1. Political importance of Arctic Russia A 2/3 of Russian territory is represented by permafrost lands A 2/3 of Russian territory is represented by permafrost lands 11 million inhabitants of Russian population are resident of the arctic region of Russia 11 million inhabitants of Russian population are resident of the arctic region of Russia 20% of Russian GNP is provided by the economy of arctic region 20% of Russian GNP is provided by the economy of arctic region

2. The 2001-2003 AMAP Arctic Health Survey in Russia There were 18 native communities in the selected study areas. There were 18 native communities in the selected study areas. The followed-up cohorts of indigenous minorities of the North: The followed-up cohorts of indigenous minorities of the North: 407 mother-child pairs 407 mother-child pairs 1514 adults 1514 adults

4. Internationally approved package of recommendations on health risks reduction derived from the 2001-03 Russian Arctic Health Survey Nutritional advices Nutritional advices Training of local health workers and community volunteers Training of local health workers and community volunteers Health services improvement Health services improvement Financial, organizational and technical assistance to support Human Health Risk Reduction Campaign. Financial, organizational and technical assistance to support Human Health Risk Reduction Campaign.

5. Levels of implementation The 2003-2007 Action Plan based on AMAP recommendations Regional level - 2 arctic counties (Chukotka, Nenets AO) Community level - 6 heavily contaminated indigenous communities were selected Individual level - family planning program for 1870 indigenous women at age of fertility

6. Selection and training of communicators Demands: trustworthiness, creditability trustworthiness, creditability sympathetic insight sympathetic insight expert knowledge expert knowledge commitment commitment sincerity sincerity

7. Field training of indigenous volunteers engaged in clean-up operations in native communities of Cukotka Peninsula

9. On spot analysis for POPs

11. Community cleaning-up

12. Printed brochure on health risk reduction

13. The 2010 Interim Evaluation of Implemented Action Plan Human exposure to 6 persistent priority contaminants Incidence rates of diseases potentially associated with exposure to PTS in question (immune deficiency, malignancies, pregnancy miscarriage, birth defects, diabetes, mental retardation)

14. Temporal trends in the human exposure to POPs (adult males)

15. Annual incidence rates of diseases potentially associated with the exposure to POPs in indigenous population

17. Temporal trend of annual incidence rates of diseases associated with the exposure to POPs in the cohort of children, new cases per 1000 20032004200520062007200820092010

18. Intensity of Tsunami Occured in the South-East Pacific Region

19. 27,000 victims and16,000 have been missing due to the 2011 tsunami

20. Estimated Cumulative Temporal Trend of Intensity of Washouts due to Natural Catastrophes

21. Ocean currents: A Pathway of POPs Transfer from Tropics to the Arctic

22. Major Flyways of Migrating Birds into the Arctic

23. Ocean currents in the main Salmon stock in subarctic area

24. Questions from AMAP: What is the lesson to be learnt? What should be done next?

25. A Suggested Regional Model for Healthy Arctic Community Public health practice adjusted to Russian arctic circumstances is particularly important to indigenous health. Public health practice adjusted to Russian arctic circumstances is particularly important to indigenous health. A new model for healthy arctic communities has been recently suggested and is being discussed at national level. A new model for healthy arctic communities has been recently suggested and is being discussed at national level.

26. A suggested national model for healthy arctic community This model is primarily addressing developmental goals while enhancing the abilities that will allow us to achieve measurable and sustainable results in the implementation of Good Arctic Health Care Practice concept. This model is primarily addressing developmental goals while enhancing the abilities that will allow us to achieve measurable and sustainable results in the implementation of Good Arctic Health Care Practice concept.

27. Educational needs An obstacle is that existing educational and training programs for public health professionals are not adequately reflect specificity of both the arctic environmental risk factors and lifestyle, social and economic status of indigenous peoples. An obstacle is that existing educational and training programs for public health professionals are not adequately reflect specificity of both the arctic environmental risk factors and lifestyle, social and economic status of indigenous peoples.

28. Educational needs Identifying critical gaps and broad level principles for Indigenous health curricula within training programs and to respond with innovative teaching modules. Identifying critical gaps and broad level principles for Indigenous health curricula within training programs and to respond with innovative teaching modules. Increasing the number of indigenous public health graduates by teaching public health using a community based approach; Increasing the number of indigenous public health graduates by teaching public health using a community based approach;

29. Educational needs Identifying the priority arctic health risk factors and specifying the public health policy and practice needs to deliver comprehensive education for the professionals are to serve in the arctic indigenous communities; Identifying the priority arctic health risk factors and specifying the public health policy and practice needs to deliver comprehensive education for the professionals are to serve in the arctic indigenous communities; Increasing the rate of indigenous graduates nationally awarded a MPH degree; Increasing the rate of indigenous graduates nationally awarded a MPH degree; Establishment of a national network of indigenous public health professionals; Establishment of a national network of indigenous public health professionals;

30. Health Care needs Prioritization of health care in the arctic communities as primary goal of local policy. Prioritization of health care in the arctic communities as primary goal of local policy. Selection of the best values in health care providers and treatment. Quality of health services benchmarking. Selection of the best values in health care providers and treatment. Quality of health services benchmarking. Securing a universal access to health care Securing a universal access to health care Encouraging arctic people of taking personal responsibilities for their own health and for others by helping them to obtain health promoting services. Encouraging arctic people of taking personal responsibilities for their own health and for others by helping them to obtain health promoting services.

31. Do we need to set up another paradigm in health policy for arctic communities It is essential to enable arctic indigenous communities to feel themselves as an important constituent of Good Arctic Health Practice and to create a sense of purpose of it. It is essential to enable arctic indigenous communities to feel themselves as an important constituent of Good Arctic Health Practice and to create a sense of purpose of it.

32. International dimension of Arctic Health Policy Do we need to achieve the Arctic Treaty to harmonize environmental and human health policies and to limit exploration and use of the arctic resources? Do we need to achieve the Arctic Treaty to harmonize environmental and human health policies and to limit exploration and use of the arctic resources? The Antarctic Treaty unique experience: what works and what doesn’t? The Antarctic Treaty unique experience: what works and what doesn’t? Are current environmental exposure limits to be the same as those developed for a better climates? Are current environmental exposure limits to be the same as those developed for a better climates?

33. Thank you for attention! Thank you for attention!