler et al., 2014).

The 1918 influenza and COVID-19 pandemics in Alaska

The 1918 influenza pandemic

The 1918 influenza pandemic is often considered a worst-case scenario for an infectious disease outbreak. It is sometimes referred to as the deadliest pandemic ever, with a death count ranging from 15-40 million on the low end and 50-100 million on the high end (Crosby, 1989; Johnson & Mueller, 2002; Patterson & Pyle, 1991; Spreeuwenberg et al., 2018). With an early 20th century global population of about 1.8 billion people, this amounted to approximately 2-2.5% mortality (Johnson & Mueller, 2002). Discrepancies in death counts stem from differences in methodological approach (estimating mortality indirectly versus counting existing death records) and missing data in much of the world that did not keep extensive demographic and/or vital records. Even so, there were few places the 1918 flu did not reach, and though its global spread is often attributed to movement of troops during World War I, even nations not directly involved in World War I suffered from the disease (Humphries, 2013; Oxford et al., 2002). Additionally, there are general characteristics of the pandemic that have been observed worldwide, independent of geographic location, demographic composition of the population, or sociocultural diversity.

The two characteristics of the 1918 flu most pertinent to the context of Alaska are (1) the age pattern of mortality, and (2) the disproportionate burden of pandemic influenza in Indigenous versus non-Indigenous populations. First, younger adults, typically aged 20-40, experienced unprecedented excess mortality during the 1918 flu, which is atypical for what could be expected for a seasonal influenza outbreak (Gagnon et al., 2013; Luk et al., 2001). This is one of the most widely observed yet poorly understood characteristics of the 1918 flu, since the ages at highest risk were the very young and very old. A detailed discussion of theories explaining this phenomenon

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are outside the scope of this paper, but the key takeaway is that people who died at the highest rates from the pandemic virus were those who were otherwise expected to be in their prime of life, working regularly to earn money and resources for their families, reproducing, and providing dependent care. Second, Indigenous peoples worldwide were observed to suffer disproportionately more from the 1918 flu than the settler populations in the same regions (Mamelund, 2003; Mamelund et al., 2013; Rice, 2018). While there are some limitations to understanding in the current body of observations on Indigenous versus non-Indigenous experiences with the 1918 flu (van Doren et al., 2023), the observation that Indigenous pandemic outcomes were generally worse seems robust.

Despite the relative wealth of information now available for populations worldwide about the 1918 flu, there have not been many extensive studies of the 1918 pandemic experience in Alaska. The flu likely came to Alaska via steamships delivering resources, and the first cases emerged in the southeast in October 1918. By the end of October there were over 200 cases in Ketchikan, and only 10 days later there were 336 cases and 7 dead, 250 cases in Hydaburg, and 98 cases in Alaska Native individuals in Sitka (Lauterat, 1986). It is difficult to say how many people total died during the flu in Alaska, but early estimates placed the number somewhere between 2000 and 3000 people, leaving 500 children orphaned and some localities totally abandoned (Lauterat, 1986). The governor of Alaska at the time, Thomas Riggs, stated in a hearing at the U.S. Capitol that about 90% of the deaths in the territory were in the Alaska Native population (Sisson et al., 1919), which is supported by the estimate that around 950 Alaska Native people died in Nome alone.

As for the distribution of deaths in other Alaska regions, Philip and Lackman (1962) provided the first consolidated account, while Mamelund et al. (2013) further summarized this report and integrated data from other historical and academic sources (e.g., Alaska Legislature, 1921; Lauterat, 1986; U.S. Senate, 1919) to provide a more thorough presentation of available data. Philip and Lackman’s (1962) report provided an account of deaths in five major Alaska regions (Southeast, Southcentral, Yukon Delta, Seward Peninsula, and Southwest), and showed that the Southwest region (comprising Chogiung, Koggiun, and Naknek) suffered the highest mortality (35.4%) while the Seward Peninsula (comprising Nome, Teller, and Wales) had the second highest mortality (27.7%). Southcentral (9.3%), Yukon Delta (4.1%), and Southeast (1.7%) had relatively lower mortality, but even these percentages are high compared to mortality from influenza in nonpandemic years. An important observation of the distribution of deaths throughout the territory is the fact that coastal localities suffered the most from the pandemic; very few interior villages reported influenza deaths or cases. This may be due to reporting bias, but it can also be attributed to effective quarantine points in Shishmaref, Walla Walla, and Unalakleet, among other locations; villages around the Seward Peninsula that did not report any cases of influenza included Deering, Buckland, White Mountain, Koyuk, Elim, and Shaktoolik (Ganley, 1998). Fairbanks, Iditarod, and Yukon River were also protected by these quarantines (Sisson et al., 1919).2

Potentially one of the most important health conditions present in early 20th century Alaska (and for much of the rest of the 20th century) was the consistent and heavy burden of tuberculosis. The co-morbidity of pulmonary tuberculosis and influenza is severe; an existing infection with

2 Specific names of localities discussed in this paragraph are used so that they match their original use in the references in which they are published. It is possible that locality names have changed over time. Please see the references (e.g., Ganley, 1998; Philip & Lackman, 1962; Sisson et al., 1919) for more detail, includ ing labeled maps.

Biocultural perspectives of pandemics and post-pandemic population health in Alaska

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Mycobacterium tuberculosis, the bacteria that causes pulmonary tuberculosis, can accelerate the disease process of influenza and significantly increase the likelihood of death (Walaza et al., 2015, 2020). For populations in which there was a known tuberculosis burden prior to the 1918 flu, there have even been post-pandemic shifts in tuberculosis epidemiology due to selective effects during the pandemic (Noymer, 2009, 2011; van Doren & Sattenspiel, 2021). More specifically, those with active or latent tuberculosis infections were more likely to die during the 1918 influenza pandemic, leaving a smaller population of people infected with tuberculosis in post-pandemic years (Noymer, 2009). This phenomenon has not yet been explicitly investigated in the Alaskan context, but it is known that tuberculosis was present and prevalent, and was referred to as “The Scourge of Alaska” by Dr. Robert Fortuine in his classic book Chills and Fever (Fortuine, 1989).

The first systematic investigations of the prevalence of tuberculosis was not carried out until the mid-20th century (Comstock & Philip, 1961), but according to the first tuberculin survey, the prevalence of tuberculin reactors among Alaska Native children was 32% in the Aleutian Islands, 56% of the northwest coast and interior, and 75% in the Yukon-Kuskokwim Delta, with an estimated mortality rate for Alaska Natives of 501 deaths per 100,000 individuals in 1952 (compared with 1.8 deaths per 100,000 in the continental U.S. in the same year) (CDC, n.d.; Comstock & Philip, 1961). While the prevalence of tuberculosis during the exact years of the 1918 flu are currently unknown, it is reasonable to assume, based on these uncharacteristically high numbers for the mid-20th century, that the burden was heavy and likely was a strong determinant in how the people of Alaska experienced the 1918 influenza pandemic, especially since tuberculosis epidemiology is determined strongly by sociocultural and historical factors.

The COVID-19 pandemic

The COVID-19 pandemic is the most recent global infectious disease outbreak, and at the time of this writing, there have been nearly 770 million confirmed cases and over 6.9 million deaths; with a total global population of just over 8 billion people, this equals a 0.9% mortality rate worldwide (WHO, 2022), which is substantially lower than the 2-2.5% global mortality rate estimated for the 1918 flu. So far, there have been few research programs dedicated exclusively to the nature of the COVID-19 pandemic in Alaska, but general characteristics including cases, vaccinations, and deaths for each census area and borough have been well accounted for in the Alaska COVID-19 Information Hub (2022).

The first case of COVID-19 was identified in Ketchikan, Alaska in late spring 2020, but the epidemic curve was relatively delayed compared to the rest of the U.S. and other circumpolar nations (Petrov et al., 2020, 2021). By December 2020, vaccines were available in Juneau and were quickly distributed to Sitka, and then other rural island communities in Southeast Alaska as well as north to Anchorage and throughout the northern region of the state (McKinstry et al., 2020). By January 2021, Alaska had the highest per capita vaccination rate in the U.S. and was the first state to make COVID-19 vaccines available to everyone age 16+, in large part due to the extensive and tireless work of tribal health organizations, like the Alaska Native Tribal Health Consortium, and the thorough vaccination of the most remote villages (Berman, 2021). To date, there have been ~294,000 cases of COVID-19 in Alaska, and 1,449 deaths (0.5% mortality compared to 1.1% mortality for the whole U.S.) (Alaska COVID-19 Information Hub, 2022; WHO, 2022). The highest number of deaths per capita have occurred in Anchorage Municipality (187), Northwest Arctic Borough (184), and North Slope Borough (Utqiagvik) (142), and the largest number of cases

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have occurred in Denali Borough (71,388 cases per 100,000), Northwest Arctic Borough (68,351 cases per 100,000), and North Slope Borough (51,515 cases per 100,000) (Powell et al., 2022).

There have been many studies published that attempt to address inequalities observed in COVID19 disease and mortality broadly, including but not limited to: critical evaluations of differences in risk in the spectra of sex and gender (Shattuck-Heidorn et al., 2021); different outcomes in socially constructed race categories, including Indigenous versus non-Indigenous populations (Holmes et al., 2020; Mackey et al., 2021); and pre-existing co-morbidities and disability (Gleason et al., 2021; Zhou et al., 2021). The observations of inequalities for all these examples, as well as others not mentioned, are mixed and context dependent. Of particular applicability to the experience of Alaska during COVID-19 is the pattern in unequal outcomes between Alaska Native and nonAlaska Native peoples. Alves et al. (2022) reviewed the global observations with available data on COVID-19 outcomes in Indigenous peoples compared to non-Indigenous people of the same regions and found mixed results: sometimes Indigenous outcomes were worse, sometimes Indigenous communities were well protected from negative pandemic outcomes. The results for Alaska simply stated that there were not much data available, but the trends leaned towards slightly worse pandemic outcomes in Alaska Native peoples (Alves et al., 2022). Recently, Petrov et al. (2023) identified Alaska Native peoples’ agency over the pandemic response and sovereignty as a primary source of resilience, given Alaska Native peoples’ COVID-19 outcomes were generally not as severe as non-Alaska Native COVID-19 outcomes.

In a qualitative analysis of interviews with Alaska Native individuals in rural Southeast Alaska island communities, van Doren et al. (2023) show that there was significant adaptive behavior and considerable resilience in the face of the new pandemic. Specifically, Alaska Native communities drew on historical knowledge of the 1918 flu, knowledge of subsistence gathering, and communitycentered (rather than individualistic) protections to bolster their communities against COVID-19. Protections like the COVID-19 vaccines were considered the best way to “get back to normal” after spending most of the year isolating from one another in 2020. Even though communities throughout Alaska (not just in the southeast) occasionally expressed hesitancy about the vaccinations and opposition to mandated vaccines, they became widely accepted and well taken up throughout Alaska (Eichelberger et al., 2022; Hahn et al., 2022).

The results point towards an essential distinction between our current knowledge of the 1918 flu and COVID-19 pandemics: it is still somewhat unclear why Alaska Native communities seemingly suffered far more negative outcomes during the 1918 flu, but community-centered research that highlights the strengths of these communities during the COVID-19 pandemic shows ways that Alaska Native peoples are resilient in the face of novel pandemic threats. General epidemiological and demographic analyses, which make up a large proportion of 1918 flu knowledge of Indigenous peoples’ experiences with the historical pandemic, do not necessarily capture the lived experience of the 1918 flu or the agency of Native communities in resisting pandemics. In this vein, we must also consider the substantial bias in perspective of pandemic experiences, as most of the written historical record in Alaska is written from the colonial perspectives of both the U.S. and Russia. Therefore, most, if not all, of Indigenous historical knowledge and memory of the 1918 flu in Alaska Native communities exists in the form of oral histories in their own languages. In this way, it is possible that settlers will never know the nuance of how Alaska Native communities experienced this historical event.

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One parallel between the 1918 flu and COVID-19 pandemics in Alaska is the pattern of which communities suffered the most in terms of cases and mortality: coastal communities, especially those in the northern regions of Alaska, appear to have suffered the worst observed outcomes, while those in the interior seem to have suffered the least. This may seem counterintuitive on the surface, because if one of the essential determinants of maintaining health and treating ailments in remote Alaskan locations is access to care, then considerable distance from healthcare could have interfered with the ability of remote villages to endure the 1918 flu. However, the escape of many remote villages in Alaska during the 1918 flu is strongly tied to the movement of people and resources or rather, the lack thereof since quarantines were so essential in limiting the spread of the virus. Moving forward, pandemic preparedness plans must reflect on the characteristics of previous major pandemic events to integrate the methods that worked to reduce pathogen spread and mortality outcomes with the needs of idiosyncratic communities throughout Alaska. This work requires interdisciplinary cooperation between social scientists and public health practitioners to ensure that remote communities can continue to receive necessary resources safely (including vaccines), that remote communities can also access healthcare when needed for existing conditions and regularly circulating pathogens, and that larger cities in Alaska (e.g., Juneau, Anchorage) also have protective resources as main entry points to the state.

Population health futures: Delayed care and its consequences

The role of delayed care in holistic pandemic knowledge

Pandemics are disruptive epidemiological events that often have clear and substantial proximate impacts, but we must also consider the ways in which pandemics affect population health in the long term. Pandemic impacts do not end with those who died during the pandemic from the pandemic disease. Far more who are infected with a pandemic pathogen will survive than will not, and even people who may have never been infected or never progressed to active disease may be influenced indirectly via multiple possible pathways (van Doren & Brown, 2023). Here, we expand upon the current knowledge of how COVID-19 has impacted access to healthcare for other nonCOVID conditions, and why this phenomenon is going to be important for understanding longterm impacts of pandemics.

Post-pandemic impacts are difficult to study, but current evidence shows that demographic, epidemiological, and even genetic consequences manifest in the surviving population. While an extensive discussion of these patterns is outside the scope of this paper, others have reviewed demographic evolution in response to the Black Death and 1918 flu (DeWitte & Wissler, 2021), observed improvements in life expectancy and respiratory-specific survivorship and mortality in post-pandemic periods (Kelmelis & DeWitte, 2021; Noymer, 2009; Noymer & Garenne, 2000; Saglanmak et al., 2011; van Doren & Kelmelis, 2022; van Doren & Sattenspiel, 2021), and hypothesized about high selective mortality during the Black Death and its consequences on allele frequencies that are protective against certain intracellular pathogens (Klunk et al., 2022; Moalem et al., 2002; Weinberg, 2008).

Importantly, much of what we know about post-pandemic health in any population comes from records of people who died, such as mortality records or skeletal material. This bias in the data limits our understanding of survivor health in post-pandemic populations. Some countries such as Iceland (Cliff et al., 2009), Denmark (Saglanmak et al., 2011), and Norway (Mamelund et al., 2016)

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had well established methods of tracing cases in the early 20th century and could report on morbidity. However, this is the exception. We can better understand how pandemics affect population health by investigating how health changes in the surviving population, and one approach to this is through a closer look at the consequences of delayed care.

Over three years after the beginning of the COVID-19 pandemic in March 2020, the World Health Organization downgraded the COVID-19 pandemic from a public health emergency of international concern to an ongoing health issue (WHO, 2023). Now, we have some insight into how the COVID-19 pandemic has both directly and indirectly impacted not only epidemiological patterns, but also how people obtained medical care from 2020-22. From March to May 2020 in New York, over 24,000 deaths from all causes were found to be in excess of the baseline number of expected deaths for a typical three-month long non-pandemic period. It was suggested that these excess deaths could be attributed to social distancing, hospital burdens, and fear of exposure to the novel SARS-CoV-2 pathogen (Olson et al., 2020). From this initial observation, indications of changes in care-seeking behavior followed shortly: after this initial excess mortality burden was reported, the Weekly Morbidity and Mortality Report from June 12, 2020, reported that there was an observed 42% decrease in emergency room visits from March to April 2020 compared with the same weeks in 2019 (Hartnett et al., 2020). Research that has started to investigate the phenomenon of delayed care in more detail shows that up to one-third of adults experienced delayed care, and about 20% of those feel their health was negatively impacted by the delay, irrespective of the reason for delay or health condition (Zhong et al., 2022). However, Atherly et al. (2020) point out that there is still little known about the extent of delayed care or what kinds of services most patients needed but delayed. Importantly, delays in healthcare may impact people independently of whether they were ever infected with SARS-CoV-2 or ever suffered from COVID-19 disease.

Biocultural anthropologists are well positioned to study delayed care in the context of pandemics because it highlights how many different human behaviors public health decisions, personal choices, and social norms can have biodemographic consequences (van Doren & Brown, 2023). Biocultural theories and studies can help inform the concept that pandemics and other acute threats are possible inflection points in population health that may reverberate and be identifiable for long after the epidemic curve is over.

Observations of delayed care

There is an emerging body of literature investigating delayed care during the COVID-19 pandemic, but who delays care and why will be specific to a population’s environment, ambient social conditions, trust in public health guidance, effectiveness of public health interventions, and more. Here, we briefly review some of the current literature on delayed care published since the beginning of the COVID-19 pandemic. We note that there are no purposeful investigations of this problem in any Arctic space worldwide, or Alaska specifically. With this in mind, we will highlight some key considerations for social scientists and public health practitioners moving forward to meet the challenges of this potential new public health burden in Alaska.

First, it is critical to understand why delayed care occurred. There has not been a systematically derived characterization for reasons why people delayed care, but van Doren and Brown (2023) outlined a possible scheme: (1) public health mandates like social distancing guidelines, shutdowns, and pauses of non-emergent procedures prevented people from accessing medical institutions (Ashkenazy et al., 2021; Atherly et al., 2020; Beran et al., 2020; Gupta et al., 2021); (2) hospitals and

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clinics overburdened with COVID-19 cases additionally prevented patients from accessing healthcare, even for emergent conditions (characterized as involuntary care disruption [Callison & Ward, 2021]) (Blay et al., 2021; Lei & Maust, 2022; Wilson et al., 2021); and (3) personal risk assessments leading to the choice not to enter institutions that could put them at risk of exposure to COVID-19 at any point (Beran et al., 2020; Caston et al., 2021; Clodfelder et al., 2022; Doncarli et al., 2021; Lusambili et al., 2020; Nab et al., 2021). Underlying motivations for or determinants of delayed care rest on various human behaviors and layered decision-making processes, which is important information even for more biologically oriented population health researchers. Importantly, each of these reasons for delayed care may intersect with one another and with other sociocultural factors, leading to a much more complex picture of how and why delayed care has become so prevalent during the COVID-19 pandemic.

Second, it is important to understand which health conditions were most affected by delayed care. The initial research published that investigates the health conditions for which delayed care was common covers a broad range of conditions. Most prominently, at least in the early phases of the pandemic, dramatic reductions in presentations of myocardial infarction (MI) were observed; in June 2020 in Denver, Colorado, over 18% of patients refused emergency transportation during an MI and 22% of MI patients died in the hospital compared to only 4% during the same period in the previous year (Clodfelder et al., 2022). Others observed that there was as much as a 60% drop in cardiology visits, 50% reduction in blood pressure evaluations, and millions of cardiac rehabilitation sessions were canceled overnight (Duffy et al., 2021). Overall, the total number of emergency room visits dropped around 30-42% from 2019 to 2020 (Hartnett et al., 2020; Igal et al., 2021). Lange et al. (2020) point out that the data collected on emergency room visits represents an important stress test for the state of life-threatening conditions that could result in permanent disabilities in the surviving population, so even during a pandemic, it is ideal neither for patients to skip visits, nor for population health researchers after the fact.

Cancer has also been studied in terms of delayed care. The observations and consequences of delayed cancer care are diverse and complex and are dependent on the type of cancer and progression of the disease. Overall, in 2020 there were drastic reductions in chemotherapy, immunotherapy, and new cancer diagnoses (de Joode et al., 2020), as well as home care services for progressed cases (Jeba et al., 2022). For breast cancer patients in the U.S., younger patients who had larger households and childcare responsibilities were significantly more likely to delay appointments (Li et al., 2021), which to some extent speaks to the ways domestic responsibilities especially the elevated responsibilities of women during the COVID-19 pandemic (Power, 2020) impeded on the ability to access healthcare, as well.

Other conditions that have been investigated, albeit sparingly, include diabetes, sexual and reproductive health, and other (non-COVID) infectious diseases. One of the only analyses of the consequences of delayed care on other infectious diseases was in the context of dengue fever in the Philippines. The study found that the determinants of care delays included financial constraints associated with illness and disease, location and transportation relative to care-providers, and hospital capacity, which were all important factors in administration of care to patients (Lisgay et al., 2021). Recent observations of diabetes have shown that there has been a recent increase in cases of diabetic ketoacidosis in people of all ages, suggesting that delayed care-seeking for diabetes may have caused more rapid diabetes progression (Ambati et al., 2022). Finally, many of the

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conditions discussed above are also known to be exacerbated when co-morbid with COVID-19, especially cardiovascular disease (Bansal, 2020; Clerkin et al., 2020; Nishiga et al., 2020), cancer (AlQuteimat & Amer, 2020), and kidney disease (Durvasula et al., 2020; Khouchlaa & Bouyahya, 2020).

In Alaska, one of the most pressing concerns for emergent, infectious, and chronic diseases in addition to wellbeing, in general is the ability to access healthcare. Most of Alaska is rural, and most of its rural locations are also remote, that is, a distance that cannot be traversed in a single day of travel, or across rivers that freeze over for months of the year (Allhoff & Goleman, 2020). A report from the Arctic Council (2020) has indicated that there has been some delay in regular healthcare administration during the COVID-19 pandemic. The report acknowledged that delayed care during the pandemic is only one facet of a complex web of health determinants, and that people are broadly battling higher risk from pandemic influenza due to underlying health conditions, tuberculosis, difficulty accessing healthcare due to geographic isolation and travel complications, and some lack of infrastructure (Arctic Council, 2020). Further, delays in or absence of transportation to health centers has led to further health complications and preventable death, and the delay of non-emergency visits will worsen in places in which ischemic heart disease, cancer, chronic respiratory disease, and mental health issues are already present (Arctic Council, 2020).

The authors of this paper have collected two waves of survey data from hundreds of respondents around Southeast Alaska from spring 2020 and winter 2020-21 to explore the way Southeast Alaskans perceived risks related to COVID-19, prepared for the pandemic to reach Alaska, and then subsequently modified their behaviors to protect themselves and their communities from the pandemic. In the winter 2020-21 wave of the survey, there was a specific question regarding to what extent respondents delayed seeking healthcare since the beginning of the COVID-19 pandemic. The results of this question are presented in Table 1, with the responses stratified by whether the response came from a person in a large town (Juneau, Sitka, or Ketchikan) or a small town (Angoon, Craig, Elfin Cove, Gustavus, Haines, Hoonah, Klawock, Petersburg, Skagway, Wrangell, Yakutat, or other small localities). Results are additionally stratified by whether the respondent self-identified as Alaska Native or non-Alaska Native on the survey. Without statistical analyses, most people who responded to the survey in winter 2020-21 had, to some extent, experienced delayed care for one reason or another: for Alaska Native respondents, 81% in large towns and 75% in small towns said they experienced delays in care, while 82% and 85% of nonAlaska Native respondents said they experienced delays in care in large and small towns, respectively. To this point, this small set of results (relating only to Southeast Alaskan communities) comprise most of our knowledge of delayed care in Alaska; therefore, much more work needs to be done to understand to what extent Alaskans experienced delayed care during the COVID-19 pandemic, to detangle reasons why care was delayed, and to prepare for post-pandemic medical and public health burdens of the consequences of delayed care.

The observations presented here, and those presented by the Arctic Council (2020), strongly underlie the idea of the indirect impacts on population health introduced above. Moving forward, public health emergency responses to and preparedness plans for pandemics should not forget to invest energy and careful thought into how pre-existing population health conditions and idiosyncratic ecological barriers could influence the outcomes of a pandemic, and potential outcomes for long into the future. This may be true whether the pandemic pathogen is introduced

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or becomes epidemic at any given time within a population. Most of the articles cited throughout this discussion of delayed care were from a biomedical, clinical, or epidemiological perspective (only a couple were qualitative and patient-centered). Moving forward, social scientists and public health practitioners should work together, using a holistic perspective to understand and address the complex determinants and potential consequences of delayed care during a pandemic event in a region like Alaska, especially for conditions like cardiovascular disease, diabetes, and cancer, which charge interest on the body if they go untreated and are uncontrolled. We outline more specific pathways forward below.

Table 1. Distribution of responses to the question: Did you delay seeking healthcare for any reason since the beginning of the COVID-19 pandemic? Answers obtained during a pulse survey throughout Southeast Alaska to investigate risk perception of and preparation for COVID-19 in winter 2020-2021. Results here are stratified by Alaska Native vs. non-Alaska Native respondents, and whether the respondent comes from a large or small town in Southeast Alaska.

Conclusions: Integration for holistic pandemic preparedness

Reflection upon the historical experiences of Alaska during the 1918 flu can be useful context for the modern experience with COVID-19, and more importantly, for developing preparedness plans for the inevitable future epidemic challenges. From a social science perspective, some essential conclusions can be made: there are complex determinants for how Alaska Native peoples experience pandemics versus non-Alaska Native people; human behaviors that mitigate the spread of the pathogen (e.g., quarantines) work very well in Alaska; and when Alaska Native communities have agency over emergency pandemic responses that are grounded in traditional ecological knowledge, the response can be effective in mitigating an otherwise potentially detrimental pandemic wave. These commonalities across a century are important to draw upon as strengths of the socioculturally diverse and geographically disparate Alaskan population and should be carefully considered as we move into a post-pandemic period.

Research on pandemic effects, responses, and resilience in Alaska communities will inherently involve rural and remote communities, including those populated mostly or entirely by Alaska Native peoples who rely on hunting, fishing, and gathering for subsistence. Due to their relative geographic isolation and the ecological diversity across Alaska, these communities vary dramatically in local organization and governance and the way they connect with the land, both factors that are vitally important in pandemic vulnerability (including biological vectors and pathways for

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Alaska Native respondents Non-Alaska Native respondents Large Small Large Small Response n (%) n (%) n (%) n (%) Not at all 7 19 3 25 52 18 5 15 To some extent 11 31 3 25 127 44 8 24 Certainly 18 50 6 50 107 37 20 61 % of respondents who delayed care "to some extent" or "certainly" 81 75 82 85

transmission), resilience, and response. As a result, assumptions and research practices used in the lower 48 states, especially those established in large urban communities, cannot be simply exported and transplanted to the unique Alaskan context. Instead, biocultural research on COVID-19 and other pandemics must follow the principles of community-embedded co-design (Parsons et al., 2016). This allows local knowledge to co-lead the research process as an equal partner, which increases not only the accuracy and relevance of research but also local buy-in by Indigenous peoples and other communities. Ideally, communitycentered approaches would begin with the Indigenous communities identifying areas of need for the basis of the research to yield the most benefit from the knowledge created through their leadership and collaboration. Incorporation of traditional ecological knowledge will help pandemic research programs stay attuned to ecological diversity and the diversity of mental models used by communities to understand and adapt to pandemics (Southwell et al., 2020). Importantly, such research programs require iterative, participatory design. This comes at a cost; such research is often ill-matched to current, biomedically-based ethical review panels (Goodyear-Smith et al., 2015), and research co-design takes careful, long-term work in communities to establish rapport and engage in non-traditional methods for data collection and mutual understanding that is, coproduction of knowledge (Armitage et al., 2011; Latulippe & Klenk, 2020). Additionally, this relationship requires a re-framing of how Western scientists conceptualize Indigenous knowledge, which is too often not considered scientific or rigorous despite many millennia of observation, iteration, refinement, precision, and communication. That is, Indigenous knowledge should never be treated as inferior to Western science in the process of knowledge co-production. We believe the process of such an approach is worth the effort; “one size fits all” pandemic policies can lead to confusion, resistance, loss of trust, and unintended negative consequences.

Other researchers in the Arctic have also written on the importance of the value of this coproduction approach: while not referring to the framework as “biocultural” specifically, Cueva et al. (2020) put forth a similar and useful framework to more accurately represent health challenges in circumpolar spaces and highlight a participatory community-based approach to better understand the individual, family, social, cultural, historical, and environmental contexts of communities in the circumpolar north. The need for this framework comes from their observation that most research dedicated to health of circumpolar communities is most focused on (a) epidemiology and inequalities; and (b) resilience and survival-oriented characteristics (Cueva et al., 2020). We are encouraged by the move towards more holistic knowledge creation and understanding of the Arctic and emphasize that these community-centered approaches have much to contribute to pandemic preparedness through purposeful intersections with not only public health, but other areas of research such as disease ecology (Archie et al., 2009; Young et al., 2017), One Health (Rock et al., 2009), and climate change (Jacobs et al., 2021; Wu et al., 2022).

Because co-design and co-production are newer approaches and create tension with established, top-down methods of research, this approach is in its formative stages. However, research that does not follow these principles is often rejected or perceived negatively, especially by Indigenous communities (Zurba et al., 2022). Co-design and co-production are especially important for research that may involve biological data collection or biological inferences, given the rocky history of such research involving Indigenous peoples. Based on our review, a biocultural approach to pandemics in Alaska that takes local context seriously has much to promise and will aid our

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understanding of the long-term consequences of pandemics as well as future pandemic preparedness.

Acknowledgments

This research was funded by the National Science Foundation Arctic Social Sciences Program RAPID grant #2030653.

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Zhou, J., Liu, C., Sun, Y., Huang, W., & Ye, K. (2021). Cognitive disorders associated with hospitalization of COVID-19: Results from an observational cohort study. Brain, Behavior, and Immunity, 91, 383-392. https://doi.org/10.1016/j.bbi.2020.10.019

Zuckerman, M. K., Tribble, A. G., Austin, R. M., DeGaglia, C. M. S., & Emery, T. (2022). Biocultural perspectives on bioarchaeological and paleopathological evidence of past pandemics. American Journal of Biological Anthropology, in press. https://doi.org/10.1002/ajpa.24647

Zurba, M., Petriello, M. A., Madge, C., McCarney, P., Bishop, B., McBeth, S., Denniston, M., Bodwitch, H., & Bailey, M. (2022). Learning from knowledge co-production research and practice in the twenty-first century: Global lessons and what they mean for collaborative research in Nuatsiavut. Sustainability Science, 17, 449-467. https://doi.org/10.1007/s11625021-0096-x

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Taming Coronavirus: Siberian Yup’ik COVID-19 strategies on St.Lawrence Island, Savoonga USA

As the COVID-19 spotlight has been primarily focused on developed nations and their domestic agendas, the challenges for remote regions are often overlooked. Among the most compelling stories in the health care crisis centers around the small Siberian Yup’ik island community of Savoonga. With a population of 826, Savoonga is in the Bering Sea, off Alaska’s western coast, closer to Russia. It is one of only two villages on St. Lawrence Island, along with Gambell. (Bartholomew, 2015).

Like other Alaskan Native communities in the High North, for Savoonga, the deadly coronavirus epidemic has exacerbated the tangible consequences of climate change. Changes in sea ice melt has created seasonal imbalances in the Bering Sea’s marine ecosystem, creating food insecurity. The loss of sea-ice hinders Savoongan whalers, seal and walrus hunters and fishers’ ability to access their traditional sustenance. Warming is altering the finely tuned and interconnected marine ecosystem. “The seals and walrus are getting skinnier,” according to George Noongwook, the recently departed whaler and author. The fish these mammals feed upon are moving north, seeking colder waters.

As the coronavirus silently made its way to Savoonga’s shores, the hard, skillful work of a subsistence way-of-life, already impeded by climate change, got that much harder.

Anita Parlow, Esq., MSt. Oxford. Fulbright Scholar, Iceland 2017-2018.

The resolve of Savoongans, like all Alaskans, to survive COVID-19 is fueled by painful memories of past plagues, epidemics, pandemics, and an 1887 starvation at the onset of commercial whaling that left St. Lawrence graveyards full, often with Elders who are the mainstay to keep the Siberian Yu’pik culture, ethic and language from “disappearing.” (Martin, 2009).

The 1918 Spanish flu pandemic that, according to author Alfred W. Crosby, killed some 30 million worldwide, wiped out more than half of Alaskan Native villages, with dying adults and children alike having scant resistance to the infections brought by outsiders. Of the villages that survived, more than half the population was gone. (Crosby, 2003).

Seven years later, in 1925, a diphtheria outbreak, again, brought by outsider commercial fishers, fur traders or miners, enveloped both Nome and its nearby Native villages. The Nome-based doctor, Curtis Welch, predicted an unstoppable mortality rate without the anti-toxin serum. Getting the diphtheria anti-toxin to Nome posed a formidable problem to a town accessible only by boat, plane, or dogsled. That winter, one of the worst in decades, Nome was blocked by sea ice that froze the harbor. It was also unreachable by bush plane whose water-cooled engines froze. (Crosby, 2003).

With cases mounting, public health officials in Anchorage assembled a non-stop relay of 20 dog teams to deliver the lifesaving anti-toxin “serum run.” The primarily Indigenous mushers and about 150 sled dogs trekked, non-stop, the 674 miles from Nenana to Nome, in just five and a half days. Leonhard Seppala, an award-winning dogsledder, and his Siberian Husky lead dog, Togo, traversed 264 miles in the sub-zero temperatures, handing off the serum to his colleague, Gunnar Kassen, who borrowed Seppala’s dog, Balto. Balto famously ran the last leg, bringing the serum into Nome. Today’s internationally known Iditarod dogsled race offers an annual tribute to the lifesaving relay. (Martin, 2009 and Crosby, 2003).

Once again faced with a global pandemic reaching their shores, the Elders set the tone for Savoonga’s careful and effective COVID-19 strategy, with particular focus on protecting the children. The Elders and leadership knew they had to act fast and unified. A single case could decimate the entire village, with multi-generational families living close-together in small homes.

Savoonga Tribal Chairman, Ben Pungowiyi, a world class ivory carver, teacher, and hunter, said “we are a people with a long future and deep past.” Pungowiyi put the 2,000-year-old community of subsistence hunters and whalers on full lock down. All public movements were restricted. Noone was allowed to leave their home, except to get their mail. Everyone played a role in the communities’ unified effort to stay safe. The Savoonga Native Store announced it would accept orders only by telephone on its landline, and then made door-to-door deliveries. The tribe offered transport to anyone who needed stove oil or gas.

Preston Rookok, a lifelong Savoongan whaler, noted that tribal leadership, as part of its protective effort to shut the island down, restricted the number of whalers allowed on the small whale-hunting boats to family members only. The tribe also required everyone on the boat stand six feet apart.

“We call it prevention,” Rookok said. The schools were shut down. The daily plane coming in and out of Nome, across the Bering, required full testing before anyone was allowed aboard. Ceremonial dances for funerals, celebrations or spiritual purpose were halted.

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Parlow

While a considerable amount of reporting focused on the high mortality rates in the lower 48 states, academics like Andrey Petrov noted that the high level of vigilance and preparedness of Alaskan Native communities allowed for an effective COVID-19 response (Petrov, 2017).

The second prong of Savoonga’s strategy to curb the pandemic was that the federally recognized sovereign tribes opted to coordinate with the state’s centralized public health infrastructure to form Alaskan Native community partnerships. This cooperative approach made direct and coordinated links between the state’s vaccine distribution with community-based protection strategies. Additionally, Alaskan Native Tribes generally opted for total lock-downs, mask wearing and social distancing, despite the reluctance of the State to mandate protective action. However, all of Alaska’s Tribal governments opted to partner with the Alaskan State agencies rather than the more top-down federal agencies, such as the DC-region based Indian Health Service. Alaska’s vaccination program was perhaps more successful than many of those in the lower 48 states due to the integrated working relationship developed between the Alaskan Natives and the State. Dr. Anne Zink, Alaska’s Chief Medical Officer, told the American College of Emergency Physicians that Alaska’s strategy to deliver the vaccines worked as effectively as it did because of a partnership with Alaska’s 229 sovereign tribes. (ACEP News Central, 2021).

Alaska’s leadership took aggressive action with the federal government that granted Alaska territory status, rather than a state. This, along with the Indian Health Service and the Department of Defense’s higher allocation of doses, allowed for vaccines to be delivered in monthly tranches rather than more limited weekly deliveries. Dr. Zink said the territorial designation allowed Alaska more time for planning and logistics, which was important given the need to get the vaccines to remote villages by air, boat, snowmobiles or dogsled, in harsh storms or temperatures well below zero. In Savoonga, where the vaccines are delivered by air from Nome, the number of vaccines were boosted by support from the Indian Health Service and U.S. Department of Veterans Affairs, given the high number of veterans who live in, or retire to, Alaska, as well as the high number of Alaskan Native military veterans and Native peoples generally. (ACEP News Central, 2021).

During one of the regular Tribal-Health COVID-19 Zoom calls between Dr. Zink and the tribal leadership, one of the participants noted his resolve to protect his community in direct tribute to the grandparents he never knew; they all died of diphtheria, according to a participant.

The rapid and aggressive actions of the tribal-state partnership made a difference.

As of February 8, 2022, the Nome Nugget reported that:

• the U.S. had 76,852,768 COVID-19 cases and 905,543 COVID-related deaths. Alaska had 220,388 cases, 3,478 hospitalizations and 1,060 deaths.

• the current 127 patients diagnosed with COVID-19 hospitalized, with four additional patients who are under investigation for a total of 131 current COVID-related hospitalizations in Alaska.

• the Nome Bering Strait and Norton Sound region, (that includes Savoonga,) saw at least 4,332 cases, 37 hospitalizations and 3 deaths. (Schreiber, 2023).

While Savoonga has experienced several spikes in numbers that then retreat, the Savoonga Emergency Room Tech at the Norton Sound Health Corporation, Rene Trevino, said the number of patients at the clinic doubled during COVID. But, he added, thanks to the preparedness of the

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tribal actions, “no one needed to be medevaced out.” And, he said with relief, “no one in Savoonga has died from COVID-19.”

By April 2023, Chairman Ben Pungowiyi spoke as though COVID-19 had become just another hard issue that the tribe must address, much like many other of the mounting challenges for the centuries old community that has prevailed with its 2,000 years of living in balance with the Bering Sea’s marine ecosystem.

As though anticipating the time when the U.S. Government would shift COVID-19 from “pandemic” to “endemic” status, the Savoonga Tribal Chair said his people are moving on. “We have red tide that is poisoning the mussels on shore with threats to people and mammals that consume them; we are inundated with impacts of climate change that melts the sea-ice; The different seasons are changing the biodiversity and timing of the marine ecosystem; our waters are being polluted by increasing numbers of passing ships in the Bering Sea, with plastics now showing up on our shores,” he explained.

Savoongans are on the front lines of climate change, and they succeeded in both accessing the vaccine and developing a community-based strategy in which no lives have been, thus far, lost during the COVID pandemic. They handled the pandemic better than most with tribal and state government cooperation at its center. The Chairman noted that Savoongans are increasingly being invited to state, national, Indigenous, and international meetings to discuss strategies to build greater balance in policies that reject concepts of human domination of the natural world, and instead, hear the voices of the plants, mammals and oceans

Savoongans, like Indigenous subsistence communities worldwide, embody a philosophy and practice strengthened by thousands of years in the High North. For a truly safe, sustainable and equitable future, Savoongans – and all Indigenous subsistence peoples - must have a seat at the table of international discourse and policymaking to improve the possibility for a safe and sustainable future.

References

ACEP News Central (2021, Oct. 26). “You have to Keep Your Eye on the Bal” State medical directors discuss lessons learned during pandemic response., American College of Emergency Physicians Scientific Assembly 2021 News. Retrieved from https://www.acepmeetingnewscentral.com/acep-21/article/21796554/you-have-to-keep-youreye-on-the-ball

Bartholomew, B. (2015). Savoonga Ivory Carvers: A Yup’ik Ivory Carving Tradition. CA Design.

Bohrer, B. (2021, April 19). Some remote Alaska villages achieve high vaccination rates. Anchorage Daily News. Retrieved from https://www.adn.com/alaska-news/rural-alaska/2021/04/19/someremote-alaska-villages-achieve-high-vaccination-rates/

Crosby, A. W. (2003). America’s Forgotten Pandemic: The Influenza of 1918. Cambridge University Press, Second Edition.

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Grybill, J. & Petrov, A. (2020). Arctic Sustainability, Key Methodologies and Knowledge Domains: A Synthesis of Knowledge I. Routledge.

Loewi, P. (2022, Nov. 2). Windstorms Affects Testing Efforts. Nome Nugget, front page.

Martin, V. E. (2009). A Long Way to Nome: The Serum Run ’25 Expedition. CreateSpace.

Parlow, A. (2022). Decolonization, Food Sovereignty, and Climate Risks: The Case of St. Lawrence Island in the Bering Sea, Arctic. In: Behnassi, M., Gupta, H., Kruidbos, F., Parlow, A. (eds) The Climate-Conflict-Displacement Nexus from a Human Security Perspective. Springer, Cham. https://doi.org/10.1007/978-3-030-94144-4_10

Schreiber, M. (2023 Winter). Setting Our Sights by the Northern Lights. The Wilson Quarterly. Retrieved from https://www.wilsonquarterly.com/quarterly/the-new-north/setting-our-sightsby-the-northern-lights

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Indigenous approaches to public health: Lessons learned from Yukon First Nation responses to the COVID-19 pandemic

Council of Yukon First Nations, Math’ieya Alatini, Kari Johnston, Alison Perrin, Rhiannon Klein, Kiri Staples & Kristeen McTavish

The COVID-19 pandemic brought many challenges to Yukon First Nations (YFN) in relation to intergovernmental collaboration, including coordination of health services, emergency measures communication, and access to health data. These challenges are in part related to the complex landscape of relationships between multiple governing authorities in the territory. The Yukon is one of three territories in northern Canada and is home to 14 YFNs, 11 of which are modern treaty holders. YFN modern treaties recognize and present the opportunity for collaboration between governing authorities, specifically YFN governments, the Government of Yukon (YG), and the Government of Canada. However, nation-to-nation collaboration involving both treaty and non-treaty nations must be sought.

YG is primarily responsible for health-care program and service delivery for all Yukoners, inclusive of Indigenous populations, as well as administering Yukon's Civil Emergency Measures Act (CEMA). We sought to better understand the intergovernmental dynamics that were at play during the COVID-19 response in the Yukon and identify lessons learned for interjurisdictional emergency and pandemic response. We conducted qualitative Intra-Action Reviews with YFN, territorial, and municipal government representatives involved in the pandemic response. Our preliminary analysis highlights challenges and lessons learned related to YFN self-determination in emergency planning, critical challenges faced by rural and YFN communities in emergency response, and lessons for future pandemic planning and public health strategies in the Yukon. These findings confirm key gaps and priorities that have been identified by others, provide context-specific elaboration and examples, and identify additional opportunities to be explored.

Council of Yukon First Nations; Math’ieya Alatini, Yukon First Nations COVID Response Team; Kari Johnston, Yukon First Nations COVID Response Team; Alison Perrin, Yukon University; Rhiannon Klein, Yukon University; Kiri Staples, Kiri Staples Consulting; Kristeen McTavish, Council of Yukon First Nations

Introduction

In early 2020, the Government of Yukon (YG) declared a state of emergency in response to the spread of Sars-CoV-2, dubbed “the COVID-19 Pandemic”. The Yukon, a territory in northern Canada, faced several governance challenges in responding to the pandemic in subsequent months and years. Some challenges were ubiquitous across Canada; for example, many jurisdictions struggled to navigate the relationship between different levels of government that is required when responding to an emergency such as COVID-19. The pandemic also presented unique governance challenges in the Yukon. These challenges were grounded in the complex legal and governance landscape, which includes modern treaty holders1 , unsigned First Nations, and transboundary Nations, as well as multiple systems of law and legal traditions. The unique geography of the Yukon added further complexity to the pandemic response, as the region remains relatively isolated from much of southern Canada, has limited health-care facilities, and is home to numerous small, geographically dispersed communities. The Yukon is also no exception to a long history of exploitative and colonial treatment by the state in its relationship with Yukon First Nations (YFN). This ongoing legacy is especially relevant to health care, creating further complexities in the context of a pandemic.

In coordinating its response to the pandemic, YG was tasked with managing multiple relationships, including those with federal, municipal, and YFN authorities. The ongoing efforts to respond to COVID-19 in the Yukon therefore present an opportunity to learn about complex interjurisdictional relationships during emergencies and in health-care responses. While some literature has provided early reflections on the pandemic response in the Yukon (McPheeKnowles et al., 2022; Graham, Curran and Johnston, 2022), there has yet to be an analysis that focuses on interjurisdictional dynamics or one that centres YFN perspectives. This perspective is especially important for informing future emergency responses in the region and may be informative for other regions with similar interjurisdictional contexts. In the Yukon, it is particularly timely to document this perspective as YG is currently undertaking a review of the Civil Emergencies Measures Act (CEMA).

The research team aimed to respond to these needs by supporting YFNs in a process of reflection and examination of intergovernmental relationships during the COVID-19 pandemic. In this paper we outline the key contextual elements needed to understand the jurisdictional complexities at the centre of the Yukon’s COVID-19 pandemic response. We then present preliminary research results from an Intra-Action Review process and discuss these results in the context of interjurisdictional emergency planning and response involving Indigenous and nonIndigenous authorities

Context

Interjurisdictional dynamics and the COVID-19 pandemic in Canada

Reflections and lessons learned from the response to the COVID-19 pandemic will likely continue to emerge for years to come. Nonetheless, there are already numerous publications that

1 In this article, we use the term “modern treaties” and Final and Self-Government Agreements interchangeably.

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provide preliminary observations and analyses of pandemic responses, including those discussing the challenges and interjurisdictional dynamics of addressing COVID-19. Early in the pandemic, Indigenous legal scholars and others observed that provincial, territorial, and federal governments in Canada were failing to acknowledge Indigenous jurisdiction and sovereignty within their pandemic responses. For example, Craft, McGregor, and Hewitt (2020) noted that both Ontario and federal emergency acts fail to provide funding to First Nation communities when declaring a state of emergency. The need to respect Indigenous sovereignty within emergency responses – for example, by ensuring Indigenous authorities decide how funding is used during a pandemic – has also been acknowledged internationally (Hillier et al., 2020).

Another theme highlighted by the literature has been the lack of attention to specific needs of Indigenous communities within pandemic responses. This is demonstrated by the absence of action plans specific to the unique challenges of First Nation reserves in Canada, the need to better understand specific capacity constraints that the pandemic placed on Indigenous governments and organizations, and the need for public education materials grounded in local contexts and languages (Craft et al., 2020; Mashford-Pringle et al., 2021; Richardson & Crawford, 2020). In the Northwest Territories, the territorial government tailored communication strategies to specific communities and provided communication resources to local governments, exemplifying how tailored approaches can be more successful (Cochrane, 2021). In addition, the need for Indigenous-specific data accompanied by data sovereignty agreements to support pandemic responses has been noted (Mashford-Pringle et al., 2021; Richardson & Crawford, 2020).

Reflections from the pandemic response in Canada have illustrated the importance of honouring a nation-to-nation relationship between Indigenous governments and other levels of government, and the need to improve that relationship to support future pandemic and emergency planning and preparedness (Hillier et al., 2020; Mashford-Pringle et al., 2021; NCCAH [National Collaborating Centre for Aboriginal Health], 2016; Richardson & Crawford, 2020). For example, in the Northwest Territories, the territorial government found collaboration and relationshipbuilding with Indigenous governments on the pandemic response was key to its success (e.g., meeting early on and regularly providing briefings) (Cochrane, 2021). Hand-in-hand with this relationship is the importance of ensuring community-based leadership and preparedness within emergency response (Kyoon-Achan & Wright, 2020).

Indigenous health literature has long documented inequities in health care, health outcomes, and basic services that exist in many Indigenous communities. Since the onset of COVID-19, researchers, practitioners, and community leaders have been quick to call attention to the negative impact these longstanding inequities in infrastructure and public services within Indigenous communities have on the effectiveness of pandemic responses (Inuit Tapiriit Kanatami, 2020; Levesque & Thériault, 2020; Mashford-Pringle et al., 2021; Penney & JohnsonCastle, 2020). These underlying inequities (e.g., inadequate housing, poor access to clean water) must be addressed if future pandemic responses are to be made more effective within historically marginalized communities that are often at greater risk (Levesque & Thériault, 2020).

Finally, early publications during the pandemic documented strategies and tools for responding to the COVID-19 pandemic that involve or are led by Indigenous governments and organizations. Examples include lockdowns, travel restrictions, curfews, checkpoints, failure-to-

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comply fines, culturally appropriate wellness responses, and Indigenous community emergency preparedness plans (Craft et al., 2020; Richardson & Crawford, 2020). Indigenous governments and organizations drew on multiple sources of authority to enact these pandemic responses, including treaties, bylaws, various sections of the Indian Act, and the United Nations Declaration on the Rights of Indigenous Peoples (Craft et al., 2020). While some approaches have been solely enacted by Indigenous authorities, others require intergovernmental collaboration.

Although it is nascent, the literature reviewed here highlights several key themes related to jurisdictional complexities of pandemic response in Indigenous communities. These include challenges to and successes of Indigenous jurisdiction and self-determination, nation-to-nation relationships with non-Indigenous authorities, and persistent inequities impacting health within Indigenous communities. The preliminary research results presented here will build upon this emerging body of knowledge, providing additional practical considerations for policy and action.

Geographic context and governance in the Yukon

The Yukon is geographically located in the northwest corner of Canada, with an area of 482,443 km2 and a population of 43,774 (Yukon Bureau of Statistics, 2021, 2022). Approximately 22% of the Yukon’s total population is Indigenous, with 17% identifying as First Nations2 (Statistics Canada, 2021). There are 14 YFNs that are part of eight linguistic groups including, Gwich’in, Hän, Upper Tanana, Northern Tutchone, Southern Tutchone, Tagish, Kaska, (all of which are Athapascan languages) and Tłingit. There are also several transboundary Indigenous groups with settled or unsettled land claims within the Yukon (see Figure 1). The majority of the Yukon’s population (79%) lives in or around the urban centre of Whitehorse (Yukon Bureau of Statistics, 2022), while the rest is spread throughout seven rural municipalities and a number of smaller unincorporated communities. Of Yukon’s rural population, 43% identify as Indigenous, whereas 17% of the Whitehorse population identifies as Indigenous (Yukon Bureau of Statistics, 2021).

The territory has always been home to Yukon First Nations. Their rich cultures, languages and community-oriented values and beliefs ensured their survival and allowed them to thrive. Although YFNs encountered European and Russian colonizers in the 1700s, the discovery of gold in 1896 brought the most transformative impacts, imposing colonial and patriarchal systems, views, and practices. These deeply affected YFN traditional ways of life, disconnecting people from their lands and food sources, and creating significant barriers to the continuity of their culture and languages.

Acting on concerns of YFNs at being displaced from their lands and having their inherent rights eroded, in 1902, Hunde-aelth (Chief Jim Boss) of the Ta’an Kwäch’än, urged the Crown to settle a land claim with YFNs (McClellan & Birckel, 1987, p. 99). His plea was dismissed, and it was not until the early 1960s that YFNs began to mobilize again. This mobilization included producing the landmark document Together Today For Our Children Tomorrow in 1973, which laid out a case for the negotiation of a modern treaty recognizing First Nation rights and title in the Yukon. In 1993, the Umbrella Final Agreement (UFA) was signed, becoming the framework for negotiating individual Final and Self-Government Agreements for each YFN. Between 1993 and

2 There is no indication of what percent of the population are Yukon First Nations. Statistics Canada reports on the number of people who identify as Indigenous (First Nations, Métis, and Inuit) but does not identify individual nations.

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approaches to public health: Lessons learned from Yukon First Nation responses to the COVID-19 pandemic

2005, 11 of the 14 YFNs signed Final and Self-Government Agreements. These modern treaties are entrenched in s.35 of the Constitution and recognize First Nation governments as having extensive legislative powers and authorities paramount to territorial legislation. The SelfGovernment Agreements set out arrangements for YFNs to govern their internal affairs and assume responsibility and control over decision-making that affects their citizens, communities, and traditional territories.

Figure 1: Map of Yukon First Nations’ traditional territories (Department of Environment, 2021)

Three YFNs are still governed under the Indian Act through the federal department of CrownIndigenous Relations and Northern Affairs Canada. These three nations, the Liard First Nation, Ross River Dena Council, and White River First Nation, are currently participating in Recognition of Rights discussion tables with the Crown to advance the recognition of First Nation selfdetermination and protection of their rights.

In 2001, the Government of Canada transferred responsibility for lands, forests, water, and minerals in the territory to YG through the Northern Affairs Program Devolution Transfer Agreement

In 2003, a revised Yukon Act came into effect, granting province-like powers to the territorial government. This Act delegated to YG the primary responsibility for services such as health and social services, education, and land and resource management until such time as there was successor legislation developed that recognized the authorities set out in the Final and SelfGovernment Agreements (Crown-Indigenous Relations and Northern Affairs Canada, 2013).

Jurisdictional responsibility for health care and emergency response

Jurisdictional responsibility for health care in Canada is divided between federal, provincial, and territorial governments. The federal government plays a critical role in allocating health-care funding to the provinces and territories under the Canada Health Transfer Program. The provincial and territorial governments have jurisdiction over the administration and operation of

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health-care services, but they must follow certain criteria and conditions laid out federally under the Health Care Act. Where things differ is regarding health-care services for Indigenous peoples (First Nations, Inuit and Métis), which are generally shared between provincial/territorial governments and the federal government (Weller, 1990), and in some cases with Indigenous governments. Across Canada, provincial and territorial governments typically provide health services to First Nations living in urban centres and off reserves, while the federal government funds on-reserve services and non-insured health benefits (Bruce, 2016). The level of program funding for health benefits provided to First Nations, Inuit, and Métis creates a significant disparity in provision of services between them and provincial/territorial clients (Bruce, 2016).

The Yukon Government operates health centres or nursing stations to provide basic health-care support in most communities. It also provides a greater range of services at two community hospitals and at Whitehorse General Hospital. However, the provision of these services is not without challenges. Given the context of this research, it is important to note that a recent review of Yukon’s health and social services found that YFNs are still experiencing racism in the healthcare system and inadequate care (Health and Social Services Review Expert Panel, 2020). This finding reflects the legacies of a long and ongoing history of harmful relationships between medical institutions and Indigenous people across Canada; issues such as forced sterilization and unethical medical research involving Indigenous people have been well documented (Boyer & Bartlett, 2017; Leason, 2021; Mosby & Swidrovich, 2021).

The 11 self-governing YFNs can take over jurisdictional authority for the delivery of health and social services. To date, none have completely drawn down health services, though some have drawn down specific programs and services. For example, Kwanlin Dün First Nation provides basic health services in Whitehorse for its citizens through the Natsékhi Kù nursing clinic, the only First Nation-run health-care clinic in the territory. The majority of health services funding that comes to the Yukon from the federal government is currently allocated directly to YG. While Self-Government Agreements in the Yukon provide a mechanism for First Nations to enact health laws and provide health care, the level of funding provided through fiscal transfers is insufficient to provide these services at a comparable level to the territorial government (Abele et al., 2019).

The territorial government has primary responsibility for emergency response in the Yukon under CEMA (Civil Emergency Measures Act, 2002). CEMA is an outdated piece of territorial legislation that neglected to acknowledge the Yukon Final and Self-Government Agreements, despite the fact that seven YFN agreements were in place at the time that CEMA was created. Within CEMA, there are provisions for municipalities but no mention of First Nation governments. Self-governing YFNs have not yet drawn down responsibilities for emergency response, which would apply to settlement land3, but several YFNs have developed their own emergency plans.

COVID-19 pandemic and Yukon First Nations responses

YG led the emergency response to the COVID-19 pandemic in the Yukon. When YG declared the state of emergency in March 2020, the Health Emergency Operations Center (HEOC) was

Indigenous approaches to public health: Lessons learned from Yukon First Nation responses to the COVID-19 pandemic

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3 Settlement land refers to land that is owned and managed by a Yukon First Nation. On this land, the First Nation is the primary decision and lawmaker.

created to coordinate and oversee the government’s pandemic response. In Fall 2020, the YG COVID-19 Response Unit (CRU) was formed, which eventually replaced the HEOC. The CRU included staff seconded from across the government and held a range of responsibilities related to pandemic response and planning, including interjurisdictional relationships. They were responsible for communicating with federal, municipal, and First Nation governments regarding testing procedures, active cases, border control, immunization campaigns, and other pandemicrelated issues. YG updated their Pandemic Co-ordination Plan in March 2020 to provide details on their pandemic-related preparedness, decision-making, and actions.

In March 2020, YFN Chiefs identified the need for a coordinated approach to pandemic response and communications, leading to the creation of a new initiative under the Council of Yukon First Nations (CYFN) called the YFN COVID Response Team. This team was made up of staff from YFN governments, non-governmental organizations, and independent contractors. There were also political representatives who participated in the YFN COVID Response caucus calls, including YFN Chiefs and Executive Directors, and YG Ministers and Deputy Ministers. The COVID Response Team was intended to be nimble and responsive to the direction of YFN Leadership, which was provided through the caucus calls. This collaboration led to the development of the YFN COVID Communications Working Group, made up of communications experts and those tasked with COVID-19 coordination from various Yukon First Nation governments. This working group developed new channels of communication to reach YFN citizens. These included an information hub on the CYFN website and a social media presence on Facebook, YouTube, Twitter, and Instagram.

YFN Leadership advocated for an abundance of caution to protect Yukoners, knowing that colonization and historic traumas have left First Nations people more vulnerable to the COVID19 pandemic. During the Yukon’s “First Real Wave” in June/July 2021 (Figure 2), it became clear that barriers such as systemic racism in the health-care system prevented a number of YFN

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Council of Yukon First Nations, Alatini, Johnston, Perrin, Klein, Staples & McTavish
Figure 2: Timeline of pandemic phases in the Yukon based on key events marking shifts in public policy and emergency response.

citizens from accessing testing. This meant it was difficult to assess the level of transmission and accurate number of active and total cases in a given community. In August 2021, data communicated by YG confirmed what the YFN COVID Response Team suspected, that Indigenous Yukoners were disproportionately affected by the pandemic. While approximately 22% of Yukon’s population identify as Indigenous, they accounted for 56% of Yukon’s cases, 63% of hospitalizations, 56% of medevacs, and 50% of deaths related to COVID-19 (Government of Yukon COVID Response Unit, personal communication, April 9, 2021)

There were multiple organizing bodies at the heart of the COVID-19 pandemic response in the Yukon, including one providing a coordinated approach for YFNs (the YFN COVID Response Team). Relationships between these organizations and individual territorial, federal, and First Nation governments were complex, leading to multiple tensions and frustrations, and highlighting significant inequities and barriers. However, there were also opportunities for relationships to evolve in new, collaborative directions. The research described below aimed to further explore these complexities, with the goal of using the COVID-19 response to elucidate broader lessons about interjurisdictional dynamics involving Indigenous and non-Indigenous authorities in emergency response.

Methods Approach

The research project was designed to respond to needs identified by YFN Leadership and the YFN COVID Response Team. The project was hosted and administered by CYFN, a non-profit society in the Yukon dedicated to working for YFNs in advancing their rights, title, and interests.

CYFN worked with a team of Yukon-based researchers with experience working alongside First Nation communities to design and implement the project. Math’ieya Alatini is a member of the Kluane First Nation and worked throughout the pandemic for CYFN and YFNs as a member of the YFN COVID Response Team. Kari Johnston is a community member in Haines Junction where she coordinated COVID-19 initiatives for Champagne and Aishihik First Nations and was the Communications Lead for the YFN COVID Response Team. Alison Perrin, Rhiannon Klein, and Kiri Staples are academic researchers who have extensive experience working with YFNs. Kristeen McTavish has a background in health research and works on data governance and related initiatives for CYFN.

The goal of this project was to understand the perspectives of YFN governments4 and organizations, as well as other governments in the Yukon, on interjurisdictional dynamics during the COVID-19 pandemic response. The World Health Organization’s Intra-Action Review (IAR) process was employed to support participants in reflecting on lessons learned from the COVID-19 response (World Health Organization, 2021). The aim of an IAR is for stakeholders to identify current best practices, gaps, and lessons learned, and propose corrective measures and actions to improve and strengthen the response (Mayigane et al., 2020; World Health Organization, 2021). IARs can be used to explore questions related to communication, resources, operational procedures, strategic planning, and long-term resiliency (Greiner et al., 2021; Hoang et al., 2022). IARs bring together small groups of people within an area of expertise – in this case,

4 The term “YFN government” is used throughout the remainder of the paper to refer to the governing authorities/bodies of all 14 YFNs, regardless of whether they have signed Self-Government Agreements.

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pandemic governance or operations in the Yukon context – and can be adapted to be conducted with individuals when necessary (World Health Organization, 2021).

Data collection and analysis

IARs were the primary means of data collection, and a total of 23 IARs were conducted over Zoom and recorded. There were 36 unique participants who were recruited by email and phone. Participants were identified based on their role within a YFN government, YG, municipality, or an intergovernmental working group. Two participants took part in two separate IARs, representing different roles in each. This duplication is reflected in the breakdown of participants by group (Table 1).

IARs are similar to a semi-structured interview or focus group, with the facilitator asking unscripted follow-up questions for clarification as required. The research team created a timeline of key events and pandemic phases (Figure 2) based on publicly available documents including press releases and media articles and informed by the experiences of the YFN COVID Response Team. This timeline was used during the IARs as a visual aid to jog participants' memories. When reviewing each distinct phase of the pandemic timeline, participants were asked short prompting questions related to the pandemic response and interjurisdictional dynamics. Informed consent was recorded at the beginning of each IAR, and participants were given the choice when they reviewed their quotes to have their name attached or to remain confidential.

The IAR transcripts were automatically generated using Otter.ai software and shared with participants along with a summary report. The transcripts were coded in NVivo using a coding framework based on existing themes in the literature and emergent themes identified during the IARs. The coding framework and data analysis were both done collaboratively, ensuring that any preconceived ideas “earned” their way into the analysis, per Charmaz’s (2006, 2014) approach to grounded theory. While future analysis will involve a second round of coding to add more detailed themes, the results below come from a preliminary analysis based on the first round of coding. The contextual information (e.g., press releases, media articles, etc.) gathered to prepare the timeline used during the IARs (Figure 2) was also used during the analysis to connect personal experiences with pandemic events.

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Participant Group Number of Participants YFN Government Leaders (Chiefs, Deputy Chiefs or Councillors) 9 YFN Government Employees 15 YFN Working Group Members 8 YG Leaders (inclusive of the Office of the CMOH) 4 Municipal Government or Association of Yukon Communities Representatives 2
Table 1: Number of participants by organization type and role

Results

In this preliminary analysis of the IAR data, we focused on the topics of collaboration, communication, and relationships between YFN governments and YG, and identified three broad themes. These themes highlight important challenges and lessons learned from the Yukon experience of interjurisdictional relationships throughout the pandemic.

Yukon First Nation self-determination in emergency planning

A common theme that arose from this study was the need for YFN self-determination5 in emergency planning. Participants articulated the need for self-determination as an important element of considering a First Nation lens when it comes to emergency planning and response, in particular for a pandemic. When planning the COVID-19 vaccine rollout, for example, participants raised concern that YG had not considered the historical context and related trauma of medical interventions and colonial policies in relation to First Nations in the Yukon. These experiences have resulted in a long history of distrust of the medical system and government. One YFN employee explained:

[As] a community that has faced so much trauma and has so many different challenges with the territorial government … there’s one thing that I’ve learned from the Elders and council is the feeling amongst community members that we are alone and we have to get through this on our own, no one is coming to help – that is the starting point in [our community]

there is an element of fear and mistrust. So, anyone coming to help needs to know this is the starting point

Participants discussed the importance of First Nations determining how their ways of knowing, doing, and being can guide effective and relevant emergency planning, response, and communication approaches for YFN communities. When a First Nation lens is applied to emergency planning and communication, historical context is considered, and cultural values and traditions can be at the forefront of planning, policies, and response. As an example, several respondents identified that the vaccine rollout was most effective when the First Nation and local community played the lead role in organizing the logistics and communications.

Throughout the pandemic, YFN Leadership identified opportunities to use the strengths within their nations to their benefit. As an example, Champagne and Aishihik First Nations Chief Steve Smith stressed the importance of “Dän K’e”, which translates to “Our Way”. He noted that Champagne and Aishihik First Nations’ citizens have unique characteristics, “and we can exploit those characteristics in a way that will enable our people to respond to emergencies and

5 Self-determination has been defined in a few ways. It can broadly be thought of as, “the right of a people to decide how it wants to relate to a majoritarian population” (Imai, 2008, p. 10). The right to self-determination is enshrined in Article 3 of the United Nations Declaration on the Rights of Indigenous peoples (UNDRIP), which states: “Indigenous peoples have the right to self-determination. By virtue of that right they freely determine their political status and freely pursue their economic, social and cultural development” (United Nations General Assembly, 2007, p. 4). However, it can also be understood outside of a rights-based approach. For example, Corntassel (2008) emphasizes the self-determination of Indigenous peoples as a process that must consider the interconnections between critical features, such as environment, well-being, natural resources, sustainability, cultural practices, and future generations. In this context, “indigenous self-determination can be rearticulated as part of a sustainable, community-based process rather than solely as narrowly constructed political or legal entitlements” (Corntassel & Bryce, 2012, p. 53).

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everything else and actually how our people respond to emergencies.” An example of this is a YFN approach to communication which focuses on trust, accountability, and open communication. Many participants mentioned YG’s lack of effective communication compared with their expectation that “when we call upon ‘Our Way’ to communicate to us, what is very important for us is to listen, decipher and hear, and taking the time to talk things through” (Chief Smith).

Participants brought attention to the lack of recognition in CEMA of the Self-Government Agreements and the self-determination of non-signatory YFNs. As noted by a YFN Leader, We’re now starting to really see the challenges and gaps of CEMA. We’re trying to go into this as partners but we’re starting to get marginalized a bit. It was systemic racism and injustice that was being incredibly perpetuated. We are an order of government. Not a third order and not just another stakeholder.

Participants discussed the lack of consultation by YG on key initiatives, as exemplified by YG’s immunization program that was implemented without approval from YFN Leadership, and without incorporating YFN advice on when and how to bring vaccines to their communities. Notably, participants expressed that unilateral decision-making by YG was not as much of an issue early in the pandemic, when decisions were time-pressured and sometimes had to be taken quickly. However, concerns related to unilateral decision-making did emerge in later phases, when decisions could have been anticipated and better planned in the time available (e.g., vaccine delivery and re-opening of borders).

Critical challenges faced by rural and First Nation communities in emergency response

An important theme that arose from the IARs was the urban-rural divide that exists in the Yukon, where 43% of the rural population is Indigenous. Participants described how rural experiences of pandemic-related challenges and needs, particularly for rural First Nation communities, often contrasted with those of Whitehorse. Some participants stressed that the voices of rural Yukoners and the institutions that represent them were not reflected in some pandemic policies, regulations and decisions being made by YG. In addition, we heard concerns from many participants that rural communities often felt they were left on their own without the support or resources they needed: “... we needed to have messaging that was suitable in the communities, that was relevant for the communities rather than blanket statements and blanket solutions across the territory” (working group member). This was reflected in decisions to relax measures such as travel and mask mandates, despite concerns communicated by YFNs (CBC News, 2021). While the territorial government was loosening restrictions, some communities responded by putting up checkpoints, restricting access to communities, and keeping their government offices closed, at their own expense.

Lack of access to data was a hindrance for YFN governments in being responsive to their communities’ needs and acting for their citizens. As noted by a YFN employee, “[we] requested several times to have [nation] specific data, and they just blankly said that they could not do that.”

The small population size of rural Yukon communities posed a barrier as YG did not want to release community-specific data or exposure notices because they thought it would be too easy to identify individuals who had tested positive. They did eventually share data on community vaccination rates but did not separate First Nation data from non-First Nation, and the

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information was not provided in time to inform vaccination messaging. One YFN Leader stressed how impactful the lack of access to data was on decision-making: “It's important for us to make our decisions. Overall, I think [we] did a good job … of managing the pandemic, but we did it with one eye closed. We didn’t have the proper statistics and data to back us up.” The YFN COVID Response Team tracked and shared data as much as possible, supporting YFNs to respond to increased risk or active cases and safeguard their communities by moving to remote work, issuing travel advisories, and distributing resources like cleaning supplies and food to support people when isolating.

Lessons for future pandemic planning and public health strategies

The Yukon pandemic experience provides lessons on interjurisdictional governance for both the territory and other regions. Participants noted how relationships between YFNs and other governments and organizations were critical in providing the capacity and information necessary to respond and make informed decisions throughout the pandemic. Several participants spoke to the positive relationship that existed between YFNs and YG going into the pandemic, stating how reassuring it was to feel that they could all come to the table as true partners. However, the majority of YFN participants also spoke to a breakdown in the relationship between YG and YFNs that occurred as the pandemic progressed: “Yukon government started reducing their relationship with Yukon First Nations in terms of a collaborative process for rolling out mandates, and the Yukon Government did not consult with Yukon First Nations in terms of developing a state of emergency” (YFN Leader). This breakdown in the relationship resulted in mistrust and created significant barriers to the pandemic response at the local level.

Participants highlighted the importance of relationships at the community level, including strengthened partnerships among YFNs, as well as with municipal governments. Though CYFN plays a role in convening all YFNs to discuss shared issues and opportunities, and present a shared voice when appropriate, participants said that the pandemic brought forward a particularly concerted effort and commitment to partnership and collaboration. As one YFN Leader asserted: “we’ve all been, to a Nation, very unequivocally together on the fact that our whole process for this has been about the protection of our people and the protection of our young ones.” This collaborative partnership allowed YFN Leadership to develop a coordinated pandemic response and strengthened their position in discussions with YG.

Numerous participants identified communications with YG as one of the major challenges throughout the pandemic. This included timing of communications (e.g., not providing enough time to respond or prepare), lack of communications (e.g., releasing information to the public without consulting or informing YFNs), and content (e.g., not using plain language). As noted by a YFN employee,

there was huge frustration I think across the board from First Nations with the lack of information flow with regards to cases and communities… [I]t was very, very tightly controlled, and as a result, it did not allow First Nations to have the information, the data, the knowledge that they needed to appropriately respond; to respond with the smallest possible footprint.

Yet, when there was a consistent and sustainable approach to communication and consultation, information flow between YG, YFN governments, and municipal leadership supported better

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decision-making. Participants cited the YFN COVID Communications Working Group, which included all 14 YFNs, as a positive example of effective communications. It was a critical body that supported communication and collaboration between First Nations and created a muchneeded bridge with YG. This was accomplished through both operational and leadership calls between YFNs, and with YG and the CMOH, providing avenues for information sharing and consultation. A member of this working group noted that “having those relationships and meetings that happened on a recurring basis helped give structure and helped with good communication…. There was a feeling of two-way communication and listening on both ends and incorporating feedback into responses.”

Participants also identified lessons learned regarding tensions over boundaries of jurisdictional authority. These tensions were exemplified by issues surrounding borders and the freedom to travel during the pandemic. While many were worried about travel for recreation and tourism, for some YFNs the closure of borders with BC and Alaska restricted their citizens’ ability to see family, access traditional lands, or access certain services. YFNs worked with YG to find solutions to improve cross-border travel for citizens. Concerned about protecting their communities, a few YFNs enacted their own community checkpoints, which brought up jurisdictional questions over who would fund these efforts and who had authority to impose and enforce travel restrictions. While community checkpoints became a touchpoint issue, they provided an avenue for sharing information with community members and visitors and were a demonstration of successful leadership by YFNs.

Discussion

As noted previously, reflections from the COVID-19 pandemic response are still forthcoming, including on questions related to interjurisdictional dynamics involving Indigenous governments and organizations. Several broad themes are apparent, however, including issues related to Indigenous self-determination and jurisdiction, the specific needs of rural and Indigenous communities, nation-to-nation relationships, and legacies of ongoing and historic inequities. Indigenous-led approaches to the pandemic response in Canada have also been documented. The preliminary results from our research contribute to these findings in important ways. They confirm the key gaps and priorities that have been identified by others, provide context-specific elaboration and examples, and identify additional opportunities to be explored.

Collaboration, communication, and the importance of relationships

A well-established and fundamental component of effective emergency planning and response is good interjurisdictional collaboration and communication (Asfaw et al., 2019; Genest et al., 2021; NCCAH, 2016). While collaboration and communication can take many different forms, there is a basic need for multiple jurisdictions to work with one another and talk to one another during an emergency such as the COVID-19 pandemic. Indeed, this assumption is at the core of our research. The results of the IARs demonstrate this point, specifically in the context of COVID19. Although participants did identify phases where collaboration and communication between YFNs and YG was strong, there was a general sense that further and ongoing collaboration was required. The research pointed to the centrality of relationships within collaboration and communication - and, more broadly, effective decision-making - including relationships between YG and YFNs, and community-level relationships.

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The results also identified what good communication looks like and how interjurisdictional collaboration can be supported. For example, the ongoing phone calls between YFNs, YG, and the CMOH that took place throughout the pandemic demonstrated the value of working across jurisdictions. When communication was frequent and collaborative, YFNs were better positioned to make decisions quickly to protect the health and wellbeing of their communities. The IARs demonstrated the importance of having a YFN central body (e.g., the YFN COVID Response Team) that can coordinate amongst YFNs, liaise with other governments and organizations, and be flexible and responsive to communities’ needs. However, the ad hoc nature of these collaborative processes raises questions about their longevity post-pandemic. While the context of future emergency responses (e.g., to a fire or flood) will likely be distinct from that of the pandemic, there is value in formalizing or codifying collaborative arrangements where applicable, in particular when a state of emergency is declared (NCCAH, 2016). A codified relationship may help ensure the ongoing sustainability of the relationship between YFNs and YG when it comes to emergency planning and response, and give direction on how YFNs will be integrated into policy and decision-making in future states of emergency. It may also provide direction on how information should flow between YFN governments and with YG, to aid future coordination and collaboration.

Respect Indigenous self-determination and a nation-to-nation relationship

The preliminary results of our study align with work elsewhere that emphasizes the importance of intergovernmental collaborations founded on respect for Indigenous self-determination, and recognition of a nation-to-nation relationship when collaborating with Indigenous Peoples (Craft et al., 2020; McNeill & Topping, 2018; Montesanti et al., 2019). The IARs allowed YFNs to reflect on how they see respect for YFN self-determination being operationalized in the pandemic response. This acknowledgement of self-determination would include actions such as applying a First Nation lens to emergency response (e.g., taking a collective approach to health), recognizing YFN authority in territorial legislation, and ensuring YFN control over resources and data. YFNs felt YG’s respect for self-determination was lacking; for example, when decisions about or impacting YFN communities were made unilaterally by YG, especially during phases of the pandemic where decisions were not as time sensitive. This situation was exacerbated by the failure of legislation such as CEMA to acknowledge YFN authorities, resulting in a significant gap in emergency governance. Finally, our results also highlight areas of opportunity for advancing self-determination. While some of these opportunities would require legislative change (e.g., updating CEMA), others may be pursued through policies or programs (e.g., communication strategies that apply a YFN lens to ways of being, knowing, and doing).

Unique considerations and needs of rural and Yukon First Nation communities

Across Canada, the pandemic has highlighted the underlying inequities that impact emergency response effectiveness, and the need for responses that address the unique contexts and needs of Indigenous communities. This trend is not unique to emergency response but one that has been noted in health-care delivery in rural and Indigenous communities across the country as well (Lavoie, 2013; Reading & Wien, 2009; Richmond & Cook, 2016; Young & Chatwood, 2011). YFNs and rural communities in the Yukon are at a disproportionate risk when it comes to emergencies, particularly health emergencies. Compounding this problem are concerns highlighted by participants that their voices were not being heard and that legislation, policy, and

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key decisions are being developed through an urban-centered lens without awareness of the inequities this creates for rural Yukoners. The results from this research highlighted key inequities between urban and predominantly rural First Nation communities that arose during the pandemic including limited services, capacities, and access to community-specific data.

This research emphasized the need for community-scale data as an important component of addressing the unique considerations and needs of rural and YFN communities. Participants noted that access to data could have supported local leaders to make informed decisions about how to keep communities safe (e.g., when to enforce lockdowns or other measures). The importance of access to data was underscored by the vaccination program. Once YG started to share community-level vaccination data, it was possible for YFNs to identify where communication efforts should be targeted to increase uptake. In other words, having access to data allowed YFN Leadership to be responsive to the needs of their communities, rather than simply reacting to events and YG decisions. This example highlights the critical need for formal processes and agreements that safeguard data sovereignty for YFNs. Similar to the need for formalized communication processes, formalizing data-sharing agreements and processes would ensure there is a built-in mechanism for YFNs to access the critical data they need to make decisions in future emergencies.

Despite – or potentially in light of – these context-specific challenges, YFNs implemented several responses to the COVID-19 pandemic, many of which were seen in other regions as well (e.g., limiting access to communities and implementing rapid testing for community gatherings). Although our research did not reveal to what extent these interventions were followed, it did identify the potential for discord between competing authorities and their associated orders and legal systems. This became clear in other areas of Canada when visitors ignored checkpoints and requests to stay off First Nation reserve land, claiming that closures interfered with individual rights (Deer, 2020; Lisk, 2020). During the pandemic, some YFNs created their own emergency acts or called a state of emergency. While these were an effective means to communicate the real fear and concern in First Nation communities, they leave lingering questions about how jurisdictional overlap is managed when different governments call a state of emergency.

Implications for future research and policy

Several opportunities for further study were identified that could inform future policy and practice in Yukon emergency planning and management. Lessons learned about the importance of a consistent and stable approach to communications may be useful for future emergency responses. For example, in situations where an emergency affects a First Nation, a formal mechanism should be implemented to ensure immediate and ongoing communication between YG and YFN Leadership and, when appropriate, CYFN. Lessons learned from the experiences of the YFN COVID Response Team and YFN Communications Working Group also demonstrated the opportunity to explore a more formal structure to ensure YFN collaboration in health-care and emergency response.

Another critical concern in establishing pathways for YFN self-determination is to identify avenues for resolving conflicts between jurisdictions (e.g., checkpoints, enforcement, etc.). There is still an obligation to ensure that existing legislation, particularly CEMA, formally recognizes and supports YFN self-determination and jurisdiction within emergency response. Moreover, the pending reviews of CEMA and the Public Health and Safety Act provide an opportunity to respond

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to that need. Part of that process may also include finding avenues to ensure YFN ways of knowing, being, and doing are at the forefront of emergency management. Considering the specific challenges and needs of YFN communities within emergency response, there may be opportunities to support YFN data governance and health surveillance at the community level. There are opportunities to explore other health surveillance tools that can be used in the Yukon to support local decision-making (e.g., wastewater testing). There are also opportunities for YFNs to continue discussions on data governance and sharing with other data holders. Building on the opportunities identified through this research will require collaboration amongst YFNs, YG, and the federal government.

Conclusion

This study sought to prompt reflections on the interjurisdictional dynamics that were at play during the Yukon’s COVID-19 response, centering YFN perspectives. Using an Intra-Action Review approach, the results from this work identified three key themes. First, it noted the importance of respecting Indigenous self-determination within the interjurisdictional response to the pandemic. The results showed that respect for self-determination can be operationalized in many ways, such as ensuring YFNs have the option and resources to apply a YFN lens to emergency response, ensuring other jurisdictions recognize Self-Government Agreements and other forms of self-determination in legislation and practice. Second, the research highlighted the specific challenges of rural and YFN communities, which were not always successfully navigated during the pandemic response. Nonetheless, we saw examples of YFN-led approaches to addressing community-specific challenges. Finally, important lessons for interjurisdictional emergency response were drawn from the Yukon’s experience with COVID-19, including the importance of relationships, a consistent approach to communications, a centralized body for coordinating YFNs and communicating with other levels of government, and identifying potential sources of tension for situations where governments and their respective orders and legal systems come into conflict.

These results support initial findings from other jurisdictions in Canada, where similar experiences have been identified. Our results offer context-specific examples and highlight new areas of opportunity, revealing some of the critical governance challenges that arose in the Yukon during the COVID-19 pandemic. We have identified important lessons learned from the pandemic response, including barriers, opportunities, and innovative approaches, grounded in the experiences of YFN staff and Leadership. These insights may be useful for future policy and legislative efforts related to emergency and health-care response in the territory.

Acknowledgements

We would like to express our gratitude to all the participants of the Intra-Action Reviews; this project would not have been possible without the reflections, knowledge, and experiences they shared with the project team. We would also like to thank Dr. Sara McPhee-Knowles and Dr. Lisa Kanary for their review and feedback on an early draft of this paper. This research was conducted with funding support from the Government of Yukon’s COVID-19 Research Recovery Fund.

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Hoang, N. V., Hoang, N.-A., Pham Quang, T., Quach, H.-L., Nguyen, K. C., Vu, L. N., Hoang, D. M., Field, E., & Vogt, F. (2022). Evaluating epidemic preparedness and response to COVID-19: A nation-wide multisectorial intra-action review of the points of entry surveillance system in Vietnam, January to September 2020. Asia Pacific Journal of Public Health, 34(6–7), 702–704. https://doi.org/10.1177/10105395221112863

Imai, S. (2008). Indigenous self-determination and the state. Comparative Research in Law & Political Economy Research Paper No. 25/2008. https://digitalcommons.osgoode.yorku.ca/clpe/196

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Indigenous Services Canada. (2022). Emergency Management Assistance Program. Government of Canada.

https://www.sac-isc.gc.ca/eng/1534954090122/1535120506707

Inuit Tapiriit Kanatami. (2020). The potential impacts of COVID-19 on Inuit Nunangat

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Kyoon-Achan, G., & Wright, L. (2020). Community-based pandemic preparedness: COVID-19 procedures of a Manitoba First Nation community. Journal of Community Safety & Well-Being, 5(2), 45–50.

Lavoie, J. G. (2013). Policy silences: Why Canada needs a national First Nations, Inuit and Métis health policy. International Journal of Circumpolar Health, 72(1), 1–7.

https://doi.org/10.3402/ijch.v72i0.22690

Leason, J. (2021). Forced and coerced sterilization of Indigenous women: Strengths to build upon. Canadian Family Physician, 67(7), 525–527. https://doi.org/10.46747/cfp.6707525

Levesque, A., & Thériault, S. (2020). Systemic discrimination in government services and programs and its impact on First Nations Peoples during the COVID-19 pandemic. In C. M. Flood, V. MacDonnell, J. Philpott, S. Thériault, & S. Venkatapuram (Eds.), Vulnerable: The law, policy, and ethics of COVID-19 (pp. 381–392). University of Ottawa Press.

Lisk, S. (2020, April 23). What it’s like working a checkpoint in a First Nation during COVID-19. Tvo Today. https://www.tvo.org/article/what-its-like-working-a-checkpoint-in-a-firstnation-during-covid-19

Mapping the Way. (2022). The Yukon First Nations COVID Response Team takes on the pandemic through collaboration, advocacy and action. Mapping the Way.

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Mashford-Pringle, A., Skura, C., Stutz, S., & Yohathasan, T. (2021). What we heard: Indigenous Peoples and COVID-19 [Supplementary Report for the Chief Public Health Officer of Canada’s Report on the State of Public Health in Canada]. Government of Canada.

https://www.canada.ca/content/dam/phacaspc/documents/corporate/publications/chief-public-health-officer-reports-state-publichealth-canada/from-risk-resilience-equity-approach-covid-19/indigenous-peoples-covid19-report/cpho-wwh-report-en.pdf

Mayigane, L. N., de Vázquez, C. C., Vente, C., Charles, D., Copper, F. A., Bell, A., Njenge, H. K., Schmidt, T., Samhouri, D., Htike, M. M., Kato, M., Stephen, M., Van Kerkhove, M. D., & Chungong, S. (2020). The necessity for intra-action reviews during the COVID-19 pandemic. The Lancet Global Health, 8(12), e1451–e1452. https://doi.org/10.1016/S2214109X(20)30414-9

McClellan, C., & Birckel, L. (1987). Part of the land, part of the water: A history of the Yukon Indians. Douglas & McIntyre.

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McNeill, R., & Topping, J. (2018). Federal, provincial and territorial public health response plan for biological events. Canada Communicable Disease Report, 44(1), 1–5.

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McPhee-Knowles, S., Hoffman, B., & Kanary, L. (2022). The Yukon’s experience with COVID19: Travel restrictions, variants and spread among the unvaccinated. Canada Communicable Disease Report, 48(1), 17–21. https://doi.org/10.14745/ccdr.v48i01a03

Montesanti, S., Thurston, W. E., Turner, D., & Medicine-Traveler, R. (2019). A First Nations framework for emergency planning: A community-based response to the health and social effects from a flood. International Journal of Indigenous Health, 14(1), 85–106.

https://doi.org/10.32799/ijih.v14i1.31952

Mosby, I., & Swidrovich, J. (2021). Medical experimentation and the roots of COVID-19 vaccine hesitancy among Indigenous Peoples in Canada. Canadian Medical Association Journal, 193(11), E381–E383. https://doi.org/10.1503/cmaj.210112

NCCAH [National Collaborating Centre for Aboriginal Health]. (2016). Pandemic planning in Indigenous communities: Lessons learned from the 2009 H1N1 influenza pandemic in Canada University of Northern British Columbia. https://www.ccnsa-nccah.ca/docs/other/FSInfluenzaPandemic-EN.pdf

Penney, J., & Johnson-Castle, P. (2020). COVID-19 and Inuit Nunangat: Research, responsibility & infrastructure inequality. Yellowhead Institute, 57(4).

https://yellowheadinstitute.org/2020/03/31/covid-19-and-inuit-nunangat-researchresponsibility-infrastructure-inequality/

Public Safety Canada. (2022). Disaster Financial Assistance Arrangements (DFAA). Government of Canada. https://www.publicsafety.gc.ca/cnt/mrgnc-mngmnt/rcvr-dsstrs/dsstr-fnnclssstnc-rrngmnts/index-en.aspx

Reading, C., & Wien, F. (2009). Health inequalities and social determinants of Aboriginal Peoples’ health. National Collaborating Centre for Aboriginal Health. https://nccahccnsa.ca/docs/social%20determinates/NCCAH-Loppie-Wien_Report.pdf

Richardson, L., & Crawford, A. (2020). COVID-19 and the decolonization of Indigenous public health. Canadian Medical Association Journal, 192(38), E1098–E1100. https://doi.org/10.1503/cmaj.200852

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Weller, G. R. (1990). The devolution of authority for health care services to the governments of the Yukon and the Northwest Territories. The Northern Review, 5, 37–59.

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Storytelling through uncertainty: How a Yukon entrepreneur podcast helped chronicle the COVID-19 experience

The COVID-19 pandemic brought unprecedented challenges to entrepreneurs and businesses during its early phases, forcing them to rapidly adapt their means of product and service delivery. This involved coping with the closures of brick-and-mortar stores, constantly changing public health and safety measures, decision-making to support and retain employees, and managing customer and employee expectations in response to these changes. In the unique context of the Yukon Territory in the Western Canadian Arctic, entrepreneurs were faced with additional challenges due to the territory's small size and population, relative isolation, and strict territorial border controls. This makes the Yukon a compelling case study to examine how entrepreneurs adapted to the pandemic both in the short and longer term.

This article focuses on Kari Johnston, a local entrepreneur and business leader who also served as a Municipal Councilor during the early stages of the pandemic. Johnston initiated a podcast that highlighted the experiences of business owners and leaders as they grappled with the new and shifting pandemic context. The podcast also highlighted the importance of community-oriented supports like Yukon University’s PIVOT Program (April-September 2020), the Tourism Industry Association forum and Yukon Government programs, all of which helped Yukon businesses reboot and grow during the pandemic. The podcast chronicled how, together, these initiatives created a collaborative knowledge-sharing network that provided support during the

Sonia Wesche, Associate Professor, Department of Geography, Environment and Geomatics, University of Ottawa, swesche@uottawa.ca; Kari Johnston, Owner, Rafter 14 Strategies, krjohnst@gmail.com; Christy Huey, Business Student, Yukon University; Mark Andrachuk, Owner, ReConnect Consulting; Felix Arndt, John F. Wood Chair in Entrepreneurship, Department of Management, University of Guelph; Jiamin Jiang, Graduate Student, Department of Management, University of Guelph

Sonia Wesche, Kari Johnston, Christy Huey, Mark Andrachuk, Felix Arndt & Jiamin Jiang

critical period of initial pandemic response when entrepreneurs were facing high levels of uncertainty. This exploration provides insights into the resilience of the entrepreneurial sector, and highlights the importance of tailored, community-based supports in responding to pandemic-like crises.

Introduction

In March 2020, the COVID-19 pandemic spread rapidly across North America, leading to the abrupt cancellation of two major Yukon-hosted events – the Arctic Winter Games and the Yukon First Nations Hockey Tournament. For entrepreneurs, especially those in the hospitality industry, these cancellations signaled that the playing field was rapidly and unpredictably shifting. Amid these challenges and the ensuing lockdown, Kari Johnston, Municipal Councilor for the rural town of Haines Junction, former caterer, community development consultant, and member of Yukon University’s Innovation and Entrepreneurship Advisory Council (IEAC), recognized the difficulties that business leaders were encountering in connecting with each other and sharing information across communities in the absence of in-person meetings. She remembers receiving a message from Yukon University colleague Lauren Manekin Beille, who asked whether social media could be used as a platform to support community-building among small and rural business operators during this time of transition. Recognizing the need for a mechanism that enabled connection and an exchange of experiences, Kari decided to begin interviewing entrepreneurs and business leaders to document their stories. She reached out to her network with a focus on small and rural business operators; she knew that they would benefit from a platform that amplified their voices within the broader community and where they could learn from each other about how to work through uncertainty to adapt their businesses and continue servicing Yukon communities.

Yukon Entrepreneur Podcast

After posting initial interviews on YouTube and receiving positive feedback from listeners, Kari recounts “a bit of a daisy chain. At the end of each interview, I would say ‘Who should I interview next?’ and I would cold call those folks.” It quickly became clear how important this sharing of experiences was for the business community. “Nobody said no, really, because I think it was a way of us building and creating that sense of community and support, which is what we do for each other.” Realizing the important role that the interviews were playing in connecting members of the business community, Kari created a podcast feed to improve listener access.

The experience of entrepreneurs during the initial months of the pandemic was captured through the early interviews, which initially reflect a collective state of shell shock. “I think there was a real sense of ‘What

do I do? I don’t

know how to manage this in the business community.” At the same time, interviewees reflected on the notion that it was important to take time, pause and take stock before acting. The first interviewee, Joanne Thomas, who has spent much of her career in the Yukon and Alberta, reinforced this message (as paraphrased by Kari): “Meditate. Don’t take in too much information. There’s not much you can do right now; the situation’s moving quickly. In all of the emotion and all of the hardness that’s about to unfold, you can’t take this on by yourself.”

From those initial interviews, business owners clearly had the sense of being part of a collective of people who were in this together. Kari reflected that that this sense of mutual support is common in the territory: “We’re so accustomed to that as Yukoners. When we have fire, when we have flood, when we have sickness or a death in our community, we rally together”.

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Wesche, Johnston, Huey, Andrachuk, Arndt & Jiang

After the initial brief period of bewilderment, discussions shifted toward adaptation and questions about the types of opportunities that the pandemic disruption might bring for the Yukon and for businesses. “Really early in the interview series, it brings a very hopeful and inspiring message: there’s certainly a challenge that’s being reflected and a sense of grief, but it very quickly pivots to ‘Okay, here’s how the cards are falling; where’s our opportunity to transition and move forward?’”

While the actions of Yukon-based retail outlets of larger companies were being dictated from corporate headquarters, the many small, Yukon-based businesses were navigating these challenges without the benefit of corporate human resources departments. This required managers to continually adapt as the context evolved.

As the podcast progressed, interviewees reflected on the importance of several communityoriented initiatives that collectively created a web of support for business owners. At the time, many Yukon businesses had a limited online presence and relied on pop-up models or brick-andmortar infrastructure. Yukon University’s Innovation & Entrepreneurship (I&E) group responded by bringing together a diverse group of business and economic development professionals to share their perspectives on the challenges faced by local businesses during the pandemic, and to initiate action. Very quickly, the I&E launched the PIVOT Program, which ran from April to September 2020. The program had two main components: matching coaches with Yukon business owners and providing funding to support pandemic-related transitions (e.g., development of an online presence). According to Kari, “having money doesn't necessarily equate to being able to figure out what you need; the PIVOT program played a critical role in helping businesses move forward and achieve system sustainability.”

Podcast interviewees also highlighted the important role of industry associations in building and supporting the tourism community during the pandemic. A prime example was the monthly online forum hosted by the Tourism Industry Association (TIA) that served as a conduit between tourism operators from across the territory and relevant government, non-government, and industry partners. With the closure of Yukon territorial borders, tourism operators struggled to reach their client base during the first year of the pandemic. The TIA's initiative to host a regular Zoom forum provided an innovative way to hold the space and connect the tourism community during the pandemic. At the same time, the Yukon Government (YG) promptly established a Business Advisory Council to provide guidance on the types of support programs and policies needed to help the territory manage through the pandemic. This led YG to launch a paid sick leave program and business support programs during the first week of the pandemic.

A further dynamic raised by interviewees was the recognition that protecting rural First Nation communities from COVID-19 was a top priority. However, there were varying opinions about how to effectively achieve a balance between safeguarding community health and supporting businesses. To address this, in the early days of the pandemic efforts were made to ensure that the rural perspective was represented in discussions and decision-making processes (see Indigenous approaches to public health: Lessons learned from Yukon First Nation responses to the COVID-19 pandemic, this volume). By doing so, rural concerns were given consideration and incorporated into broader strategies for pandemic response and recovery.

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Lessons learned

The Yukon Entrepreneur Podcast played a critical role in helping entrepreneurs and business leaders connect with each other, share experiences, and support each other during the uncertain and isolating time of the pandemic. The podcast highlighted the success of the Yukon's community-oriented approach in supporting its businesses and entrepreneurs during the initial stages of the pandemic. More specifically, it highlighted the key role of the PIVOT program, which helped business owners identify the gaps in their operations and develop sustainable solutions for the long term. The Yukon's small size, relative isolation, and early engagement of actors at different scales enabled the rapid initiation of a range of complementary initiatives that provided a web of support for Yukon entrepreneurs, helping them to weather the initial phase of the pandemic and adapt their business models to thrive in the ‘new normal.’ For example, new opportunities arose to enable the decentralization of consulting businesses; they can now be run primarily out of rural areas rather than being concentrated in Whitehorse. Consequently, the Yukon's entrepreneurial landscape now features a broader range of business models, and some businesses are no longer as reliant on brick-and-mortar establishments.

By examining perspectives from the Yukon business community during the early days of the pandemic, we identified lessons learned, including the importance of multi-level engagement in dealing with rapid change in the business environment. Our exploration also offers insights into the resilience of the entrepreneurial sector and can inform pandemic preparedness for the future. We hope that our reflections inspire and offer hope to other entities that face similar challenges, showcasing the importance of community-oriented approaches and the power of collaboration in times of crisis. Find out more at www.yukonentrepreneur.com.

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The past, our stories local and global, the present, our communities, cultures, language and social practices – all may be spaces of marginalization, but they have also become spaces of resistance and hope. Linda Tuhiwai Smith, Decolonizing Methodologies (Smith, 1999: 65)

Today, the pandemic of SARS-CoV-2 has touched every corner of the globe and the Canadian North is no different. Dinjii Zhuh (Gwich’in) living in the Gwich’in Settlement Area, alongside other northern Indigenous Nations, have undoubtedly been affected – culturally, socially, economically – by these measures. Dinjii Zhuh living in Inuvik have experienced unemployment, isolation, psychological distress, and other hardships. Dinjii Zhuh families have returned to the Land during the pandemic, where one can socially distance themselves from others yet still enjoy community. And our cultural practices and Gwich’in Knowledge have been passed on during the pandemic: storytelling, hunting, working with wood and snow, preparing moosehides for smoking, gathering traditional medicines, and much more. For those who remained indoors, Youth learned how to bead and sew, work with leather, engage in storytelling, and learn our language Dinjii Zhuh Ginjik. There is a need to better understand Dinjii Zhuh lived experiences and coping mechanisms through the COVID-19 pandemic. We have connected health, wellness, and spirituality to our ancestral Lands since Time Immemorial and today is no different. Accounts of cultural resurgence, resiliency, humour, and strength are at the forefront.

This project seeks to better understand ongoing Dinjii Zhuh oral histories: the kin networks in which stories are kept alive, how stories are told, in which contexts stories are shared, and how

Dr. Crystal Gail Fraser, Assistant Professor, Department of History, Classics, and Religion, Faculty of Arts and Faculty of Native Studies, University of Alberta

“Dinjii Zhuh (Gwich’in) perspectives of epidemics: Contemporary Indigenous concepts of survival, community, strength, & COVID-19 in the Northwest Territories, Canada”
Crystal Gail Fraser (she/her)

these ancient Dinjii Zhuh practices are ongoing in the North. Despite over a century of colonialization, forced institutionalization at Indian Residential Schools, and oppressive language policies, traditions around stories have persisted. And despite the pandemic and public health orders, we can still engage in the rich Dinjii Zhuh storytelling philosophies and practices, from a safe distance.

This project is a partnership first originating between the Department of Culture and Heritage, Gwich’in Tribal Council (GTC) and Dr. Crystal Gail Fraser at the University of Alberta. As a result of our 1992 Gwich’in Comprehensive Land Claim Agreement, the Gwich’in Social and Cultural Institute (GSCI) was established in 1993 as the cultural and heritage arm of the GTC; in 2016, the GSCI became the Department of Cultural and Heritage (DCH). Over the past twenty-seven years, the DCH has had a strong presence in all Dinjii communities, with offices in Inuvik, Tsiigehtchic, Fort McPherson, and Yellowknife. They have undertaken dozens of studies that have ranged from the sewing of traditional clothing to wildlife management to astrological studies. The DCH have a history of partnering with academic institutions in the pursuit of undertaking important and relevant research for Dinjii Zhuh. Together, the GTC and Fraser are working together on how best to interview interested Dinjii Zhuh about their experiences, not only with the COVID-19 pandemic, but also with historical disease outbreaks, epidemics, and public health issues.

The body of scholarly literature about northern Indigenous societies is small, particularly when focusing on Dinjii Zhuh communities and epidemics. Considering the North more broadly, most academic analyses have been undertaken by non-Indigenous, southern scholars. In Canadian history, it has been commonplace to reflect on the expansionist agenda of the Canadian state, and settler forms of exploration, economies, politics, and administration in the North, all within an exploitative and colonial “frontier” lens that frames the North as an empty, “primitive” Land. Social histories of Indigenous Peoples in the North have been scant, although settler historian Kerry Abel did write about the 1928 and 1944 influenza epidemics, in the context of fur-trading economies, missionaries, and sweeping socio-economic and political changes. Rightly, Abel notes that

the psychological impact of these epidemics must have been tremendous, and the substantial reduction of the population was indeed socially, economically, and politically significant. A seriously demoralized population had no energy left for long-distance travel or warring (Abel, 1993: 111).

This was devasting for Indigenous health; not only did communities lose large numbers of people, but their inability to travel to their fish camps in the fall and into the mountains for hunting big game in the winter severely restricted their ability to feed their families and provide furs to the Hudson’s Bay Company in exchange for food stuff and vital equipment. Indigenous northerners have been grateful for and engaged with our histories, even those told by non-Indigenous outsiders.

This project, however, provides a much-needed perspective based on the local knowledge of Dinjii Zhuh communities and their experiences. We have always known that our communities creatively navigated challenging times, such as diseases, illnesses, and epidemics. For a better historical understanding, the DCH has a number of accounts of the influenza epidemics of 1928 and during the mid-1940s. Documents such as the unpublished Gwich’in COPE Stories, various Elders’ Calendars, and Gwichya Gwich’in Googwandak tell the stories of these health hardships, often in the words of our own Elders (Heine et. al., 2007). Although these stories are culturally invaluable, they only shed light on how our ancestors and Elders processed epidemics, death, and social trauma after time had passed. For a contemporary understanding, we are undertaking interviews among Dinjii Zhuh of all ages, in the pursuit of publishing video stories, adding to the historical record,

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Fraser

and sharing some of the more poignant stories (contemporary and historical) to write an academic article that examines the strength, fortitude, and resilience of Dinjii Zhuh in times of pandemic.

References

Abel, Kerry (1993). Drum Songs: Glimpses of Dene History. Montreal and Kingston: McGill-Queen’s University Press.

Heine, Michael, Alestine Andre, Ingrid Kritsch, and Alma Cardinal (2007). Gwichya Gwich’in Googwandak: The History and Stories of the Gwichya Gwich’in Tsiigehtshik and Fort McPherson, NWT: Gwich’in Social & Cultural Institute.

Smith, Linda Tuhiwai (1999). Decolonizing Methodologies: Research and Indigenous People New York: St. Martin’s Press.

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“Dinjii

Assessing pandemic risk through a lens of vulnerability and resilience: A case of the Northwest Territories, Canada

Background: The Arctic communities are socially vulnerable, yet they also have enormous inherent resilience and adaptive capacities leading to low COVID-19 mortality rates (except for Northern Russia) compared to their national counterparts. Thus, a conventional vulnerability approach to understanding pandemic risks across the Arctic seems insufficient. This study considers vulnerability and resilience as separate but interrelated and complementary facets of a risk assessment. Based on this premise, this study introduces a pandemic vulnerability-resilience framework that synthesizes underlying factors defining the Arctic communities’ susceptibility and ability to cope with and recover from disease outbreaks.

Methods: In particular, using North West Territories (NWT) communities as an example, we developed the pandemic vulnerability-resilience framework considering its communities’ vulnerability and resilience features.

Results: We found that highly vulnerable Indigenous communities ranked medium or high in resilience, whereas lowresilient non-Indigenous communities ranked low in vulnerability. The primary sources of resilience to a pandemic in

Sweta Tiwari, ARCTICenter and Department of Geography, University of Northern Iowa, USA; Andrey N. Petrov, ARCTICenter and Department of Geography, University of Northern Iowa, USA; Michele Devlin, ARCTICenter, University of Northern Iowa and United States Army War College, USA; Mark Welford, United States Army War College, USA; Nikolay Golosov, Department of Geography, Pennsylvania State University, USA; John DeGroote, Department of Geography, University of Northern Iowa, USA; Tatiana Degai, ARCTICenter, University of Northern Iowa and Department of Anthropology, University of Victoria, Canada; Stanislav Ksenofontov, ARCTICenter and Department of Geography, University of Northern Iowa, USA

Sweta Tiwari, Andrey N. Petrov, Michele Devlin, Mark Welford, Nikolay Golosov, John DeGroote, Tatiana Degai & Stanislav Ksenofontov

remote Indigenous communities are traditional country food, the strength of knowledge systems, and geographic isolation. With respect to vulnerability, these communities are often found to be vulnerable in socioeconomic, demographic, housing, and transportation domains.

Conclusion: High-resilience communities, even though highly vulnerable, have capacities to cope with or recover from the pandemic. Low-resilience communities will be less impacted by a pandemic only if they are low in vulnerability. Considering either vulnerabilities or resilience would result in the misallocation of resources thus this study recommends a combined assessment of both. Thus, the proposed pandemic vulnerability-resilience framework enables community leaders and/or government officials at different levels to identify the indicators which are below par or thresholds and plan interventions accordingly.

Introduction

From the onset of the COVID-19 global pandemic, the concept of vulnerability once again became popular and entrenched within several research fields, from public health and social science to medical and sustainability studies (Gatto et al., 2022; Liao et al., 2022; McGowan et al., 2022; Mude et al., 2021; Pan et al., 2020). One consistent thread found in the vulnerability-focused studies is to identify the populations or communities with disproportionate COVID-19 burden1 (i.e., mortality and morbidity wise) through indices constructed using their socioeconomic, demographic, and health indicators, among others (Adjei-Fremah et al.,2023; Daras et al., 2021; García-Peña, 2023; Liao et al., 2022; McGowan et al., 2022; Wang et al.,2022). Given these domains’ indicators, almost all these studies reached a common conclusion that the likelihood of experiencing COVID-19 mortality is much higher in marginalized, remote, and Indigenous or minority communities than in others (Adjei-Fremah et al., 2023; Daras et al., 2021; Ingram et al., 2022; Liao et al., 2022; Mude et al., 2021; Wang et al., 2022)

The Arctic, including Canada’s northern territories, is one of the known remote regions in the globe with underdeveloped healthcare systems, poor civic infrastructures, a low standard of living, and a higher prevalence of underlying medical conditions, making its residents highly susceptible to COVID-19 outcomes (Arctic Council, 2020; Huot et al., 2019; Petrov et al., 2021a). Further, the Arctic is home to over one million Indigenous people who have been and continue to be socioeconomically marginalized, lacking equal access to resources needed to combat COVID-19 (Arctic Council, 2020; Coates, 2020; Young et al., 2020). In these contexts, vulnerabilities refer to characteristics of a community that increase the likelihood of susceptibility of that community to the adverse impacts of a pandemic. From a vulnerability perspective, high COVID-19 death rates are anticipated in the most deprived Arctic northern regions, particularly among Indigenous communities (Barik et al., 2022; Petrov et al., 2021b). However, for most Arctic regions (except for northern Russia), the actual COVID-19 death rates per 100,000 were much lower than expected and as compared to their national counterparts or southern parts (Tiwari et al., 2022). The lower COVID-19 death rates among the Arctic communities raise the question of whether or not the conventional vulnerability approach is useful for explaining variability in deaths across the Arctic regions.

There is no doubt that the Arctic communities are socially vulnerable, yet the communities also have enormous resilience leading to fewer COVID-19 deaths (Cook & Johannsdottir et al., 2021; Petrov et al., 2021a; Tiwari et al., 2022; van Doren et al., 2023). Resilience, in this study context,

Assessing pandemic risk through a lens of vulnerability and resilience: A case of the Northwest Territories, Canada

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refers to the ability of a community to withstand, cope with, and recover from the adverse impacts of a pandemic. Resilience includes both inherent and adaptive capacities (Keck & Sakdapolrak, 2013). Lessons from past pandemics, traditional knowledge and medicines, and subsistence practices are Arctic communities’ inherent resilience which they relied on while dealing with the COVID-19 crisis (Petrov et al., 2021a; van Doren et al., 2023). Self-determination, proactive community leadership, and strict adherence to COVID-19 health guidelines are reflective of their adaptive capacities. These adaptive activities stemmed from the previous pandemics’ devastating experiences and a need to protect the most vulnerable (Banning, 2020; Richardson & Crawford, 2020; Tiwari et al., 2022).

The nuanced differences between vulnerability and resilience, and the role of resilience in managing and reducing health risks, including pandemics, in the Arctic are well understood (Adams & Dorough, 2022; Darren, 2016; Healey et al., 2019). Yet, quantitative metrics of resilience to assess pandemic risk have not been developed for the Arctic and, globally, are in their infancy (Pileggi, 2022; U.S. Census Bureau, 2022; van Doren et al., 2023). Further, when evaluating potential pandemic risks, consideration of vulnerability and resilience together is almost absent. One of the main reasons could be some prominent community resilience features, such as social and locationspecific capitals, are latent constructs and spatially heterogeneous (uneven distribution) (Cutter, 2016; Kawachi et al., 2008).

This study is an effort to advance the place-based health resilience metric, i.e., a composite index of societal factors quite distinct from vulnerability indicators, for evaluating the Arctic communities’ ability to cope with and recover from health adversities including pandemics. We strongly believe that vulnerability working in tandem with resilience influences pandemic outcomes and their severity. Thus, this paper considers vulnerability and resilience as separate but interrelated and complementary facets of risk assessment and presents a framework that integrates both to understand Arctic communities’ risk concerning public health emergencies. In particular, this study introduces the vulnerability-resilience framework for the Northwest Territories (NWT), Canada that incorporates indices of vulnerability and resilience developed using various societal indicators tailored to its communities and assesses both indices integratively. Examination of vulnerability and resilience indicators individually and combinedly have their merits, especially helping public officials, policymakers, and/or concerned parties to identify a particular societal indicator that needs intervention for improvement and to find communities at most risk for efficient allocation of resources and services required to prepare, intervene and recover from a pandemic.

Northwest Territories (NWT) as a case study

The availability of community-based socioeconomic data and the resemblance of the NWT geography, socioeconomic, health, and cultural characteristics with other remote regions of the Arctic informed our decision to choose NWT as a case study for designing and applying the vulnerability-resilience integrated framework. This conceptual framework can also be tailored and is applicable to remote communities with large Indigenous populations in other parts of the world.

The Northwest Territories is one of the northern Canadian Arctic regions and is bordered to the east by Nunavut, to the west by the Yukon Territory, and to the south by British Columbia, Alberta, and Saskatchewan (Wonders, 2021). While the NWT covers 1,171,918 square km, the region is inhabited by only 41,070 people, which constitutes 0.11 percent of the total Canadian population

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in 2021 (Statistics Canada, 2022). About 50 percent of the NWT population is Indigenous (Statistics Canada, 2022). First Nations, Inuit, and Métis represent the larger Indigenous population (Statistics Canada, 2022). First Nations include over 25 groups, primarily Dene and Cree (JamesAbra, 2022). The Inuvialuit are the main Inuit nation in the NWT. Among the remaining NWT population, about 12 percent were minorities, including Asians, Black, Arabs, and Latin Americans, and the rest mostly were European descendants (Statistics Canada, 2022) In this study, the Arctic communities refer to both Indigenous and non-Indigenous communities. For research analysis, we defined Indigenous communities as communities with more than fifty percent of their residents being Indigenous and vice versa as non-Indigenous communities. Though the nature of a disease outbreak is nondifferential in exposure, its health consequences are unequally distributed across Canadian communities, like everywhere else, and are most pronounced among the Indigenous Peoples and communities with lower socioeconomic status than others (Huyser et al., 2022; Power et al., 2020; Spence et al., 2022; van Ingen et al., 2021). For example, the incidence rates of tuberculosis (TB) in 2016 were 23.8 and 170.1 per 100,000 among the First Nations and Inuit (Vachon et al., 2018). Whereas among the Canadian non-Indigenous population, the rate was 0.6 per 100,000 only (Vachon et al., 2018). Similarly, the First Nations had nearly triple hospitalizations rates compared to non-First Nations during the 2009 pH1N1 pandemic (Boggild et al., 2011). The prevalence rates, of not just infectious diseases but also chronic health conditions (such as diabetes, heart disease, high blood pressure, asthma, depression, cancer, obesity, etc.) in Indigenous communities, are much higher than the national average (Bruce et al., 2014; Indigenous Services Canada, 2018). A greater percentage of the First Nation and Métis Canadians living in provinces had three or more chronic conditions (Hahmann & Kumar, 2022). Besides chronic health conditions, 20 percent of provinces’ Indigenous Canadians were identified as having a disability as opposed to 11 percent of non-Indigenous people (Hahmann & Kumar, 2022). Like other infectious diseases, the COVID-19 mortality rate was much higher (i.e., 1.7 times) for residents in the lowest-income neighborhoods than those in the highest-income neighborhoods (Statistics Canada, 2020). Most of the residents in low-income neighborhoods live in poverty which constrains, to the most extent, their choices for living arrangements and working conditions which significantly increases their susceptibility to infectious diseases (Statistics Canada, 2020; van Ingen et al., 2021).

Such observed disparities in disease outcomes can be more thoroughly understood within the context of pre-existing inequities in social, political, health, and economic domains, affecting access and use of resources, including healthcare services and quality of living (Hahmann & Kumar, 2022; Huyser et al., 2022; Spence et al., 2020). As per the Community Well-Being (CWB)2 index, despite significant improvement in overall well-being in 2016 compared to 1981, the Indigenous communities scored lower in every component than non-Indigenous communities in 2016 (Indigenous Services Canada, 2019). Further, in some components, such as education and labor force activity, the gap has widened between these communities over time (i.e., from 1981 to 2016) (Indigenous Services Canada, 2019). In the NWT, Métis communities had the lowest average CWB index scores and the largest gap in the score when compared to their non-Indigenous counterparts (Indigenous Services Canada, 2019). Regarding food security, 21.6 percent of households in the NWT in 2017-18 were food insecure, and the proportion of children living in those households was 30 percent (Tarasuk & Mitchell, 2020). Moreover, the quality of healthcare services delivered to Canadian Indigenous communities in the territories was substandard due to poor civic

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infrastructure and shortages of healthcare providers (Hahmann & Kumar, 2022; Milligan et al., 2023; Vigneault et al., 2021). No doubt, where such a differential vulnerability exists, diseases flourish, and the above differential rates of diseases and chronic health conditions between Indigenous and non-Indigenous communities in Canada are not surprising. Despite these challenges, the NWT has well contained the proliferation of COVID-19. As of Jan 9, 2023, the NWT had 48.34 per 100,000 fatalities and almost zero hospitalization rates per 100,000, cumulatively (COVID-19 Tracker Canada, 2020). The less severe COVID-19 outcomes, healthwise, can largely be attributed to strict adherence to COVID-19 preventive measures (such as travel restrictions, social distancing, and self-isolation), efficient contact tracing, ongoing communication efforts of the NWT government with Indigenous Peoples, and higher vaccination rates (Cochrane, 2021; Fleury & Chatwood, 2022). Since the beginning of the pandemic, the NWT government has translated the general COVID-19 public health awareness messages and guidelines into various Indigenous languages, as well as disseminated information regarding how to participate in a traditional ceremony and harvest safely on a regular basis (Cochrane, 2021; Fleury & Chatwood, 2022). The NWT government was also continuously working in conjunction with the Government of Canada, Indigenous governments, and municipal leaders to pool resources and coordinate pandemic services across the NWT (Cochrane, 2021).

In terms of COVID-19 immunization, the NWT started vaccinating its people as early as December 2020 and was leading Canada initially (ArcticCovid-UNI, 2021; Public Health Agency of Canada, 2023). On June 1, 2021, 68 percent of the NWT population received at least one dose of the COVID-19 vaccine (ArcticVax, 2021; Public Health Agency of Canada, 2023). And, by January 9, 2023, 77.4 percent of the population had completed the primary series of the COVID19 vaccination (Public Health Agency of Canada, 2023). These higher vaccination rates were achieved through culturally safe vaccine hesitancy reduction initiatives driven by the NWT Indigenous Peoples (Government of Canada, 2023). Moreover, initiatives such as the utilization of traditional healing knowledge and medicine for both physical and mental well-being, measures taken to ensure food security (such as funding provided by the NWT government for the continuation of on-the-land-practices, and delivery of groceries, free to those who cannot afford, to all homes) and safety of community members were vital in curtailing adverse negative effects of the pandemic on people’s health (Cochrane, 2021; Fleury & Chatwood, 2022). Public health measures, collaboration, communication efforts, immunization, traditional healing practices, and well-being initiatives all proved to be vital in curbing catastrophic COVID-19 death tolls in the NWT which would be inevitable without such responses.

Data and methods

To understand the risks exposure of Arctic communities concerning pandemics and their effects, this study introduces a pandemic vulnerability-resilience framework (Figure 1) that synthesizes underlying factors defining Arctic communities’ susceptibility and ability to cope with and recover from disease outbreaks. We considered NWT communities as a proxy of Arctic communities and developed the framework for the territories considering its communities’ vulnerability and resilience features.

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Figure 1. NWT Pandemic Vulnerability-Resilience Framework

Based on the framework, we developed metrics of vulnerability and resilience, which both are composite indices calculated using a common set of societal variables (i.e., representative of the Arctic in general) but at the same time tailored as per the social, demographic, economic, healthcare, geographic, and cultural context of NWT communities and availability of data. These indices are called the NWT Pandemic Vulnerability Index and NWT Pandemic Resilience Index. The lists of the variables used, and their description and data sources are given in Tables 1 and 2.

This study adopted the Cutter et al. (2012) ranking method to develop indices. This method was also employed by the U.S. Centers for Disease Control and Prevention (CDC) to calculate the Social Vulnerability Index (SVI) (CDC/ATSDR, 2018; Flanagan et al, 2011). For calculating the vulnerability index, we computed the percent ranks of each variable listed in Table 1 using equation (1). Except for median income and health care facilities estimates per 100,000, the higher percentile ranking values of each variable indicate higher vulnerability. The higher percentile rankings value of median income and health care facilities estimates per 100,000 represents lower vulnerability. Thus, we reversed the ranking of these two variables by subtracting them from one, so that their higher scores represent higher vulnerability. After making all the variables in the same order, we linearly combined (i.e., summed) the rankings of all these variables, and the summed values were again ranked representing the scores for the index that range from 0 to 1, where 0 refers to the least and 1 refers to the most vulnerable communities.

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The same percentile ranking methodology was applied to create scores for the resilience index using variables listed in Table 2. Each community received a percent rank from 0 to 1. The higher the values of the index, the more resilient a community is, and vice versa.

The pandemic vulnerability and resilience indices then were assessed together visually using a bivariate map. The bivariate map shows various combinations of resilience and vulnerability

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categories pinpointing communities which will be most affected and must be prioritized accordingly during the distribution of the resources needed to prevent, cope with and recover from the consequences of disease outbreaks.

Source

Socio-economic Unemployment Rate

Percentage of the population with less than a high school diploma

Median Total Income ($) of households in 2015

NWT Bureau of Statistics

(Year: 2019)

NWT Bureau of Statistics

(Year: 2019)

NWT Bureau of Statistics

(Year: 2019)

Household Composition and Size & Disability

Percentage of the Population 60 years and over

Percentage of the population aged 14 and younger

Percentage of Lone-parent families

Average size of census families

2016 Census

2016 Census

NWT Bureau of Statistics (Year:2016)

2016 Census

Minority and Language

Percentage of minorities (except Caucasian & Indigenous) for the population in private households

Percentage of the population excluding institutional residents who do not have knowledge of official languages, i.e. neither English nor French

2016 Census

Housing & Transportation

Percentage of population institutionalized residents

Percentage of number of private households with more than one person per room

2016 Census

Health Factors

2016 Census

2016 Census

Percentage of the population without driver licenses NWT Bureau Statistics (year:2019)

Crude Prevalence (Data value in %) of heavy drinkers

Crude Prevalence (Data value in %) of current smoking adults aged 12 years and over

Estimates of Health Care Facilities (i.e., health clinics, medical clinics, and hospitals) per 100,000 population

NWT Bureau Statistics (Year:2014)

NWT Bureau Statistics (Year:2014)

NWT Bureau

Statistics/Infrastructure Profile

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Tiwari, Petrov, Devlin, Welford, Golosov, DeGroote, Degai & Ksenofontov Table 1. NWT Pandemic Vulnerability Index Variables Domains Description

Category Description

Economic Factors Labor Force Participation Rate

Percentage of the population not receiving any kind of income assistance

Source

NWT Bureau Statistics (Year:2019)

NWT Bureau Statistics (Year:2019)

Demographic Factors

Cultural Factors

Percentage of the Population aged from 20 to 54 years

Percentage of the population having knowledge of aboriginal languages in a private household

Percentage of Households Consuming Country Food

2016 Census

2016 Census

NWT Bureau Statistics (Year:2019)

Health Factor

Percentage of the population having at least one dose of COVID-19 vaccine

NWT COVID-19 Dashboard

Geography Index of Remoteness Statistics Canada (Year:2016)

Results

We mapped both pandemic indices scores to explore spatial patterns. For mapping purposes, the indices scores were classified into five categories: 0.0-0.2 equals very low, 0.2-0.4 equals low, 0.40.6 equals medium, 0.6-0.8 equals high, and 0.8-1.0 equals very high.

NWT Pandemic Vulnerability Index

In the Beaufort Delta region, communities (except Aklavik and Inuvik) with very high and high vulnerability index values, as shown in Figure 2, were concentrated in the east and northwest: Ulukhaktok (0.857), Fort McPherson (0.785), Tsiigehtchic (0.75), Tuktoyaktuk (0.71). Higher unemployment rates, low median income, and lower educational attainment were the main reasons for the very high and high vulnerability scores of Fort McPherson, Tuktoyaktuk, and Ulukhaktok. While Tsiigehtchic had good socioeconomic status, Tsiigehtchic as well as Fort McPherson, Tuktoyaktuk, and Ulukhaktok communities also had a considerable percentage of lone-parent families, crowded private households, heavy drinkers, and smokers.

Aklavik ranked medium, and Inuvik ranked low in vulnerability. Aklavik had a sizable proportion of lone-parent families, elderly population, and population involved in risky health behaviors, and did not own vehicles. Very low levels of vulnerability were seen in communities along the center Beaufort Delta region [i.e., Paulatuk (0.14) and Sachs Harbour (0.10)] and the south of NWT. Southern communities located in Decho and South Slave regions had medium to very low vulnerability index values. Other communities with high levels of vulnerability were located in Sahtú (except for Norman Wells), Tłıchǫ (except Wekweètì), and North Slave (except Yellowknife) regions. Although vulnerable, communities in Tłıchǫ (except Gamètì) and Sahtú regions ranked low to medium in socioeconomic vulnerability.

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Table 2. NWT Pandemic Resilience Index Variables

2. NWT Pandemic Vulnerability Index

NWT Pandemic Resilience Index

Regionally, communities in Sahtú and Tłıchǫ (except Behchokǫ) had high resilience index values (Figure 3). Both regions are home to Indigenous Peoples, mostly Dene and Métis, and thus found to be quite resilient in cultural indicators (i.e., a higher percentage of people having knowledge of Indigenous languages and a proportion of the population consuming traditional country food). The communities of both regions also had higher COVID-19 vaccination rates. Besides these factors, communities like Délınę, Norman Wells, Fort Good Hope, Tulita, Gamètì and Wekweètì had medium to very high economic resilience (i.e., measured through labor force participation rates, percentage of the population not relying on income assistance).

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Tiwari, Petrov, Devlin, Welford, Golosov, DeGroote, Degai & Ksenofontov Figure

Lower resilience was found across the communities in the South Slave Region as well as northwest of the Beaufort Delta region. Even though less resilient, all communities in the South Slave Region had medium to very high economic resilience and communities in northwest Beaufort had higher vaccination rates. Paulatuk, Sachs Harbor, and Ulukhaktok located in central and eastern Beaufort Delta regions had higher levels of resilience in demographic, geographic, and health indicators listed in Table 2.

In the Decho regions, Sambaake and Fort Simpson communities had higher levels of resilience, Nahanni Butte and Jean Marie River had medium-level, and Wrigley and Fort Liard had lower levels. Except in cultural indicators, Wrigley and Fort Liard communities ranked low in every resilience indicator.

Among communities in the North Slave Region, Łutselk’e ranked in medium while Yellowknife ranked high in resilience. Yellowknife is the capital of the NWT jurisdiction and the only city in the region. Thus, except in remoteness and cultural indicators, Yellowknife was highly resilient in every indicator.

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Figure 3. NWT Pandemic Resilience Index

Integrated vulnerability-resilience assessment

To accurately identify which community has the potential to be most affected if a disease outbreaks, we integratively evaluated the vulnerability and resilience (Figure 4). For the assessment, we categorized the communities using quantile into four continuums of vulnerability and resilience, combined (i.e., High-High, High-Low, Low-High, and High-High). High-vulnerability and lowresilience communities include Aklavik, Fort McPherson, Tsiigehtchic, Tuktoyaktuk, Łutselk’e, and Behchokǫ. Thus, these areas have a higher likelihood to be severely impacted by COVID-19 or a future pandemic. Inuvik, Fort Liard, Wrigley, Jean Marie River, and all communities in the South Slave Region could also be affected by a disease outbreak as these communities ranked low in both. Even though Ulukhaktok, Nahanni Butte, Colville Lake, Délınę, Fort Good Hope, Tulita, Gamètì and Whati communities had higher levels of vulnerability, these communities were also high in resilience, thereby they would have capacities to cope with and recover from a pandemic. Similarly, Paulatuk, Sachs Harbour, Fort Simpson, Yellowknife, Norman Wells, and Wekweètì communities which ranked high in resilience and low in vulnerability would probably be less impacted by the pandemic.

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Tiwari, Petrov, Devlin, Welford, Golosov, DeGroote, Degai & Ksenofontov Figure 4. NWT Pandemic Vulnerability-Resilience Typology

To understand which domains of vulnerability and resilience (as shown in figure 4 and 5) were most influential, we chose four sample communities each representing a combined continuum of vulnerability and resilience: Colville Lake (high in both), Paulatuk (low vulnerability and high resilience), Behchokǫ (high vulnerability and low resilience), and Fort Smith (low in both); and capital of the NWT, Yellowknife.

Figure 5. Vulnerability Domains in Selected Communities

The high vulnerability index values for Colville Lake and Behchokǫ were driven by their high percentile ranking scores in three out of five domains: household demography, minority status & language, and housing & transportation. Although highly vulnerable in all domains, Colville Lake ranked high in resilience and key domains that contribute to high resilience include culture and health. Colville Lake is a small Indigenous (primarily Dene) community with a strong engagement in subsistence and connection to the land (Government of Northwest Territories, 2023). In the health domain, the community had higher vaccination rates: around 92 percent of the population had received at least one dose of the COVID-19 vaccine by the summer of 2022. In contrast, Behchokǫ ranked low in resilience domains. Even though Behchokǫ is a predominantly Indigenous community, very few households consumed country food, and a relatively small number of residents had knowledge of their Indigenous languages. Further, the proportion of working-age adults and labor participation rate was relatively low despite Behchokǫ being one of

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the six main regional centers and economic hubs of the NWT. Behchokǫ also had a lower vaccination rate as compared to other NWT communities.

Paulatuk had a low to medium vulnerability ranking in all domains and was highly resilient, especially in geography, demography, health, and culture domains. However, it ranked relatively low in economic resilience. Paulatuk is the home to the Inuvialuit who have continued their traditional practices such as hunting, trapping, and Arctic char fishing (Government of Northwest Territories, 2023). Paulatuk had a large percentage of households consuming country food, although Indigenous language retention was lower. Due to limited wage employment opportunities, the labor force participation rate was relatively low.

Figure 6. Resilience Domains in Selected Communities

Paulatuk and Yellowknife both ranked low in vulnerability and high in resilience, but these two communities are very different. Most residents in Yellowknife are non-Indigenous including other minority populations (i.e., other than Caucasian). Only a small percentage of the Yellowknife population was involved in traditional activities, consumed country food, and had knowledge about Indigenous languages. Despite low scores on the cultural domain of resilience, the strength in the economic and demographic domains was sufficient for making Yellowknife highly resilient. Further, Yellowknife ranked near the bottom in three domains of vulnerability: socioeconomic status, household demography, and housing & transportation.

For Fort Smith, though the percentile rankings for the four domains of vulnerability were generally low, the cultural, health, and geographic indicators of resilience were weak. Fort Smith is a regional

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hub for the South Slave Region and the headquarters of the Wood Buffalo National Park, which is well connected to the rest of Canada. The community is less vulnerable and more resilient in respect to the economic domain.

In general, for remote Indigenous communities, the main sources of resilience are traditional country food, the strength of knowledge systems, and isolation. For non-Indigenous communities, the primary domain of resilience is economic indicators. With respect to vulnerability, remote Indigenous communities are found to be vulnerable in socioeconomic, demographic, and housing & transportation domains. In non-Indigenous communities, vulnerable groups are minority communities (other than Indigenous or Caucasian) and populations who speak neither English nor French.

Discussion and conclusion

Over the past two years, a strong research foundation has been built for understanding Indigenous communities’ vulnerability to the COVID-19 pandemic (Arriagada et al., 2020; Flores-Ramirez et al., 2021; Hathaway, 2021; Huyser et al., 2021; Mendes et al., 2022; Millalen et al., 2020); whereas only a countable number of empirically based studies on community-level resilience to the pandemic exist globally (Pileggi, 2022; U.S. Census Bureau, 2022; van Doren et al., 2023). In the Canadian context, some researchers have opted to define resilience as a subset or inverse of vulnerability while others took specific approaches such as location-based case studies or specific sectors, e.g., food systems, ecological or climate change, or natural hazards (Andrachuk & Smit, 2012; Chakraborty et al., 2020; Journeay et al., 2022; Lede et al., 2021; Oulahen et al., 2015; Ross, & Mason, 2020 and many more). Less is known about whether such studies capture the outcomes or processes of resilience meaningfully in the context of a pandemic. This study proposes a pandemic resilience index, a composite metric of societal indicators used as proxies of the Arctic communities’ inherent resilience needed to deal with adversities amid a pandemic.

The internal capacities of Arctic communities are distinctly different from communities in other parts of the world. For example, not only does access to country food make an Indigenous community’s food secure but also supports its people’s overall well-being (i.e., physical, mental, and spiritual health) by nurturing their sense of identity and belonging (Collings et al., 2016; Robin et al., 2021; Robinson, 2018). Further, households consuming country food can also be considered knowledge keepers who have preserved their ancestral wisdom of the Arctic ecosystem required to subsist off the land and of medicine, either in the form of food or herbs, required to recover one’s health (Kendrick, 2013; Mead et al., 2010; Sheremata, 2018). Thus, the percentage of households consuming country food in this study is used as a proxy for self-sustaining communities with the know-how of their natural environment and traditional healing practices. Likewise, another proxy of traditional knowledge and culture is the percentage of the population-speaking Indigenous languages since language is a way of knowing and a key medium of knowledge transfer (Degawan, 2019; Patel, 2006).

A further indicator of the Arctic’s inherent resilience spatially is its remoteness. Remoteness not just delayed the arrival of the pandemic in the Arctic but also provided an opportunity for Arctic communities to prepare for its eventual onset (Petrov et al., 2021a; Tiwari et al., 2022;). Like many Arctic communities, NWT capitalized on this opportunity through a massive COVID-19 awareness campaign using social media, radio, and door-to-door outreach; early monitoring of

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possible outbreaks using a rapid response team for contact tracing, and waste-water surveillance; instituting stand-alone government agency to pool resources and coordinate with Indigenous and municipal leaders, and massive rapid vaccination campaign, among others (Cochrane, 2021; Fleury & Chatwood, 2022; Public Health Agency of Canada, 2023). We also used the COVID-19 vaccination rate as a proxy of both immunity and the healthcare system. In addition to the individual health benefit of preventing serious illness, higher COVID-19 vaccination rates among communities are also indicative of NWT’s ability to deliver immunization services despite the inhospitable weather, difficult terrain, and pandemic-created obstacles, thus justifying the use of the vaccination rate as a proxy of health domain. Vaccination success also characterizes the public readiness to accept the vaccine, which is indicative of the potential success of pandemic public health actions (Government of Canada, 2023).

Among statistical methods that have already been applied to create a vulnerability index concerning the pandemic, we relied on percentile ranking to develop both indices for four main reasons: 1) simplicity, 2) reproducibility, 3) applicability, and 4) comparability.

Simplicity in the sense that, percentile ranking is easy to understand, calculate, and interpret, irrespective of the observed scores’ statistical distribution and audiences’ statistical background. Data of each variable in this study are easily and freely accessible thus any researcher could reproduce the results. The same category of variables, indices, and pandemic vulnerability-resilience framework can be applied with or without modification to other Arctic communities or remote regions in other parts of the world. Moreover, communities combined ranking in vulnerability and resilience can aid in the accurate identification of the communities at the most risk thereby assisting in the prioritization and allocation of resources and services accordingly.

This study clearly suggests that highly vulnerable Indigenous communities (i.e., communities where more than fifty percent of residents are Indigenous) ranked medium or high in resilience, whereas non-Indigenous communities (i.e., communities with less than ten percent Indigenous population) with low resilience were found to be low in vulnerability. For remote Indigenous communities, the main sources of resilience are traditional country food and their isolation and key domains in which they are high in vulnerability include socioeconomic, demographic, and housing & transportation domains. Non-Indigenous communities are economically resilient and vulnerable populations in these communities are minorities (other than Indigenous or Caucasian peoples) and individuals who speak neither English nor French. High-resilience communities, even though highly vulnerable, have capacities to cope with or recover from the pandemic. Communities with low resilience will still be less impacted by a pandemic only if they demonstrate low vulnerability. Thus, we conclude that considering either vulnerabilities or resilience separately would result in the inefficient allocation of resources and recommend a combined assessment of both. Further, the proposed pandemic vulnerability-resilience framework enables community leaders and/or government officials at different levels to identify the indicators which are below par or thresholds thus providing a reference for planning interventions required for improvement.

Although policy implications of the proposed approach can be far-reaching, this analysis has some limitations, hence results need to be interpreted very carefully. First, various indicators of vulnerability (such as poverty, population with special needs and chronic or underlying medical conditions, etc.) and resilience (such as housing stock, insurance coverage, medical care capacity, etc.) are not included in the indices construction as these data are not available at a finer spatial

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scale and/or for small communities. The same applies to the data on the COVID-19 epidemiological outcomes, which precludes an assessment of community indices vis-à-vis outcomes. Lastly, this study strongly recommends an in-depth field study to better understand the role of the social capital components (e.g., support networks, self-determination, and community engagement) of resilience in coping and facilitating recovery from the effects of the pandemic.

In summary, since the beginning of the COVID-19 global pandemic, there has been considerable research interest in quantifying pandemic vulnerability to identify high-risk populations. From the vulnerability perspective, the Arctic was expected to experience COVID-19 morbidity and mortality at disproportionately higher rates than their national counterparts, but for most Arctic regions the actual course of the COVID-19 pandemic was the opposite. In fact, a few Arctic regions such as NWT experienced only a handful of deaths and very low mortality rates. Thus, a vulnerability approach to understanding pandemic risks that does not account for the community’s resilience has been insufficient. The literature is still mired in defining resilience as the opposite of vulnerability and strewed with a variety of statistical methods to measure vulnerability. Almost no empirical measure of resilience that considers a community’s unique strengths and assets exists. This study is an effort to understand pandemic risk through a lens of community resilience, in addition to vulnerability.

Acknowledgments

This research was supported by NSF PLR#2034886. We are also grateful to Marya RozanovaSmith and Nino Mateshvili for their suggestions in writing this paper.

Funding Statement

The research is supported by NSF 2034886.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

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Endnotes

1. In the above-cited studies, the community-level vulnerabilities indices (such as the area deprivation index employed by Adjei-Fremah et al. (2023), small area vulnerability index by Daras et al. (2021), global vulnerability index by García-Peña (2023), and CDC social vulnerability index by Wang et al. (2022), and so on) found to be significantly associated

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with COVID-19 mortality and morbidity as well as socioeconomically disadvantaged communities with higher COVID-19 death or confirmed cases rates. Some common indicators used in these studies to measure a community's vulnerability include housing quality, poverty, age, employment, chronic disease conditions, race/ethnicity, and healthcare resources.

2. CBW Index is a composite measure of community welfare assessed using seven indicators of four components: education, labor force activity, income, and housing. For more information: https://www.sac-isc.gc.ca/eng/1419864229405/1557324163264

3. Our team has employed a similar vulnerability-resilience framework to assess pandemic risk within the Alaskan context. Further information is available at https://gh.bmj.com/content/8/6/e011646.

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Understanding the Power of Community During COVID-19

COVID-19 has posed a significant threat to Indigenous populations across the Arctic who experience many of the social, economic, geographic and health risk factors that are associated with severe outcomes of COVID-19.

“Indigenous peoples of the Arctic have historically almost always been severely impacted by pandemics and have shown a higher mortality rate than communities further South – due to a suit of reasons. However, their traditional knowledge has enabled communities to respond to pandemics in flexible and adaptive ways, strengthening their resilience.” (AC, 2020)

In the Circumpolar region, communities have and continue to rise to the challenge of addressing the complex challenges of the public health measures stemming from COVID-19 (UN, 2020) Arctic peoples live in regions that implemented a diversity of policies in response to the pandemic, and a variety of public health measures were introduced that included, but were not limited to, social distancing, self-isolation, quarantines, mask-wearing, and testing, which influenced and impacted community level responses.

Indigenous organizations, governments, communities, and leadership have required timely and reliable information to prepare, track, and communicate about the impacts of COVID-19 in ways that reflect our unique experiences (Healey, 2018; Redvers et al., 2019; UN, 2020). For this reason, Qaujigiartiit Health Research Centre (www.qhrc.ca) has been documenting the impacts of the COVID-19 pandemic in Nunavut communities since April 2020. First, by documenting the

impacts on community-serving organizations such as non-profits, wellness centres, and hunters and trappers organizations, then by systemically investigating the Iqaluit COVID-19 outbreak (April-June 2021), and continuing on into studies exploring education outcomes, quarantine/isolation hubs, and community and healthcare provider perspectives.

Nunavut is a Canadian territory, formed in 1999 as a result of Canada’s Nunavut Act (Commons, 1993). The population of Nunavut in the 2021 Canadian Census was 36,858 (Satistics Canada StatsCan, 2021) and the population of Iqaluit, the capital city, was recorded as 7,429 in the 2016 Canadian Census (Statistics Canada StatsCan, 2021). The remoteness of Nunavut’s communities has provided both advantages and disadvantages for the management of COVID-19. For example, the remoteness of Nunavut’s 25 communities and the lack of inter-community road infrastructure provided opportunities to limit spread by limiting inter-community air travel. Disadvantages of Nunavut’s remote geography included an already limited and disbursed healthcare infrastructure and low staffing rates, as well as additional complex logistics for the disbursement of personal protective equipment and vaccines.

The factors involved in COVID-19 decision-making for the territory of Nunavut were identified as (GN, 2021): status of transmission of COVID in territory; state of testing capacity; health system capacity locally and at tertiary care centres; transmission and case levels in our gateway cities (Ottawa, Montreal, Winnipeg, Edmonton, Yellowknife); current health/medical evidence; Assessment of risks and vulnerabilities; and Epidemiological and public health evidence.

Qaujigiartiit’s studies have been implemented using the Piliriqatigiinniq Community Health Research Model (Healey & Tagak Sr., 2014), which was developed by Nunavummiut to guide communitybased health and wellbeing research. The model prioritizes 5 Inuit concepts for research excellence: Inuuqatigiitiarniq (respect for all/shared humanity), Pittiarniq (to be good or kind), Iqqaumaqatigiinniq (to think deeply until realization), Unikkaaqatigiinniq (the power, meaning, and role of story), Piliriqatigiinniq (to work for the common good). These values provide the foundation for this research study. The study focuses on: addressing key community research questions; acknowledging that the narratives and voices of Nunavummiut are essential to the story; understanding experiences and identifying solution-seeking pathways; and conducting the research with compassion and kindness at the heart of the work.

Our research findings are just beginning to emerge. However, what we are observing in our early analyses is the profound power and importance of community in the COVID-19 response. Initial reactions to the pandemic were rooted in terror and fear of death, similar to reactions around the globe. What stands out among the voices from our Nunavut communities are the multiple ways in which people supported one another, and the ways in which they showed care and nurtured connections to others without being able to visit in person.

Nunavut has struggled with outbreaks of Tuberculosis for decades (ITK, 2018; Orr, 2013), and previous research of lower respiratory tract infections in infants showed that medevacs accounted for between 18% and 55% of the total cost of hospitalizations in northern Canada (Young et al., 2019). During our COVID-19 research studies, however, we were hearing from healthcare providers that respiratory illness among infants, and cases of Tuberculosis, diminished significantly. There are important lessons to be learned about the role of public health interventions such as isolation, masking, and care packages, for sanitizing multi-use spaces, as well as for supporting families through food deliveries (food baskets for isolating families) and living wages. The

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infectious illnesses that have plagued our communities for decades have clear solutions when the financial resources are available to implement them.

Few, if any, Nunavummiut who have participated in the studies have talked about the impact of COVID-19 on themselves – “How will *I* survive? How will *I* eat? What will *I* do?” rarely, if ever, came up. The questions Nunavummiut asked were, “How will *we* look after our little ones? How will *we* protect our Elders? How will *we* support our homeless population?” Our communities are powerful, strong, and protective, and have the desire and capacity to look after one another. The greatest concerns expressed by our communities in these numerous and broad studies focused on how we, as Nunavummiut, can care for our most vulnerable and how our leaders can address structural determinants such as housing, water, and healthcare so that we can all participate in taking better care of our people. This is a very important learning for public health

our communities know and understand the issues and have solutions. Big, structural health determinants are blocking the pathways forward. There is power in community and we need to support the systems and processes that release it.

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Young, T., Tabish, T., Young, S., & Healey Akearok, G. (2019). Patient transportation in Canada's northern territories: patterns, costs and providers' perspectives. Rural and remote health, 19(2).

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Challenging dominant narratives to enable effective responses to pandemics and other crises in rural and island communities

This article strongly evidences the need to transform narratives and perspectives on rural, island and indigenous communities, and the many elements for such transformation that are already in place. We start by summarising extensive research conducted during COVID-19 on communities across the Northern Periphery and Arctic that turned what are often regarded as the challenges of peripherality to their advantage as resilience factors. In the process, they challenged many economic frameworks that have long dominated development policy for ‘remote’ regions. We then examine emerging research on dominant paradigms that are driving responses to the climate and biodiversity emergencies. Once again, these paradigms are often not rooted in the lived experience and (inherited) knowledge of local peoples and communities, who manage the vast majority of our natural assets. This leads to the wrong ‘solutions’ which can directly threaten rural, island and indigenous communities while not delivering positive outcomes for the climate and biodiversity. The call to “redefine peripherality” is backed by extensive evidence, and makes a series of recommendations for a more integrated, holistic and sustainable approach to peripheral communities, building on their many assets, strengths and resources. Likewise, many voices, from local communities to international bodies, are calling for more effective responses to the climate and biodiversity emergencies that incorporate the worldviews of indigenous peoples and local communities who have so much to contribute

Transforming dominant narratives cannot happen until we genuinely listen and respond to the voices of rural, island and indigenous peoples within the Arctic and beyond.

Thomas Fisher and Theona Morrison, Co-Directors of Community Development Lens (CoDeL), which is a small social enterprise based in the islands of the Outer Hebrides of Scotland; see www.codel.scot

Introduction

The COVID-19 pandemic along with the twin climate and biodiversity emergencies are demanding urgent responses and actions, not least within the Arctic region. Why then spend time focusing on narratives and the lenses through which powerful outsiders often understand, frame, analyse and prescribe for Arctic and other so-called ‘peripheral’ communities? The answer is simple. If the narratives are wrong, if perspectives, policies and decisions are based on a misunderstanding of the actual conditions and characteristics of Arctic and other so-called ‘peripheral’ communities, then such policies and decisions will not achieve their desired outcomes. This came strongly to the fore during COVID-19 when many peripheral communities across the Northern Periphery and Arctic (NPA)1 turned what are often regarded as the challenges of peripherality to their advantage as resilience factors. In the process, they challenged many of the economic narratives and frameworks that have long dominated economic development policy for ‘remote’ regions and communities, showing just how unsustainable such policies have often been.

Reframing dominant narratives has become all the more urgent amidst the highly visible impacts of the twin climate and biodiversity emergencies. Again, by listening to the voices of local, rural and island communities, we are discovering that dominant narratives that are not rooted in the lived experience and knowledge of such communities are generating the wrong ‘solutions’ that may be doing more harm than good. This is not least the case because the vast majority of natural assets are located in rural and island areas. According to the UN, 80% of the world’s biodiversity is stewarded by indigenous peoples who make up just 5% of the world’s population (United Nations, 2021).2 And the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) states very clearly, “Despite the diversity of nature’s values, most policymaking approaches have prioritized a narrow set of values at the expense of both nature and society, as well as of future generations, and have often ignored values associated with indigenous peoples’ and local communities’ worldviews” (IPBES, 2022)

This article therefore seeks to challenge dominant narratives that are undermining communities across the NPA, first around so-called ‘peripherality’ itself, for which we summarise extensive research conducted during the pandemic. This research covered Atlantic Canada,3 Greenland, Iceland and the Faroe Islands, rural Sweden, Finland, Scotland and Ireland. Next, drawing insight and inspiration from the call to “redefine peripherality”, we turn to emerging research on the dominant narratives that are driving responses tothe twin climate and biodiversity emergencies, often undermining peripheral communities in the process. This emerging research is so far primarily rooted in rural and island voices in Scotland, which is keenly seeking to build collaborative relationships across the Arctic region as the most northerly non-Arctic country with a strong sense of commonality with its Arctic neighbours.4 But it is very clear that the emerging findings are relevant across the NPA as our on-going engagement with diverse partners across the region demonstrates. A key conclusion of this emerging research is: “The insights, whether from rural and

1 For the research reflected in this article, the “Northern Periphery and Arctic” is delineated by the EU’s Northern Periphery and Arctic Programme (www.interreg-npa.eu), involving EU member states Finland, Ireland, Sweden and, until recently, the UK (Scotland and Northern Ireland), in cooperation with the Faroe Islands, Iceland, Greenland and Norway, as well as enabling partnership working with Canada (and Russia).

2 Other sources say indigenous peoples make up 6% of the world’s population.

3 Atlantic Canada is made up of four provinces - Nova Scotia, New Brunswick, Prince Edward Island and Newfoundland and Labrador, with a population of almost 2.5 million.

4 “For centuries, Scotland and the Arctic have enjoyed close links that have had a lasting impact on our cultural, economic and social fabric. Scotland is among the Arctic region's closest neighbours; we share many features and outlooks and have long looked to each other for inspiration, solutions and ideas.”

Foreward to the Scottish Government’s Arctic policy framework, Arctic Connections.

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island communities in Scotland to the international IPBES, all indicate that top-down frameworks, strategies and policies based on a narrow set of values, including those reflected in the dominant Natural Capital frameworks, will not just fail to deliver justice and community wealth for our rural and island communities, but will also fail to address the climate and biodiversity emergencies or to restore nature.”

Seeking a just transition for rural and island communities across the NPA is hugely important. And these communities also have so much to offer that transition. Both our extensive research during the pandemic and our emerging research responding to the climate and biodiversity emergencies demonstrate that, when viewed through fresh lenses, peripheral regions are in fact at the forefront of innovation, with significant experience and wisdom, including among indigenous peoples, of how to live well, sustainably and more lightly on the earth. This places innovation in the periphery at the very heart and centre of solutions to societies’ most pressing challenges, especially the climate and biodiversity emergencies.

Redefining peripherality

In the past, most common features of so-called ‘peripheral’ regions have been regarded as challenges: demographic imbalances and outmigration, dispersed populations, remoteness and low accessibility, fragile local economies distant from major markets and with low diversity and being the most vulnerable to the impacts of climate emergencies. So-called ‘peripheral’ regions, defined primarily by their vulnerability and disadvantage, need to ‘catch up’ with more ‘developed’ and ‘central’ regions.

But the picture that emerged from extensive evidence gathered across the NPA during the pandemic demonstrated peripheral communities often showed remarkable resilience, drawing on many local assets and strengths, demonstrating significant flexibility and adaptation, generating much innovation and creativity (from technology to sustainable living) and many localised solutions. Often borne out of necessity, peripheral communities tapped into their long history, rooted in generations of experience, of having to respond and adapt to changes and crises. They turned what are often regarded as the challenges of peripherality to their advantage during COVID19 as resilience factors, including:

• their geography, including remote dispersed populations where self-reliance is the norm, and access to nature, e.g., opportunities for outdoor experiences and growing local food;

• close knit small communities, e.g., supporting vulnerable individuals and suppressing local outbreaks quickly, supporting local businesses, as well strong vision and energy for imagining positive futures beyond the pandemic;

• collaborative services, including across sectors;

• the relative importance of public sector employment in many peripheral regions and their ability to access government support;

• diversified economies created by the dense and diverse web of micro- and small enterprises and their flexibility and adaptation; and

• innovation and digitalisation, including digital technologies to deliver health services. Even with regards to the critical demographic challenges, there is growing evidence from many different peripheral regions or localities that long-term demographic decline may be turning, trends which started even before COVID, but which COVID-19 accelerated (see further below)

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Changing paradigms

COVID-19 not only disrupted people’s lives, health care and economic activity; it also disrupted accepted paradigms, not just on peripherality but also on economics. Our COVID-19 research:

• demonstrated significantly increased direct intervention of public authorities in the economy, which will have long-term effects on public spending and on the relationship between public authorities and private enterprise and ownership.

• presented a fundamental challenge to the common view that saving lives and saving the economy are in conflict with each other (CoDeL, 2021: Part 2) The economic analysis by Kostarakos and O’Toole (2021) suggested that the sharp rise of COVID-related deaths in three NPA countries led to a sharp deterioration of economic sentiment, which was reversed once the number of deaths stabilised, demonstrating the strong economic impacts of health outcomes via their effect on economic expectations. The human rights report by Svanberg (2021) also argued against health and economy objectives being in conflict.

• challenged standard economic development prescriptions for prosperity and wellbeing, by revealing how unsustainable for long-term, and even for short-term prosperity and wellbeing, traditional economic frameworks are.

It is therefore imperative to look for alternative frameworks that put people and the planet first. This shift in economic thinking was already happening before COVID-19, but was hugely accelerated by the pandemic and has now entered into mainstream economic thinking, not least in response to the climate and biodiversity emergencies.

The COVID-19 research (CoDeL, 2021: Part 2) highlighted two well-established paradigms of new economic thinking: Wellbeing Economics (www.weall.org) and the Doughnut Economy (www.doughnuteconomics.org). The Governments of Iceland, Scotland and Finland, as well as New Zealand and Wales, are all members of the Wellbeing Economy Governments partnership (WEGo). The research also illustrated that innovation and practice to deliver on new economic thinking were already taking place on the ground in many peripheral regions. This makes the new economic thinking deeply relevant to such regions.

Introduction to the research on the economic impacts of COVID-19

The call to “Redefine Peripherality” emerged from extensive and detailed analysis of the experiences and lessons learned from COVID-19 across the NPA. The research, focused primarily on the economic impacts of COVID-19, looked at regions both within and without the Arctic, including Ireland and Scotland. The way in which the diverse evidence across different countries, territories and sectors reinforced each other is striking. Funded by the EU’s Northern Periphery and Arctic Programme, under the NPA’s COVID-19 Response Project, the research was delivered by 12 partners as well as independent researchers5 across the area, with CoDeL (Community Development Lens) as Lead Partner. The research was conducted during the pandemic itself, specifically late 2020 to early 2021.

5 Including research commissioned by the project partners from others, in total 8 universities/research institutes, 2 public agencies, 6 social or private enterprises, and 3 independent researchers contributed to the research on the economic impacts of COVID-19. The research, and the insights it delivered, would not have been possible without these partners and researchers, and without the funding and support from the Northern Periphery and Arctic Programme under their special COVID-19 Response Project.

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The extensive findings were captured in 10 reports, all available on the web.6 The reports cover economic impacts on different regions, sectors and businesses in Atlantic Canada, in Greenland, Iceland and the Faroe Islands, in the Highlands and Islands of Scotland, in Sweden, and on Finnish regional health care services. Two of the reports were cross-cutting, analysing comparative macroeconomic data as well as extensive Nordic research on regional development, emerging sectors and demographics. One of the reports focused on how human rights perspectives can be introduced, assessing adherence to human rights during the pandemic and seeking to reconcile human rights and the economy.

Insights from this large body of evidence, based on extensive desk research, 80 interviews and almost 30 case-studies, were gathered into a main report that challenged many traditional perspectives on NPA regions and on so-called ‘peripherality’ in general. The diverse body of research is significant for two reasons:

1. the weight of evidence it delivers across many different regions, from Finland to Canada, and across many different sectors: economics, enterprise, tourism and regional development, health care, culture and human rights; and

2. it is rooted in lived experience in peripheral areas during the pandemic, drawing on many different voices within peripheral communities and conducted, evaluated and written by researchers, many of whom themselves live in peripheral regions.

It is the strong focus on the experiences, knowledge and lessons at local and/or community levels that led to such a profound challenge to the dominant narratives that have determined perspectives, policies and decision-making towards peripheral areas. Instead of defining so-called peripheral areas as ‘backward’, needing to ‘catch up’ with more ‘developed’ and ‘central’ regions, the research demonstrated the need for a fresh perspective which redefines peripherality and properly assesses the assets, strengths and opportunities of peripheral regions, and their many resilience factors in times of crises, like COVID-19.

“While rural places are not without their challenges, they are also unquestionably places of opportunity.” (OECD)

Reflections on the experience of indigenous peoples during the pandemic are included in our research, especially in the reports from Canada and on human rights. However, our COVID-19 research conducted over a very short timeframe (end of 2020 to early 2021) does not directly reflect indigenous voices. The “Covid-19 in the Arctic - Briefing document for Senior Arctic Officials" prepared for the Arctic Council in June 2020 and the article by Jennifer Spence and Sai Sneha Venkata Krishnan in this special issue of the Arctic Yearbook include much more analysis of indigenous issues during the pandemic.

The sections that now follow, on economic impacts, resilience, demographic challenges and recommendations, draw on key findings from our COVID-19 research that are summarized in different parts of the Main Report (CoDeL, 2021).

6 All the 10 reports, including a detailed Main Report (CoDeL, 2021), are available on CoDeL’s website: www.codel.scot (click on Redefining Peripherality tab). The main report includes six parts summarising the findings on economic impacts; small and micro-enterprises; sustainable tourism; resilience factors; and demographic trends; as well as the recommendations. Some of the individual reports are also listed in the references at the end of this article

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Economic impacts of COVID-19

The severe economic disruption caused by COVID-19 in peripheral regions across the NPA is undeniable. As examples from three of the 10 research reports demonstrate:

1. In the Nordic countries, from April to June 2020, international tourism to Norway dropped by 95%, by 66% in Sweden and by 61% in Finland (CoDeL, 2021: Part 4). Northern Norway is particularly dependent on tourism.

2. In Canada, exports accounted for 29% of the Atlantic region’s GDP, supporting over 118,000 jobs. These exports were down 50% in May 2020 from 12 months earlier (Chapman et al, 2021). Based on several indicators, Newfoundland and Labrador was the Atlantic province hit hardest.

3. Of 1,200 business owners and the self-employed surveyed in the Highland region of Scotland, 54% were closed (45% by law and 9% voluntarily), 35% were struggling to stay afloat, and a further 33% experienced a fall in sales and profits. Almost half were concerned about their ability to survive for the next few months (Westbrook and Golding, 2021).

The macro-economic data confirmed significant declines in economic activity across the NPA, although different regions and different sectors fared very differently (CoDeL, 2021, Part 2; Karlsdóttir and Cuadrado, 2021; Kostarakos and O’Toole, 2021). The impact of sudden falls in output and jobs, consumption and investment should not be underestimated, dramatically increasing the already significant impact of the pandemic on citizens and households. There was also clear evidence of sharply increased inequality, with severe impacts, for example, on low-paid workers, young people, women, indigenous communities and gig economy workers (CoDeL, 2021: Part 2)

The economic impacts of COVID-19 also extended to the delivery of health care services, as seen in small hospital districts in East Finland (Mankki et al, 2021) The Finnish report reflects how COVID-19 increased health care costs and exacerbated shortages of health personnel. The report argued that this will continue to have significant impacts with lower tax revenues for municipalities leading to further retrenchment in services and further expansion of digital and tele-health services. Above all, there was an accumulating ‘care debt’ during the pandemic, with the postponement of non-urgent health services and a reduction in services for some of the most vulnerable groups.

Resilience

Nevertheless, a clear pattern emerged from the research and its diverse sources: on balance socalled peripheral areas performed relatively well during COVID-19, even though there were significant variations across different regions and sectors, and across different waves of the pandemic over time (CoDeL, 2021: Part 5).

The researchers pointed to the low infection and death rates in many, although not all, peripheral regions, especially in the first wave of COVID-19. Peripheral areas benefitted from their geography, including their remote and sparsely populated regions; and islands, with their welldefined geographic boundaries, were able to limit and control access. Peripheral areas often developed and/or used testing and tracing systems very quickly and effectively and shut down community transmission swiftly, based on cohesive communities, responsive governance and the ability to create local solutions. There was rapid community engagement and participation, volunteering and generosity expressed in practical action to help the most vulnerable and at-risk in particular.

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Micro- and small businesses form the bedrock of local economies in many peripheral regions, and research suggests that small businesses tend to be more flexible and are able to change faster during a crisis. Over half of 62 entrepreneurs surveyed in Greenland, Iceland and the Faroe Islands indicated that COVID-19 had brought about new business opportunities (Voluntās, 2021), and similar findings came from surveys in Greenland and Atlantic Canada. Community and social enterprises are also critical in sustaining communities and local economies across peripheral regions.7

Economic responses in peripheral regions to COVID-19 were characterised most by flexibility and adaptation, innovation and creativity, and not least collaboration (CoDeL, 2021, Part 3). The micro- and small business sector acts as a seedbed for new businesses, developments and innovations, including in a wide range of innovative sectors, from the bio-economy in Nordic countries (Karlsdóttir and Cuadrado, 2021) to the exponential growth in traditional music in Scotland (Morrison, 2021). Another NPA COVID-19 project, this one focusing on technology solutions (TechSolns, 2021), surveyed 35 technology companies across the NPA that had engaged in significant innovation, adaptation or market expansion in response to health needs during COVID-19. Of these, three-quarters were small and micro-enterprises, and almost half had 10 or fewer employees. The many examples of innovation across all these reports paint the picture of an enterprise sector that not only showcases ingenuity, but one that is motivated by a sense of community and generosity.

The pivot to local markets was one of the most prevalent adaptations that micro- and small businesses made in response to COVID-19, not least within the tourism sector (CoDeL, 2021, Part 4). They often benefitted from strong support from local costumers. North Iceland had a good tourist season in 2020 based entirely on domestic tourists. COVID-19 also sharply accelerated the growth of web-based activity, with many enterprises moving on-line to reach new markets.

The flexibility and adaption of micro- and small enterprises, and pluralistic lifestyles where individuals engage in multiple economic activities (including employment, self-employment and volunteering) proved critical resilience factors for many local economies in peripheral regions. And their ability to innovate new products and services, including in response to a crisis, highlighted significant dynamism and resilience (CoDeL, 2021, Part 3). Evidence for this came from across many regions and sectors, from the primary and manufacturing sectors, as well as diverse services, from tourism (Voluntās, 2021) to traditional music and culture (Morrison, 2021). The evidence also ranged from traditional activities like forestry (Bogren et al, 2021: 10) to emerging sectors like the bio-economy (Karlsdóttir and Cuadrado, 2021). By the end of 2020, the bioscience sector in Prince Edward Island had added 200 jobs since the pandemic began and seven of its companies were planning expansions (Chapman et al, 2021). These characteristics were also common among community and social enterprises within peripheral communities, as well as among small public service providers, as the research on the smallest hospital district in Finland demonstrated (Mankki et al, 2021). In this case, public services engaged effectively with collaborative local networks involving public, private and community actors. And Nordic regions have been at the forefront of tele and digital health service provision, which accelerated during COVID-19 and provided significant protection and resilience during the pandemic.

In summary, the research found significant evidence from across the NPA, reflected in all 10 reports, that many peripheral regions and communities proved significantly resilient and relatively effective in responding to COVID-19. This does not mean every peripheral area did relatively well. Some regions, like northern Norway, which was so highly dependent on tourism, were particularly hard hit economically. The picture in Sweden was more mixed because of its very different response nationally to COVID-19. And the pandemic’s second and third waves often impacted

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7 See, e.g., the brochure on Social Enterprise Place Uist (Social Enterprise Scotland, 2021).

peripheral areas more than the first, although the rates were often still low in comparison to other regions, and some of the peripheral areas responded well with fast roll-outs of vaccination programmes.

A key focus of the research was therefore on identifying the many factors, often existing before the pandemic, that helped peripheral and rural communities to respond well: such as low population density; cohesive, engaged and personalised communities; effective local governance, strong networking and partnerships across sectors; flexible and innovative businesses; and social enterprises rooted in their communities and local economies. All of these preconditions helped peripheral communities in their response to COVID-19, in terms of both health and economic outcomes.

Demographic challenges

As stated earlier, the research also found growing evidence from many different peripheral regions that long-term demographic decline may be turning; trends which often started even before COVID. The research cites examples from the Nordic countries, Scotland, Iceland, the Faroe Islands and Atlantic Canada (CoDeL, 2021, Part 6). The rapid expansion of remote working and on-line business opened up significant opportunities for peripheral areas in attracting population, as well as challenges, especially around housing. And many regions, e.g. in Canada, Iceland and Scotland, are now taking a pro-active approach to attract people to settle or return in order to reverse demographic decline.

Box 1: COVID-19 and the impact on older people in peripheral areas

Our research project did not look in detail at the impact of COVID-19 on the elderly because the core focus of the research was on the economic impacts of the pandemic. The pandemic overall had a disproportionate impact on older people, and populations in many peripheral areas are, for historical reasons, skewed towards a more elderly demographic. It is a fair assumption then that COVID-19 would have had a particularly negative impact on peripheral areas.

While we do not wish to underplay the impact of the pandemic on the elderly in peripheral areas, it is nonetheless true that many of the resilience factors we have cited acted as protective factors for the elderly in some peripheral areas: lower infection rates, effective test and trace mechanisms, already well advanced tele and digital health service provision with further innovation among local businesses in response to the pandemic, significant community engagement and generosity, active community enterprises, and quick and high uptake of vaccines.

The report on Finnish regional health services (Mankki et al, 2021) looked at the East Savo Hospital District (in east Finland) which has an aging population. “Exceptional times have certainly called for exceptional measures, but … the peripheral regions have also relied on already established innovations such as integrated models in health care, training and education, a strong public sector and its cooperation between regional and national level actors, and strong regional infrastructure. The strong effort to digitalise health care throughout the 21st century has also eased the transition to on-line, remote service provision during the pandemic.” (, Mankki et al, 2021: Section 5.1)

Measures adopted within East Savo specifically relating to the elderly ranged from contracting out selected services to private service providers to community-based nurse training “in a way”, as one interviewee explained, “that everyone has the opportunity to take part in the training for an assistant nurse and from there to proceed to a community-based nurse, i.e. to see that people who have not studied for a while would have the lowest possible threshold. And in recruitment we have tried to take into account the educated people in sparsely populated areas who currently work in agriculture, so that they’d be able to work part-time, even in home care, around their own residential area. … We have not been able to recruit a significant number of people through this, but these measures are constantly being considered and we have a good cooperation with our educational institutions in the area.” (Mankki et al, 2021: Section 4.2)

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As examples, the NGO Ungt Austurland (Young East Iceland) and the municipality of Klakksvík in the Faroe Islands are both trying to attract young people (back) to their regions by raising awareness of local opportunities and the visibility of local companies and businesses, enhancing networks among young people in and from their areas, engaging with former students who are studying elsewhere, and getting young people in their area involved in development and local politics.

In direct response to COVID-19, Tourism Nova Scotia and Nova Scotia Business Inc. launched a marketing campaign to attract people working from home to move to Nova Scotia. It includes a website (www.workfromnovascotia.com) with relevant information and innovative advertisements like, “Not all breakout rooms are created equal. Work where you want to live” and “You always wanted an office with a view”. The campaign’s goal was to attract 15,000 to the province within one year

Figure 1: Image on the work from Nova Scotia website

The digital platform Uist Beò also emerged during COVID-19, initially through social media (Facebook, Instagram, TikTok and Twitter). The Uist Beò website (www.uist.co) was launched in March 2022, and has already attracted over 3000 visitors. The platform is run by a team of young islanders to reflect the realities of the vibrant and dynamic island life in Uist in the Outer Hebrides of Scotland, instead of perpetuating the romanticised views of islands “lost in the mists of time” with empty beaches, ruined blackhouses and sheep as traffic jams. A key aim is to attract younger people and families to return or settle in the islands full of community and culture, activities and opportunities. So the platform features many stories of young people returning or settling and setting up dynamic enterprises, as well as weekly posts on activities and job opportunities, Gaelic language and culture, etc.

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Recommendations from the COVID-19 research

In the past, policies for so-called ‘peripheral’ regions have been framed by an (often condescending) mindset that peripheral regions are ‘backward’ and need to ‘catch up’. Policy prescriptions focused, for example, on growth enterprises, linking regions to large more prosperous markets (e.g. tourists from urban centres and abroad), and attracting inward investments by large businesses and corporations.

This policy framework often did not help peripheral regions and communities to respond effectively to emergencies like the pandemic because it ignored many of the realities and strengths of peripheral areas set out above. The main project report set out 18 recommendations for a new, integrated, more holistic and appropriate approach to peripheral regions (CoDeL, 2021, Part 1). These recommendations recognise that peripheral economies look very different from urban or ‘central’ economies.

The recommendations include the need to redefine peripherality; adopt new economic paradigms; address inequalities and, in the light of experience during the pandemic, focus on enhancing protective and resilience factors rather than growth, not least by building on the many assets and strengths to be found in peripheral regions, which COVID-19 brought into strong focus.

There are also recommendations to invest in new emerging sectors, like the green economy and clean technologies, the bioeconomy, bioscience, technology and the digital economy; build circular and local economies; diversify regional and local economies, including by investing more in micro and small enterprises, in community and social enterprise, and in young entrepreneurs, rather than prioritising large-scale inward investments.

Other recommendations focus on the need to:

• develop local food production, local supply chains and value addition, to reduce transport emissions and support greater self-sufficiency and resilience, especially in times of crises.

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Figure 2: Image representing vibrant and young island living in the Outer Hebrides of Scotland

“Seventy percent of the world’s population is fed by food produced on small farms, many less than 2 acres in size. This one statistic illustrates that 70% of the world’s population has a much closer connection to how and where their food is grown. That leaves 30% of the world’s population in a dependency culture, dependent on food being produced by someone else, somewhere else fed predominantly by industrial farming methods, a myriad of monocropping production in the name of efficiency, but this single-focus production is destroying the earth that supports its production. (CoDeL, Draft report on “Community conversations on nature”)

More local food will also require significant changes in legislation around food production. The Faroe Islands support Heimablídni, a local concept that allows family businesses to start serving food in their own home without the prior sanitary approvals normally required when starting a cafe or restaurant. In Greenland, the innovative Foodlab Nuuk is offering access to public kitchen facilities, allowing people to rent a protocol and sanitation-approved kitchen to cook, invite paying guests and share their life story in a home away from home. And addressing the obstacles to more localised and home slaughtering is critical. Greenland has a concept called “Kalaaliaraq”, establishing designated local slaughtering and trading areas where farmers themselves can use the facility to slaughter and process their meat in a food and safety-approved environment. ( Voluntās, 2021)

• value the role of government, and of public expenditure and investment. Securing continued access to schools and health care locally, for example, is a critical strategy to support resilience and to retain and attract families and others in peripheral regions. Investment in education, social and health care also provides employment and income to individuals, and enhanced tax revenues to national, regional and local government.

• build and invest in effective, empowered and resourced regional and local governance, and cross-sectoral collaboration, including community-based organisations. Individual regions and localities must be given the ability and support to develop their own local solutions to key challenges, in line with local people’s aspirations and available assets, strengths and skills.

• implement human rights. Human rights obligations provide critical frameworks for protecting the rights of individuals and groups, not least during crises. Understanding, practice and adherence to human rights needs to be enhanced.8

• address demographic trends proactively to showcase peripheral areas as great places to live and work, and to run sustainable businesses, focusing on assets and strengths, enterprising opportunities and quality of life. Attracting young economically active people is an essential target group, building on the significant shifts in aspirations among young people around wellbeing, balanced lifestyles, family and community, and the climate and biodiversity emergencies.

• support transnational partnerships. The COVID-19 project itself demonstrated the value of bringing together experience from diverse peripheral regions across the NPA, to amplify peripheral voices to the extent of redefining dominant narratives and perspectives.

8 The report on human rights (Svanberg, 2021) suggested e.g. (on-line) learning for diverse actors, developing appropriate Codes of Ethics, and human rights ombudsmen / councellors who can both support implementation of human rights and conduct audits of policies and actions against human rights criteria.

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Relevant to all these recommendations was the analysis showing the similarities and differences in regional impacts of COVID-19, demonstrating how critical it is to adapt policies and actions to be appropriate and effective for each different peripheral region. There is no “one size fits all”

Finally, the main report developed recommendations on genuinely sustainable tourism to illustrate the radical shifts that are needed in economic and regional policy. Tourism was one of the sectors that was most deeply affected by COVID-19. This shock also deeply challenged most economic development and regional policies for peripheral regions, which often have tourism development at its core, with success measured by ever growing visitor numbers multiplied by estimates of visitor spend. Over dependence on tourism was one of the greatest factors undermining economic resilience in peripheral communities during the pandemic, demonstrating how risky, economically and socially, an excessive dependence on tourism can be.

While tourism development has brought some undoubted economic benefits to peripheral regions, the employment opportunities within the tourist sector are often limited, poorly distributed, lowskilled and seasonal. Seasonality can overwhelm communities in the often short tourist seasons, and leave them essentially 'closed' out of season and bereft of meaningful activity. Tourism has been hugely destructive to the environment, and often to cultural identity and the sustainability of communities as well. At worst, there are reports of last chance tourism within the NPA, to visit ecologically fragile environments before they disappear, thereby contributing to hastening ecological collapse in these places.

A radical shift in tourism development is called for, including significant decarbonising of tourism impacts. What is striking about the COVID-19 project’s research is just how many entrepreneurs on the ground in the NPA are looking for alternatives too, and just how many good practices there already are, from cozy outdoor dining huts that will be repurposed as greenhouses in the spring, through entrepreneurs going on-line to sustain their businesses virtually, to a massive shift across the NPA to the opportunities of local and domestic tourism. Tourist providers in Iceland reported that domestic visitors often stayed for longer, engaged in sustainable activities like hiking, and enjoyed exploring their own national and regional culinary and cultural traditions.

Tourism needs to:

• be one part of the local economy, not the dominant one;

• be embedded in a local circular economy that primarily benefits local people, producers and enterprises, including through sustainable year-round job opportunities and buying and eating local food;

• benefit local communities, their culture and society;

• radically reduce its contributions to the climate emergency with slow and more local tourism and sustainable activities; and

• reimagine its focus from satisfying the needs and wants of external visitors to addressing critical demographic challenges to attract permanent residents, especially young adults and families.

Pilot project responding to the climate and biodiversity emergencies

The COVID-19 research clearly demonstrated the need to challenge dominant narratives and paradigms, and to redefine peripherality. As the focus of public attention has shifted from the pandemic to the twin climate and biodiversity emergencies, the same need for challenging dominant narratives and paradigms emerges. Recent exploratory research by CoDeL was triggered by engagement with communities and key policy-making institutions across Scotland. It reflects

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that rural and island communities are often excluded by the frameworks and processes adopted by policy-makers which determine the interactions between nature and people. This is in spite of the critical roles that rural and island communities play as stewards and guardians of the vast majority of natural assets. We have seen this globablly in terms of indigenous peoples and biodiversity. And in Scotland, 98% of the country’s area is defined as rural, but with only 17% of its population who are critical to sustaining Scotland’s natural assets.

Despite extensive community consultations and engagement, local communities are among the most disempowered stakeholders when it comes to influencing land use and other solutions to address the climate and biodiversity emergencies. Based on community engagement around land use in Scotland, the Social Enterprise Academy reports that “communities are frustrated that their highly informed voices are not being heard .... There is a strong sense that the key stakeholders were consulting but not listening and not ready to change their actions as a result of what they have heard. ... Land use needs to ensure that the value is retained locally and facilitates Community Wealth Building. The Glenkens vision [see Box 2] is that everyone who takes value from the land, returns value to it.”

Box 2: Land use in the Glenkens – 2023 context

from a draft Vision for Land Use in Glenkens, Dumfries and Galloway, Scotland (see www.gcat.scot)

• We are a forested area, a farming area, an energy generation area. We are a watery area, given life by our rivers and lochs. Our natural environment is so special that we are part of the Galloway and Southern Ayrshire UNESCO Biosphere. Our landscapes attract visitors from all over the world. We are a peaty area and our soil stores some of Scotland’s best carbon. It is our home, where we work, live and play. All of these land uses are intertwined and affected by influences within and without our control.

• We are an organised and coherent community which has sought and achieved balance in land use over many years through partnership working and effective engagement. However, we are now overwhelmed by the speed and intent of land use change in the area and by the lack of power that we hold to effect change. ... The disconnect between national and regional policy intent and what is actually happening in the Glenkens feels absolute.

• Some of the land use developments in our area appear purely extractive. Most profits and benefits are realised elsewhere, jobs are created elsewhere. Community Wealth Building principles are not embedded or mandated and so the impact of these developments on our communities is not a catalyst for more jobs, a circular local economy and thriving and sustainable communities. Opportunities are being missed.

Their vision for the future sets out how Glenkens seeks to be “an exemplar of sustainable land use practice in building resilience for climate, biodiversity and communities, where learning is valued and all voices are listened to”.

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And so there often remains a significant disconnect between grassroot, rural development priorities and actions and the large-scale policy initiatives to restore nature. CoDeL’s small pilot project, funded by the Scottish Government’s Scottish Rural Network and the Loch Lomond and Trossachs National Park Authority, is seeking to explore this disconnect by building up knowledge from the local perspective: rooted in rural and island voices, in communities’ own experience of nature. CoDeL is working with potential partners in Denmark, Iceland, Sweden and Canada, who are also engaging with rural communities and voices, to explore the relevance of these issues across the Northern Periphery and Arctic. We hope to build on this research to develop frameworks and processes that can genuinely incorporate the understanding, perspectives and values of local communities and indigenous communities, and empower them to deliver, contribute to and influence relevant actions and policies.

Emerging findings

The message coming loud and clear from rural and island communities is that policies designed at the national level to address the climate and biodiversity emergencies are not delivering.

“The current massive changes in land use in rural Scotland, although designed to deliver positive climate and biodiversity outcomes, are not actually doing so. This is what we are hearing from local communities at the sharp end of the transformation of land use, who are experiencing consequences like loss of livelihoods, loss of land for growing food locally, and flooding. Positive examples of communities deriving direct benefit, for example from carbon markets, do not compensate for these widespread negative impacts.” (from CoDeL’s draft report)

Such policies are instead damaging and threatening many rural and island communities, in some cases threatening their very existence. The emerging carbon markets which enjoy significant government support, are the most obvious example of these policies in the Scottish context (see McIntosh, 2023). From the perspective of communities on the ground, the rapidly evolving carbon markets are leading to large-scale changes in land use, for example extensive tree planting for carbon credits, and soaring land prices. And the current market mechanisms are weighted in favour of powerful interests, like large corporations and private land owners, and against communities.

Soaring land prices will put an end to strategies to grow food locally in sustainable and low intensive ways; risk pushing the most vulnerable farmers (especially tenants) off the land and out of food production; threaten many other rural livelihoods and communities; prevent extending community land ownership; and threaten the cultural inheritance rural and island communities hold around land and nature that are vital sources of knowledge as we confront the climate and biodiversity emergencies. In spite of some positive examples, policy implementation overall will not deliver on emerging policy around a ‘Just Transition’. And such policies will fail in the longer term because they are undermining rural and island communities, who are the people who must deliver on a transition to net zero as stewards and guardians of rural Scotland’s huge natural assets.

Once again we discover that some of the critical frameworks that underpin policy responses to the climate and biodiversity emergencies, especially frameworks for “natural capital” and “ecosystems services” (see Figure 3), are not fit for purpose and compound the disconnect we have identified.

“Natural Capital can be defined as the stocks of natural assets which include geology, soil, air, water and all living things. It is from this Natural Capital that humans derive a wide range of services, often called ecosystem services, which make human life possible” – Scottish Forum on Natural Capital

These frameworks exclude so much of the lived experience and knowledge of rural and island communities, and barely even recognise the role of home and community, local livelihoods and enterprise, culture and identity, etc. Instead they tend to combine both a narrow focus on economic activity and urban perspectives on rural areas; providing resources for economic activity that make urban living possible, as well as benefits like aesthetics, recreation and education that

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meet the consumption needs of urban populations.9 As with urban perceptions of peripherality, such frameworks distort understanding of the realities on the ground, and lead to misguided and harmful policies and actions. With their emphasis on monetising nature as an additional capital for economic activity, are these frameworks simply an extension of the same economic approaches that led to climate and biodiversity emergencies in the first place?

Communities on the ground are experiencing the impacts of this narrow focus on monetising nature (to support market transactions) as the next example of extracting economic value from their places. Some are comparing this to replicating economically driven clearances of people off their land (as happened massively in highland and island Scotland during the 18th and 19th centuries). This is the message coming from highly informed and knowledgeable rural and island communities across Scotland. It is mirrored across many regions within the Arctic. As an indigenous leader from Alaska said at an Arctic Circle Assembly 2022 session on A “Just” Energy Transition in the Arctic, “be careful what you wish for”. Tesla is rolling out electric cars as a green alternative for cars, but this has already resulted in the destruction of a mountain in their territory being mined for the minerals needed.

9 Figure 3 reflects the typical approach to ecosystem services. The Millenium Assessment (www.millenniumassessment.org) which originally highlighted ecosystem services included spiritual and religious benefits, sense of place and cultural heritage under “cultural services”, and some diagrams include some of these. All face the challenge of embracing these elements in holistic ways, rather than compartmentalising them into individual segments. The original Millenium Assessment set out each element as a bullet point in a categorised list!

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Figure 3: Ecosystem services (IUCN, The International Union for Conservation of Nature)

The limitations of frameworks like natural capital are strongly affirmed by key stakeholder groups, not least by the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services. Their extremely important report on The Diverse Values and Valuation of Nature (IPBES, 2022))sets out why current policies and frameworks “emanating from predominant political and economic decisions based on a narrow set of values (e.g., prioritizing nature’s values as traded in markets)” will fail to deliver on climate and biodiversity expectations until they incorporate the understanding, perspectives and values of indigenous peoples and local communities (see quotation from IPBES in the Introduction to this article).

In fact, the IPBES report repeatedly refers to the “worldviews” of indigenous peoples and local communities. This goes so much further than consulting or engaging with local people, and recognises the real insight and value that indigenous peoples and local communities bring to any climate and biodiversity responses. One common aspect of such worldviews is the holistic understanding that indigenous peoples and other communities bring, rather than categorising and separating everything. It is no wonder then that people with holistic worldviews may struggle to identify with diagrams like the one of ecosystem services (see Figure 3), with all its separated segments, even if their designers hope that creating a circle will make it look holistic.

“Our language roots us with our traditions [Inuit]. English phrases such as ‘traditional ecological knowledge’ put us in a box.” from Arctic Circle Assembly session on Indigenous Knowledge and Cosmovision in Climate Mitigation.

Moving forward

As we stated in the introduction to this article, the insights from rural and island communities in Scotland to the international IPBES indicate that top-down frameworks, strategies and policies based on a narrow set of values, including those reflected in the dominant natural capital frameworks, will not just fail to deliver justice and community wealth for our rural and island communities, but will also fail to address the climate and biodiversity emergencies.

Like many others, we recognise the need for a radical change in approaches to addressing these emergencies, approaches that:

• are rooted in indigenous and local worldviews and voices, building up from the experience, knowledge and expertise of local communities, rather than top-down from policy-making processes that are deeply influenced by powerful interests;

• are nuanced, recognising the complexity of effective action to restore nature at a local level, for example following ecological principles of connection, concerned with the relationships and interactions of life, with diversity and ‘patchiness’, rather than a mono-cultural onesize-fits-all solution;

• empower local communities, as equal partners with institutions and policy-makers to deliver positive environmental outcomes, giving local communities a critical role in delivering positive change;

• place a just transition for rural and island communities at the core of policy-making.

Many building blocks for such change are already emerging. In redefining peripherality, we were able to point to many new emerging economic frameworks like wellbeing economics and the

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doughnut economy.10 Liz Zeidler’s Discussion Paper on The Shared Ingredients for a Wellbeing Economy (Zeidler, 2022) compares eight different frameworks and tools, from the local to the international, including the Thriving Places Index, the Doughnut Economy, the Well-being of Future Generations (Wales) Act, the National Performance Framework (Scotland), the OECD Better Life Index and the UN’s Sustainable Development Goals. Liz concludes that “there is an overwhelming degree of agreement about the ingredients for an equitable and sustainable wellbeing economy”. Within economics therefore there are many emerging frameworks that can help in challenging the dominant paradigm of growth, markets and monetisation. And on the ground there are numerous individuals and communities, businesses, organisations and networks seeking to turn new economic thinking into reality. As just one of many examples we cite “social enterprise as part of a global response to a broken economic system that is increasing inequality and causing a climate emergency” and the goal of the Social Enterprise World Forum “to grow the global social enterprise movement to accelerate our transition to a new global impact economy” (https://sewfonline.com/). Common to all these frameworks and approaches is the desire to make our economies more sustainable for the planet and future generations, so these frameworks contribute significantly towards new thinking and approaches around the climate and biodiversity emergencies also. And there are of course innumerable individuals, communities and organisations working to respond to these emergencies through practical action. Nevertheless there remain significant challenges. “Contemplating the infinite intricacy of the natural world, botanist Frank Egler observed that ‘ecosystems are not only more complex than we think but more complex than we can think’. ... climate change is a wicked problem, resistant to single solutions, its roots woven into economics, cultures, livelihoods and habits. It traverses every sector of society and every level of human relations. Every perspective, from law to agronomy, medicine to oceanography, is relevant in addressing it. ... For too long, the dominant conversation on climate change has included only a tiny range of people, namely a handful of policymakers and valuable scientific sources. This selectivity sidelines the contributions of popular, personal, local and indigenous knowledges, which will be vital if we are to attain any plausible climate safety we are going to need to pull together our collective wisdom, in its plurality of lenses and expressions.” (Voskoboynik, 2018: 17-18)This strongly reinforces the call by the IPBES not just to consult but to incorporate the worldviews of indigenous peoples and local communities.

Concluding reflections

This article has strongly evidenced the need to transform narratives and paradigms about rural, island and indigenous communities. To conclude we want to emphasise again that these communities are often asset rich, not poor and backward as they are often seen through an urban lens. We need to move beyond such condescending attitudes to enable and recognise just how much rural and island communities are contributing. Many of them have huge renewable energy and other resources, huge carbon reserves, and much agricultural land suitable for low-intensive sustainable food production and grazing. They have versitile businesses, and multi-skilled individuals engaged in diverse economic activities to provide resilience. They have close-knit communities, dynamic community organisations/social enterprises and rich cultural heritages.

10 A recent article about the economist Kate Raworth who created Doughnut Economics reflects on the challenges of growth and degrowth, and not least on the perennial question of how best to generate positive change; see https://www.theguardian.com/environment/2023/jun/08/theplanets-economist-has-kate-raworth-found-a-model-for-sustainable-living.

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They have a stunning environment for livelihoods, wellbeing and recreation. And they have a strong sense of home, identity and place, so critical in a world where loss of identity and sense of belonging, and the associated disconnection, drive so many negative trends as well as overconsumption to “make up” for such losses.

Rural and island communities are often highly informed and knowledgeable, drawing on their lived experience and knowledge, including inherited and indigenous knowledge.11 From our community conversations we know that their analysis of their local context, local opportunities and threats, and their visions for the future, all point to a depth of knowledge and identification with their place, and more holistic and integrated perspectives and worldviews.

Critical to the sustainable future of rural, island and indigenous communities, and to a just transition to net zero that builds community wealth, is the extent to which these communities can benefit from their many assets, tangible and intangible. Powerful economic interests have ensured that value from these assets, from minerals and renewable energy to culture and knowledge, has been realised far more by external parties extracting those resources than by the communities where these resources are located.12 To ensure a positive future for rural, island and indigenous communities, the perceptions and lenses which underpin narratives and paradigms for resource allocation and decision-making need to be transformed. And this cannot happen until we genuinely listen and respond to the voices of rural, island and indigenous people. It is their lived experience and inherited knowledge that is perhaps now one of the most precious resources not just for themselves, but also for the global community, because of the contributions they can make to positive ways forward as we collectively address the twin climate and biodiversity emergencies.

References

Bogren, Maria, Celina Gustafsson and Joanna Lundstam (2021). Changed Strategies of Small Businesses during the COVID-19 Pandemic 2020: A Casestudy in Jämtland, Sweden, Mittuniversitetet, http://codel.scot/covid-19-economic-impacts-recovery-in-the-northern-periphery-arctic Chapman, Marlene, Laurie Brinklow and Alyssa Gillespie (2021). Economic Impacts and Future Pathways: COVID-19 in Atlantic Canada, University of Prince Edward Island, http://codel.scot/covid-19-economic-impacts-recovery-in-the-northern-periphery-arctic

CoDeL (2021). NPA COVID-19 Response Project on Economic Impacts: Main Report, Parts 1 to 6, CoDeL, http://codel.scot/covid-19-economic-impacts-recovery-in-the-northern-peripheryarctic

IPBES (2022). Summary for Policymakers of the IPBES Methodological Assessment Report on the Diverse Values and Valuation Of Nature, released 11 July 2022: https://ipbes.net/media_release/Values_Assessment_Published

Karlsdóttir, Anna and Alex Cuadrado (2021). Considerations on Regionally Varied Impacts of COIVD19 in NPA Regions, Nordregio, http://codel.scot/covid-19-economic-impacts-recovery-in-thenorthern-periphery-arctic

11 The many statements and excuses that ‘communities do not understand’ are almost always just that, excuses, and reflect more on the institutional perspectives of those making such statements than on the communities they are apparently reflecting on.

12 As one example among many, renewable energy pricing in Scotland is structured so that many local communities sell the energy they generate at a fraction of the cost at which households and businesses within those communities buy back that energy, even though it was generated locally.

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Kostarakos, Ilias and Conor O’Toole (2021). Economic Impacts of the COVID-19 Pandemic: An Exploration for the Northern Periphery and Arctic, Economic and Social Research Institute and Trinity College Dublin, http://codel.scot/covid-19-economic-impacts-recovery-in-the-northernperiphery-arctic

Mankki, Laura, Iiris Lehto, Helena Hirvonen and Eeva Jokinen (2021). The Economic Impact of COVID-19 on the Finnish Regional Health Care Services, University of Eastern Finland, http://codel.scot/covid-19-economic-impacts-recovery-in-the-northern-periphery-arctic

McIntosh, Alastair (2023). The Cheviot, the Stag and the Black, Black Carbon: Natural Capital, the Private Finance Investment Pilot and Scotland’s Land Reform, Community Land Scotland, https://www.communitylandscotland.org.uk

Morrison, Theona (2021). Economic Impacts of COVID-19 on the Cultural Sector: Traditional Music in Scotland, http://codel.scot/covid-19-economic-impacts-recovery-in-the-northern-peripheryarctic

Social Enterprise Scotland (2021). Social Enterprise Places: Uibhist/Uist, http://codel.scot/socialenterprise-place-uist

Svanberg, Katinka (2021) Human Rights in Times of COVID-19: Camping on Seesaws when balancing a State’s Human Rights Obligations against the Economy and Welfare of its People, with special focus on Sweden, http://codel.scot/covid-19-economic-impacts-recovery-in-the-northern-peripheryarctic

TechSolns (2021). Impact on COVID-19 from Technology Solutions in NPA Regions, available at http://codel.scot/covid-19-economic-impacts-recovery-in-the-northern-periphery-arctic

United Nations (2021). https://www.un.org/development/desa/dspd/2021/04/indigenouspeoples-sustainability/

Voluntās (2021) COVID-19 and Economics: Assessing the Impact of COVID on bio-tourism entrepreneurship, http://codel.scot/covid-19-economic-impacts-recovery-in-the-northern-periphery-arctic

Voskoboynik, Daniel Macmillen (2018). The Memory We Could Be: Overcoming Fear to Create Our Ecological Future, New Internationalist

Westbrook, Steve and Jayne Golding (2021). Sectoral and Cross Sectoral Impacts from COVID-19 on Scotland’s Highlands and Islands, http://codel.scot/covid-19-economic-impacts-recovery-in-thenorthern-periphery-arctic

Zeidler (2022). The Shared Ingredients for a Wellbeing Economy, Centre for Thriving Places, www.centreforthrivingplaces.org

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Pre-travel testing of travelers to Greenland during the COVID-19 pandemic – formation of a screening program

’Anders, can you help us? It is 7:00 AM and we have a passenger who has not yet received his COVID-19 test result. He will be flying to Greenland in 2 hours…’. This was an example of a phone call that we regularly got from the staff at Air Greenland in Copenhagen airport during the period March 2020

February 2022.

The first case of COVID-19 was diagnosed in Denmark on February 26, 2020, in a man returning from a ski vacation in the Lombardy region in Italy. For weeks, special awareness had been paid to persons with symptoms returning to Denmark from the Alps, because the first European cases had mainly been seen in this region. Access to test kits was heavily restricted in the beginning of the pandemic in Denmark, so the few tests carried out were reserved to cases returning from destinations with known outbreaks of COVID-19 and with typical (at the time) symptoms. Also, only a few places tested for COVID-19, including the Rigshospitalet University Hospital in Copenhagen. This strategy soon appeared to have been too restrictive, as cases in Europe quickly proved not to be limited to the Alps. But that is history…

Anders Koch, MD, PhD, MPH, Department of Infectious Diseases, Rigshospitalet University Hospital, Copenhagen, Denmark, Queen Ingrids Hospital, Nuuk, Greenland, Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Ilisimatusarfik, University of Greenland, Nuuk, Greenland; Mie Møller, MD, PhD student, Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark, Ilisimatusarfik, University of Greenland, Nuuk, Greenland, University of Copenhagen; and Åse Bengaard Andersen, MD, DMSc, Department of Infectious Diseases, Rigshospitalet University Hospital, Copenhagen, Denmark

Anders Koch, Mie Møller & Åse Bengaard Andersen

Early in the pandemic, it was realized that the Arctic would be vulnerable with regards to COVID19 (https://arctic-council.org/news/coronavirus-in-the-arctic-it-is-imperative-to-keep-the-virusout/). The notion was that the population was susceptible to the epidemic, both in terms of nonimmunity, but also because of the prevalence of risk factors for severe diseases in the Greenlandic population. Crowded living conditions like those of the Arctic would also favor transmission of the virus. Further, because of large distances, patient transportation issues and a health system that would quickly be overburdened in case of many hospitalized COVID-19 patients. Thus, there were considerable concerns regarding the possible consequences of the pandemic in Greenland. However, Greenland is an island with only a few major routes of immigration. The main route is by air from Copenhagen to the airports of Kangerlussuaq or Narsarsuaq with daily flights up to six days a week. Also, there are flights from Reykjavik, Iceland, to East Greenland and in the summer season to Nuuk, the capital of Greenland, besides military flights to the Thule Air Base. Finally, apart from private aircrafts, there may, in the summer season, be planes from Iqaluit in Canada to Nuuk. By sea, there are weekly cargo freighters from Denmark to Greenland, but these carry only a limited number of passengers.

For these reasons and to prevent or limit possible spread of COVID-19 in Greenland, the authorities in the country quickly took advantage of the special possibility to restrict travel to Greenland. Almost simultaneously with the first case of COVID-19 in Greenland, by March 13, 2020, the authorities discouraged unnecessary travel to the country, and by March 14, restricted entry to the country for foreigners without ‘a creditable purpose of travel’. Citizens of the Danish realm could still enter the country. However, it was also realized that this might not be sufficient, as persons infected in Denmark could still travel to Greenland. The Greenlandic authorities therefore asked the Department of Infectious Diseases at Rigshospitalet University Hospital in Copenhagen, that had already set up a COVID-19 testing unit (Photo 1), if travelers to Greenland could be tested for COVID-19 prior to travel. This was at a time when universal COVID-19 testing was not widely available in Denmark, but because preventing COVID-19 entry to Greenland was a main priority for the Greenlandic authorities and supported by the Danish authorities, such pretravel screening was established, and the first traveler to Greenland was tested under the program by March 15.

By March 20, 2020, all travel to the country closed down, but it was also realized that this could not be maintained. Thus, Greenlandic citizens and vital staff, e.g. healthcare workers could still travel to Greenland, but now on small planes usually used for domestic travel. Travel restrictions resulted in a drastic reduction in net travel to Greenland from March 2000 (Figure 1) with only five officially registered travelers for April 2020 (Statistics Greenland). Later, travel restrictions were modified, but throughout the pandemic and until travel restrictions were lifted by February 2022, the number of travelers to the country was markedly reduced (Figure 1).

In parallel with travel restrictions, many other restrictions in the Greenlandic society were imposed during the pandemic including temporary domestic travel restrictions, closing of shops, schools, daycare centers, bars, etc.

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Pre-travel testing of travelers to Greenland during the COVID-19 pandemic – formation of a screening program

Greenland

(https://bank.stat.gl/pxweb/en/Greenland/Greenland__TU__TU20/TUXUPAX.px/, accessed April 5, 2023)

However, for the main part of the pandemic in Greenland, pre-travel screening was an integral part of the preventive efforts against the disease.

How did this pre-travel screening in Denmark work? When pre-travel testing became mandatory in March 2020, proof of a negative PCR test for SARS-CoV-2 with a maximum age of 48 hours before scheduled departure was required for entry to Greenland. From Copenhagen, only Air Greenland flies to Greenland, so the staff of this airline was responsible for controlling test results. In the beginning of the epidemic, when testing was not freely available in Denmark, travelers had to be tested at Rigshospitalet in Copenhagen. Later, testing could be performed anywhere in Denmark, where the tests were prescribed and organized by Rigshospitalet. For reporting of results, we took advantage of the special conditions in the realm of Denmark where every citizen is assigned a central person registry number that uniquely identifies the person in public registries. Using this number and an electronic app, a Danish citizen could access his or her microbiological test results on a smart phone and present this result to the airline staff.

However, there was a problem for a large part of Greenlandic citizens. Not all citizens of Greenland or the Faroe Islands have access to this smartphone app. Therefore, twice daily the secretariat at Rigshospitalets COVID-19 testing unit produced and forwarded lists of test results to Air Greenland.

The system was in effect until February 2022, when all travel restrictions in Greenland were lifted. Did the system work? Yes, it did, but like any other system, it was not completely smooth. For the overwhelming majority of travelers, test results were available on the day of departure, but some travelers did not have their tests taken in time, and their results would not be on the lists submitted to the airline before departure. Thus, it was not unusual that a member of the testing staff (in this

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Koch, Møller & Andersen Figure 1. Number of international passengers to Greenland by month and time. Statistics

case the first author) would receive a phone call early in the morning when a traveler had shown up in the airport without a test result that then had to be looked up in the electronic test systems.

April 5, 2023

Also, some tests went wrong and had to be repeated. Finally, some travelers had tests taken outside of this system, and if something went wrong with their results, the Rigshospitalets testing unit could not help. From time to time, some passengers did not catch their planned flight, although they (eventually) tested negative. However, Air Greenland rebooked travelers to the next available flight without extra costs, and in general, delayed passengers were understanding.

Did the pre-travel screening in Greenland have any effect? A formal evaluation of the program is ongoing, but a hint may be obtained from Figures 2 and 3 that show the course of the epidemic

Pre-travel testing of travelers to Greenland during the COVID-19 pandemic – formation of a screening program

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Figures 2 and 3. Number of new cases of COVID-19 per day in Denmark (top) and Greenland (bottom). https://ourworldindata.org/coronavirus/country/denmark and https://ourworldindata.org/coronavirus/country/greenland, accessed

for Denmark and Greenland. Although different in absolute numbers, in Denmark, the first sharp increase in numbers were seen around the end of 2020, while in Greenland, very few cases were seen before the summer of 2021. Both countries had received their first vaccine doses from the end of December 2020, so by the time Greenland experienced a significant increase in cases, a large part of the population had been vaccinated. For both countries, by the end of 2021 the number of infected persons increased markedly with the advent of the Omicron variant, but at that time the majorities of both populations had been vaccinated. Also, this variant appeared to cause milder disease than previous variants. The pre-travel screening program did not fully prevent infectious COVID-19 cases from entering Greenland, because tests might be falsely negative and travelers could have been infected in the period between testing and departure. Also, it is obvious that other interventions including those implemented nationally and locally in Greenland (social distancing, domestic travel restrictions, etc.) played major roles, and it is difficult to single out the isolated effect of the pre-travel screening program. However, taken together, the interventions including pre-travel screening, likely resulted in a much milder course of the epidemic than what was seen in e.g. Denmark and what was originally feared in Greenland.

Can the experiences with establishing a pre-travel screening program be used in future pandemics affection Greenland and similar Arctic areas? Absolutely! In our opinion, in a short period of time, an effective and flexible screening program was launched that, together with travel restrictions, significantly delayed entry of COVID-19 into Greenland. We suggest that the outline of a similar system is prepared in case of an unexpected pandemic by “Disease X”.

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Koch, Møller & Andersen Photo 1. The SARS-CoV-2 testing unit at Rigshospitalet University Hospital, Copenhagen, Denmark

Social life and use of an Arctic city centre during the COVID-19 pandemic

From March 2020, regulations and recommendations were implemented in Sweden to reduce the spread of COVID19, which included limitations to public life. Overall, these sought to reduce activities that brought people together and in so doing, transitioned the relationship between cities and people into a new paradigm.

The study explores public usage of an Arctic city during the pandemic to understand how COVID-19 altered people’s ‘social life’. Data was collected in the Arctic city of Luleå, by structured questionnaires and semi-structured interviews. These indicate that: 1) a significant reduction in city visits, 2) multi-faceted city visits were reduced to single task based visits, 3) a significant reduction in leisure based activities, 4) an increase in digitalization of work, retail and leisure activities, 5) perceptions of responsibility, guilt, boredom and minimizing social networks were reported, and 6) post-pandemic, people questioned the ability of cities to bounce back.

The survey and interviews show that in the Arctic city of Luleå, restrictions put in place to reduce spread of the infection had a significant impact on public life and use of the public realm, which is in accordance with research from outside the Arctic.

The conclusion is that in the short term, the role of urban centres in daily life was reduced and the role of digitalisation for work, goods and services was rapidly advanced. However, the research also shows that the ‘social dimension’ of Arctic cities - to see other people and take part of civic life on site - was not easy to replace and is valued by the community.

Introduction

Attractive urban centres and cities are a fundamental objective of good design and planning (Hidman, 2018) and the last decades have seen a sustained focus on improving cities, settlements and urban areas (Carmona, 2021) to facilitate urban life.

Since 2020, the role of cities was challenged by a form of coronavirus, which is commonly named COVID-19. Initially found in Wuhan, China (WHO, 2020), the virus spread rapidly with the first case of COVID-19 in Sweden confirmed on 31 January 2020 (Public Health Agency, 2020). By March 11, 2020, the World Health Organisation (WHO) classified COVID-19 as a pandemic (WHO, 2020). To reduce the spread of COVID-19, recommendations were introduced by the Swedish Government (Folkhälsomyndigheten, 2021). Overall, these sought to reduce activities that brought people together and in so doing, transitioned the relationship between cities and people into a new paradigm.

To deepen the knowledge of COVID-19 in Swedish Arctic cities, research addressed in this article explores how peoples’ ‘social life’ in the public spaces of these communities changed with COVID19 recommendations. The study was carried out spring 2021, during the third wave of increasing infections, which in turn followed directly on the second wave, with high infection rates throughout the winter and spring season 2020-2021.

COVID-19 restrictions in Sweden

In Sweden, regulating responsibilities for communicable diseases like COVID-19, is legislated by the Communicable Diseases Act (SFS 2004:168). According to the Act, everyone has an individual responsibility to prevent spread of the infection and is obliged to take reasonable precautions in order to do so. The Public Health Agency of Sweden (PHAS) issues recommendations of how to make these precautions. The regions can in turn issue guidelines, adapted to the regional situation. The government can decide on restrictions, which need to be adapted to the constitution. Table 1 lists various recommendations, guidelines, and restrictions that were implemented in Sweden during the pandemic.

Table 1: General and regional guidelines and recommendations due to the COVID-19 pandemic, affecting public life and the public realm. Based on information at www.krisinformation.se and www.norrbotten.se

Date Infection control measures

1 February 2020 The Swedish Government classifies the corona virus as dangerous for society according to the Communicable Diseases Act.

12 March 2020 Maximum 500 persons allowed at public gatherings and public events.

16 March 2020 PHAS requests persons older than 70 to drastically limit all contacts with others, including avoiding public transport, shops, public facilities etc.

17 March 2020 PHAS recommends employers to allow those who could work from home to do so.

17 March 2020 PHAS recommends all upper secondary schools, adult education, and universities to shift to distance teaching.

19 March 2020 PHAS recommends all unnecessary domestic travel to be avoided.

25 March 2020 PHAS regulates that crowding is not allowed in queues, at tables, buffets, or bar counters at restaurants, bars or cafés.

29 March 2020 Maximum 50 persons allowed at public gatherings and public events.

1 April 2020 General guidelines by PHAS says that:

• People older than 70 and other risk groups should limit all physical contacts and avoid public transport, shopping etc.

• The number of people on public transport vehicles should be limited, and services adapted to avoid crowding.

• Employers have a responsibility to make sure distance is kept between both employees and visitors.

• Shops and shopping malls should limit the number of customers at the same time in the facilities, and make sure there is distance between customers.

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1 November 2020 The government allows sitting audiences at culture and sport events to maximum 300 persons.

3 November 2020 PHAS changes the regulations and general guidelines, for restaurants, bars and cafés, to allow maximum 8 persons at a table, and have at least one metre between tables.

10 November 2020 The Norrbotten Region introduces regional guidelines that says:

• Refrain contacts with everyone except those you live with, including all social activities.

• Refrain visiting all indoor places such as shops, shopping malls, museums, libraries, public baths and gyms.

• Refrain from meetings, concerts, performances, sport practice and competitions.

• Refrain from all unnecessary travel within or outside the region.

20 November 2020 The parliament prohibits serving of alcohol after 10 pm.

24 November 2020 Maximum 8 persons allowed at public gatherings and public events.

7 December 2020 PHAS recommends all upper secondary schools to partly close and shift to distance teaching.

23 December 2020 PHAS recommends use of facemasks in public transport.

24 December 2020 The government strengthens restrictions, including:

• Maximum 4 persons are allowed at the same table at restaurants.

• Serving of alcohol is not allowed after 8 pm.

• The number of persons allowed at shops, shopping malls, gyms etc. at the same time is restricted based on the size of the facilities.

• Christmas sales should be refrained.

• Everyone who can must work from home, both in public and private.

• All non-essential public facilities, such as baths and museums, should be closed.

10 January 2021 The government regulates that shops, shopping malls, gym and baths must limit the number of visitors to one per square metre.

9 March 2021 Strengthened restrictions of the number of people allowed in shops, baths, gyms etc., and customers and visitors should come by themselves, without company.

25 March 2021

28 May 2021

June 2021

1 June 2021

14

Strengthened restrictions of the number of people allowed at museums, art galleries, amusement parks, zoos etc., and crowding must be minimized.

The Norrbotten Region introduced strengthened regional guidelines and restrictions emphasising the need to keep the distance to others, avoid all new contacts, avoid crowding, avoid all unnecessary travel within and outside the region, work from home etc.

The first of five steps in gradually easing restrictions and general guidelines is introduced, including allowing more people at public gatherings and events, and allowing restaurants, bars, and cafés to be open until 10:30 pm.

In March 2020, measures to prevent the spread of COVID-19 began to be implemented. The PHAS requested persons older than 70 to drastically limit all contacts with others, including staying away from public transport, shops etc. They also recommended that all who could work from home should be allowed to do so, and that all upper secondary schools, adult education centres, and universities should shift to distance teaching. The guidelines further stipulated that no crowding was allowed at restaurants, bars or cafés, and the number of people allowed at public gatherings was limited. In April 2020, new guidelines stipulated that the number of people taking public transport and visiting shops and malls should be restricted to avoid crowding.

During autumn 2020, further limitations were made. E.g., in November 2020, PHAS changed the regulations and general guidelines, only allowing sitting customers at restaurants, bars and cafés, with a maximum of eight persons at a table, and with a distance between tables. During the autumn, many regions implemented regional guidelines, and in November 2020 Norrbotten Region strengthened the guidelines so that all contacts with other than the ones you lived with should be avoided. This included avoiding visiting places such as shops, museums, libraries, public baths and gyms, as well as abstaining from all unnecessary travel within or outside the region.

During spring 2021, further restrictions were put in place. In February 2021, all restaurants, bars and cafés were only allowed to be open until 20:30, and unless they had a separate entrance, only one person per table was allowed in eating areas in shopping malls etc. In March 2021, further restrictions of the number of people allowed in shops, gyms, museums, amusement parks etc. were

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introduced, and people were asked to shop by themselves, without company. In May 2021, until mid-June, Norrbotten Region again introduced strengthened regional guidelines and restrictions emphasising the need to keep the distance to others, avoid all new contacts etc. (Region Norrbotten, 2021).

Starting in June 2021, restrictions and guidelines gradually started to ease, as the decision to classify the coronavirus as dangerous for society was revoked.

Sweden has been considered to have had softer restrictions compared to other countries. E.g. schools remained open to a larger extent, and facemasks were not mandatory at public places as you were supposed to stay at home when feeling ill. Overall, the Swedish population obeyed the recommendations, guidelines, and restrictions (Pashakhanlou 2022).

Public space of the Arctic city

Public space has long been a focus for social life, movement and gathering (Carmona, 2021; Larsson & Chapman, 2020; Sjöholm & Hidman, 2020) and urban design has focused the last decades on re-urbanising urban cores as densely populated centres for work and life (Batty, 2020; Frey, 1999). This has been argued as a way to offer more sustainable patterns of living (reducing resource consumption and pollution) with increased levels of attractiveness to people (socially, culturally, economically) (Campbell & Cowan, 2002; Jenks, Burton & Williams, 1996; Urban Task Force, 1999). This type of approach to ‘urbanization’ has been adopted across nations, including in the European Arctic (Nyseth, 2017; Tunström et al, 2018).

Like elsewhere, this prioritisation of Arctic urban centres as places for people is always under challenge. For many decades the car and the easy movements it facilitates also promoted dispersed activities, such as peripheral residential areas and shopping (Newman, & Kenworthy, 1989). Equally, today digitalisation is opening up new ways of out-of-town consumption with online shopping (Satish et al, 2021) and alternative ways of interacting and social gathering with reduced physical contact (Gehl, 2011).

Here the traditional role of city centres, as a place for people’s daily chores, such as trade (Olsson, 2000) is diminishing in importance by the development of society (Carmona, 2021). However, while some reasons for visiting city centres may have diminished, the primary ‘social role’ for public space has remained of great importance (Mehta, 2013). City centres and their restaurants, bars, and public spaces are today’s courts where people go to see, be seen and be part of public life (Sudjic, 1992).

Here the social life of public places is part a sceptical of society. Medieval times saw the notion of ‘theatrum mundi’, the idea of human society as theatre, while Shakespeare described the world as a stage and us as actors (1975). At a basic level, people playing a part in public space leads people to being seen, seeing others and in a way, is a complement to contact in private life (Olsson, 2000). However, relationships in public places are non-binding and can be a gateway for deeper contact between people (Gehl, 2011). They offer individuals an opportunity to shape their identity and enable an understanding of relationships and actions between people and places (Olsson, 2000). They can also act as resources of information about society and individuals and ways of behaviour (Gehl, 2011; Wallentin, 2007). Here, the social life in public places can be a source of inspiration, for individuals and society in the form of knowledge and needs (Carmona 2021; Gehl, 2011).

For Arctic settlements such as Luleå, seasonal climate variation can be a major enabler and barrier to public space usage. Temperatures can reach highs of +30 °C in the summer and lows of -30 °C in the winter, while the sea is frozen for around 6-7 months per year (Chapman, 2018). In summer the city’s green and public spaces are destinations for social life & public gathering, and in winter new ephemeral public spaces, such as Luleå’s ‘Ice Road’, are created by the winter covers of ice and snow (Larsson & Chapman, 2020; Chapman, 2021). These new temporary spaces become

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destinations promenading, skating, and gathering, and present additions to the public realm network that are created by nature; a feature uncommon in settlements outside the Arctic. Winter conditions, however, do make public space usage a challenge. Studies in Finland show people spend only 4% of their total time outdoors in winter (Mäkinen et al. 2006) and winter-related decreases in outdoor activity are common (Chan & Ryan, 2009).

While the importance of public space has varied over time, it has always related to the social life of society and norms at a given point. People’s social lives affect places, and at the same time places affect people’s social lives. This means they are interdependent (Carmona, 2021) and are altered by events such as a pandemic (Frank, 2020).

In 2020 and 2021 use of public space and interdependencies were changed by the measures taken to reduce the spread of COVID-19 (Batty, 2020; Honey-Rosés et al, 2020). These kind of measures changed person’s roles and appropriate behaviours in the city (Sennett, 1977) and (in Sweden) required self-regulated and reduced use of the city, in stark contrast to the ideas of the compact city (Alraouf, 2021; Breheny, M. 1997).

The aim of this research was to gain insight into people’s behaviour and perception, and on the impact on shops, restaurants and cafés, and cultural life in an Arctic city centre during the COVID19 pandemic in early spring of 2021. Moreover, it reflects on how this knowledge can be used to make places more resilient to pandemics. The research questions addressed included: How did pandemic restrictions affect urban social life in a Swedish Arctic city? Is it possible to protect public safety while also ensuring a strong civic social life that maintains human connections?

Method

Study design

This study was conducted as a case study, an approach to a question with the aim of explaining and understanding a case in its context (Johansson, 2002). This approach to case studies is explanatory and involves studying new problems without variable limitations, with the aim of shedding light on what is important. Case studies are important in that the reader who takes part in the case study can apply it to parts of their own context. Quantitative data and qualitative data were collected in parallel in March 2021, and used for answering the aim of the study. The focus was on what effects the pandemic has had on citizens’ perceptions and behaviours; on shops, restaurants and cafés; and the cultural life in an Arctic city centre.

Survey

The survey was open to the public to answer between 2nd March 2021 and 2nd April 2021. During March 2021, the average temperature in Luleå was -2.4 °C. The average high in March in Luleå is -0.1 °C and the low is -14.3 °C (SMHI, 2023). The purpose of the survey was to obtain quantitative data about how people’s usage of the Luleå city centre changed during COVID-19 and their prospects on how the city centre and their own behaviours would be different when the pandemic ends. The questionnaire had explanatory text introducing the purpose and goals of the research including a map of the study area. In four sections, the survey was used to gather:

• General information. This question set had closed answer alternatives and concerned age, gender, and occupation.

• Habits before the pandemic related to the frequency and main and secondary reasons for visits to the city centre and usage of facilities there. Frequency was rated on 6-point scales ranging from 1 (never) to 6 (daily). The question on reason had closed response alternatives and one open ended free response item.

• Habits during the pandemic. With a similar structure to the previous section, questions were concerned with understanding the use of the city centre during the pandemic.

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• Your social life and future situation. This section of the survey gave respondents the opportunity to reflect on their use of the city centre during and after the pandemic. This question set was open and three questions asked:

o What changes did you make during the pandemic?

o Do you think these changes will last after the pandemic?

o What are your further reflections on how the pandemic has affected your social life and behaviour related to usage of the city centre?

With a snowball sampling strategy, starting with networks with a geographically close proximity to Luleå, the survey was shared with the public digitally to reach as wide a response group as possible. Forums used were Facebook, LinkedIn and email. Those who received the survey were encouraged to share it with their contacts, which resulted in further dissemination.

Interviews

Semi-structured individual interviews were undertaken between 9th March 2021 and 9th April 2021, via digital communication with eight representatives from the public and private sector. The respondents, four men and four women, were strategically selected to represent the retail trade (3 respondents), restaurants (3 respondents) and culture (2 respondents). Open ended questions related to the following topic: How did the pandemic impact on social life in the centre of Luleå, and especially in the especially the trade, restaurants, and culture sectors? The respondents talked freely about the topic for about one hour; the interview data were recorded using video recording at Zoom then transcribed and analysed.

Data analysis

Firstly, the characteristics of the respondents and the frequency of visits and main reasons for visiting the centre were summarized using frequencies, percentages, and median values.

Secondly, a sub-analysis was performed considering potential differences between men and women, respondents that were students or working, and of different age groups. Due to a limited sample size, non-parametric statistical methods were applied: the Mann-Whitney U Test to analyse differences in time and the Wilcoxon Signed Ranks Test for sub-group differences. The software SPSS version 27.0 was used, with a statistical significance of p < 0.05.

Thirdly, the survey questions with open answer alternatives were analysed to find recurring tendencies in how the respondents' lives and use of public places had changed during the pandemic.

Qualitative data from the interviews with public and private actors was analysed in the following steps: (1) identification of meaningful units in relation to the research question, (2) categorization of the meaningful units, (3) description of the units’ content.

Results

The case study location was the centre of Luleå, a city located by the coast in northernmost Sweden. It is the administrative centre of the Norrbotten Region, housing institutions such as the County Museum of Norrbotten, the Norrbotten Music, and the Norrbotten Theatre. These are all situated in the city centre, together with other cultural institutions such as Luleå’s Cultural House (housing concert halls, conference facilities, an art gallery, and the main city library), Ebeneser cultural centre, and the stage Lillan. There are also two movie theatres, and a couple of art galleries. The municipality of Luleå has about 78,500 inhabitants, of which 49,100 live in the city, and 9700 in the city centre (Luleå Council, 2020). Luleå has net commuting of about 12%. The municipality’s upper secondary school with roughly 2400 pupils is located within the city centre, as well as both public and private workplaces with about 13,400 persons working during daytime and 5.000 during night-time (Luleå Council 2021). Luleå University of Technology, with a total of 17,670 students

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including distance teaching, has its main campus at Porsön in Luleå, where many of the students also live.

The city centre is located at a peninsula, with average walking distance to major neighbourhoods: Örnäset around 2 km; Skurholmen and Kronan roughly 2.5 km; Mjölkudden, Svartöstaden and Bergnäset around 3 km; Porsön and Björkskatan around 4 km; Hertsön roughly 5 km. A hub for the local bus network is in the very city centre, including a bus transfer to the Luleå Airport. There is also a bus station for regional busses, and a train station.

Being the biggest city in the region, Luleå is also a centre for trade and commerce. Over 300 shops, cafés and restaurants (including three shopping malls) are located in the city centre, the majority along the main street Storgatan. Luleå also has two other commercial centres, especially Storheden but also Notviksstan, which are competing with the city centre as they provide an increasing number of shops and are more accessible by car.

Survey Results

Characteristics of the respondents and frequency of visits to the city centre

120 citizens responded to the survey. Age distribution was uneven with 54% of respondents between the age of 20 and 29 years old. Gender distribution was 57% women and 42% men; 40% of the respondents were students and 58% were employed (Table 1). Of the whole group of respondents, 20% worked in the city centre and 14% had their home in the city centre.

Table 2: Characteristics of the respondents and subgroups occupation and sex, the frequency of visits to the city centre and facilities.

Scale: 1=never, 2= < once/month, 3= once/month, 4= several/month, 5= several/week, 6=daily visits

p-values: Comparison of scores between the groups females or males (p1) and those working or studying (p2), using the Wilcoxon Signed Ranks Test

Comparison of scores before and after the pandemic on visits to the centrum (p3) and use of services (p4) using the MannWhitney U Test.

The respondents significantly reduced their frequency of visiting the centre and its facilities for trade, restaurants, or culture during the pandemic in comparison to what they did before. From an

Social life and use of an Arctic city centre during the COVID-19 pandemic

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All respondents n=120 Female n=68 Male n=51 Working n= 70 Studying n=48 p1 p2 Sex (female/male/other) n (%) 68(57)/51(42)/8 68(100)/0/0 0/51(100)/0 36(51)/3 3(47)/1( 2) 65/35/0 Age groups (20-29/3039/40-59 />60 years) n (%) 65(54)/27(22)/2 2(18)/6(5) 39(57)/17(25) /11(16)/1(2) 25(49)/10(20) /11(22)/5(10) 17(24)/2 7(39)/21 (30)/5(7 ) 100/0/0/0 Occupation (working/studying/ unemployed/pension) n (%) 70(58)/48(40)/1 (8)/1(8) 36(53)/31(46) / 1(0)/0 33(65)/17(33) /0/1(2) 70(100)/ 0/0/0 0/100/0/0 Before the pandemic Visits to Centrum, Md (min-max) 4 (1-6) 4 (2-6) 4 (1-6) 4.5 (1-6) 4 (1-6) .444 .003 Use of services, Md (minmax) 4 (2-5) 4 (1-6) 4 (2-5) 4 (2-5) 4 (2-5) .565 .386 During the pandemic Visits to Centrum, Md (min-max) 3 (1-6) 3 (1-6) 3 (1-6) 3 (1-6) 3 (1-6) .768 .989 Use of services, Md (min-max) 2 (1-6) 2 (1-6) 2 (1-5) 2 (1-6) 3 (1-6) .837 .355 p3 .001 .001 .001 .001 .001 p4 .001 .001 .001 .001 .001

average of visiting the centre on several occasions per month, visits were now reduced to once a month. They also less frequently used the facilities in the centre (Table 2).

Despite great intra-group variation, a shift towards fewer visits were clear amongst most of the respondents. Before the pandemic, 22% stated that they were daily visitors to the city centre, 17% visited several times per week, and 45% of respondents visited the city centre several times a month. 8% visited the centre less than once a month, and 2% never visited.

In contrast, during the pandemic, 36% of respondents stated that they visited the city centre less than once a month during the pandemic and 7% never visited the centre. Yet, 12% of respondents were daily visitors, and 5% visited the city centre several times a week.

This trend corresponds with less frequency of using the facilities in the centre. Before the pandemic, 11% of respondents stated that they used retail trade, restaurants, and cafés as well as culture facilities less than once a month, while during the pandemic a majority, 52%, of the respondents used these services less than once a month (38%) or never (14%).

Commonalities and differences between respondents that are female versus male, student versus worker, and of different age groups

Tables 2 and 3 show how the different sub-groups reported their use of the city centre and facilities before and during the pandemic. The results show that all sub-groups reduced the frequency of visiting the centre and its facilities for trade, restaurants, and culture. The reduction was significant for all groups except for the oldest age group.

There were great intra-group variations in the frequency of visits to the city centre and its facilities. The only significant difference between sub-groups was that the students before the pandemic less frequently visited the city centre than those who were working. Correspondingly, the sub-group of 20–29-year-old respondents (of which 74% were students) visited the centre significantly less (on several occasions per month) than the other age groups did. All age groups above the youngest on average visited the centre several times per week. This significant difference in visits was already visible when comparing the youngest to the respondents in ages 30-39.

During the pandemic, all sub-groups reduced their visits, however, the age group of 40–59-yearold respondents, on average, had the relatively highest frequency of visits; several per month. This was significantly higher in comparison to the responders just below them in age, the 30–39-yearolds (Table 3).

Table 3: Characteristics of the subgroups based of age groups, the frequency of visits to the city centre and facilities.

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Age group 20-29 n=65 Age group 30-39 n=27 Age group 40-59 n=22 Age group > 60 n=6 p1 p2 p3 p4 Sex (female/male/other) n (%) 39(60)/25(38) /1(2) 17(63)/10(37) /0 11(50)/11(50) /0 1(17)/5(83)/0 Age (20-29/3039/40-59 />60 year) n (%) 65(100)/0/0/0 0/27(100)/0/0 0/0/22(100)/0 0/0/0/6(100) Occupation (working/studying/ unemployed/pensio n) n (%) 17(26)/48(74) /0)/0/0 27(100)/0/0/0 21(96)/0/1(4) /0 5(83)/0/0/1(1 7) Before the pandemic Visits to Centre, Md (min-max) 4 (1-6) 5 (3-6) 5 (2-6) 5 (4-6) .001 .006 .619 .892 Use of services, Md, (min-max) 4 (2-5) 4 (2-5) 4 (2-5) 4 (2-5) .394 .925 .381 .764

Scale: 1=never, 2= < once/month, 3= once/month, 4= several/month, 5= several/week, 6=daily visits p-values: Comparison of scores between the youngest age group and the other age groups combined (p1) and also the other groups versus another such as age group 1 versus 2 (p2), age group 2 versus 3 (p3), and age group 3 versus 4 (p4), using the Wilcoxon Signed Ranks Test

Comparison of scores before and after the pandemic on visits to the centrum (p5) and use of services (p6) using the MannWhitney U Test.

Reasons for visiting the city centre

Before the pandemic, the main reasons for visits were shopping (44%), work (20%), and going to restaurants and cafés (18%). 2% percent of respondents stated that cultural activities were their main reason for visiting. 14% were living in the area. In addition, 2% of the respondents chose the option to share other reasons for visiting the centre.

During the pandemic, 4% had no motive to go to the centre at all and an increase in other healthrelated reasons for visits was reported (8%). Reasons included pharmacy visits, doctor visits, eye examinations, training, and a change of environment and use of outdoor space (such as the ice road), etc. (Table 4).

As a supplement, respondents reported their use of retail areas, restaurants, cafés, and cultural offers as add-ons to their primary reason for visiting the city centre. 77 % of the respondents stated that they used restaurants and cafés in combination as a main reason to visit the city centre. 46% stated that they used trade and 45% culture in combination with the main reason.

During the pandemic, only 60% used any additional facilities at all. Shopping was limited the least, while about one-third of the respondents reduced their visits to restaurants (reduced to 38%). The main drop was cultural events that were very limited (reduction to 2%) (Table 4).

Table 4: Main and secondary reasons for visiting the city centre

Reflections on social life and future situation

The final, free-response questions yielded a range of results. Respondents commonly highlighted that they had adopted ‘working and studying from home’. They were avoiding ‘public transport’ and ‘busier places’ such as the city centre, shopping malls, and cultural facilities. Equally,

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pandemic Visits to Centre, Md, (min-max) 3 (1-6) 3 (1-6) 4 (1-6) 2.5 (2-6) .350 .908 .102 .604 Use of services, Md, (min-max) 2 (1-6) 2 (1-6) 3 (1-5) 2.5 (2-5) .902 .433 .151 1.00 p5 .001 .001 .002 .063 p6 .001 .001 .003 .109
Social life and use of an Arctic city centre during the COVID-19 pandemic
the
Before n (%) n=120 During n (%) n=120 Main reason 1 Work 24 (20) 19 (16) Living in the area 17 (14) 16 (13) Shopping 53 (44) 55 (46) Restaurants and cafés 21 (18) 13 (11) Culture events 2 (2) 2 (2) Other: Health reasons 3 (2) 9 (8) None 0 (0) 6 (4) Secondary reasons 2 Shopping 55 (46) 37 (31) Restaurants and cafés 92 (77) 45 (38) Culture events 54 (45) 3 (2) None 5 (4) 48 (40)
Single choice question, free answer option
Multiple choice question
1
2

respondents said that they avoided activities such as ‘strolling in town and window-shopping’, visits were also at ‘less crowded times’ and keeping ‘distance’ from others when in central areas was seen as important. For most, urban visits were for ‘emergencies’ and these were kept to as ‘short a time as possible’, and they tried to effectively gather priority errands into a single visit. Some had to a higher extent than before aimed to support local businesses.

The void created by recommendations were seen to be replaced by home-based activity. While respondents highlighted increased home cooking, a great emphasis was placed on digital activities, including on-line shopping (necessary and optional goods and especially take-away), on-line entertainment (programmes/movies, gaming, cinema) and virtual social gathering. While the nighttime economy (pubs, restaurants & bars) remained open, few respondents continued to frequent these establishments.

The respondents shared a common view that after the pandemic, things would inevitably not go fully back to how they were before. They thought that some behaviour changes and priorities made during the pandemic were beneficial and would continue. Being more goal focused, saving time and money and changed travel patterns were perceived as positive outcomes. So were adopting new habits of more active outdoor life, using the ice road and parks, and walking to destinations. Keeping distance and avoiding crowds and public transport would continue.

Online shopping and pre-ordering groceries or meals to be collected were highly valued by the respondents. However, they perceived that the expansion of such choices/options had already begun before the pandemic and therefore was inevitable. Also, many had a positive belief that more work, meetings, and lectures would be achieved digitally from home.

What respondents were mainly missing was the social dimension of meeting up with friends at pubs, restaurants or cafes, strolling and shopping, open preschool, public baths, gyms, library, etc.; to see other people and take part of civic life on site. They hoped that there would be options to do so again after the pandemic but were not sure. The current closures of facilities in the centre were worrying. The value of having a central meeting point was highlighted: ‘I’ve understood the importance of there being a city centre, I did take it for granted before’. The outdoor space in the centre needs to be attractive enough to be perceived pleasant to stroll through.

Respondents reported feelings of loneliness, boredom with the situation, being more goal focused, having increased responsibility, and feelings of guilt. Some experienced decreased social networks. These additional comments were mainly made by the youngest age group.

Interviews

Semi-structured interviews with representatives from the public and private sector revealed a range of outcomes. The interviews with Luleå City Council and Norrbotten Region highlighted major impacts on the cultural sector. Recommendations to close public facilities and/or restrictions on the number of people meant all but the city library and the public art gallery closed. The city library however limited its services to short visits for lending or returning books, printing etc. Longer visits for studying, using the computers, or reading the newspapers, were not allowed.

Luleå was described as a ‘place filled with association-active people. But due to the pandemic, association life has been erased as no events are carried out’. In 2020, ‘not a single application was received to implement …events’ Here, concern was raised about whether such associations will continue after the pandemic.

Concern was also expressed about whether the cultural audiences will return after the pandemic, ‘People have developed new patterns of behaviour’ and while attempts have been made to meet and hold events digitally, there is reduced demand.

Respondents from both the city and region saw that COVID-19 had resulted in a digital leap, ‘Cultural practitioners have had to adapt to the pandemic and have therefore learned a lot about how to reach an

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audience via social media and other digital tools’. For the region, this was seen as positive, as until now ‘large parts of the cultural offer have been site-bound’. However, this digital transition had not provided any income, and ‘digital payment methods for visitors who take part in the cultural offer have not come very far yet’ Here a future model could be ‘hybrids, a mixture of physical performances where digital participation is also possible’

Further concerns included the ‘possible lack of skills after the pandemic. During the pandemic, many of those who have lived as freelancers, for example actors and musicians have shouldered other tasks in order to survive financially’. The behaviour of future consumers was also a major cause for concern. ‘Will people dare to take part of cultural events to the same extent as before?’

While the private sector was mainly allowed to continue operating during the pandemic, retailers saw a dramatic but ‘irregular impact’ on trade. Here digitization was ‘accelerated’. In particular, food retail started to ‘work with a mobile applications for ordering food’ with extended offers to ‘takeaway food and weekend bags’. During the pandemic people wanted, ‘to treat themselves, people have therefore chosen to order food from restaurants’. And after pandemic, one restaurateur thought it ‘does not feel relevant to remove it’ in the future. Other non-food retailers, especially clothing, expressed that even before the pandemic they were challenged by e-commerce and during the pandemic, this has led to even greater losses.

Discussion

The aim of this study was to gain insight into how pandemic restrictions affected the urban social life in an Arctic city, as well as reflecting on how public safety can be protected while maintaining human connections.

The survey and interviews made in Luleå during the third wave, in the aftermath of the second wave, show that the restrictions put in place to reduce spread of the infection had a significant impact on public life and the use of the public realm in the Luleå case, which is in accordance with earlier research (Alraouf, 2021; Ellis & Grant, 2021; Frank, 2020; Honey-Rosés et al, 2020). While some public facilities were closed, restaurants, pubs, cafés and shops remained open with limitations, and society was functioning, as also noted in a recent study (Niitamo, 2021). However, the results show that people drastically limited their visits to the city centre, and their use of public transport and facilities (Simonen et al, 2021). In Sweden, travels with public transport reduced on average 42% 2020 from March when the pandemic started (WSP 2021).

The traditional role of the city and people’s behaviour changed due to restrictions. Visits to the city centre faster and more efficient than before the pandemic. Here the focus was on what were considered essential activities. Secondary activities, such as visiting restaurants, cafés, or cultural offers either halted or were significantly reduced. In line with Batty’s (2020) conjecture, the city and public realm were also used differently. It was clear that the respondents avoided places with a lot of movement during the pandemic, as similarly illustrated by Neuman et al (2021). Optional activities like strolling around the city without a goal and window-shopping (Gehl, 2011), were largely avoided. The winter weather and micro-climate also likely contributed to the limited use of outdoor spaces in the city centre; although exceptions were made in the planning regulations to allow restaurants and cafés to open outdoor seating areas earlier in the season, the main street Storgatan tends to be windy and is in shade large parts of the day even during summer.

No restrictions were made on moving around outdoors in Sweden, and data from the southern parts showed that a slightly higher share of residents increased their moderate outdoor activity such as walking during the pandemic, especially those in larger cities, while residents in smaller towns and villages maintained their levels of mobility. Especially the older residents reduced their mobility due to susceptibility to COVID-19 (Eek et al, 2021). Our data reflects that the youngest group’s travels to the city centre were reduced, while the oldest tended to reduce their visits to the centre

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and services less. However, their general outdoor mobility was not measured. Place of residence, work, and studies could have impacted the need to use public spaces in the city centre.

Travel behaviour patterns also changed. Visits to the city centre were ‘planned’ to avoid rush hours and busy public transport, highlighting mobility based behavioural changes elicited by the pandemic, as also shown by Büchel (2022). Even if biking or walking could be an option for some, there are barriers to soft mobility during winter and spring-winter; snow, ice and slush results in decreased movement due to comfort reasons or fear of slipping.

Online shopping and takeaway food were not introduced with the pandemic, but use of these services accelerated. This trend was recently reported by Hassankhani et al (2021) and Hyung (2021). Cultural events to a larger degree moved online during the pandemic, with the expectations of free access that are challenging for cultural institutions as professionals. Also, there was a concern that many initiatives and smaller cultural organisations would not be able to bounce back after the pandemic.

Overall, the restrictions put in place to reduce spread of the infection forced a change in people’s relationship with the city (Honey-Rosés et al, 2020), which could impact the resilience of urban centres and their ability to bounce back after COVID-19 (Scott, 2020). The long-term effects can be challenging for both public and private sectors if people, as the respondents predict, keep the behaviours developed during the pandemic with online shopping, avoiding of crowds etc. This, in turn, can have different outcomes for public life and the public spaces (Sepe, 2021). On one hand, digitalisation could lead to the city centres being less frequented, draining urban life (Abusaada & Elshater, 2021). On the other hand, the desire to have a social life, in which public places are key, could lead to an increased use of the city centres at ‘odd’ hours. If to avoid crowds and rush hours, higher accessibility to facilities can enable this.

Representing half of the respondents, and distinctive to the youngest age group, were additional comments on feeling lonely and jaded and experiencing disappearing social networks. Partly this can be reflected by many student responses, where those who have moved to Luleå to study are likely to have a weaker social network. Also, many students returned to their hometowns when the university shifted to online teaching. Similarly, Elmer et al (2020) found that physical isolation, lack of interaction and emotional support were associated with negative mental health trajectories among students. However, Eek et al (2021) noted that mental wellbeing is not consistently associated with being physically active, through activities such as walking, during the pandemic. Reasons could relate to the fact that no restrictions were made on moving around outdoors in Sweden, the density of neighbourhoods, and the age of the citizen. The youngest age group also commented on taking on responsibility by following guidelines and recommendations. It is interesting to note in regard to the Swedish strategy its focus on softer restrictions and balancing individual rights and the common good (Bauhn 2022), which placed expectations on individuals to obey. As such this could explain our results of older people using the city centre to a greater extent, made possible by others using it less.

Future research should, in a larger scale data collection, further investigate the perceptions, rationales, behaviour, and visions of the diverse population groups in Arctic settlements.

Methodologically, a note needs to be made that the sample is cross-sectional and rather small. As such, the results reflect the perceptions of a limited number of residents, mainly younger and university students, who are primarily represented in the results. Possible biases in the reported data could be recall biases, protests, or social expectations.

However, the strength of this data collection is that it happened during a brief and specific window of time. People had already experienced more than twelve months with COVID induced public and eventual individual restrictions due to illness or susceptibility and the public restrictions and recommendations had recently been further enhanced. As such this data gives valuable insights. It

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is acknowledged that if asked to recall older memories of situations people perceive situations based on where they are today and their current knowledge base, as both individual and societal knowledge is evolving. This could be applied to how respondents recall their use of urban centres before the pandemic, and how the results from this data should be understood when read about today.

Another strength of this study is the mixed methods design. Quantitative and qualitative information from residents as well as representatives from the public and private sector gives a deeper understanding of the pandemic situation in this Arctic city in March 2021.

A higher proportion of younger residents that are mainly students are represented in this sample (54% of respondents between the age of 20 and 29 years, in comparison with the proportion (14%) of this age group in Luleå). The age group of 30-59 years old matches the overall Luleå proportion, with 40% in our sample and 38% in Luleå. Also, the gender distribution was slightly higher for women in our sample (57% women and 42% men, while in Luleå the proportion is about 49% women and 51% men).

Conclusion

This research focusing on an Arctic city during COVID-19 shows consistent results with similar studies from other parts of the world. It shows that in the Swedish European Arctic, there was a rapid transition to digital solution for work, commerce, and social activity. Equally, there was a rapid reduction of city usage. Importantly, the research shows that during the pandemic, the city centre remained important for ‘necessary activities’. However, necessary visits were no longer combined with other more social or recreational activities traditionally associated with city visits. Here optional activities were either decreased or abandoned. This is important, as such activities are seen as vital to the dynamics that make cities attractive for people to visit. Finally, the results suggest that the restrictions illustrated to people the social importance of the city and outdoor public space of an Arctic city in winter. While temperatures were commonly below 0°C and can reach -14°C during the survey period, people commonly highlighted the benefits of outdoor activity for physical and mental wellbeing. They also referenced the importance of unique Arctic public realm structures such as the Ice-Road as destinations in winter. This suggests that outdoor winter social activity is important and that as restrictions are removed, the social dimension of Arctic cities are likely to bounce-back.

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Local newspaper as a solution seeking actor in Northernmost Finland during the COVID -19 pandemic

The aim of this media analysis is to investigate how the COVID-19 pandemic emerged in Finnish Lapland during its first years from the perspective of a local newspaper. The data consists of published articles during years 2020 –2021 which concentrated on the COVID-19 pandemic, and it was collected from one local newspaper called “Inarilainen” by using paper versions of the newspaper. “Inarilainen” is published on a weekly basis, reaching out to people in the northernmost municipalities of Finland, including Sámi and non-Sámi, and being an important source of information for locals. Papers were reviewed, and news was initially included if it provided any information about the COVID-19 pandemic. Analysis continued to find answers to following questions: what kind of information related to COVID-19 was published, who provided the information and what kind of content and style the news used. During the analysis four journalistic styles were found: authority style, humane style, societal style, and realistic style. When identifying the main results, the reviewed articles were found to be solution seeking, empowering and empathetic, because humane and societal styles were emphasized in the communication.

Introduction

The first case of COVID-19 in Finland was identified at the end of January 2020 in Saariselkä tourist restrict located in Northern Lapland, which generated a high level of interest from national and international media. It was the starting point for the Finnish health care system in the COVID19 pandemic. During all types of crises, the responsibility of the media is emphasized. Processing the information, analysing it, and interpretating it are central tools for the media user to navigate the challenging circumstances.

Kati Parkkinen, Researcher, PhD, Faculty of Medicine, University of Oulu, Finland

Ulla Timlin, Post-doctoral researcher, Faculty of Medicine, University of Oulu, Finland

Arja Rautio, Professor, Thule Institute and Faculty of Medicine, University of Oulu, Finland and VicePresident in Research, University of Arctic, Finland

It is argued that during crises people use media much more than during the normal times (Zhang, 2022; Ghode, 2021; Perreault et all, 2022). Media control our understanding of the situation and provide answers about how to behave in unusual circumstances. The more media is used, the more important the communication style becomes because the role of media is accentuated in your life. Moreover, Perreault et al (2022) write that journalists operate, among other things, as storytellers when providing coverage of dangerous actors. One way to use storytelling is to write an article from the point of view of ordinary people. It is important to recognize that at these times journalistic style heavily influences how the message is received and the impact of the communication.

Media analysis

A total of 101 printed issues of the newspaper ‘Inarilainen’, during the years 2020 – 2021, were reviewed. “Inarilainen” is published on a weekly basis, reaching out to people in the northernmost municipalities of Finland, including Sámi and non-Sámi, and being an important source of information for locals. There were altogether 207 articles in the Finnish language that included information about COVID-19. These were collected and categorized according to their publishing date, page number, writer, title, theme, and other characteristic. Analysis continued to find answers to following questions: what kind of information related to COVID-19 was published, who provided the information and what kind of content and style the news used. During the analysis four journalistic styles were found: authority style, humane style, societal style, and realistic style. Thirteen articles were found in Sámi languages, but due to lack of language skill they were not included into the analysis.

Results

COVID-19 articles from the “Inarilainen” were initially categorized as shown in the Table 1. The largest group of articles were classified as bulletins, followed by analyses and reports.

About one third of the articles concerned being healthy or sick; there were articles about quarantine, lockdowns, testing and vaccination. Also, northern lifestyle and everyday life was highlighted. About one fifth of COVID-19 information described healthy ways of living, resources, hobbies, and relationships.

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Sort of Article Amount Percentage Bulletins 63 30 % Analyses and Reports 26 13 % News 22 11 % Colums and Comments 21 10 % Editorials 16 8 % Notifications 14 7 % Profiles and Interviews 13 6 % Surveys 7 3 % Religious writings 7 3 % Opinion pieces 7 3 % Top stories 6 3 %
Table 1. Covid-19 articles in the Inarilainen during 2020 - 2021

Almost one fifth of the articles focused on social issues. Among those there were articles about people who needed help, discrimination, the border of countries, international co-operation, and the treatment of nature. Themes of the COVID-19 communication found are listed in the Figure 1.

Four communication styles were used to classify the data: authority style, humane style, societal style, and realistic style. The biggest style group (34%) was the societal style. Articles using this style provided thoughtful perspectives and potential solutions, and offered comparisons. Societal style articles examined both the past and future. It relies on memories, literature, and culture.

The second most commonly used was the humane style (29%), where central attributes were, for example, enthusiasm, energy, hopefulness, humor, and wisdom. Articles using the authority style (21%) were informative, and provided instructions, responses, and explanations. Realistic style articles (15%) had practical, honest, and critical characteristics. It is interesting to note that realistic style articles had contradictory elements

Themes found from covid-19 articles in Inarilainen 2020-2021

Economy

Carrying capacity of healthcare system?

Remote work

Border Social supports Companies Society

Everyday life Protection

Discussion

This media analysis focuses on the writing style of articles and summarizes the information published in the “Inarilainen”, a local newspaper in Northernmost Finland, related to the COVID19 pandemic between 2020 and 2021. Analysis was completed systematically, but some articles may have been missed in the data collection. It should also be recognized that interpretations and classification might be subjective. It is important to recognize this to avoid unreliability (Breakwell et all, 2006). Only a few articles had characteristics from only one writing style. A majority of articles contained elements of several styles. In this media analysis, it was not relevant to prioritize any style because every article has its own place and role. During the analysis, the same four styles were considered, throughout the process.

Content of the reviewed articles were based on the facts, but there were also local peoples’ stories which could enhance joyfulness in the region. Hong and Zhang (2020) refer to civil happiness as

Arctic Yearbook 2023 Special Issue: Arctic Pandemics Local newspaper as a solution seeking actor in Northernmost Finland during the COVID-19 pandemic 203 Poems and Songs 5 2 % TOTAL 207 100 %
Figure 1. Categorized COVID-19 themes during the years 2020-2021
69 41 26 22 21 17 14 12 11

subjective well-being and life satisfaction. This kind of experiences of life quality reflects to the society. Pandemics affect dramatically on social structures, media, and science (Jones, 2021). The COVID-19 pandemic was not only a crisis for the public health sector It also impacted social, economic, and political elements of peoples’ and communities’ lives (Tong, 2022), and a quick intervention was expected (Meadows et all, 2022) Based on this analysis, despite the sudden effects of COVID-19, the articles provided positive messages for readers through “ordinary people´s thoughts.” When readers viewpoints are represented widely, it is easier to empower everyone

Jones (2021) asks, what aspects of the pandemic should media coverage highlight? In this media analysis ordinary people´s voice was strongest. Who are this ordinary people? Examples from the articles include, a municipal citizen, a voter, and a public or private customer. Almost as many messages were told by politicians during the COVID-19 crises. In general, the different aspects of the COVID-19 pandemic were widely represented, reflecting democratic atmosphere. This analysis serves the media and other information providers by pointing out the power as well as the responsibility of the communication sector at a societal and individual level. Concentrating on a printed paper made it possible to capture a specific Finnish region that includes Sámi and non-Sámi people. In addition, older people in particular may have been reached by this printed newspaper (Ghode, 2020). Most of the COVID-19 media depends on digital media use. It is important to evaluate the characteristics of the COVID-19 communication in national level, and in regional basis.

References

Breakwell, G.,Hammond, S., Fife-Schaw, C. & Smith, J (2006) Research Methods in Psychology. 3. edition. London: Sage.

Ghode, R. (2020). “‘Media and Me’ in the Lock-down: An Exploratory Study to Understand Media Consumption Pattern among Urban Millennial during Lock-down Period due to Covid-19.” Global Media Journal; Hammond 18 (36).

Hong, Y. & Zhang, P. (2022). “Political news and happiness: the difference between traditional media and new media use.” Chinese Journal of Communication 13 (4): 370–388. Inarilainen, local newspaper, printed versions 2020–2021.

Jones, A.M. (2001). “Constructing the Outbreak: Epidemics in Media & Collective Memory.” American Journalism, 38(2): 235-236.

Meadows, C.Z., Tang, L. & Zou, W (2022) “Managing government legitimacy during the COVID19 pandemic in China: a semantic network analysis of state-run media Sina Weibo posts.” Chinese Journal of Communication 15 (2): 156-181.

Perreault, G., Perreault, M. F. & Maares, P. (2022). “Metajournalistic Discourse as a Stabilizer within the Journalistic Field: Journalistic Practice in the Covid-19 Pandemic.” Journalism Practice 16 (2-3): 365-383.

Tong, J. (2022). “Confronting COVID-19: constructing and contesting legitimacy through the media in Chinese contexts.” Chinese Journal of Communication 15 (2): 145-155.

Zhang, Z. (2022). “Contesting legitimacy in China’s crisis communication: a framing analysis of reported social actors engaging in SARS and COVID-19.” Chinese Journal of Communication 15 (2): 182-204.

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Voluntary work in the shadow of COVID-19: Experiences from a Norwegian-Russian border region in the Arctic

This commentary presents the results of a study on volunteering during the COVID-19 pandemic in two neighbouring regions in the Arctic Troms og Finnmark county in Norway and Murmansk oblast in Russia. Our research shows that volunteering is one of the most efficient crisis response tools and that it adds indispensable value to reducing the workload of public health and social care institutions in promoting health and well-being for vulnerable groups. In both Norway and Russia, responses to the pandemic included the rise of the volunteer movement, but volunteering has different traditions and scopes in the two countries Established NGOs in Troms og Finnmark ounty took on new responsibilities for vulnerable groups. Such organizations were less developed in Murmansk oblast, and new volunteer structures in the form of united regional and municipal volunteer centres were quickly established in addition to existing organizations.

VOLRUSS project: Research in times of a pandemic

The COVID-19 pandemic has influenced many aspects of people’s lives worldwide. We, as social scientists working in an Arctic border region formed by Troms og Finnmark county in Norway and Murmansk oblast in Russia, have been affected too. In March 2020, right at the start of the pandemic, we launched a Norwegian-Russian research project, Adapting to a changing society: The case of civil society in the Murmansk region1 - VOLRUSS, which focused on the role of NGOs in the field of health and well-being The project was planned before the pandemic, and in new circumstances our research involving joint data collection and crossing the borders between our countries, has been called into question by quarantine restrictions and closed borders. Furthermore, the object of the research has changed literally in front of our eyes, and this has

1 The project is financed by the Norwegian Research Council, grant No.303247. The project home page: https://www.norceresearch.no/en/projects/adapting-to-a-changing-society-the-case-of-civil-society-in-themurmansk-region

Vigdis Nygaard is a senior researcher at Norwegian Research Center – NORCE in Alta, Norway

Larissa Riabova is a research director at Luzin Institute for Economic Studies, Kola Science Centre of the Russian Academy of Sciences, Apatity, Russia

brought challenges and also opened up new opportunities for research. In times of crisis, the civil society engaged in voluntary work had to adapt to new tasks and we as researchers had to adapt too.

The COVID-19 pandemic forced our research team to change the focus of the project and also influenced the ways the research was conducted. We decided to concentrate on the role of volunteer structures in providing assistance to the most vulnerable populations – the elderly, people with limited mobility and with chronic diseases, citizens in self-isolation. Right at the start of the project we realized that we had to work as a remote team and find ways of getting information during COVID restrictions. Reflecting on the situation that we have never experienced before, we have written about these changes and published an article “Adapting to the unpredictable: The story of a Norwegian-Russian study of NGOs in the Murmansk region during a pandemic” as the reflexive act of writing about the project’s disrupted start-up and as an exercise of flexibility and dynamics in the research process (Sørly et al 2021a). Further, we contributed with a chapter in a book with the title Stories of change and sustainability in the Arctic regions. Here we used the autoethnographic research method and presented our individual narratives of coping with the pandemic, overcoming its challenges and using new opportunities (Sørly et al 2021b).

This commentary shares insights from third publication from the VOLRUSS project focusing on the different responses of voluntary structures to the COVID-19 pandemic on the Russian and Norwegian sides of the Artic border. A first draft of the work was presented at the Arctic Frontiers conference in February 2021, and the article was published in English in the Russian journal The North and the Market in the summer of 2022 (Nygaard & Riabova 2022). This work was presented at the XI scientific and practical conference “The North and the Arctic in the New Global Development Paradigm. Luzin Readings 2022” in September 2022 and the main results were summarized in the conference proceedings in Russian (Riabova & Nygaard 2022)

Volunteer work on two sides of the Arctic border during the COVID pandemic

The pandemic has significantly increased the importance of volunteer work in providing assistance to the population. Given the great significance placed on voluntary work, methods for organizing it and daily practices during the pandemic in the Arctic context are still understudied and need scientific investigation. This is important for understanding the role of volunteer structures in dealing with the crisis and in finding ways to improve the effectiveness of the assistance provided both in crisis situations and in the normal course of events.

The VOLRUSS project examined the activities of volunteer structures in neighboring Arctic regions – Troms og Finnmark county in Norway and Murmansk oblast in Russia – with the aim of finding out how volunteer work with vulnerable people was organized in the face of the pandemic in two national and regional contexts. We sought to deepen understanding of the role of volunteering in crisis response and how this activity was influenced by political and structural differences between the two countries.

The data presented here covers the early pandemic period from March 2020 to June 2021. Since face-to-face interviews were problematic in the situation of a just-begun and escalating pandemic, our main methods of gathering information were analysis of official and media texts, written

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requests from NGOs for a description of their daily practice, and telephone interviews with NGO leaders and staff.

Our study found that in both Russia and Norway at the onset of the pandemic (March-June 2020), the volunteer movement grew to help the most vulnerable populations. Volunteering in the two countries was organized according to different approaches, depending on the state political structure, traditions and the scope of volunteer activity.

In Russia, the response to the crisis was carried out within the framework of a centralized system and involved all levels of government and many sectors. The regional level received significant decision-making power on measures to combat the pandemic. In Murmansk oblast, the Governor headed the newly established Interdepartmental Operational Headquarters to counteract the spread of the coronavirus infection. This body included representatives from over 40 organizations, such as the Murmansk Regional Office of Rospotrebnadzor (Federal Service for Supervision of Consumer Rights Protection and Human Welfare), Healthcare Ministry of Murmansk oblast, and others. In Norway, the main responsibility for the implementation of the national policy to combat the pandemic was given to the municipal level, which acted jointly with the public health authorities.

In Russia, the need for quick help in times of crisis has led to the emergence of new organizational forms of volunteer work. On March 17, 2020, the public movement the All-Russia People’s Front announced a general NGO mobilization to protect the population from the coronavirus. Three days later, the #WeAreTogether campaign launched across Russia on the initiative of the All-Russia People’s Front, the Volunteer Medics public movement, the Association of Volunteer Centers and the Dobro.ru, the largest platform in Russia for the development of civic engagement.

As part of the campaign, regional volunteer headquarters were formed in all regions of Russia in four days to provide assistance to the population. Murmansk oblast was one of the first to create new structures, the United Russia party and the All-Russia People’s Front regional volunteer center, and soon after on this basis the United Volunteer Center of Murmansk oblast and a network of volunteer centers in all 17 municipalities of the region. The centers were created in cooperation with regional authorities, large public movements (All-Russia People’s Front, Volunteer Medics and Volunteers of the Victory) and local governments. The local volunteer centers became platforms for joint actions by regional and municipal authorities, local volunteer organizations and NGOs, corporate volunteers, business and citizens.

In Norway, the national health authorities cooperated with the three major NGOs the Red Cross, the Norwegian Women’s Public Health Association, and Norwegian Peoples Aid to work out guidelines for close cooperation with voluntary organizations. This was in line with the governmental “Voluntary declaration” from 2015 prompting municipalities to map all voluntary organizations that were active in the communities and to work out a policy for volunteer work. The volunteer center (Frivilligsentralen) is an essential local structure to put this policy into practice. Troms og Finnmark county consists of 37 municipalities, and most of them had a volunteer center in operation when the pandemic hit. Developed public organizations have taken on new responsibilities for the protection of vulnerable groups of the population, and volunteer centers, working in cooperation with local governments, became the basic structures for municipal mobilization.

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The local volonteer centers in Murmansk oblast answered the hotlines for people over 65 and people with chronic diseases, low-mobility people and people in self-isolation. Volunteers shopped for these individuals, delivered medicines and free groceries, helped with housework, and worked at checkpoints at road inspections. In April – October 2020, 700 COVID-volunteers in Murmansk oblast fulfilled 17,600 appeals for assistance and delivered more than 14,000 free meals to those in need (Edinaya Rossiya., 2021) In Norway, Red Cross volunteers helped municipalities with corona-related tasks. For example, the Red Cross in Tromsø helped the University Hospital to test staff for COVID-19, provided safe transport of infected or people suspected of being infected, operated a test station for foreign visitors at Tromsø airport, helped the elderly, disabled, and foreign workers in quarantine or isolation with shopping and ran a phone friend service for lonely and isolated people. The organization contributed with 4000 hours of voluntary COVID-related work in 2020 (Tromsø Røde kors, 2020).

The study showed that in Murmansk oblast, as well as in Russia as a whole, the basis for organizing volunteer work used a centralized model of volunteering with the support of state authorities and a leading role by large vertically integrated public organizations and movements. Under this model, volunteers in Murmansk oblast were able to quickly mobilize, increase in numbers and organize new structures “on the ground”. Volunteer centers became platforms for consolidating the efforts of regional and local authorities, volunteers, NGOs, citizens. On the Norwegian side, a decentralized model was used, this was volunteer work based on a developed network of municipal volunteer centers, with the support of local governments.

Although in different ways, volunteer structures in both neighboring Arctic regions have demonstrated the ability to mobilize and be flexible and effective to meet the needs of vulnerable groups in the initial phase of the pandemic, which was marked by extreme uncertainty. The experience gained can be used in crisis conditions related to various types of challenges, as well as to improve work in normal conditions.

References

Nygaard, V., Riabova, L. (2022). Responses to the covid-19 pandemic in the Arctic: comparing the ways of organizing voluntary work in Northwest Russia and Northern Norway. The North and the Market. 2, 124-130. https://norceresearch.brage.unit.no/norceresearchxmlui/handle/11250/3048736

Sørly, R., Kårtveit, B., Nygaard, V., Normann, A. K., Ivanova, L., Britvina, S. & Riabova, L. (2021a). Adapting to the unpredictable: The story of a Norwegian-Russian study of NGOs in the Murmansk region during a pandemic. Qualitative social work, 20 (1-2), 312319.

Sørly, R., Kårtveit, B., Nygaard, V., Normann, A. K., Ivanova, L., Britvina, S. & Riabova, L. (2021b). Overcoming isolation in the Arctic during COVID-19 times through new ways of co-writing research. In: Sørly, R., Kårtveit, B. & Ghaye, T. (Eds.) Stories of Change and Sustainability in the Arctic Regions: The Interdependence of Local and Global, (pp. 143-156). Routledge.

Riabova, L., Nygaard, V. (2022). Organizaciya volonterskoi raboty v nachale pandemii COVID19 v Arktike: Murmanskaya oblast’ i Severnaya Norvegiya (Organization of volunteer

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work at the beginning of the COVID-19 pandemic in the Arctic: Murmansk oblast and Northern Norway). The North and the Arctic in the new paradigm of world development. Luzin readings - 2022: Proceedings of the XI International Scientific and Practical Conference (Apatity, 22-23 September 2022), 114-115. Publishing House of the FRC KSC RAS, Apatity. [in Russian].

https://www.elibrary.ru/download/elibrary_49935727_90346810.pdf

Edinaya Rossiya. Andrey Chibis nagradil volonterov Murmanskoy oblasti (United Russia. Andrey Chibis gave awards to volunteers of the Murmansk region). [in Russian].

https://er.ru/activity/news/andrej-chibis-nagradil-volonterov-murmanskoj-oblasti Tromsø Røde kors. Årsmelding. (Annual report of Tromsø Red Cross). 2020.

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Section III: Arctic Impacts and Innovation

The impacts of COVID-19 on Yukon’s frontline healthcare workers

Across Canada, and the world, frontline health care (HC) workers have faced adversity and challenges in delivering quality services during the COVID-19 pandemic. In northern, rural, and remote areas of Canada, these challenges have been amplified due to limited financial and human resources. The demand for services with an increase in cases/waves of COVID-19 has pushed a struggling system to the brink. The purpose of this study was to determine how COVID-19 has contributed to frontline HC worker burnout in the Yukon. A total of 141 regulated HC workers (physicians and nurses) completed the Copenhagen Burnout Inventory, formatted as an online survey, to measure workplace exhaustion across three categories: personal, work- and client-related. Data was analysed by gender, work location and profession. In relation to personal burnout, over half of the respondents in this study reported feeling tired, worn out, physically and emotionally exhausted. Approximately two-thirds of respondents experienced work-related burnout of emotional exhaustion and feeling worn-out at the end of the workday. In contrast, when surveyed about client-related burnout, respondents were less likely to report being tired of working with clients or finding it hard or frustrating to work with clients. The HC workforce is the foundation of a safe and effective HC system. These findings can inform decision-makers and employers on the need to mitigate workplace stress. Supporting HC workers is necessary for maintaining the quality of current and future health service delivery in the Yukon. Without them there is no system to deliver care.

Liris P.R. Smith, PhD, Yukon University; Mark R. Christopher, Yukon University, and Michelle D. Leach, PhD, Yukon University. Liris P.R. Smith, Mark R. Christopher & Michelle D. Leach

Background/Literature review

The COVID-19 pandemic has placed a significant burden on the global health care system and the health care (HC) workers within this system. Several studies across the globe have looked at the impacts of the pandemic, but there is a dearth of literature on the specific impacts in northern, remote, and rural settings. The Yukon sits in the northwest of Canada, above the 60th parallel, with a geographic expanse approximately the size of Spain and a population of only 44, 535, of which approximately 25% are Indigenous (Yukon Bureau of Statistics, 2022; Yukon Government, 2023). Much of the population lives in Whitehorse, the capital city (35,196) (Yukon Bureau of Statistics, 2022). The three largest communities outside Whitehorse include Dawson City (2363), Watson Lake (1496), and Haines Junction (1035) (Yukon Bureau of Statistics, 2022). There is one hospital in Whitehorse with 55 beds, and two rural hospitals located in Dawson City and Watson Lake with six beds each. A small intensive care unit with four beds is located in Whitehorse General Hospital; however, patients requiring more advanced intensive care or specialized treatment are transferred to Vancouver. The Yukon has four long-term care (LTC) homes; three in Whitehorse and one in Dawson city. Lastly there are nine community health centers that are often staffed with 1-2 nurses at a time, servicing fewer than 1000 clients.

Impact of COVID-19 on health care workers

COVID-19 has impacted the mental health of HC workers worldwide, with reports from around the globe highlighting high levels of anxiety, depression, post-traumatic stress disorder (PTSD), burnout, stress, moral distress, and sleep disturbances/insomnia. Some studies have reported more than 50% of HC workers experiencing burnout during the pandemic (Khasne et al., 2020; Roslan et al., 2021) The World Health Organization (WHO) defines burnout as a syndrome resulting from “chronic workplace stress that has not been successfully managed” (WHO, 2019, para. 4). WHO characterizes burnout as having three components: 1) feelings of energy depletion or complete exhaustion, 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job, and 3) reduced professional efficacy (WHO, 2019).

A study of physicians, nurses, and technicians in Vietnam found the levels of anxiety to be 26.84%, depression to be 34.7%, insomnia to be 43.53%, and overall psychological problems at 46.48% (Tuan et al., 2021) Another study found high levels of depression (69%), anxiety (58.9%), stress (55.9%), and inadequate sleep (37.3%) in frontline HC workers (Arafa et al., 2021). Perceived stress (79.3% of HC workers) and insomnia related to COVID-19 was found among HC workers in India (Chatterjee et al., 2021). A study of 189 primary HC providers (physicians and nurses) working in COVID-19 medical wards in Israel reported higher prevalence of sleep issues compared to non-COVID-19 HC workers. Witnessing negative patient experiences such as patient suffering and death partially explained these findings (Cleper et al., 2022).

A cross-sectional study in Columbia during the second wave of COVID-19 revealed the prevalence of mental health symptoms in a sample of 257 HC workers (44.36% nurses, 36.58% physicians, and 19.07% other health care providers (OHP))(Guillen-Burgos et al., 2022) PTSD was reported in 16.67% of nurses, 21.28% of physicians, and 18.37% for OHPs. Prevalence of anxiety symptoms in nurses, physicians, and OHPs ranged from 40.35% to 48.98%; and levels of reported depressive symptoms in nurses, physicians, and other HC providers ranged from 22.45% to 31.91% (GuillenBurgos et al., 2022) Another study analyzed the prevalence of anxiety, depression, burnout, and

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post-traumatic symptoms in four groups of COVID-19 emergency unit HC workers in Italy (Gorini et al., 2022). Physicians showed post-traumatic symptoms which were significantly higher than nurses, other HC workers and administrative employees. The primary determinant of psychological distress was perceived stress, followed by job satisfaction, impact of COVID on work-life and a lack of recreational activities (Gorini et al., 2022)

In Canada, COVID-19-related mental health challenges are also prevalent in HC workers. A survey of critical care nurses in British Columbia found that symptoms of PTSD, as well as mild to severe depression, anxiety, and stress were highly prevalent (Crowe et al., 2021). Interviews of nurses highlighted psychological distress as anxiety, worry, distress, and fear related to 1) meeting patients’ needs while working to protect themselves and others, 2) keeping up with an overwhelming volume of unclear communication, 3) rapidly changing policies and information regarding COVID-19 knowledge, and 4) balancing aspects of their personal lives (Crowe et al., 2021). A large study in Ontario highlighted high levels of burnout amongst physicians, residents, and medical students (Gajjar et al., 2022) In March 2020, they surveyed 1400 physicians, medical residents, and students, with 28% reporting high burnout levels. The survey was repeated one year later, with 2368 respondents. Gajjar at el. (2022) found that 34.7% reported high levels of burnout, an increase of more than 6%. The main contributors to burnout included ‘patient expectations/patient accountability’, ‘reporting and administrative obligations’, and ‘practice environment.’ (Gajjar et al., 2022)

Another study investigating the impact of morally distressing experiences on HC workers across Canada (792 HC workers, 42.8% nurses) found that moral distress positively predicted symptoms of burnout, anxiety, depression, and PTSD in healthcare workers (Plouffe et al., 2021). Watching patients suffer due to a lack of provider continuity was in the top three most frequently experienced morally distressing events. Nearly 50% of HC workers who experienced a morally distressing event ranked the requirement to care for more patients than they could safely care for as being the highest source of distress (Plouffe et al., 2021).

Health care challenges in northern, rural, and remote areas

Meeting the health care needs of patients in rural, remote, and northern communities is further challenged by a health care crisis, such as COVID-19. Although there is limited research regarding the impacts of COVID-19 on northern, rural HC workers, it is reasonable to suggest that mental and physical health impacts reported across the world also exist for northern HC workers.

For many people living in remote northern communities, healthcare can be inaccessible, unavailable, and unaffordable, (Fuchsia Howard et al., 2014; Kue Young et al., 2018; Michiel Oosterveer & Kue Young, 2015; Nair et al., 2016). The challenges of delivering accessible health services include geography, human resources, as well as systemic factors, such as delivery of services that respect culture and language (Huot et al., 2019)

Lack of proper medical equipment and/or sufficiently trained community HC professionals often means individuals living in rural and northern communities cannot access appropriate care (Fuchsia Howard et al., 2014; Michiel Oosterveer & Kue Young, 2015). From the providers perspective this typically means broadening their scope of practice or being assigned tasks beyond their scope which can be challenging (Hansen et al., 2021; Kue Young et al., 2019). In places like northern Canada, Finland, Norway, and Sweden, geographical distance is an additional barrier to accessing care

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including emergency services and specialized treatments (Kue Young et al., 2019; Michiel Oosterveer & Kue Young, 2015; Vuori et al., 2010). Communities situated far from urban health centers rely on medevac transport to access advanced care (Gunnarsson et al., 2015; Kue Young et al., 2019; Michiel Oosterveer & Kue Young, 2015). Weather conditions in remote communities in the Northwest Territories (NWT) present unique barriers to accessing care, which may cause significant delays for emergency medical air services (Michiel Oosterveer & Kue Young, 2015) Traveling long distances to access appropriate health services can take multiple days, incurring a financial and/or psychosocial burden for patients and families. One study investigating the barriers to accessing medical and supportive services for cancer survivors in rural British Columbia, found that transportation fees, taking time off work and the impact of traveling with family, specifically young children, contributed to “cost” of travel as described by patients (Fuchsia Howard et al., 2014). Transportation costs also place a significant financial burden on northern health systems. For example, medical travel data from 2011-2016 demonstrated that NWT and Nunavut, spent an annual average of $9.5 and $24.8 million dollars, on medivacs, respectively (Kue Young et al., 2019) In the Yukon, during the fiscal year of 2022-2023, 2900 people travelled outside the territory for medical reasons, 300 of which were medevac air transports (Prokop, 2023).

In addition to challenges related to geography and capacity, worker specific challenges exist in the north. Understaffing, difficulty recruiting HC professionals, low retention, and a high turnover/lack of continuity with health staff are persistent challenges (Kue Young et al., 2018; Michiel Oosterveer & Kue Young, 2015; Nair et al., 2016; Niclasen & Mulvad, 2010). A comparison of the density of HC professionals in circumpolar regions found that northern Canada (Nunavut, NWT and Yukon) have a lower density of physicians than the rest of the country, speaking to the staffing challenges faced in the north (Kue Young et al., 2018). Although the Canadian north was found to have a higher density of nurses than the rest of the country, this was explained by a health system that relies heavily on nurses working with an expanded scope of practice. (Kue Young et al., 2018)

Communication barriers can also present challenges in northern health care contexts. For example, linguistic and cultural differences between non-Indigenous health service providers and Indigenous service users were recognized as barriers to service delivery in NWT (Michiel Oosterveer & Kue Young, 2015). Similarly, in Norway communication barriers between Sami speaking patients and English-speaking care providers have led to patients’ dissatisfaction with care (Nystad et al., 2008). In the Yukon, individuals who speak English as a second language experience difficulty receiving health and social services provided in English, leading to misunderstandings and suboptimal care (Department of Health and Social Services, [HSS], 2019). People in the territory also reported that rural primary care providers are not always prepared to live in a remote community or trained to provide trauma informed care for First Nations patients (Department of HSS, 2019).

One study found that the lack of culturally safe care for Indigenous patients was one of several factors that contributed to burnout in physicians practicing in the three Canadian territories (Hansen et al., 2021). The study surveyed 57 physicians in the territories, prior to COVID-19, with 39% reporting signs of burnout (Hansen et al., 2021). Other contributing factors included discontinuity of care (due to understaffing, high turnover and reliance on locum providers), physicians' perceived lack of influence on health policies, lack of support programs and being assigned administrative tasks outside their scope (Hansen et al., 2021)

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Recent reports show that 35% of nurses feel the pandemic has made them more likely to leave the profession within the next two years (British Columbia Nurse’s Union [BCNU], 2021). Additionally, 51% of ICU and emergency nurses reported that they wanted to leave the profession within the same time frame (BCNU, 2021). Similar reports in Ontario found that 32% of nurses, plan to either retire from nursing within the next two years or leave nursing for a different profession (Registered Nurses Association of Ontario [RNAO], 2021). In light of these findings, there is cause for concern that frontline HC workers in the Yukon, specifically nurses, may follow a similar trend. Seeing as the Yukon’s healthcare system is reliant on nurses, especially in those who work in rural communities, this is problematic as it could exacerbate a pre-existing staffing crisis, compromise patient care, and increase the workload for remaining staff.

The concern of further losses in the healthcare workforce is one that will have immediate and longlasting effects in northern and rural regions. As there is a scarcity of knowledge regarding the impacts of COVID-19 on healthcare workers in circumpolar regions, there is an urgent need for research within this demographic context. The purpose of this study was to assess COVID-19related burnout among Yukon’s frontline HC workers.

Methods

Setting/population

This study took place in the Yukon, Canada, utilizing the Copenhagen Burnout Inventory (CBI) to assess the current state of burnout in physicians, physician specialists or surgeons; and nurses (registered nurses (RNs), nurse practitioners (NPs), licensed practical nurses (LPNs)). The selection criteria included any staff in the above categories that practiced during the COVID-19 pandemic (January 2020-December 2022). As reported by the Yukon Government’s Department of Community Services, there are a total of 226 LPNs, 697 RN/NPs, 215 family physicians, and 131 specialists licensed in the territory as of 2022-2023. Care aides and other allied health professionals were excluded from this study. We recognize and value the perspectives of these individuals as they played a vital role in the territory’s pandemic response. However, time constraints and the recruitment plan limited the study’s scope to nurses and physicians – many of whom are members of professional organizations allowing for ease of recruitment. Notably, nurses and physicians work across a wide spectrum of care settings, ensuring that the study encapsulates the state of burnout among frontline HC workers

An advisory committee comprised of two People with Lived Experience (PWLE) and one representative from each of the following professional organizations the Yukon Medical Association (YMA), Yukon Registered Nurses Association (YRNA), and the Yukon Licensed Practical Nurses Association (YLPNA) was formed to support the research. The term PWLE is commonly used by the Canadian Institute of Health Research (CIHR) to describe individuals with personal knowledge gained through direct first-hand experience (Strategy for Patient-Oriented Research, n.d.). In the present study, our two PWLE have firsthand knowledge of the territory’s health system from the perspective of someone who has experienced significant health care services.

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Recruitment and data collection

This study received ethics approval from the Yukon University Research Ethics Board in August 2022. Consent was implied through completion of the survey. The anonymity of participants was assured as no identifying data was collected. The study comprises two phases: completion of the CBI via Survey Monkey, and an in-depth oral interview. This paper will discuss the results of the CBI only.

Recruitment occurred primarily in October and November 2022 and was facilitated through partnerships with the YMA, YRNA, YLPNA, and through the two primary employers: Yukon Government’s Health and Social Service Department, and the Yukon Hospital Corporation (YHC). Organizations recruited via email to their membership, posting recruitment information on their social media platforms, and via announcements at membership meetings. The email included an invitation outlining the study aims, researcher contacts, and a live link to the CBI survey.

The CBI was developed as an alternative to the Maslach Burnout Inventory (MBI), a so-called gold standard of burnout measures, that defines burnout as a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among those who do ‘people work’(Maslach & Jackson, 1981). While the fatigue or exhaustion component is retained, the CBI has three subscales; personal, work-related, and client-related burnout (Kristensen et al., 2005). Unlike the MBI, the conceptualization of burnout using these subscales reinforces the idea that working with clients may not be the only source of burnout.

This study utilized the CBI survey, a standardized, validated questionnaire that has been used to measure burnout in HC workers across the world, in part due to its reliability as an assessment tool (Chor et al., 2021; Ferry et al., 2021; Khasne et al., 2020; Kristensen et al., 2005; Roslan et al., 2021; Ogunsuji et al., 2022). The CBI has 19 questions, formatted as a Likert-type scale to measure workplace exhaustion across three categories: personal, work-related, and client-related. The full survey included demographic questions relating to gender, location of work, profession, and years worked. Communities outside Whitehorse were combined due to the small population and likelihood of identifying individuals within communities. The CBI comprises three subscales: personal (six items), work burnout (seven items), and client burnout (six items), which align with the key themes described in the follow up interview study. Twelve items have responses of frequency along a five-point Likert scale ranging from always, to never/almost never. Seven items use response categories according to intensity ranging from a very low degree to a very high degree (Kristensen et al., 2005). Typical questions are: “how often do you feel tired”, “does your work frustrate you”, “do you feel burnt out because of your work” and “do you find it frustrating to work with clients” (Kristensen et al., 2005, p. 200). Selecting somewhat is considered moderate, often is considered high, and selecting always is considered severe burnout.

The standardized tool was imported into Survey Monkey and was estimated to take approximately five minutes for participants to complete. At the end of the survey, participants had the option to submit contact information to arrange an individual interview. The CBI data was not linked to the contact information and was therefore completely anonymous.

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Data analysis

Developed in 1932 by Rensis Likert, the typical Likert scale is a 5- or 7-point ordinal scale used to rate the degree a respondent agrees or disagrees with a statement (Likert, 1932). Responses can be ranked, but the distance between responses is not measurable. Thus, the differences between “always,” “often,” and “sometimes” for example, on a frequency response Likert scale are not necessarily equal. Consequently, our analysis determined the frequencies by calculating the percentage of responses in each category. The data was sorted and collated using both the tools within Survey Monkey and Microsoft Excel. As selecting the first two categories (“always” or “often” and “very high degree” or “high degree”) relate to high and severe burnout, these categories were combined for ease. Similarly, the last two categories on the scale (“seldom” or “never” and “low degree” or “very low degree”) were combined. The percentage of respondents answering in each of the categories was then calculated to enable comparison across the questions and across demographics. Percentages were calculated for each response with respect to the overall CBI responses. Further analysis was conducted to determine differences between professional categories, location of work (Whitehorse or communities) and gender.

Results

Demographics

For the purposes of this study, HC workers included physicians, nurse practitioners (NPs), registered nurses (RNs), licensed practical nurses (LPNs), and surgeons/specialists. A total of 141 HC workers responded to the survey (22 LPNs, 53 RNs/NPs, 56 physicians, and 7 surgeons/specialists). Physicians were the largest proportion of respondents (40.58%) (Figure 1).

Females comprised nearly three quarters of total responses (Figure 2). Of these responses, 78.72% of individuals work in Whitehorse (Figure 3). Although most of the responses came from individuals working in Whitehorse, the gender distribution within Whitehorse and the communities was approximately equal with a ratio of 80% female to 20% male respondents in both communities and Whitehorse (Figure 3) The respondents’ years of service in their respective profession ranged from 2 to 38 years, with a mean of 13.63 years.

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Figure 1: Percentage of total responses by professional category. *LPN: Licensed Practical Nurse *RN: Registered Nurse *NP: Nurse Practitioner.
40.58% 15.94% 38.40% 5.07% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
Physician LPN RN/NP Surgeon/ Specialist Profession

Personal burnout

The CBI comprises six questions related to personal burnout (Figure 4). When asked how often they feel tired, worn out, physically and emotionally exhausted, 50% or more of the respondents selected “Always or Often”, indicating a high level of burnout. (Figure 4). More than a quarter of respondents indicated that they always or often think they “can’t take it anymore”. While we see a significant portion of respondents indicating a high level of exhaustion, most of the respondents do not feel weak or susceptible to illness (Figure 4).

How

Analyzing the data by gender highlighted differences between genders in the personal burnout questions. Over 50% of females selected “Always or Often” in response to feeling tired, worn out, physically exhausted, and emotionally exhausted (Figure 5). Across all six questions, a greater percentage of females and those identified as “other” (non-binary and those who preferred not to answer) selected “Always or Often”, while a greater percentage of males selected “Seldom or Never” (Figure 5).

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Figure 4: Percentage of the total responses to six questions related to personal burnout, organized by frequency of experience.
73.76% 21.99% 4.26% 0% 10% 20% 30% 40% 50% 60% 70% 80% Female Male Other Gender 78.72 % 21.28 % 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Whitehorse Community Location
Figure 3: Percentage of total survey responses analyzed by work location. *Community: respondents located outside of Whitehorse
74.26% 53.28% 62.50% 26.28% 50.36% 26.28% 22.79% 38.69% 26.47% 35.77% 37.23% 36.50% 2.94% 8.03% 11.03% 37.96% 12.41% 37.23% 0% 10% 20% 30% 40% 50% 60% 70% 80%
often
Figure 2: Percentage of total responses by gender *Other: nonbinary and those who preferred not to answer.
How
do you feel tired? How often are you physically exhausted?
How often are you emotionally exhausted?
How often do you think: ”I can’t take it anymore”?
often
Always/often Sometimes Seldom/Never
do you feel worn out? How often do you feel weak and susceptible to illness?

How often do you feel tired? How often are you physically exhausted?

How often are you emotionally exhausted?

How often do you think: ”I can’t take it anymore”?

How often do you feel worn out?

How often do you feel weak and susceptible to illness?

Analysis of data by community revealed that when asked about how often they feel tired, worn out, physically exhausted, and emotionally exhausted, approximately 50% or more of respondents selected “Always or Often” irrespective of work location (Table 1). Roughly three quarters of respondents in both locations reported feeling tired “Always or Often” (Table 1). Less than 1% of those working in Whitehorse selected “Seldom or Never” in response to this question, suggesting that almost all respondents located in Whitehorse have a moderate to severe degree of tiredness. In response to the same question, almost one third of community workers responded, “Seldom or Never” (Table 1). This suggests that community workers are experiencing less personal burnout compared to their Whitehorse counterparts. More respondents from both work locations selected “Sometimes” and “Seldom or Never” when asked how often they think “I can’t take it anymore” and “do you feel weak and susceptible to illness?” (Table 1). For both questions a higher percentage of those working in the community responded, “Seldom or Never” (Table 1).

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Figure 5: Percentage of respondents, by gender, who selected “Always” or “Often” when asked six questions related to personal burnout.
0% 20% 40% 60% 80% 100%
Female Male Other

Table 1: Responses to six questions about personal burnout, scaled by frequency of experience ranging from never to always and organized by work location.

*Q1: How often do you feel tired *Q2: How often are you physically exhausted? *Q3: How often are you emotionally exhausted?

*Q4: How often do you think “I can’t take it anymore?” *Q5: How often do you feel worn out? *Q6: How often do you feel weak and susceptible to disease?

When data was analyzed by profession, nurses (LPNs and RNs/NPs) comprised the greatest percentage of respondents who selected “Always or Often” (Figure 6), indicating that nurses are experiencing more personal burnout compared to physicians. Further analysis by professional category revealed a greater percentage of LPNs who selected “Always or Often” for all questions except for feeling physically exhausted (Figure 6). Contrarily, a greater percentage of physicians and surgeons/specialists responded “Seldom or Never” to all questions, suggesting that nurses are experiencing more personal burnout.

How often do you feel tired?

How often are you physically exhausted?

How often are you emotionally exhausted?

How often do you think: ”I can’t take it anymore”?

How often do you feel worn out?

How often do you feel weak and susceptible to illness?

Figure 6: Percentage of respondents, by professional category, who selected “Always or Often” when asked six questions related to personal burnout. *LPN: Licensed Practical Nurse *

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RN: Registered Nurse *NP: Nurse Practitioner 0% 20% 40% 60% 80% 100%
Physician LPN RN/NP Surgeon/Speciallist
Always/Often Sometimes Seldom/Never Whitehorse (%) Community (%) Whitehorse (%) Community (%) Whitehorse (%) Community (%) Q1 73.83 75.86 25.23 13.79 0.93 10.34 Q2 53.70 51.72 37.96 41.38 8.33 6.90 Q3 64.49 55.17 29.91 13.79 5.61 31.03 Q4 25.00 31.03 37.96 27.59 37.04 41.38 Q5 48.15 58.62 41.67 20.69 10.19 20.69 Q6 28.70 17.24 36.11 37.93 35.19 44.83

Work-related burnout

The CBI has seven questions on work-related burnout. When asked if their work was emotionally exhausting, two thirds of respondents selected “to a very high or high degree” (Figure 7). In addition, 80% or more rated the questions “do you feel burnt out because of your work” or “does your work frustrate you” as “somewhat”, to a “high degree” or “very high degree” (Figure 7).

To a very high or high degree

Somewhat To a low or very low degree

Over 70% of female healthcare workers find their work emotionally exhausting to a “high or very high degree”. Contrarily, males and “other” accounted for about half (Figure 8). Nearly 50% of females selected “to a very high or high degree” when asked whether they felt burnt out because of their work and if their work frustrated them (Figure 8). Overall, females report more burnout.

Analyzing responses by work location showed approximately 48%-58% of community workers selected “to very high or high degree” when asked if their work was emotionally exhausting, frustrating, or causing burnout (Figure 9). While a greater percentage of Whitehorse HC workers indicated emotional exhaustion compared to the community, fewer indicated a high or severe level

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Figure 7: Percentage of total responses to three questions about work-related burnout organized by degree of intensity. Figure 8: Percentage of respondents (by gender) that selected “to a very high or high degree” in response to three questions about work-related burnout.
66.42% 43.70% 39.26% 27.61% 37.04% 43.70% 5.97% 19.26% 17.04% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Is your work emotionally exhausting? Do you feel burnt out because of your work? Does your work frustrate you?
0% 20% 40% 60% 80% 100%
Is your work emotionally exhausting? Do you feel burnt out because of your work? Does your work frustrate you?
Other
Female Male

of burn out or frustration due to their work compared to community workers (Figure 9). While we observed high levels of burn out in almost 50% of community HC workers, we note that almost one quarter of community workers responded “to a low or very low degree” when asked whether they feel burnt out because of work (Figure 9).

Is your work emotionally exhausting?

Do you feel burnt out because of your work?

Does your work frustrate you?

Analysis, by profession, to work-related burnout questions indicates that a greater percentage of nurses (LPNs and RNs/NPs) selected “to a very high or high degree” in response to the three questions (Figure 10). In comparison to RN/NP, a higher percentage of LPNs selected this response when asked if their work was emotionally exhausting (Figure 10). Over 40% of surgeons/specialists compared to approximately 24% of physicians selected “to a very high or high degree” when asked if they felt burnt out because of work (Figure 10). None of the surgeons/specialists and none of the LPNs selected “seldom” or “never” when answering that question (data not shown). This suggests LPNs and surgeons/specialists have at least a moderate degree of work-related burnout.

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Smith, Christopher & Leach Figure 9: Percentage of responses to three questions about work-related burnout scaled by degree of intensity and analyzed by work location.
0% 10% 20% 30% 40% 50% 60% 70% 80%
To a very high or high degree Somewhat To a low or very low degree
Whitehorse Community Whitehorse Community Whitehorse Community

Is your work emotionally exhausting? Do you feel burnt out because of your work?

Does your work frustrate you?

Additional work burnout questions show two thirds of respondents selected “Always or Often” while only 3.70% selected “Seldom or Never” when asked if they felt worn out at the end of a working day (Figure 11). However, when asked if they felt every working hour was tiring for them 40% of respondents selected “Seldom or Never”, suggesting that while respondents are worn out by the end of the day, every working hour is not tiring for them (Figure 11). We do see most respondents are exhausted in the morning at the thought of another day at work, with over three quarters answering “sometimes”, “often”, or “always” (Figure 11). In addition to feeling worn out at the end, nearly a third of respondents reported that they “seldom or never” have enough energy for family and friends during leisure time, indicating how work may be affecting their personal life (Figure 11).

Always/often Sometimes Seldom/Never

Do you feel worn out at the end of the working day?

Are you exhausted in the morning at the thought of another day at work?

Do you feel that every working hour is tiring for you?

Do you have enough energy for family and friends during leisure time?

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Figure 10: Percentage of respondents that selected “to a high or very high degree” when asked three questions about work-related burnout, analyzed by profession.
0% 20% 40% 60% 80% 100%
Figure 11: Percentage of total responses to four questions about work-related burnout, scaled by degree of intensity.
66.66% 36.30% 20.74% 21.64% 29.63% 40.00% 39.26% 47.76% 3.70% 23.70% 40% 30.60% 0% 20% 40% 60% 80% 100%

Gender analysis highlights that females show a higher degree of work-related burnout compared to males. Females were more worn out, more exhausted in the morning, and more likely to report that every working hour is tiring. In addition, they selected that they “Seldom or Never” have time for family and friends. A further breakdown of the data shows that females comprised nearly three quarters of those who selected “Always or Often” when asked if they felt worn out at the end of the working day while 0% of those categorized as “Other” selected “Seldom or Never” (Table 2). Less than one quarter of females selected “Always or Often” when asked if they have enough energy for family and friends during leisure times (Table 2). Over 50% of male respondents selected “Seldom or Never” when asked if they were exhausted in the morning at the thought of another day of work and if they felt that every working hour is tiring, which was higher than other genders (Table 2).

Table 2: Percentage of total responses to four questions about work-related burnout, scaled by degree of intensity and analyzed by gender

*Q4: Do you feel worn out at the end of the working day? *Q5: Are you exhausted in the morning at the thought of another day at work? *Q6: Do you feel that every working hour is tiring for you? *Q7: Do you have enough energy for family and friends during leisure time? *Other: non-binary or preferred not to answer.

An equal number of workers across Whitehorse and communities report “Always or Often” when asked if they feel worn out at the end of a working day or if every waking hour is tiring. However, we do see differences with respondents who answered, “Seldom or Never”. For example, only 1.89% of HC workers in Whitehorse selected “Seldom or Never” when asked if they feel worn out at the end of the working day compared to 10.34% of community workers (Figure 12). When asked if they feel every working hour is tiring, a greater percentage of Whitehorse respondents selected “Seldom or Never”. This data suggests that community HC workers are less likely to feel worn out at the end of a working day, but some feel that every working hour is tiring.

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Always/Often Sometimes Seldom/Never Female (%) Male (%) Other (%) Female (%) Male (%) Other (%) Female (%) Male (%) Other (%) Q4 72 50 60 26 40 40 2 10 0 Q5 41 20 40 45 23.33 40 14 56.67 20 Q6 22 10 60 42 36.67 0 36 53.33 40 Q7 19 30 25 49 47 25 32 23.33 50

Do you feel worn out at the end of the working day?

Are you exhausted in the morning at the thought of another day at work?

Do you feel that every working hour is tiring for you?

Do you have enough energy for family and friends during leisure time?

When analyzing by profession, we observe more physicians and surgeon/specialists selected “Always or Often” when asked if they have enough energy for family and friends during leisure time compared to LPNs and RNs/NPs (Figure 13). Further analysis reveals that nearly three quarters of nurses (LPN and RN/NP) and surgeons/specialists reported that they are “Always or Often” worn out at the end of the day). None of the RN/NPs or surgeons/specialists selected “Seldom or Never” in response to this question, indicating that 100% of these respondents experience a moderate amount or more of being worn out at the end of the day (data not shown).

Client-related burnout

The CBI comprises six questions related to client burnout. For the purpose of the survey, the term client was used to describe people within a respondent’s scope of practice i.e., clients, patients, social service recipients, elderly citizens, etc. This section indicates that Yukon HC workers are less burned out when it relates to clients. For example, we see that fewer than 10% of respondents selected “To a very high or high degree” when asked if they found it hard to work with clients and if they found working with clients frustrating (Figure 13). A higher percentage of respondents selected “To a low or very low degree” than “to a very high or high degree” when asked if working with clients drained their energy (Figure 13).

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The impacts of COVID-19 on Yukon’s frontline healthcare workers Figure 12: Percentage of total responses to four questions about work-related burnout scaled by frequency of experience and analyzed by work location.
0% 10% 20% 30% 40% 50% 60% 70% 80%
Always/Often Sometimes Seldom/Never
Whitehorse Community Whitehorse Community Whitehorse Community

To a very high or high degree

Somewhat

To a low or very low degree

Do you find it hard to work with clients?

Do you find it frustrating to work with clients?

Does it drain your energy to work with clients?

Do you feel that you give more than you get back when you work with clients?

Gender analysis revealed that none of the respondents categorized as “Other” selected “to very high or high degree” when asked if they find work with clients hard, frustrating or if it drains their energy. Once again, a higher percentage of females selected “To a very high or high degree” across all 4 questions when compared to male respondents (data not shown).

Notably, we observed that HC workers in the community find it both harder and more frustrating to work with clients compared to Whitehorse HC workers, with approximately twice as many in the community selecting “to a very high or high degree” (Figure 14).

Do you find it hard to work with clients?

Do you find it frustrating to work with clients?

Does it drain your energy to work with clients?

Do you feel that you give more than you get back when you work with clients?

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Smith, Christopher & Leach Figure 13: Percentage of total responses to four questions about client-related burnout, scaled by degree of intensity.
7.63% 9.16% 21.54% 38.93% 38.93% 45.04% 43.85% 35.11% 53.44% 45.80% 34.62% 25.95% 0% 20% 40% 60% 80% 100%
Figure 14: Percentage of respondents that selected “to a very high or high degree” when asked four questions about client-related burnout analyzed by work location.
0% 10% 20% 30% 40% 50%
Whitehorse Community

Further analysis reveals that a greater percentage of RN/NPs selected “to a very high or high degree” for all four questions. In some cases, the percentage was more than three times the percentage of LPNs. For example, when asked if they found working with clients frustrating, the RN/NP group comprised 18.37% of those who selected “to a very high or high degree” while LPNs made up 5% (Table 5). In response to all four questions, none of the surgeons selected “to a very high or high degree” while 50% or more responded “to a low or very low degree” (Table 5). Consistent with this data, surgeons/specialists were the highest percentage of those who selected “to a low or very low degree” for all four questions (Table 5).

*Q1: Do you find it hard to work with clients? *Q2: do you find it frustrating to work with clients? *Q3: does it drain your energy to work with clients? *Q4: Do you feel you give more than you get back when your work with clients?

Approximately 80% of respondents selected “sometimes” and “seldom or never” when asked if they are tired of working with clients (Figure 15). Although nearly 30% of respondents selected “Always or Often,” when asked if they sometimes wonder how long they will be able to continue working with clients the largest percentage of respondents selected “Seldom or never” (Figure 15).

Always/often

Sometimes

Seldom/Never

Are you tired of working with clients? Do you sometimes wonder how long you will be able to continue working with clients?

Gender analysis revealed that females and “other” were twice as likely as males to select “Always or Often” when asked if they are tired of working with clients (data not shown). Community workers had a greater percentage of workers selecting “Always or Often” when asked if they are tired of working with clients. Of concern, 41% of respondents working in the community indicated ‘Always or Often’ when asked if they sometimes wonder how long this will be able to continue working with clients (Figure 16).

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Figure 15: Percentage of total responses to two questions about client-related burnout scaled by frequency of experience.
19.08% 28.68% 40.46% 33.33% 40.46% 37.98% 0% 20% 40% 60% 80% 100%
To a very high or high degree Somewhat To a low or very low degree Physician (%) LPN (%) RN/ NP (%) Surgeon/ Specialist (%) Physician (%) LPN (%) RN/ NP (%) Surgeon/ Specialist (%) Physician (%) LPN (%) RN/ NP (%) Surgeon/ Specialist (%) Q1 1.89 10 14.29 0 37.74 40 38.78 16.67 60.38 50 46.94 83.33 Q2 3.77 5 18.37 0 47.17 45 44.90 16.67 49.06 50 36.73 83.33 Q3 18.87 20 28.57 0 47.17 40 40.82 50 33.96 40 30.61 50 Q4 35.85 40 46.94 0 39.62 30 32.65 33.33 24.53 30 20.41 66.67
Table 5: Percentage of total responses to four questions about client-related burnout, scaled by degree of intensity and analyzed by profession.

Are you tired of working with clients? Do you sometimes wonder how long you will be able to continue working with clients?

Nurses (LPN and RN/NP) comprised greater percentages of those who responded “Always or Often” to both questions with 37% and almost 44% of LPNs and RNs/NPs, respectively, responding “Always or Often” when asked if they sometimes wonder how long this will be able to continue working with clients (Figure 17). None of the surgeons and less than 10% of physicians selected “Always or Often” when asked if they are tired of working with clients (Figure 17).

Are you tired of working with clients? Do you sometimes wonder how long you will be able to continue working with clients?

Discussion

Introduction/overall discussion of results

Across the globe there are reports of professionals leaving health care due to the stresses that occurred during COVID-19. Some studies suggest that even before the pandemic, particularly in Canada, the health care system was at the brink of collapse and COVID-19 further compounded and highlighted existing problems within this system (Canadian Federation of Nurse Unions, 2020;

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Figure 16: Percentage of respondents who selected “Always or Often” when asked two questions about client related burnout, analyzed by work location. Figure 17: Percentage of respondents who selected “Always or often” when asked two questions about client-related burnout, analyzed by profession.
0% 10% 20% 30% 40% 50%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Whitehorse Community
Physician LPN RN/NP Surgeon/Speciallist

Canadian Medical Association [CMA], 2017; Hansen et al., 2021). Workplace stress within a more complicated, constantly shifting health care system is pervasive in Canada, making jobs more demanding and complex (College of Licensed Practical Nurses of Alberta [CLPNA], 2019). The results of the CBI in the Yukon reflect high levels of personal and work-related burnout within the HC worker professions. This is supported by other studies performed around the world (Khasne et al., 2020; Roslan et al., 2021). Though there are multiple factors that impact HC worker burnout, the literature suggests that the COVID-19 pandemic has been a strong factor in increasing stressors (Chor et al., 2021; Gajjar et al., 2022; Khasne et al., 2020; Plouffe et al., 2021; Roslan et al., 2021). This study indicated that burnout was at its highest for respondents in the areas of personal and work-related stressors. The personal burnout questions with the highest number of responses of “Always or Often” were feeling tired (74.26%); and feeling emotionally exhausted (62.50%). The work-related burnout question with the greatest “Always or Often” response (66.42%) related to emotional exhaustion. Thus, emotional exhaustion was a factor that related to personal and workrelated factors, or a combination of the two.

Across all HC worker categories, on the personal burnout scale, there are low levels of feeling weak or susceptible to illness, despite the high levels of tiredness, physical and emotional exhaustion reported. This may be due to the increased reporting of physical activity seen in people living in the Yukon (71.7%) compared to Canada (56%) (Department of HSS 2021). In a system that is already struggling with health human resources and funding issues, burnout that is further exacerbated by the COVID-19 pandemic is of great concern. The levels of burnout among HC workers can have a direct effect on critical incidents and mortality rates of clients, making it a priority for the health care system to address burnout (CLPNA, 2019).

Gender

In 2021, about 91% of regulated nurses in Canada were female, as nursing continues to be a femaledominated profession (Canadian Institute for Health Information [CIHI], 2021). National databases in Canada, including CIHI collect data on sex (not gender), so national statistics regarding nurses with various gender expressions is unavailable. Our data also reflects a high proportion of female nurses (89%).

Of the total respondents, in all professions, almost three quarters (73.76%) were female. Females and “other” genders reported more personal stress and burnout (Figure 5). Additionally, females reported higher levels of work-related burn-out, exhaustion and frustration, compared to males. In fact, almost three quarters (72%) of female respondents reported that they often or always felt worn out at the end of a workday (Table 4). In the third subscale of client-related burnout, though the results for all respondents indicated less burnout in this area, females continue to report higher levels of client-related burnout than their male counterparts.

These results may reflect the different roles that females take within and among professions, and the additional role they carry in managing domestic activities such as cooking, cleaning, and primary responsibility for childcare (CIW, 2021). During lockdown periods when people were working from home and children were not at school, females often had an additional burden in supporting domestic tasks and roles (Kumar et al., 2021). Additionally, female nurses may be more fearful of the pandemic than males and tend to take extra precautions with infection control procedures to avoid infecting their families (De los Santos & Labrague, 2021), adding additional personal and

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work stress. Women also have less time available for leisure, even though they rank the importance of leisure in maintaining health higher than men (CIW, 2021).

If females are continuing to be the primary care provider for children, the increased levels of burnout seen in our study are supported in the Canadian Index of Well-being where 15.5% of Yukon respondents indicated they cannot stay home when sick or when their children are sick because benefits are not provided, or the work culture makes it untenable to do so (CIW, 2021). We are expanding this study to include in-depth interviews and personal reflections from participants. This will provide a more fulsome discussion of these gender differences, and how the stressors manifest themselves in the personal lives of HC workers.

Professional differences

The data from this study suggests RNs/NPs and LPNs suffer from burnout more than physicians, specialists, and surgeons. One study that focused on emergency department and critical care unit healthcare workers reported that 49% experienced moderate to severe personal burnout. Using the CBI, the levels of assessed personal burnout were 53% in nurses and 42% in doctors (Chor et al., 2021) Another study in the UK found that 79% of health care workers experienced moderate to severe burnout. In alignment with our results, the rate for nurses was 85%, which was significantly higher than doctors (59%) (Ferry et al., 2021).

While nurses are experiencing more burnout, we still see that a proportion of physicians experience burnout. This is consistent with the most recent CMA report showing that among 4000 respondents, 53% reported high level of burnout which is 23% higher than 2017 survey (Gajjar et al., 2022).

All nurses (RNs/NPs and LPNs) reported higher levels of personal stress, with LPNs scoring slightly higher scores in the areas of emotional stress and feeling tired (Figure 6). In more recent years, the role of LPNs has expanded in the Yukon and across Canada to include working in areas such as emergent and critical care, where they have not had a presence in the past. Within several settings in the Yukon, LPNs work alongside personal care workers and RNs. With staffing shortages, this may be the profession that has considerable expectations to shift work duties and priorities to support basic care needs in one setting and then shift to utilizing more advanced nursing skills in another.

For work-related stress, we see high levels of burnout in nurses, with LPNs showing the greatest frequency of emotional exhaustion, and RNs/NPs showing the highest levels of feeling burnt out due to work, compared to the other professions (Figure 10). Shifts within the health care system involve RNs taking on new roles such as leadership (Nowrouzi-Kia et al., 2022). The requirement to fulfill multiple, complex roles, leading to role conflict and ambiguity, may be a factor in higher levels of burnout in both LPNs and RNs; that we see more nurses identifying as female may also contribute to these results.

Client-related burnout was also the highest in nurses compared to physicians and surgeons, with higher levels of burnout among RNs. Over 40% of RNs reported that they “Always or Often” wonder how long they can continue to work with clients. (Figure 17). This is of significant concern in rural Yukon, where human resources and adequate staffing are constant challenges.

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Urban versus community differences

Our study highlighted similar patterns between HC workers in Whitehorse and those working in rural communities, with community staff reporting slightly lower on the scale for personal burnout. In relation to work related burnout, Whitehorse HC workers report more exhaustion, whereas the community staff report more frustration with work. The pressures of working within a large system with many staff may be a contributing factor to work-related exhaustion in the urban setting, as well as the demand to take on additional shifts and duties within this large system. In relation to client-related burnout, HC workers in the communities report higher levels of frustration with clients than those based in Whitehorse. These findings may be indicative of a rural HC workforce that was vulnerable to the impacts of COVID-19 prior to the onset of the pandemic. The small communities outside of Whitehorse have fewer health staff, many of which are agency or itinerant workers – a situation that pre-dates the pandemic. Factors such as insufficient staffing levels may increase workload, making it difficult to meet the needs of all clients. Additionally, the rural communities are staffed with primarily nurses who are experiencing higher levels of burnout, which may be related to their responsibility to provide care while working with an expanded scope of practice.

This survey revealed that physicians and nurses are feeling burnout, particularly in relation to personal and work-related stressors. Though we cannot postulate a direct casual effect, the impacts of COVID-19 are certainly a factor. The wellbeing of all Yukon citizens has been affected by the pandemic with self-rated physical and mental health dropping dramatically during the pandemic, matching a national pattern (CIW, 2021).

Hansen et al., 2021 found that physician reported factors that mitigate burnout included having relationships with colleagues and community members as well as spending time on the land and engaging in outdoor activities. A strong connection to community has been reported in more than one third of people living in the Yukon, stating they had a sense of belonging (CIW, 2021). This sense of belonging to community, and the personal connections that are established, may factor into the lower levels of client related burnout, compared to personal and work-related burnout.

Limitations

A potential limitation to this study is that care aides, allied health professionals and other health staff were excluded from the study. Care aides make up a considerable percentage of frontline HC workers in long-term care facilities and other non-acute care settings. Additionally, allied health professionals and custodial and housekeeping staff comprise a vital part of the staffing complement affected by the COVID-19 pandemic. However, given the limited timeline and the targeted recruitment through professional organizations, these professions were excluded from the study. Many of these health-related professions are often underpaid, undervalued, and belong to marginalized groups, making them especially vulnerable to the impacts of COVID-19 (Estabrooks et al., 2015). As such, it is important that future research that focuses on the impacts of COVID19, other pandemics, and health emergencies, includes these essential workers.

The CBI also provides only a snapshot of burnout at one point of time and therefore offers no insight regarding the level of compassion fatigue, which is a highly relevant concept for healthcare workers who are exposed to stressful and traumatic work environments. Additionally, the CBI

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does not reveal the specific factors that contribute to burnout. Further research is required to address these limitations.

Conclusion

The challenges of providing care in the north are compounded by the COVID-19 pandemic, contributing to increased stress. This research shows that HC workers in the Yukon are expressing high levels of personal and work-related burnout while, to a lesser extent, they are reporting clientrelated burnout. Further analysis demonstrated that females and nurses experience higher levels of burnout across all three CBI subscales. Additionally, client-related burnout was slightly higher among community HC workers than their counterparts in Whitehorse. These findings stress that occupational status and gender are among the factors that can disproportionately affect HC workers amidst a health crisis.

Supporting the HC workers responsible for providing services is essential to an effective health care system, particularly in a northern context. This research will inform managers, employers, and policymakers of the need to mitigate stressors so that the risk of burnout among frontline HC workers is reduced, they can enjoy improved job satisfaction, and continue to meet the needs of their clients. The COVID-19 pandemic has illuminated how central the health of our society and health care system is to a well-functioning society. We must build a more resilient health care system that can sustain our aging society.

Acknowledgements

We wish to acknowledge the contributions of our advisory team which includes representative from the Yukon Medical Association (Dr. C Breitkruetz), Yukon Registered Nurses Association (P. Banks) and Yukon Licensed Practical Nurses Association (A. Mackie) along with two persons with lived experience, K Secord and J Yasay.

Funding

This research was possible through the generous grant from Yukon Government (COVID-19 recovery grant) as well as the support from the Yukon Strategy for Patient Oriented Research (YSPOR) at Yukon University.

References

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The health experience of the COVID-19 pandemic among the Sámi in Sweden: A cross-sectional comparative study

Lena Maria Nilsson, Miguel San Sebastian & Jon Petter A Stoor

There is an international concern that the COVID-19 pandemic could have had serious effects on Indigenous peoples’ livelihoods and health. To our knowledge, no research has been published regarding the impact of COVID-19 on the lives of the Sámi people. The aim of this study is to assess the health care and social experience of the pre-vaccine phase of the COVID-19 pandemic among the Sámi, in comparison with the national population, in Sweden.

Two population-based surveys, in the Sámi and the Swedish populations, were conducted between February and May 2021. In addition to sociodemographic and health information, a questionnaire regarding the health experience of COVID-19 designed by the Public Health Agency of Sweden was included. Both surveys targeted individuals aged 18–84 years and the participation rate was 40.9% in the Sámi study and 44.3% in the national study.

Based on the data collected, Sámi in Sweden seem to have been affected in a similar or even in a milder way than the national population during the pre-vaccine phase of the COVID-19 pandemic. Further studies are needed to explore the distribution of these outcomes among different Sámi subgroups. Register studies are also needed to evaluate the clinical (morbidity and mortality) impact of COVID-19 in the Sámi population.

Lena Maria Nilsson (lena.nilsson@umu.se) is a project coordinator at Lávvuo – research and education for Sámi health, Department of Epidemiology and Global Health, Umeå University, Sweden and project coordinator at the Arctic Centre, and associated to Várdduo, the centre for Sámi research at Umeå University.

Miguel San Sebastian is a professor at Lávvuo – research and education for Sámi health, Department of Epidemiology and Global Health, Umeå University, Sweden.

Jon Petter A Stoor is a postdoctoral researcher at Lávvuo – research and education for Sámi health, Department of Epidemiology and Global Health, Umeå University, Sweden and a researcher to the Centre for Sámi Health Research, Department of Community Medicine, UiT – the Arctic University of Norway, Tromsö, Norway.

Introduction

As colonial history has demonstrated, Indigenous populations are often disproportionately impacted by infectious diseases (Czyzewski, 2011; La Ruche et al., 2009). This has been, and is still, explained by several factors including inequalities in the social determinants of health, different immunity, supply shortages and lack of coordination and communication from governmental bodies. Consequently, during the coronavirus (COVID-19) pandemic concerns were raised that the disease could have serious effects on Indigenous peoples’ livelihoods and health (Curtice & Choo, 2020; Power et al., 2020; Retter, 2020). So far, there is no evidence that these fears have come true on a universal scale. There are both examples of Indigenous groups who have suffered disproportionately more from the COVID-19 pandemic, e.g. in Brazil and the USA, and examples of Indigenous groups who have not, e.g. in Canada and Peru (Alves et al., 2022)

Politically, the Arctic is defined as the northernmost parts of the eight states who, since 1996, have been collaborating through the Arctic Council, including Alaska (USA), Northern territories (Canada), Greenland (Denmark), the whole of Iceland (Iceland), the counties of Nordland, Troms and Finnmark (Norway), the counties of Västerbotten and Norrbotten (Sweden), the whole of Finland (Finland), and the northernmost oblasts of Russia. More than 1,1 million Indigenous individuals live all over the Arctic region except in Iceland, and they belong to more than 40 different Indigenous peoples (Young & Bjerregaard, 2019)

The first case of COVID-19 in the Arctic was registered in late February 2020 in the Troms and Finnmark counties of Norway (Petrov et al., 2020). The first doses of vaccine were available in late December and increased vaccination occurred during spring 2021. In the pre-vaccine phase, incidence and death rates from COVID-19 were lower in the Arctic regions compared to other regions of the Arctic countries (Petrov et al., 2020), while the magnitude of the differences decreased in the post-vaccine phase, with higher incidence rates registered in Alaska, Northern Sweden and Northern Russia compared to central and southern regions in these countries (Tiwari et al., 2022). The USA, Russia and Sweden were also the countries with the highest measured COVID-19 incidences in the Arctic (Petrov et al., 2020; Tiwari et al., 2022), though differences in methodologies between nations may have affected the figures.

There is a lack of epidemiological information related to the COVID-19 pandemic among the Indigenous peoples of the Arctic (Petrov et al., 2021; Retter, 2020), including the Sámi people, who are the Indigenous people of northernmost Norway, Sweden, Finland and the Kola Peninsula of Russia (an area hereafter referred to as Sápmi) (Retter, 2020). In addition to Arctic parts of Sweden (Norrbotten and Västerbotten), Sápmi also includes the counties of Jämtland and Västernorrland (Figure 1).

The Swedish demography is skewed towards the south, with the highest population density around the three largest cities in southern Sweden, that is Göteborg and Malmö (south-west) and Stockholm (south-east) as shown in Figure 1. The Sámi demography is largely unknown as national registers do not record ethnicity, but estimates are around 100,000 of which 20,000–40,000 live in Sweden. While Sámi culture differs greatly in different parts of Sápmi, traditional Sámi sustenance includes reindeer herding, fishing, hunting, small-scale farming and arts. In Sweden, until 1993 national legislation only confirmed reindeer herding Sámi as genuine Sámi. This, in combination with forced delocalisations of Sámi in the early 1900s, still creates a lot of internal tension in Sámi

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society (Lantto, 2014). Today many Sámi live in large cities. These so-called City-Sámi have continued many aspects of a traditional Sámi lifestyle, for example in relation to consumption of traditional food and maintaining a high level of outdoor physical activity (Nilsson et al., 2011)

Typically, Sámi culture and family ties extend across the national borders of northernmost Scandinavia. In addition, reindeer herding also involves crossing national borders twice every year in connection with herd migration between winter and summer pastures. During the COVID-19 pandemic, Sweden received certain international attention for having milder lock-down restrictions compared to other countries (Paterlini, 2021). Despite this, Norway and Sweden agreed on an exception from the national border closing, allowing only reindeer-herding Sámi to cross the borders during the pandemic (Retter, 2020)

While different register-based studies on COVID-19 have been published in Sweden (Drefahl et al., 2020; Nordström et al., 2022; Sund et al., 2022), only one population-based survey describing the COVID-19 experience of the Swedish population has been published by the Public Health Agency of Sweden (Folkhälsomyndigheten, 2021)

To our knowledge, no empirical research has been published regarding the impact of COVID-19 on the lives of the Sámi people in Sweden or elsewhere in Sápmi. Thus, the aim of this study is to assess the health care and social experience of the COVID-19 pandemic among the Sámi in Sweden, in comparison with the general national population.

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Nilsson, San Sebastian & Stoor Figure 1: Arctic areas and Sápmi (traditional Sámi land) areas within the borders of Sweden, and population density by region (county) according to data from Statistics Sweden 2021.

Methods

The questionnaire used for this study was mainly based on the Health on Equal Terms (HET) questionnaire developed by the Public Health Agency in Sweden since 2004. Since 2016 this survey is performed every second year. In 2021 an extra HET questionnaire was added to study the public health effects of the COVID-19 pandemic.

Study design

Two population-based cross-sectional surveys, one among the Sámi (SámiHET) and the other among the general Swedish population (HET), were conducted between February and May 2021. In the SámiHET survey, Sámi persons identified through three partly overlapping registers were selected; the Sámi electoral roll (n = 8754), the reindeer mark registry (n=4395) and labour statistics based on administrative sources identifying persons with an income from reindeer herding (n=847). Sámi persons randomly included in the national sample (n = 76), or not available because of over-coverage (n=1055) were excluded from the SámiHET study, leaving a targeted population of 9249 persons of whom 3658 responded. In the HET survey, a random stratified sample of 39859 Swedish citizens were invited of whom 20879 responded. In addition to sociodemographic and health information, a specific questionnaire regarding the health experience of COVID-19 designed by the Public Health Agency of Sweden was included. Both surveys targeted individuals aged 18–84 years and the participation rate were 40.9% in the Sámi study and 44.3% in the national study.

The HET questionnaire covered mainly health behaviours, work, psychosocial and social circumstances, and self-reported health conditions. In addition, using the unique personal identification number assigned to all Swedish citizens, the sample data were linked to national registers administered by Statistics Sweden to obtain demographical and socio-economic information. For instance, data regarding education were collected from the education register, and data of income, economic support, sickness benefits and pensions from the income and taxation register.

Both surveys (SámiHET and HET) used the same questionnaire to allow comparability. However, Sámi-specific sections were added in the SámiHET including questions on access to health care, exposure to violence, discrimination and racism, as well as Sámi identity and language. The geographical distribution of the participants differed between the two studies. In SámiHET 79.3 percent of the participants lived in the three northernmost regions of Sweden, while this proportion was much lower, only 6.4 percent, in the HET study (Stoor et al., 2023).

The SámiHET data collection procedures mimicked those of the national HET and Statistics Sweden conducted the data collection process and the different register linkages in both surveys. More detailed information about the national HET can be found on the Public Health Agency of Sweden webpage (Folkhälsomyndigheten, 2023) and elsewhere for the SámiHET (Stoor & San Sebastián, 2022)

Measures

Health outcomes

Taking an ‘outcome-wide epidemiological approach’ (VanderWeele, 2017), where several health outcomes are explored simultaneously, we asked nine questions to cover three health dimensions

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of the population’s experience with the COVID-19 pandemic, such as: (1) testing and access to care; (2) worries and loneliness; and (3) outdoor activities.

The first dimension of testing and access to care was captured by three questions. The variable (1.1) testing positive for COVID-19 was defined by answering ‘yes’ to the question: ‘Have you tested positive for COVID-19?’, contrasting this against the alternative answer ‘no’ The two variables, (1.2) avoiding seeking health care and (1.3) visit to health care cancelled, were defined as answering ‘yes, several times’ to the two questions ‘During the corona pandemic, have you avoided seeking care (e.g. health care, dental care, psychologist or maternity care)?’ and ‘During the corona pandemic, have you had a planned care visit cancelled by the care provider (e.g. health care, dental care, psychologist or maternity care)?’, respectively, contrasting this against the alternative answers ‘yes,’ ‘sometimes’ or ‘no’.

The second dimension concerning worries and loneliness was addressed by four questions. The two variables, (2.1) nervous of becoming sick and (2.2) nervous about others becoming sick were defined by answering ‘a lot’ or ‘quite a lot’ to the questions ‘To what extent during the corona pandemic have you been worried about becoming seriously ill yourself from COVID-19?’ and ‘To what extent have you been worried during the corona pandemic that someone close to you will become seriously ill from COVID-19?’, respectively, contrasting this against the alternatives ‘not at all’ and ‘to a certain degree’. The variable (2.3) experience of loneliness was defined by answering ‘yes’ to the question ‘Have you been bothered by loneliness and isolation during the corona pandemic?’, contrasting this against the alternative ‘no’ and the variable (2.4) experience of loneliness more than previously was defined by answering ‘more than before’ to the question ‘To what extent during the corona pandemic have you been bothered by loneliness and isolation?’, contrasting this against the alternatives ‘less than before’ and ‘no difference’.

The third dimension of outdoor activities was addressed by two questions. The variable (3.1) being outdoors each day was defined by answering ‘everyday’ to the question ‘During the corona pandemic, how often have you been outdoors in parks, natural or green areas (e.g. walking, cycling or working in the garden)?’, contrasting this against the alternatives ‘never’, ‘several times per year’, ‘several times per month’ and ‘several times per week’. The variable (3.2) being outdoors more than previously was defined by answering ‘more than before’ to the question ‘How often have you been outdoors in parks, nature or green areas (e.g. walking, cycling or working in the garden) compared to before?’, contrasting this against the alternatives ‘less than before’ and ‘no difference’.

Covariates

Throughout the analyses sex, age, civil status, education and economic level were used as covariates: a) sex was coded according to registered sex as man and woman; b) age was coded into four groups (18–29, 30–44, 45–64 and 65–84 years); c) marital status into married, unmarried and divorced/widowed; d) the level of education divided into compulsory, medium and postgraduate as characterised by Statistics Sweden; and e) the economic level was assessed by the individual’s disposable income, defined according to Statistics Sweden.

Statistical analysis

Frequency tables and percentages were used to present the descriptive characteristics of the population stratified by ethnicity. The prevalence of the different outcomes was then calculated and bivariate regression analyses between ethnicity and the nine different health outcomes were

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applied (model 0). Subsequent regression models including all the covariates (model 1) were then estimated. Prevalence ratios (PR) were used as the measure of effect with their 95% confidence intervals (95% CI) to provide inference. Given the potential differences by sex/gender across the health outcomes, all regression analyses were conducted separately for men and women. All analyses were conducted using R software.

Ethics

In Sweden, no system exists for reviewing Indigenous research ethical aspects ahead of research. However, both the use of the national HET survey in the present study and the SámiHET study were approved by the Swedish Ethical Review (Dnr 2021-02398, and Dnr 2020-04803, Ö 702020/3.1 and Dnr 2021-06372-02, respectively). In addition, the SámiHET study was commissioned by the Sámi Parliament in Sweden, and continuous consultations with the mandated members of the board of the Sámi Parliament throughout the process were held. In October 2022, preliminary data from the SámiHET study, including some of the variables presented in this paper, were presented to the Sámi Parliament, and in February 2023 the same data were presented at a seminar open to the public at the Jokkmokk winter market, an important Sámi gathering with roots more than 400 years back in time.

Results

In total 1590 Sámi men (43%) and 2068 Sámi women (57%) participated in the study along with 7909 men (46%) and 9312 women (54%) from the general Swedish population. Table 1 shows the population characteristics of the samples stratified by ethnicity. In both groups, there was a quite similar distribution of participants regarding sex, age and education with a higher participation of women, older ages and those who had finished secondary school (middle level of education). Differences however were found in the composition of the marital status and income variables. In the Sámi sample, a lower proportion of participants were married (42.67%) compared to the Swedish population (49.25%) with a similar proportion of divorced or widowed (around 16–17%). The Sámi earned, as average, less money than the Swedish population.

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Sámi (n=3,658) National sample (n=17,221) Total (n=20,879) Sex/gender Men 1,590 (43.47) 7,909 (45.93) 9,499 (45.50) Women 2,068 (56.53) 9,312 (54.07) 11,380 (54.50) Age (years) 18–29 364 (9.95) 1,956 (11.36) 2,320 (11.11) 30–44 768 (21.00) 3,130 (18.18) 3,898 (18.67) 45–64 1,402 (38.33) 5,953 (34.57) 7,355 (35.23) 65–84 1,124 (30.73) 6,182 (35.90) 7,306 (34.99) Marital status Married 1,561 (42.67) 8,481 (49.25) 10,042 (48.10) Unmarried 1,507 (41.20) 5,785 (33.59) 7,292 (34.93) Divorced/Widowed 590 (16.13) 2,955 (17.16) 3,545 (16.98) Education level High 1,043 (28.56) 5,203 (30.44) 6,246 (30.11) Medium 2,176 (59.58) 9,529 (55.75) 11,705 (56.43) Low 433 (11.86) 2,360 (13.81) 2,793 (13.46) Income (mean, SEK) 270,968.6 306,060.6 299,898.2
Table 1: Population characteristics in total and according to ethnicity, Sweden 2021

Table 2 shows the prevalence of different health outcomes in men and women stratified for Sámi in Sweden and the national sample, and Table 3 shows the relationship between Sámi ethnicity and COVID outcomes by comparing Sámi in Sweden with a reference sample from the national HET survey. Here follows a description of these results according to the three dimensions of health investigated in relation to the COVID-19 pandemic.

Testing and access to care

Sámi reported a lower prevalence of having a COVID-19 positive test both in men (Sámi 8.5%, national sample 11.8%) and women (Sámi 8.1%, national sample 11.1%) than the national sample. This difference was statistically significant in both sexes (adjusted PR in men = 0.77; 95% CI: 0.64

0.93 and adjusted PR in women = 0.73; 95% CI: 0.62–0.86).

The pattern of avoiding seeking health care differed between Sámi men and women in relation to the national sample. Sámi men had a significantly lower prevalence of avoiding health care compared to the national sample (Sámi 4.4%; national sample 6.2%; adjusted PR = 0.71; 95% CI: 0.55–0.92), while Sámi women had a slightly higher prevalence of avoiding health care (Sámi 8.0%; National sample 7.1%), though not statistically significant.

No differences in the prevalence of how often visits to health care were cancelled, neither in men (Sámi, 2.2%; national sample 2.6%) nor in women (Sámi, 3.9%; national sample 3.6%) were found. Noteworthy, differences between the sexes were larger than differences between ethnicities, both regarding the prevalence of avoiding health care and the prevalence of cancelling visits to health care (Table 2).

Worries and loneliness

Sámi men were more worried of being sick from COVID-19 compared to their counterparts (Sámi 22.1%, national sample 17.2%; adjusted PR = 1.19; 95% CI: 1.07–1.33), while there were no similar significant differences in women (Sámi 28.0%, national sample 26.2%). The prevalence of Sámi being worried about others becoming sick from COVID-19 was significantly higher both among men (Sámi 48.5%, national sample 42.4%; adjusted PR = 1.18; 95% CI: 1.11–1.25) and women (Sámi 61.9%, national sample 54.9%; adjusted PR = 1.13 95% CI: 1.08–1.17) compared to the national sample. In general, the worry that others would suffer from a serious illness during the pandemic was higher among Sámi as well as participants in the national sample, than the worry that they themselves would suffer.

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Men Women Sámi National sample Sámi National sample Testing and access to care Tested positive to covid 8.5 11.8 8.3 11.1 Avoided seeking health care 4.4 6.2 8.0 7.1 Visit to health care cancelled 2.2 2.6 3.9 3.6 Worries and loneliness Nervous of becoming sick 22.1 17.2 28.0 26.2 Nervous about others becoming sick 48.5 42.4 61.9 54.9 Experience of loneliness 16.3 18.8 23.6 24.6 Experience of loneliness greater than previously 47.5 54.7 64.0 65.9 Outdoor activities Being outside each day 49.0 35.5 54.1 43.4 Going outside more than previously 14.0 20.5 22.8 29.2
Table 2: Prevalence (%) of the health outcomes by ethnicity in men and women, Sweden 2021

The reporting of loneliness during the COVID-19 pandemic was not enhanced among Sámi, neither in men (Sámi 16.3%; national 18.8%) nor in women (Sámi 23.6%, national sample 24.6%). An experience of being lonely more often during the COVID-19 pandemic compared to before was reported by more than 50% of the participants. Sámi men reported an increase in loneliness significantly less frequently than the national sample (Sámi 47.5%, national sample 54.7%; adjusted PR = 0.88; 95% CI: 0.83–0.93), while no significant difference was found among women (Sámi 64.0%, national sample 65.9%).

Outdoor activities

More Sámi reported spending extra time outdoors daily than the national sample both in men (Sámi 49%, national sample 35.5%; PR = 1.26; 95% CI: 1.19–1.34) and women (Sámi 54.1%, national sample 43.4%; PR = 1.23; 95% CI: 1.17–1.29). However, the proportion of Sámi who reported an increase in spending time outdoors compared to the pre-pandemic time was lower than the proportion in the national sample, both in men (Sámi 14%, national sample 20.5%; PR = 0.71; 95% CI: 0.63–0.82) and women (Sámi 22.8%, national sample 29.2%; PR = 0.76; 95% CI: 0.70–0.83).

Table 3. Relationship between ethnicity and covid outcomes, comparing Sámi in Sweden with a reference national sample. Prevalence ratios and their 95% confidence intervals (95% CI)

The health experience of the COVID-19 pandemic among the Sámi in Sweden

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Men Women Model 0 PR (95% CI) Model 1 * PR (95% CI) Model 0 PR (95% CI) Model 1 * PR (95% CI) Tested positive to covid No Yes 1 0.72 (0.60–0.86) 1 0.77 (0.64–0.93) 1 0.75 (0.64–0.88) 1 0.73 (0.62–0.86) Avoided seeking health care No Yes 1 0.71 (0.55–0.92) 1 0.71 (0.55–0.92) 1 1.12 (0.94–1.34) Visit to health care cancelled No Yes 1 0.83 (0.57–1.21) 1 1.08 (0.83–1.40) Nervous of becoming sick No Yes 1 1.29 (1.15–1.43) 1 1.19 (1.07–1.33) 1 1.07 (0.99–1.16) Nervous about others becoming sick No Yes 1 1.14 (1.08–1.22) 1 1.18 (1.11–1.25) 1 1.13 (1.08–1.17) 1 1.13 (1.08–1.17) Experience of loneliness No Yes 1 0.87 (0.76–0.98) 1 0.92 (0.81–1.04) 1 0.96 (0.87–1.05) Experience of loneliness greater than previously No Yes 1 0.87 (0.82–0.92) 1 0.88 (0.83–0.93) 1 0.97 (0.94–1.01) Being outside daily No Yes 1 1.38 (1.30–1.47) 1 1.26 (1.19–1.34) 1 1.25 (1.19–1.31) 1 1.23 (1.17–1.29) Going outside more than previously No Yes 1 0.68 (0.60–0.78) 1 0.71 (0.63–0.82) 1 0.78 (0.72–0.86) 1 0.76 (0.70–0.83) *adjusted for age, marital status, education and income

Discussion

In this population-based cross-sectional study we found both similarities and differences when comparing the experiences of the pre-vaccine phase of the COVID-19 pandemic in the Sámi people in Sweden (SámiHET) with participants in a national Swedish survey (HET). The lower prevalence of COVID-19 infection confirmed by a test among the Sámi in Sweden during the prevaccine phase corresponds with reports from Canada (Waldner et al., 2021), where Indigenous people in the initial stages of the pandemic had a significantly lower prevalence as well as fatality rates compared to the non-Indigenous Canadian population. Considering that most Sámi live in the Arctic parts of Sweden, our results may also mirror geographical differences in Sweden. In the pre-vaccine phase, the prevalence and case fatality ratio was lower in Arctic parts of Sweden compared to the non-Arctic parts (Petrov et al., 2020), though this was not consistent over time, with decreased differences between Arctic and non-Arctic parts of Sweden during the post-vaccine period (Tiwari et al., 2022) In addition, since the test capacity in Sweden was reported to be insufficient in the North during the pre-vaccine phase of the pandemic (Fredriksson & Hallberg, 2021), underreporting is more likely to have occurred in the national HET data than to data from the SámiHET. However, from a broader global perspective there are examples of the opposite, that is, Indigenous people who have suffered disproportionately more from the pandemic in comparison with the majority population (Alves et al., 2022). For example, in Brazil, COVID-19 related deaths among the Indigenous population were reportedly double that of the general population; and in the USA, the Navajo Nation surpassed New York in numbers of per capita COVID-19 cases (Curtice & Choo, 2020).

The pattern of repeatedly avoiding seeking health care and cancelling visits to health care did not differ much between Sámi in Sweden and the national sample, with a minor difference in Sámi men, who were less likely to repeatedly avoid seeking health care during the pre-vaccine period of the pandemic. In Sápmi, the average geographical distance to health care centres is larger than the national mean. This means that planned visits to health care centres are likely related to more severe health threats compared to areas with a shorter distance to a health care centre. This situation may have affected the relatively low prevalence of repeatedly avoiding or cancelling health care visits among the Sámi.

The higher prevalence of worrying about close friends, relatives and family suffering from disease among Sámi compared to the national sample is not surprising, when considering the strong importance of the extended family in Sámi culture (Kuokkanen, 2009). For example, because of this, the social stress that may result from social distancing may have increased worrying more among Sámi than in the general population. On the other hand, worrying about others during a state of societal crisis is not negative, but may be a sign that social networks remain functional and support resiliency. In fact, it could even be considered a positive reaction during a global health crisis, meaning that individuals are involved, empathic, and considerate for their important others. Indeed, our findings indicate that Sámi men experienced less loneliness and a lower increase in loneliness compared to Swedish men in general during the pre-vaccine phase of the pandemic. It may be that Sámi men were able to harness pre-existing social networks to mitigate negative social effects (loneliness) better than the general male Swedish Population. If so, that may have been an important boost for resiliency towards good mental health during the pandemic for Sámi men.

During the pandemic, the Swedish Public Health Agency promoted outdoor activities as a means of staying healthy (Folkhälsomyndigheten, 2021), and an increase in outdoor activities was

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considered a positive health outcome of the pandemic. We found that Sámi in Sweden reported a higher prevalence of daily outdoor activities and a lower prevalence of increasing these activities during the pandemic, compared to the general Swedish population. This is in line with previous studies showing that reindeer herding as well as non-reindeer herding Sámi in Västerbotten county have a higher level of leisure time outdoor activities compared to the non-Sámi population in Västerbotten (Nilsson et al., 2011) The pre-existing high level of outdoor activities among Sámi might be a likely explanation for the lower level of increase in these activities compared to the national sample during the pre-vaccine phase of the COVID-19 pandemic. Regardless, the relatively stronger outdoor lifestyle of Sámi may have been an important hedge against negative health effects.

Taken together, we argue that our findings suggest that the Sámi in Sweden have experienced similar, but weaker, impacts during the pre-vaccine phase of the COVID-19 pandemic, compared to the general Swedish population with regards to the explored dimensions of this study. The relatively weaker impact among Sámi may be due to a combination of lower COVID-19 infection rates, less avoidance of using health care services and stronger access to health promoting aspects of Sámi culture, i.e. stronger social networks and more active outdoor lifestyles. However, due to a lack of longitudinal health data (pre-pandemic) among Sámi in Sweden (Stoor, 2016) it will be difficult to assess the degree to which this played a part in buffering Sámi health during the pandemic, using actual health outcomes – with the exception for COVID-19 morbidity and mortality (which can be assessed retrospectively using register data).

Methodological considerations

The main strength of this study is the availability of data from both Sámi from all over Sweden and a national representative sample collected during the same period of time, and the use of identical questions with regards to the COVID-19 pandemic in both surveys, allowing comparability.

Differences in the geographical distribution of the participants of the SámiHET and the HET studies may have affected our results. Most Sámi live in the north while the general Swedish population is skewed towards the south. We cannot rule out the potential bias this may have added to our results. However, there are examples of studies where geographical matching of Sámi with their non-Sámi neighbours did not remove the health gap in focus (Hassler et al., 2005). The use of several outcomes, capturing different dimensions of exposure to the COVID-19 pandemic is also a strong asset of the study.

The moderate response rate to the surveys included in this study, that is 41–44%, may result in selection bias due to under-representation of men, young people and people with low education, as previously shown (Stoor & San Sebastián, 2022). There is also a risk of response bias, since participants may have understood the questions differently. One example of this is the question:

‘During the corona pandemic, how often have you been outdoors in parks, natural or green areas (e.g. walking, cycling or working in the garden)’. This question is reflecting a modern life in a city to a greater extent than outdoor activities common among Sámi such as hunting, picking berries and herbs, fishing or hiking on skis or by foot or collecting material for arts, and herding. Finally, a limitation is the lack of data during the entire period of the pandemic. In Sweden, the vaccine level reached 80% by the end of the pandemic (Paterlini, 2021) and the experience of the postvaccine period of the pandemic may differ from that in the pre-vaccination period.

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Conclusion

During the pre-vaccine phase of the COVID-19 pandemic, Sámi in Sweden seem to have been affected in a similar but weaker way than the national population. Further studies are needed to explore the distribution of these outcomes among different Sámi subgroups. Register studies will also be needed to evaluate the clinical (morbidity and mortality) impact of COVID-19 on the Sámi population.

Acknowledgements

We are grateful to the Sámi parliament in Sweden and the Public Health Agency of Sweden who funded the SámiHET study. The authors also would like to thank the SámiHET participants for their valuable contributions to the study. Ollu giitu!

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The COVID - 19 pandemic and regional economic resilience in Northern Finland, Norway, and Sweden – bouncing back or not?

Jaakko Simonen, Mikko Moilanen, Jemina Kotila, Joona Lohtander, Lars Westin, Anders Hersinger, Stein Østbye, Tapio Riepponen & Rauli Svento

The COVID - 19 pandemic has been first and foremost a health crisis, but it has also had severe negative impacts on the global economy. It has shaken regional economies, especially labour markets, over the last two years. Arctic regions are no exception. The aim of this article is to analyse the regional economic impacts, as well as the recovery processes, of the COVID19 pandemic in Arctic 5 cities in Northern Finland, Sweden, and Norway (Oulu and Rovaniemi in Finland, Luleå and Umeå in Sweden and Tromsø in Norway).

In many countries, including Finland, Sweden and Norway, governments decreed various types of lockdown policies to prevent the spread of the COVID-19 pandemic. Due to such policies, the pandemic has had an asymmetrical impact not only on individuals but also on communities and regions. This has given new urgency to a place-based approach to regional development, mitigating territorial inequalities. Our goal is to study how hard the Arctic 5 cities have been hit by the COVID-19 shock and how well they have been able to absorb, adapt to and recover from the crisis. The research question thus focuses on the resilience of the regions.

In this study, we focus on the analysis of public statistics concerning the development of labour markets. We also analyse changes in human behaviour during the pandemic using the information provided by Google Mobility data. These mobility data and

Jaakko Simonen , Associate Professor, University of Oulu; Mikko Moilanen, Professor, UiT The Arctic University of Norway; Jemina Kotila, Doctoral Researcher, University of Oulu; Joona Lohtander, Doctoral Researcher, University of Oulu; Lars Westin, Professor, University of Umeå; Anders Hersinger, Professor, Luleå University of Technology; Stein Østbye, Professor, UiT The Arctic University of Norway; Tapio Riepponen, Doctoral Researcher, University of Oulu; Rauli Svento, Emeritus Professor, University of Oulu

labour market indicators are used to measure regional economic and social resilience. Our research shows that, for example, regional socioeconomic structures have played an important role in how well the regions have been able to withstand the pandemic and recover from it. Differences in national containment regulations have also affected this development. These cross-border comparisons provide information on how well different measures in different regions across national borders have functioned and what impacts they have had on regional economies, especially on labour markets and people’s mobility.

Introduction

Society faces shocks of different magnitudes, durations and starting points. Shocks can be sudden or slow, temporary, or long-lasting, and local or global (Martin & Gardiner, 2019). The COVID19 pandemic is a textbook example of a shock that originated outside the economy and has had an effect on both the macro and micro levels of the global economy. The shock has affected the business activities of firms, the unemployment of individuals, and the economic development of regions. Economic crises usually start with a shock to aggregate demand or a disturbance in the financial markets. Since the COVID-19 pandemic and the related restrictive measures affected both the demand for products and services and the supply and demand for labour at the same time, the shock caused by the pandemic has been fundamentally different from that caused by previous economic crises. That is why it is important to study how the economy adapted during this pandemic.

When the COVID-19 pandemic hit, the assumption was that the economic effects of the pandemic, for example, those related to employment, would last for years. How wrong were we in that sense? Based on employment statistics, the economy has recovered from the pandemic remarkably well. However, the COVID-19 pandemic has had an asymmetric impact not only on individuals but also on communities and regions. Arctic regions are no exception in this sense. An important question is about resilience at different levels. How well have people, companies, organizations, and regions been able to cope with this unexpected event?

The concept of resilience has grown in popularity among researchers, policy-makers and economists (e.g., Riepponen, Moilanen, & Simonen, 2022). In economics and regional science, the concept of resilience is used to describe how well actors are able to adapt and how vulnerable they are to unexpected changes in their operating environment (e.g., Martin & Sunley, 2015; Christopherson, Michie, & Tyler, 2010; Weichselgartner & Kelman, 2015). Resilience concerns actors at different levels. In the case of the COVID-19 pandemic, people were forced to drastically limit their mobility and social interaction. Firms had to change their business strategies and ways of working almost overnight. The need for change at the firm level, and thereby at the regional and municipality level, depended significantly on the economic structure of the regions. Shocks and crises affect people’s consumption behaviour (Nakamura, Steinsson, Barro, & Ursúa, 2013). During the COVID-19 pandemic, both people’s mobility and their ability to use services were restricted. These restrictions had the biggest impact on the restaurant and tourism industry, as well as various cultural events. Recent development, based on our analysis, reveals that the Arctic 5 cities, Oulu and Rovaniemi in Northern Finland, Luleå and Umeå in Northern Sweden and Tromsø in Northern Norway, have recovered, i.e. bounced back, from this shock.

The vulnerability of the whole economy to shocks and crises is significantly based on the interaction between the actors at various levels. Resilience against a shock at one level reflects resilience at another level (Riepponen et al., 2022). The COVID-19 pandemic showed that thanks

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to effective measures, authorities can proactively mitigate the effects of shocks. In social sciences, the concept of social resilience is typically used to describe the adaptive and coping abilities of a large system from an actor-oriented perspective. This research emphasizes three types of societal capacities: coping capacities, adaptive capacities and transformative capacities (Keck & Sakdapolrak, 2013). When economists talk about resilience, it is quite typical to talk about recovery, i.e., bouncing back (Simmie & Martin, 2010). The speed and scope of recovery are among the most studied issues, especially in the field of regional resilience (e.g., Martin, 2012). At the organizational level, we are particularly interested in the organization’s ability to maintain and restore an acceptable operating level and recover from perturbations (Duchek, 2020). At the individual level, resilience is typically studied from the psychological point of view (Bonanno, 2004). What is our ability to act and adjust our behaviour in the face of adversity or shock? How do crises affect the behaviour of individuals? Clearly, resilience at the individual level has a significant effect on regional resilience (Simonen, Herala, & Svento, 2020). The COVID-19 pandemic has shown this to be true.

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Figure 1. Weekly COVID 19 cases per 100 000 inhabitants in the Arctic 5 cities. Sources: THL, FOHM, covid19data.no.

Infobox 1: The Arctic 5 cities.

The Arctic 5 cities are located in Northern Scandinavia: Oulu and Rovaniemi in Finland, Luleå and Umeå in Sweden and Tromsø in Norway. These five cities are either the capitals or administrative centres of their region. Oulu is the capital of North Ostrobothnia, Rovaniemi is the capital of Lapland, Luleå is the capital of Norrbotten County, Umeå is the capital of Västerbotten County, and Tromsø is the administrative centre of Troms and Finnmark County. Oulu has the highest population, with nearly 210 000 inhabitants. The population of Umeå is approximately 130 000. In Luleå and Tromsø, there are almost 80 000 inhabitants. Rovaniemi is the smallest, with approximately 64 000 inhabitants.

The name of the Arctic 5 comes not only from their location in Northern Scandinavia but also from the cross-border collaboration between these cities, especially between their multidisciplinary universities. The Arctic 5 universities of Northern Finland, Sweden and Norway are the University of Oulu (Oulu, Finland), University of Lapland (Rovaniemi, Finland), Luleå University of Technology (Luleå, Sweden), University of Umeå (Umeå, Sweden), and UiT The Arctic University of Norway (Tromsø, Norway). The Arctic Five (Arctic 5) is a forum for collaboration between the five universities.

The universities in these five cities bring students to the areas, which lowers the average age. The average age of the population is approximately similar across the cities. The highest average age is in Luleå (42.2 years), and the lowest is in Tromsø (38.4 years). There is slightly more variation in the share of people with a higher education (above secondary). In Umeå and Tromsø, over 37% of the population has a higher education, while in Oulu and Luleå, this figure is over 31%. In Rovaniemi, the share of the population with a higher education is just below 30%. The numbers are higher in all Arctic 5 cities compared to the country level, which is 28.0% in Finland, 27.9% in Sweden and 30.7% in Norway.

The private sector employs 57-70% of the total employment in the Arctic 5 cities, which is lower than the national level. Primary production, including agriculture, forestry, and fishing, accounts for approximately 1% of total employment in each of the Arctic 5 cities. The share of manufacturing in total employment ranges from 12% in Tromsø to 20% in Oulu. Services employ the most people in all cities. Infobox 2a and 2b provides further details about the industrial structures of the Arctic 5 cities.

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Simonen, Moilanen, Kotila, Lohtander, Westin, Hersinger, Østbye, Riepponen & Svento Figure 2. Industrial structure and sector shares in the Arctic 5 cities. Sources: Statistics Sweden, Statistics Finland, and Statistics Norway.

The development of the COVID-19 pandemic was significantly different in Finland and Norway compared to in Sweden. An important reason for this were the differences in national containment regulations. Irfan et al. (2022) show that Finland and Norway set very strict national restrictions starting at the beginning of the pandemic. As in many other countries, all kindergartens, schools, and educational institutions were closed, and all cultural and sports events were cancelled. Companies in which close physical contact was unavoidable were required to remain closed. People were encouraged to work from home offices whenever possible. Unnecessary travel was banned for all, and strict restrictions on foreign nationals’ access to Norway and Finland were established.

All in all, we may argue that protection regulations guided our behaviour in many ways and thus affected our resilience.

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Figure 3: Key characteristics of Arctic 5 cities. Sources: Statistics Sweden, Statistics Finland, and Statistics Norway.

Sweden applied, especially at the start of the pandemic, a different strategy to prevent the spread of the pandemic and mitigate its effects. Sweden kept its society relatively open throughout the pandemic. At the beginning of the pandemic, Sweden adopted a strategy that was based on personal responsibilities instead of regulations and restrictions imposed by the government. The economy, including shops and other services (e.g., bars and cafes), was kept open, and there were no travel restrictions imposed, which was contrary to many countries (Irfan et al., 2022). At the beginning of the pandemic, this led to people travelling to Sweden and enjoying “normal life” as much as possible by going to bars and cafes (see, e.g., Vogel 2020). Furthermore, unlike in many other countries, schools were mainly kept open to mitigate the effect of the pandemic on the development of human capital (Hallin et al., 2022). However, when looking at the restrictions starting in 2021, Sweden applied stricter restrictions than those imposed by the other Nordic countries, e.g., in regard to organizing even small public events (see Hale et al. 2021). Figure 1 below shows how these different strategies played out in COVID-19 cases in the Arctic 5 cities.

Infobox 2a: Differences in industrial structure between Arctic 5 cities.

Figure 4 shows the variation in different industries between the cities measured by the percentage point difference from the average of the Arctic 5 cities in terms of the share of people working in the industry. The values are based on the situation before the COVID-19 pandemic at the end of 2019. There are regional variations, especially in the service sector. Variation is the largest in the following service industries: educational, human health and social work, public authorities and national defence. For instance, in the human health and social work sector, the employment share in Tromsø is almost 5 percentage points higher than the regional average. In Luleå, this same value is 3.5 percentage points lower than the regional average.

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Simonen, Moilanen, Kotila, Lohtander, Westin, Hersinger, Østbye, Riepponen & Svento Figure 4: Percentage point differences in the share of people employed in different industries compared to the average of the Arctic 5 cities. Sources: Statistics Finland, Statistics Sweden, Statistics Norway.

Infobox 2b: Differences in industrial structure between Arctic 5 cities.

Figure 5 displays the differences in the industrial structures between the cities compared to the country averages, e.g., Oulu is compared to Finland and Umeå to Sweden. The values are based on the pre-COVID19 situation at the end of 2019. The employment shares in educational, human health and social work, and public authorities and national defence are typically larger in the Arctic 5 cities compared to the national averages. The share of mining, quarrying, and manufacturing sector as an employer is smaller than its share nationally in all Arctic 5 cities.

In the early stages of the pandemic, the development of new cases was highly similar in the Arctic 5 cities. However, soon after the start of the pandemic, development paths began to diverge due to different national and regional strategies to prevent the spread of the virus.

Throughout the pandemic, the number of cases decreased soon after each major outbreak. Figure 1 shows that there were clearly more cases in 2022 than in the first two years of the pandemic. In addition to different variants of the virus, loosened regulations and changed attitudes due to high vaccination coverage explain this significant increase.

In this article, we focus on the effects of the COVID-19 pandemic in the so-called Arctic 5 cities studied: Oulu and Rovaniemi in Northern Finland, Luleå and Umeå in Northern Sweden, and Tromsø in Northern Norway (see Figure 2 and Infobox 1). The development of the COVID-19 pandemic in these cities more or less followed the national development observed in Finland, Norway and Sweden.

The structure of the article is as follows: The next section will focus on changes in human behaviour during the pandemic using the information provided by Google Mobility data; In

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Figure 5: Percentage point differences in the share of people employed in different industries compared to the country average. Sources: Statistics Finland, Statistics Sweden, Statistics Norway.

section 3, we examine the regional industrial structures of the Arctic 5 cities and how the COVID-19 pandemic has affected their labour markets; In Section 4, we present some conclusions and discuss how the future of the Arctic 5 cities might look in the forthcoming years.

Social distancing and mobility – How did people change their behaviour?

In many countries, including Finland, Sweden and Norway, governments decreed various types of lockdown policies to prevent the spread of COVID-19. These restrictions affected how people spent their free time and how much time they spent at home. The rising vaccination coverage in the Arctic 5 cities (Figure 17 in the appendix) gradually eased these restrictions and increased the level of social interactions. Google Community Mobility Reports provide interesting, quickly updated data that we can use to evaluate the effect of these restrictions.1 Figure 6 shows how time spent at home developed during the pandemic. The y-axis illustrates changes in human behaviour. It is measured as the weekly average change in hours spent at home compared to the baseline, which is the median day value from January 3 to February 6, 2020. Mobility regulations and restrictions on public gatherings influenced mobility, which affected how much time people spent at home. During the first two years of the pandemic in the Arctic 5 cities, people spent approximately 5.5% more time at home than in the pre-COVID-19 period.

Figure 6: The time that people spent at home compared with the baseline in Arctic 5 cities. The baseline (dashed line) is at zero. Source: Google Community Mobility Reports.

The long-term pattern shown in the graphs in Figure 6 looks very similar in all the Arctic 5 cities. This would indicate that different strategies between countries had impacts, but the differences were not as large as one may expect. At the beginning of the COVID-19 pandemic, the time spent at home increased sharply in all cities. After returning to baseline levels in the summer of

1 Google Community Mobility Reports compare changes in visits and length of stay at various locations to a baseline of median values for the same day of the week from January 3 to February 6, 2020. The reports are based on aggregated, anonymous data from users who have enabled location history on their mobile phones and may not accurately reflect the behaviour of the general population. For more information, see, https://www.google.com/covid19/mobility/.

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2020, the amount of time spent at home increased again by the end of the year and peaked around the beginning of 2021. In the spring of 2021, people spent much more time at home in all cities except Sweden, although the number of COVID-19 cases was extremely low at the same time. In all the cities, we notice a return to baseline in the summer of 2021. However, we must remember that baseline describes the situation in the 5-week winter period ranging from January–February 2020. People in Arctic areas tend to spend less time at home during summer than during winter. In Christmas 2021, we see a peak similar to that seen in the year before. By the end of 2022, the trend in all cities returned to levels close to the baseline set in 2022.2

Figure 7: The time that people spent at home compared with the baseline in Arctic 5 cities, year comparison. The baseline (dashed line) is at zero. Source: Google Community Mobility Reports.

Figure 7 provides further insight into how the behaviour of the inhabitants of the Arctic 5 cities has changed over the course of the pandemic. It appears that the pandemic may have permanently increased the amount of time we spend at home, with the greatest impact seen in Oulu and Rovaniemi, where the trends three years after the start of the pandemic still follow the patterns of the first year (Figure 7).

2 The percent increase in time spent at home in the Arctic 5 cities was lower than in the national capitals of Helsinki, Stockholm, and Oslo, with average increases of 8.9%, 10.3%, and 11.4%, respectively.

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This change in human behaviour affects the economy. When the time spent at home increases, that time is taken away from something else. Spending time at home during the COVID-19 pandemic has negatively influenced local demand for services, for example. Services related to tourism, for example, hotels and restaurants, have suffered the most. Figure 8 shows how the number of visits to places categorized as retail and recreation have changed in the Arctic 5 cities. The retail and recreation category consists of places such as restaurants, cafes, shopping centres, theme parks, museums, libraries and movie theatres. Figure 8 demonstrates that the number of visits to retail and recreational places in all Arctic 5 cities was higher in the first half of 2022 than in 2021. Most people had received their first COVID-19 vaccinations by August 2021, and most social distancing measures were lifted in each of the Arctic 5 cities in 2021 (see Figure 17 in the appendix). In autumn 2022, the mobility patterns in all cities followed those of autumn 2021, with the exception of Oulu and Rovaniemi, where mobility was lower.3

Figure 9 illustrates the impact of the pandemic on visits to workplaces; in other words, it shows the shift towards remote work. Throughout the whole pandemic, the Arctic 5 cities have been

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Simonen, Moilanen, Kotila, Lohtander, Westin, Hersinger, Østbye, Riepponen & Svento Figure 8: The number of visits to retail and recreation places compared to the baseline in all Arctic 5 cities, year comparison. Source: Google Community Mobility Reports. 3 The changes in visits to grocery stores and pharmacies and to transit stations are shown in the appendix.

below the baseline. The differences in regional development can be seen, especially starting from the beginning of summer 2021. Stricter regulations and recommendations in Finland compared to those in neighbouring countries during the whole pandemic at least partly explain this outcome. The differences in industrial structures are another possible factor behind this development. In Oulu, for instance, visits to workplaces have been approximately 30-40% below the baseline level since the beginning of 2020. Although the pandemic is more or less over, people have not returned to their workplaces. The ICT sector and other knowledge-intensive sectors employ a significant number of people in Oulu, making remote working more available. Rovaniemi and Tromsø saw a decline of approximately 20%, while the average decrease in Luleå and Umeå was approximately 10% in 2022.

The effect of the pandemic on the regional labour market

The economic shock caused by the pandemic has been unique in many respects, from the scale and speed of its impact to the specific nature of how economic activity was curtailed. The COVID-19 pandemic slowed economic activity and, as a result, had a significant effect on the labour market. When the pandemic started, it harmed employment in the Arctic 5 cities. At the same time, it increased the marginalization of the unemployed by affecting their job search. The economic impact of the pandemic did not have the same effects across regions. At the regional level, the effects were linked to both the length and stringency of the lockdown measures and the

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Figure 9: The number of visits to workplaces compared to the baseline in all Arctic 5 cities, year comparison. Source: Google Community Mobility Reports.

resources and economic structures of the regions. In the bigger picture, questions remain about the resilience of the regions.

The concept of regional resilience is typically used to describe how regions respond to changes in their economic environment. The concept of regional resilience refers to a region’s capability to adapt to changes in a way that provides good opportunities for the development of both production and employment after a shock. Equally important is the ability of regions to anticipate and prepare for disturbances and to recover from them through regional policy (e.g., Martin, 2012). From a regional economics point of view, the interesting question is why “highly resilient” regions are less vulnerable and more capable of adapting to and recovering from external shocks and disturbances than “less resilient” regions.

The local industrial structure is closely linked to regional resilience. Regarding regional resilience, when a region’s industrial structure becomes increasingly specialized, the risk of a slowdown in growth arising from external shocks also increases. A diversified industrial structure provides regions with better resistance against shocks by acting in the same way as a decentralized investment portfolio against risk (e.g., Martin, Sunley, Gardiner, & Tyler, 2016). However, Simonen, Juutinen, and Svento (2015) have shown that the optimal diversified structure of a region, from the point of view of regional economic growth, is highly dependent on the size of the region. This may well also be true in the case of regional resilience.

Regional socioeconomic structures, for example, industrial structures (Martin & Sunley, 2015) and the roles of the public and private sectors as employers (European Central Bank, 2022), also have an important influence on how well regions are able to withstand and recover from various shocks. The public sector can act as a stabilizing force and help other sectors (e.g., tourism and other industries in the service sector) and industries adapt to economic shocks. It can create demand for other industries and reduce unemployment during and after economic shocks and recessions. In all Arctic 5 cities, the public sector employs a higher share of workers than it does nationwide. The share of the public sector is largest in Tromsø at 42% and lowest in Oulu at 29%, which at least partially reflects the larger size of Oulu compared to other cities. In the Euro area, for instance, the increase in public employment during the COVID-19 pandemic has been stronger than in past recessions (European Central Bank, 2022). In this article, we focus specifically on the employment effects caused by the pandemic. The bankruptcy of companies and subsidies offered by the government to companies are excluded from the review.

Industrial structures also vary quite a lot among the Arctic 5 cities (Infobox 2a and b). There are regional variations, especially in the following industries of the service sector: educational, human health and social work, public authorities and national defence. Interestingly, in the Arctic 5 cities, the employment shares of these same industries in the service sector are typically larger than the national average. Employment shares also vary in mining, quarrying, and manufacturing, while their position as employers in these cities is smaller than their share nationa lly. The industrial structures of the manufacturing sector in these cities vary widely. For instance, Oulu and Luleå have internationally recognized research and business activities in the fields of wireless technology, health technology, and data centre industries.

Infobox 3: Overnight stays by foreign and domestic visitors.

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The COVID-19 pandemic caused a significant decrease in overnight stays by foreign visitors in many regions. However, the lifting of travel restrictions and the use of COVID-19 vaccination passports led to an increase in travel during 2021, which was reflected in overnight stays in the Arctic 5 cities. After a record-breaking summer for domestic tourism in 2021, overnight stays by foreign visitors in December 2021 were close to prepandemic levels, compared to reaching only a fraction of these levels in December 2020. The increase was particularly significant in Lapland during the Christmas holidays, largely due to the increase in charter flights from European countries. Although overnight stays decreased in January–February, it is expected that both domestic and foreign tourism will return to prepandemic levels in 2022.

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Figure 10: Overnight stays by domestic (above) and foreign (below) visitors in all accommodation establishments in counties where the Arctic 5 cities are located. Source: Statistics Finland, Statistics Sweden, Statistics Norway.

While the hotel and restaurant sectors received much attention during the pandemic due to strict restrictions, it is important to note that many other sectors in the tourism industry were also severely impacted. This was particularly evident in Lapland and Tromsø, where companies such as husky and snowmobile safari operators, which employ hundreds of workers, saw a decrease in foreign visitors (see Infobox 3). The event industry, including summer festivals, was also affected by restrictions on movement and gatherings. For instance, in the summer of 2020, a survey of event organizers in Oulu (unpublished report) found that two-thirds of those surveyed estimated their 2020 turnover to be at least 25% lower than that in 2019, and one-third estimated their 2020 turnover to be only half of their 2019 turnover.

The COVID-19 pandemic has had a unique impact on the labour market compared to previous crises in recent decades, which typically first impacted manufacturing. Currently, the private service sector is the most affected. This sector has long been responsible for employment increases, especially in large cities (Brodeur, Grey, Islam, & Bhuiyan, 2021). The introduction of strict control measures in mid-March 2020 contributed to a sharp increase in unemployment in Oulu, Rovaniemi and Tromsø (Figure 11). The unemployment rate rose in those cities to the highest point it had been in over ten years. One reason for this was that Finland and Norway made changes to unemployment and laid off coverage on the eve of the COVID-19 pandemic (Møller et al., 2022). In Luleå and Umeå, the effect was substantially smaller as the unemployment rate increased by approximately five percentage points.

Figure 11: Seasonally adjusted unemployment rates in Arctic 5 cities, Finland, Sweden, and Norway (January 2008 – November 2022). Sources: Ministry of Economic Affairs and Employment in Finland, Swedish Public Employment Service, Norwegian Labour and Welfare Administration. The differing magnitude of the shock reflects different national prevention strategies. In Finland and Norway, strict regulation measures were executed, forcing firms to lay off employees or even shut down businesses. Sweden, on the other hand, kept its society relatively open, and there was no sharp increase in the unemployment rate. Although the initial shock hit Oulu, Rovaniemi and Tromsø harder, the unemployment rate of these cities started to decline quickly. The development of unemployment rates in the Arctic 5 cities did not differ significantly from the development at the national level.

Despite the magnitude of the initial shock, all Arctic 5 cities have recovered quickly. During April 2020, many companies in these cities began to call bac k laid - off workers. The number

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of unemployed individuals declined markedly through the spring and summer of that same year. Unemployment in Umeå and Luleå peaked slightly later and began to decrease later on. Unemployment in all five cities stabilized at a higher level in autumn 2020 when infection control measures were tightened again. According to figures from labour market authorities, the number of unemployed individuals as a share of the labour force was 21 percent higher in Oulu, 33 percent higher in Rovaniemi, 7 percent higher in Luleå, 13 percent higher in Umeå and 87 percent higher in Tromsø than in February 2020, before the COVID - 19 pandemic began. Comparing the impact of the COVID - 19 shock with the effects of the financial crisis in 2008

2009, the unemployment level in Luleå and Umeå rose slightly less. In Oulu, Rovaniemi and Tromsø, the initial growth in un employment was approximately of the same size as in the financial crisis (excluding the spike in March – April 2020). In May 2021, unemployment rates in those three cities were approximately 20% (2 – 3 percentage points) higher than before the pandemic. However, the effect was not long - lasting; the unemployment rate was already at approximately the same or lower level in spring 2022 as it was before the pandemic in every city.

Typically, male - dominated sectors are more cyclical, and previous major shocks have hit them harder. The COVID - 19 pandemic, on the other hand, has affected more femaledominated service sectors, as regulatory measures have forced service businesses to close, at least temporarily. At the same time, the demand for labour in female - dominated health care has increased due to the pandemic. The overall trend seems to be that the employment of women suffered more at the beginning of the pandemic, but it also recovered more quickly than the employment of men.

This trend is especially evident in Oulu and Rovaniemi, where the COVID - 19 pandemic caused a sudden increase in unemployment for both sexes (Figure 12). The increase was steeper among women, but the decline also occurred more rapidly. Currently, the unemployment rates of both men and women in Oulu and Rovaniemi are below the preCOVID - 19 level. In Luleå and Umeå, the effect of the COVID - 19 pandemic was smaller than, for example, the effect of the recent financial crisis ( 2007–2009). In Luleå, the pandemic hit men and women quite evenly, and recovery occurred at the same rate.

In Umeå, the difference appears to have been greater as the unemployment of men rose more steeply than that for women. This is contrary to the general trend observed. In both Luleå and Umeå, both men and women have recovered from the pandemic well, and the unemployment rates seem to continue to decline.

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The extent of open vacancies is a good indicator for the demand for labour and thereby for economic growth (Ando et al., 2022). The number of open vacancies fell sharply immediately after March 2020 but picked up well during the following quarters (Figure 13). By April 2021, the numbers were already above the pre-COVID-19 level in all Arctic 5 cities. Therefore, although the labour market has been strongly affected by the pandemic, the demand for labour is currently well maintained in all Arctic 5 cities. One important explaining factor of this quick rise in open vacancies is the fact that many foreign employees travelled to their home countries at the beginning of the pandemic and have not returned. Additionally, many native workers moved from hard-hit industries to other industries. Currently, at the end of 2022 and the beginning of 2023, the number of new open vacancies is declining. This may indicate that the vacant jobs have been successfully filled or that a generally observed decline in economic growth (International Monetary Fund, 2022) can also be seen in the Arctic 5 cities. In some cities, the number of open jobs has decreased, for example, in the construction industry, which typically quickly reflects a

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Simonen, Moilanen, Kotila, Lohtander, Westin, Hersinger, Østbye, Riepponen & Svento Figure 12: Seasonally adjusted unemployment rates for men and women in Arctic 5 cities (January 2008 – November 2022). Sources: Ministry of Economic Affairs and Employment in Finland, Swedish Public Employment Service. Data concerning Tromsø were not available.

weakening of the economy’s prospects. On the other hand, the current situation in Europe has increased inflation and caused uncertainty about the future of the economy in the short run. As inflation continues, it weakens consumers’ purchasing power. This will reduce, among other things, the demand for services and thus affect employment.

Despite this present uncertainty, in the long run, a lack of labour force and skills will be one of the most prominent challenges in the Arctic 5 cities. There is already a significant shortage of skilled labour throughout the entire North Calotte region, with some variations between countries, and the demand for labour is increasing in several industries. For example, there is an increased interest in the energy minerals and green energy sources of Arctic cities. At the same time, the increasing dependency ratio, especially in rural areas, further amplifies the problems stemming from the shortage of labour. This trend indicates that the labour market in the Arctic 5 cities will be influenced by global factors such as demographic changes, an ageing population, rapid technological advancement, globalization, and the shift towards more environmentally sustainab le energy sources. (European Strategy and Policy Analysis System, 2019).

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Figure 13: New open vacancies during the month, four month moving averages. The vertical line in each figure shows the date when the WHO declared COVID-19 a pandemic. Sources: Ministry of Economic Affairs and Employment in Finland, Swedish Public Employment Service, Norwegian Labour and Welfare Administration.

In the longer term, we believe the demand for labour in the Arctic 5 cities will increase in several industries. Both technology and other trends will create many new jobs. Many of these jobs will be in industries and professions other than those we have today. Large labourintensive industrial projects in Northern Sweden, for example, the car battery factory in Skellefteå and fossil-free steel plant in Boden, and the bioproduct mill in Kemi, Finland, are good examples of this type of development. It will also be interesting to see what will happen in the tourism sector. How much will the increasing trend of local and domestic tourism (Mintel, 2021) and flight shame (Mintel, 2020) decrease foreign tourism in Arctic regions? How will the increasing interest in slow tourism (Clancy, 2018; Moira, Mylonopoulos, & Kondoudaki, 2017; Haemoon, Assaf, & Baloglu, 2016) affect the development of the sector in the Arctic regions? Another interesting topic is how the supply chains of firms will change (Shih, 2020). Will we see an increase in the demand for domestic or even local products? These global trends will offer new challenges and opportunities for Arctic cities and regions. It is clear that there is an increasing demand for the development of regional resilience.

Conclusions

The last three to four years have been a turbulent time in the global economy. Although the COVID-19 crisis was not caused by problems in the monetary real economy, as was the case in the financial crises in 2007-2009, for instance, it nonetheless changed our world and the global economy in ways which may be permanent. Digital solutions, an increasing level of remote work, and delivery services have become part of our lives. Instead of talking about our competitiveness, we are now much more concerned about our resilience and our ability to adapt to future disturbances, shocks, and crises. We all wish we were better prepared for these changes because of the lessons we learned from this pandemic.

Our results indicate that two and a half years after the outbreak of the COVID-19 pandemic, the Arctic 5 cities had bounced back in many ways. Currently, the unemployment rates in the Arctic 5 cities are lower than ever. In fact, the effects of the crisis on the labour market were ultimately relatively minor and short-lived. Although the first phase of the crisis caused an explosive immediate increase in layoffs and unemployment, the demand for labour in all Arctic 5 cities continued to grow after the crisis. It can be said that we have returned to the situation we were in before the pandemic, and there is even a labour shortage in several industries throughout the North Calotte region.

Although there are some differences between the Arctic 5 cities, they all have a relatively large public sector. This characteristic has helped these cities to bounce back. As medium-sized university cities and administrative centres, these locations employ a large number of employees with public funds. This, together with the support provided by the public sector for different industry sectors, has stabilized these cities (and the Nordic countries as a whole) and made them more resilient. However, following the general arguments in public economic theory, this dependence on the public sector may also hamper the long-run development of regions (e.g., Caponi, 2017).

The pandemic seems to have changed our behaviour in many ways. As a good example, the ways in which we work have irrevocably changed as a result of the COVID-19 crisis. Remote work and digital tools have established their position of importance. Our results based on Google

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Mobility data seem to suggest that remote work has changed in all Arctic 5 cities. Generally, this fast process of learning to work digitally over global distances will increase Arctic 5 cities’ resilience against future crises.

The Google Mobility data also provide evidence of some changes in consumer behaviour, with fewer visits to restaurants and cafes and more time spent at home. It remains to be seen whether these changes caused by the pandemic will also be permanent in the long run. If this change is found to be not only a local trend but also a global trend, that might have an effect on, for example, tourism in the Arctic 5 cities too.

What have we learned about the pandemic over the past few years? At the very least, we must be prepared for impeding crises and the related changes that increase uncertainty in society as a whole. We live in a risky world where many events around the world affect our daily lives. Fortunately, following general arguments in the resilience literature (e.g., e.g., Riepponen, Moilanen, & Simonen, 2022), we can learn from past events and crises to improve our resilience. From the perspective of Arctic regions and cities, the COVID-19 pandemic also showed that we need to be prepared for changes and shocks, including changes other than those caused by climate change in these regions.

The pandemic crisis was also an eye-opener in that it showed how Nordic cooperation is still partly a vision, which in many respects lacks a common foundation. One of the things that we should definitely improve is cross-border collaboration in case of crises. During the pandemic, the restrictions on movement across borders within the Nordic countries were an unfortunate failure for Nordic cooperation, especially in border areas. Nordic countries should either move towards joint decision-making when crises affecting free movement occur or at least engage in a discussion on whether there should be common Nordic decision-making in matters pertaining to travel restrictions, especially in the case of cross-border labour market mobility.

The current high inflation rate, the tightening economic situation and the war in Ukraine all serve to increase the level of uncertainty about the future. There is a tendency towards a flattening or decreasing demand for labour in all Arctic 5 cities, as the Russian invasion in Ukraine increases uncertainty about the further development of the world economy. It remains to be seen what consequences this may have in the long term for the economy of the Arctic 5 cities. Nevertheless, it is clear that interest in the Arctic regions will increase in the future in many ways. Hopefully, our experiences in recent years will help us face the challenges that such interest causes. Our results indicate that at least our level of resilience will most likely be better than it was before the pandemic.

Acknowledgements

This research is connected to the GenZ project, a strategic profiling project in human sciences at the University of Oulu. The project is supported by the Academy of Finland [grant number Profi4 318930] and the University of Oulu.

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Figure 14: Change in visits to grocery stores and pharmacies compared to the baseline in all Arctic 5 cities. Source: Google Community Mobility Reports. Figure 15: Change in visits to retail and recreation places compared to the baseline in all Arctic 5 cities. Source: Google Community Mobility Reports.
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Simonen, Moilanen, Kotila, Lohtander, Westin, Hersinger, Østbye, Riepponen & Svento Figure 16: Change in visits to transit stations compared to the baseline in all Arctic 5 cities. Source: Google Community Mobility Reports. Figure 17. Share of the population who received their first COVID-19 vaccination. Note that for the two Swedish counties, the number of first vaccinations is divided by the number of people who were born latest during 2010. Sources: FHI, THL, Fohm.

Fishing in the time of COVID: Assessing risk in the Bristol Bay commercial salmon fishery and the societal benefits of social science research

Around 13,000 people from outside Alaska arrive each summer in the Bristol Bay region of Western Alaska to participate in the world’s most valuable wild salmon fishery. The small regional hub community of Dillingham is the home port of the Nushagak River salmon fishery. The National Science Foundation funded a RAPID project to assess planning needs for the fishery, community, and region. Our project developed pandemic preparedness scenarios for local residents and decision-makers through online surveys to better understand the costs and benefits of varied mitigation policies; and risk preferences from fishers, processors, local residents, and local decision-makers to better understand cooperation and decisions under risk and uncertainty.

Our project administered an online survey to identify risk perceptions, responses to policy, and compliance. Our first survey was administered in the summer of 2020, and we received 926 valid responses (Smith et al. 2023). To further understand the benefits of the survey to the community, we conducted in-person qualitative interviews in May 2022 with 10 Bristol Bay area fishery participants, fishery operators, and decision-makers. This short article will focus less on the data produced through this survey and more on how the results were useful for the City of Dillingham (City) in planning mitigation strategies for processors and captains. In Alaska, every fishing boat is a business. In 2020, every captain had to have a mitigation plan for their crew, and fishing operations and processors also had strict mitigation measures. Their workers could not leave the campus, and visitors were not allowed. As one fish processing manager said, “I didn’t manage a fishery in 2020; I managed COVID.”

Davin Holen, University of Alaska Fairbanks, dlholen@alaska.edu

E. Lance Howe, University of Alaska Anchorage, elhowe@alaska.edu

Guangqing Chi, The Pennsylvania State University, gfc5047@psu.edu

Davin Holen, E. Lance Howe & Guangqing Chi

In 2020, before the survey, the City implemented a travel permit system to monitor every individual arriving in the community and document their COVID-19 mitigation plan. This permit system was overwhelming for the city government to manage. They had a full-time staff member to administer the permit tracking system, and several other City employees assisted. One captain who has two fishing boats and a tender shared how in the summer of 2020, every time a new crew member arrived, they had to start over with quarantine. This occurred a total of six times over the summer. As a community member with many family members, including elders, he was cautious, and the constant vigilance gave him a great deal of anxiety. For most of the 2020 season, he did not visit elders in his family. While delivering fish, he stayed on the boat to ensure he did not come into contact with anyone. Another fisher related how when they arrived at a dock, instead of roping up to other boats passing lines across, they would only handle their own lines. The captains we spoke with knew of fishers who decided to sit out the fishery in 2020.

Survey results support this, as two-thirds of respondents knew someone who decided to sit out the fishing season. However, data shows that in 2019 there were a total of 1,605 permits fished, and this only dropped to 1,521 in 2020. As noted, each fishing boat is a business, and fishers had to weigh the cost versus revenue. In 2019, for example, the average gross revenue was $173,571, while in 2020, due to the drop in salmon consumption with so many shuttered restaurants that often feature fresh Bristol Bay salmon, the average gross dropped to $113,625 (CFEC 2021; Tiernan et al. 2021). Fishing revenues, though, were supplemented through the COVID-19 relief Paycheck Protection Program (PPP) and grants from the Bristol Bay Native Corporation through the Cares Act. However, PPP funding was only available to captains who had three years of business records. As a result, some felt the pressure to fish to ensure they continued to make boat and permit payments, adding additional anxiety.

Fish processing plants closed their campuses in 2020. One operator said they were only able to operate as their workforce was already in Alaska at other locations. They were able to move workers around and Bristol Bay operated at 50% capacity in 2020. In 2021, they were back to normal capacity. Processors often open their cafeterias to fishers and provide coffee while fish is being delivered as a courtesy to captains who choose to work with them. In 2020, they were unable to allow fishers to enter their facilities. Overall, the closed campuses worked. One processor related how they only had 3-4 positive COVID-19 tests in 2020, and they were only caught during random testing, and those infected were not sick. One of the advantages of the mitigation measures is that stricter hygiene and cleaning procedures led to fewer sick days. They intend to continue and improve upon these measures. The processors did not like the strict mitigation measures put into place by the City in 2020. However, they did learn from these mitigations, and in 2021 they maintained the closed campus.

We provided data that for the 2020 fishing season showed strong support for quarantine periods, testing, use of masks and social distancing, closed campuses, and other mitigation measures put into effect. The COVID-19 tracking system was not favorable and was burdensome for the City to administer. For the 2021 season, the City used findings from the survey to understand risk and mitigation preferences to implement mitigation measures instead of continuing with the permit system, with a resultant major reduction in staff time and cost. During the interviews, we learned that in 2021 due to fewer restrictions and paperwork required by the City, captains were under significantly less stress and could focus more on their operations.

With feedback from Dillingham decision-makers on data needs that would benefit their mitigation measures, we administered two additional surveys in the spring of 2021 to our original respondents to understand vaccine participation and hesitancy. Just over 90% of respondents participated again. We found that almost half of the respondents were not vaccinated before the fishing season. Still, in a third survey administered mid-season in 2021, about 40% of unvaccinated respondents had decided to get the vaccine, often due to work requirements.

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One captain left it up to his crew to choose whether to get the vaccine. He said that if they refused, then they were required to wear a mask. Most complied and got the vaccine. In addition, they maintained distance when delivering fish. Another captain noted they would not tie up to other boats while delivering fish. If they had to get off the boat, they would wear masks and maintain distance. Processors highly encouraged workers to be vaccinated. One processor said their staff and workers had 90% vaccination compliance. It was understood that you could refuse to be vaccinated, but that would jeopardize your chances of being hired. Some processors required proof of vaccination for fishers to enter their property. In conversations with City officials, they related that the data provided by the State of Alaska was useless, especially in 2021. Most people were home testing, and without accurate COVID-19 rates, they could not determine when to recommend additional mitigation measures, so they relied on tracking COVID-19 rates in the schools. This uncertainty with COVID-19 rates during the winter meant they would not have good data during the summer fishing season. To share information, the City organized a weekly informal meeting with entities in the community, including the school, hospital, Tribes, and others. This sharing of information provided the data they needed to monitor the situation in the fishery. This allowed them to track COVID-19 rates jointly. In 2022, the City chose not to establish mitigation measures, leaving it to companies and captains to monitor themselves and set their own rules. Overall, fishers and processors took the pandemic seriously. A sick crew cannot fish, and a sick workforce in the processing sector cannot keep up with supply, leading to a loss of revenue during a short period of time when fishing occurs each summer. The City said it would be business as usual in 2022, but not the same as three years ago; it will be business as usual in a new era.

Finally, with 2022 as a normal year, the City is considering how to move forward for the people they serve. As noted above, there was much anxiety among fishers, processors, and community members. The City would like to find ways to address mental health. The takeaway is that the City had to work with others locally to monitor the COVID-19 situation. They could not rely on data provided by the State of Alaska. Local data collected through this project provided the City of Dillingham with what was needed to verify compliance by fishers and processors in the Bristol Bay fishery.

Acknowledgments

This project is supported by the National Science Foundation (Awards #2032790, #2032787, #2033493, and #1927827.

References

CFEC, Commercial Fisheries Entry Commission. 2021. 'Commercial Fisheries Entry Commission online database. http://www.cfec.state.ak.us/fishery_statistics/earnings.htm', Accessed 2021. http://www.cfec.state.ak.us/.

Smith, Morrison Luke, Guangqing Chi, Hannah Hennighausen, Davin Holen, and E. Lance Howe. 2023. 'Differences in perceptions of COVID-19 risks in a fishing community in Alaska 2020-2021', Marine Policy (in review)

Tiernan, Aaron, Travis Elison, Tim Sands, Jordan Head, Stacy Vega, and Gayle Newfeld. 2021. "2020 Bristol Bay Area Annual Management Report." Anchorage.

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What do COVID-19 stimulus measures delivered in the Arctic region tell us about the prospects for a nature-based economy?

Background

In 2020, in the midst of the global pandemic of COVID-19, the WWF Arctic Programme commissioned a study, COVID-19 Green Stimulus & Jobs in the Arctic, on the environmental impact of stimulus packages announced by eight Arctic nations.1 Ten green policy areas were identified for the analysis: green infrastructure investments and nature based solutions (land use), green R&D, new grid and grid innovation, solar photovoltaics (energy), bailouts with green strings attached, energy efficiency retrofits in buildings (industry), green R&D, bailouts with green strings attached (transport), and expanding management and recycling of waste. Their potential was measured by the number of green jobs to be created within each policy area per a million US dollars invested. Out of these areas, nature-based solutions and waste management received the highest score for their green job potential.

Although the research findings showed that in general these COVID-19 recovery packages failed to pave the way for the long-term creation of green jobs in the Arctic, mostly because of the

1 These countries were the US, Canada, Iceland, Denmark, Norway, Sweden, Russia and Finland. Only the impact of stimulus packages announced prior to October 31, 2020 was considered.

Dr. Elena F. Tracy, Senior Advisor, Sustainable Development, WWF Arctic Programme. Email: etracy@wwf.no

countries’ massive spending on fossil fuel-related industries rather than on the efforts to create jobs in green sectors, there was a silver lining.

Sweden was the only country among eight Arctic nations in which the number of green jobs resulting from stimulus packages delivered in its Arctic region outnumbered the jobs created in the polluting and fossil-fuel based sectors. Specifically, the government of Sweden used their Arctic COVID-19 recovery packages to finance nature-based solutions, to endorse the conservation of ecosystems and to support Indigenous communities relying for their livelihood on ecosystembased services. Between 2021 and 2023, the Swedish government spent USD$ 80 million on the restoration of drained wetlands to decrease the release of greenhouse gas emissions. In addition, some stimulus measures targeted Saami communities and reindeer herders.

From nature-based solutions to a nature-based economy

There is a growing body of literature on nature-based solutions (NBS), viewing them as innovative policy tools targeting simultaneously multiple challenges within different policy areas including employment, environmental health, climate change, and biodiversity crisis (Mayes & Jacobs 2017; Mendes et al 2020). The European Union, a key promoter of these measures, defines NBS as “living solutions inspired by, continuously supported by and using nature, which are designed to address various societal challenges in a resource-efficient and adaptable manner and to simultaneously provide social, economic and environmental benefits” (The EU Commission 2015). Another definition, adopted by the International Union for Conservation of Nature (2016), emphasizes “actions to protect, sustainably manage, and restore natural or modified ecosystems, that addresses societal challenges effectively and adaptively, simultaneously providing human wellbeing and biodiversity benefits.” And yet another definition, widely used in the literature, is offered by Mayes and Jacobs, describing NBS as “any transition to a use of ecosystem services with decreased input of non-renewable natural capital and increased investment in renewable natural processes” (2017, p. 123)

Lately, NBS projects have been viewed as the constituting blocks for a nature-based economy, a model of socio-economic development that has its origins in and draws its main assumptions from ecological economics, a well-established field with a rich, multidisciplinary and diverse research agenda (Costanza 1991; Daly 2005, Rockstrom et al 2009, and many others). Herman Daly, a prominent scholar of ecological economics who worked as senior economist at the World Bank, was among the first scholars who argued that the human economy could no longer take for granted the natural world as a source of infinite growth in economic prosperity. “In the past, the number of fish catch was limited by the number of fishing boats and fishermen. Now, it is limited by the number of fish and their capacity to reproduce” (2005, p. 103). “Because of the exponential economic growth since World War II, we now live in a full world, but we still behave as if it were empty, with ample space and resources for the indefinite future.” (p. 100). Yet the economic logic of today’s full world, the one that has reached or even exceeded the planetary boundaries, continues Daly, is to invest in natural capital “through restoration ecology, biodiversity conservation, and sustainable use practices” rather than in “building new boats.”

Similar to ecological economics, the NBS research and policy agenda challenges the mainstream economic models’ perilous assumption that natural resources, renewable and non-renewable, can be used to support infinite economic growth. The examples of NBS projects include reforestation,

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wetland restoration, restoring coastal areas, investing in ecological agriculture, increasing urban green spaces to serve as community gardens, and many others.

On the governance side, nature-based solutions largely borrow from their precursor, the ecosystem-based management, the decision-making principle of participatory governance and the engagement of stakeholders in the co-design and co-management of these measures. Not surprisingly, NBS projects take a longer time to create, approve and implement as compared to traditional command-and-control policy tools. Three requirements are mentioned for nature-based solutions to succeed in the long-term (Maes and Jacobs 2017). They should: 1) result in a decrease of fossil fuel input per unit of production; 2) be based on synergies between environment and economy; and 3) be labour intensive, as opposed to technology-intensive, by increasing labour input and job creation.

Conclusion and implications for the Arctic

A perfect storm is gathering over Arctic ecosystems, species and communities, brought by powerful economic and political interests that view the Arctic region as the territory, both marine and terrestrial, of unlimited mineral and hydrocarbon riches, commercial fishing and new polar transportation routes. The trend is clear: shipping is increasing, new mining projects are planned, frontiers for mineral extractions are pushed further north,2 and the deep seabed is eyed for mining exploration and extraction. These challenges are amplified by the fast pace of climate change in the region, which is warming close to four times faster than the global average, creating more pressure for Arctic people and ecosystems.

Nature-based solutions offer a silver lining in the midst of this gathering storm. Their attractiveness is further enhanced by the requirements of the new Kunming-Montreal Global Biodiversity Framework, which all countries, including those in the Arctic, must now implement in order to better protect, conserve and restore nature. Several Arctic countries have committed to expand their repertoire of policy tools, similar to the NBS employed by Sweden, in their respective Arctic regions. For example, in Canada, the federal government has announced a project to clean up plastic waste in the Arctic that will require the establishment of recycling and circular economy initiatives, and the monitoring of plastic pollution in the marine Arctic environment.3 In Finland, green stimulus measures have supported the restoration of natural sites and initiated green tourism in the Arctic.4

A nature-based economy is not about selling natural resources in global commodity markets or using the Arctic as the resource frontier periphery, to sustain and increase global production and consumption levels. Instead, it is about conserving the foundations for the economy to exist in the first place, to support the livelihoods of people living in the rapidly changing Arctic.

2 The Citronen Mine in Greenland (Citronen Fjord), with the construction planned for 2023, will be the world’s northernmost mine, above 80⁰ North.

3 $183.1 million over 5 years, starting in 2022-2023, to Environment and Climate Change Canada, Department of Fisheries and Oceans, Health Canada, Transport Canada, Crown-Indigenous Relations and Northern Affairs Canada, Statistics Canada, and the National Research Council. https://www.rcaanccirnac.gc.ca/eng/1562853124135/1562853167783

4 See WWF, Left Out in the Cold: Finland, 2021. https://www.arcticwwf.org/newsroom/reports/left-out-in-the-coldfinland/

Tracy

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Public investments in preserving and restoring ecosystem functions offer the greatest potential to create green jobs while adding long-term value to the services of Arctic marine, coastal and terrestrial ecosystems, for the benefit of local communities and future generations.

References

Costranza, R. 1991. “Ecological Economics: a Research Agenda.” Structural Change and Economic Dynamics. 2 (2): 335-357.

Daly, Herman. 2005. “Economics for a Full World.” Scientific American. 293 (3): 100-107.

European Commission. 2015. Towards a EU Research and Innovation Policy Agenda for Nature-based Solutions and Re-naturing Cities. Final Report of the 2020 Horizon Expert Group on Nature-based Solutions. Brussels.

IUCN. 2016. Nature-based Solutions to Address Global Societal Challenges. Gland, Switzerland.

Mayes, Joachim and Sander Jacobs. 2017. “Nature Based Solutions for Europe’s Sustainable Development.” in Conservation Letters. 10 (1): 121-124.

Mendes, Ruben, Teresa Fidelis, Peter Roebeling, Filip Teles. 2020. “The Institutionalization of Nature-based Solutions - A Discourse Analysis of Emergent Literature.” Resources. 9 (1).

https://doi.org/10.3390/resources9010006

Rockstrom, J., Steffen, W. Noone, K., et al .2009. “A Safe Operating Space for Humanity.” Nature. 461: 472-475.

WWF Arctic Programme. 2021. Left Out in the Cold: COVID-19 Stimulus and Green Jobs in the Arctic. Available at https://www.arcticwwf.org/newsroom/reports/left-out-in-the-cold-COVID-19green-stimulus-and-jobs-in-the-arctic/

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Gendered Impacts of COVID-19: Designing a COVID-19 Gender Impacts and Policy Responses Indicators Framework for Arctic Communities 1

The COVID-19 pandemic has had a devastating effect on Arctic communities. However, women have faced disproportionate negative impacts across key domains of gender equality. These include impacts in the political/public administration, economic, social, civic, and personal spheres. Most importantly, it is likely that the COVID-19 pandemic has deepened gender inequality for years to come.

As the potential COVID-19-driven gender inequality continues to unfold in the Arctic, it is critical to capture, measure, and assimilate available data and conduct just-in-time analysis to inform action to address COVID-19 pandemic gender impacts and gendered consequences. The existing gender analysis frameworks for the COVID-19 pandemic on gender impacts and gendered policy responses mainly focus on indicators at the national level. To narrow this knowledge gap, this paper presents the preliminary results of the science-driven academic exercise conducted by a diverse group of experts. It introduces a system of indicators organized within a framework that allows the analysis of available data at the regional and local levels.

The designed COVID-19 Gender Impacts and Policy Responses Indicators (COVID - GIPRI) Framework aims to provide a systematic way of analyzing the COVID-19 pandemic's gender impacts in conjunction with government and community responses across key gender equality domains. It will also evaluate their effectiveness over time. The COVID - GIPRI framework has primarily drawn on Western concepts of gender, and we recognize appropriate modifications are needed to incorporate Indigenous definitions to the greatest extent possible. The focus on Arctic women, rather than all genders, is

1 This research is supported by the U.S. National Science Foundation (award PLR #2137410).

Marya Rozanova-Smith (The George Washington University, USA), Andrey N. Petrov (ARCTICenter, University of Northern Iowa, USA), and Charlene Aqpik Apok (Iñupiaq, Cloudberry Consulting, USA) Marya Rozanova-Smith, Andrey N. Petrov & Charlene Aqpik Apok

conditioned by the lack of gender-specific data across the Arctic. However, the system of indicators developed by this project could be applied to other gender groups, in addition to women, should such data become available.

The COVID-19 Gender Impacts Index, which is develop using the COVID – GIPRI framework, can be used to inform decision-making, and program planning to accurately assess, improve, and monitor gender-oriented policies and practices.

Introduction

The first case of COVID-19 was recorded in the Arctic as early as February 2020, but the larger pandemic waves reached the Arctic regions later due to remoteness and relative isolation. The Arctic experienced at least four large waves of the pandemic, impacted mainly by the Delta (Fall of 2021) and Omicron (Winter of 2022) variants, which drastically increased the number of infections and deaths (Tiwari et al., 2022). Overall, by January 1, 2023, 2,677,457 positive COVID19 cases and 29,492 deaths were recorded.

Overall, the COVID-19 pandemic has had devastating effects on Arctic communities (Petrov et al., 2020; Petrov et al., 2021a). Recent studies have demonstrated the scale of multifaceted challenges the Arctic communities have been experiencing during the COVID-19 pandemic. In general, it has exacerbated economic and socio-cultural vulnerabilities, food insecurity, and adverse mental and physical health issues among the residents across Arctic jurisdictions (Barik et al., 2022; Markova et al., 2021; Lemieux et al., 2020; Cook & Johannsdottir, 2021; Men & Tarasuk, 2021; Golubeva et al., 2022). The pandemic also brought great challenges for the government emergency response (Cook and Jóhannsdóttir, 2021; Hardarson & Kristinsson, 2022; Chhean et al., 2021).

The pandemic situation was particularly acute in remote Indigenous communities. Historically, Indigenous Peoples of the Arctic often faced considerable health and socioeconomic disparities compared to other populations. During the pandemic, Indigenous communities were confronted with numerous additional challenges, including public health system vulnerabilities, food insecurity as a result of undercut subsistence economy (Burki, 2021; Hathaway, 2021; Manson, 2021; Markova et al., 2021; Lemieux et al., 2020; Cook & Johannsdottir, 2021; Men & Tarasuk, 2021; Golubeva et al., 2022; etc.), and higher COVID-19 mortality and morbidity rates (Arrazola et al., 2020; Burki, 2021; Manson & Buchwald, 2021; Hatcher, 2020; Retter, 2020; Indigenous Russia, 2020).

Impacts and consequences of the pandemic differ not only from region to region (Arctic Council, 2020; Petrov et al., 2021b; Tiwari et al., 2022) and community to community, but also across genders. An increasing volume of gender-focused publications demonstrates that during the pandemic, women particularly tend to experience disproportionately negative impacts and consequences related to elevated unemployment, loss of income, and increased unpaid care (homework and child/elderly care) during stay-at-home orders (Hjálmsdóttir & Bjarnadóttir, 2021; Auðardóttir & Rúdólfsdóttir, 2021; Haney & Barber, 2022; ADLAWD, 2021), risks related to maternal and perinatal health (Engjom et al., 2021; Collin et al., 2020; Birkelund at al., 2023), more profound adverse effects on mental health and well-being (Halldorsdottir et al., 2021), increased rates of domestic violence and abuse (Nesset, 2021; Moffitt et al., 2022; Trudell & Whitmore, 2020), and are at a greater risk of contracting the COVID-19 infection, especially if employed in the health, social care, primary education and child care sectors (Lundgren et al.,

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2023; Sigursteinsdottir et al., 2022; Smith, 2021). Not many studies addressed gender imbalances in decision-making processes in the Arctic countries; however, despite female political leadership being crucial in response to the pandemic, there is evidence that women were not equally involved in the pandemic-related decisions in some Arctic jurisdictions (Tyner & Jalalzai, 2022; Kwan et al., 2020), for instance, in most Arctic regions of Russia, Alaska, Greenland, etc.

As a result, an aggregated effect of the COVID-19 pandemic's negative impacts has deepened gender inequality in all spheres for years to come (Aton et al., 2020; Madgavkar et al., 2020; Azcona, 2021; Gentilini et al., 2020; Miliken et al., 2020; UNDP 2020a; UN Women, 2021; UNDP 2020b). Delays in immediate public policy actions to restore and advance gender parity not only can have a lasting effect on economic growth given drastically increased unpaid work, elevated unemployment, and additional pressure placed on female-dominated spheres of the economy during the pandemic, but also negatively influence the lives of women afterwards. This makes it crucially important to understand and analyze the COVID-19 gender impacts and gendered policy responses to identify good practices supporting gender equality and advancing the UN Sustainable Development Goals in the Arctic (Degai & Petrov, 2021; Retter, 2020).

Despite the evidence of widening gender disparities, significant data availability issues and knowledge gaps exist regarding COVID-19 impacts and implications for Arctic communities in general, Indigenous Peoples, and women specifically. Existing gender-oriented indices either do not have a COVID-19 perspective (for instance, The Global Gender Gap Report, UNDP Gender Empowerment Measure (GEM), UNESCO Gender Parity Index (GPI)), or non-gendered (for instance, COVITA UNI, COVID-19 policy response trackers as Oxford COVID-19 Government Response Tracker, World Bank Tracker of Subsidies and State Aid to mitigate COVID-19 Effects, OECD Coronavirus Country Policy Tracker, Kaiser Family Foundation tracker, COVID-19: Local Action Tracker, CoronaNet (Cheng et al., 2020), or primarily focus on indicators at the national level (for instance, UN Women COVID-19 Global Gender Response Tracker) and thus do not shed light on the outcomes of COVID-19 gender-oriented response actions at subnational (regional), municipal (city/town), and local (community) levels.