Environmental Health

The team supports the director of Public Health in his tasks of disease prevention, health promotion, information for the public, monitoring of the population’s state of health and its determining factors, and particularly the field of health protection. Threats to health can arise from physical, chemical or biological agents related to environmental contamination (water, air, soil), technological accidents or criminal or terrorist acts.

The team responds to reports from various interveners of the health network, other organizations or ministries such as the Kativik Regional Government and the Kativik School Board, the municipalities and the public concerning exposure to environmental risk factors. It maintains a constant duty roster (24/7) in order to be able to respond at all times to emergencies of an environmental nature. As needed, it conducts epidemiological investigations and issues health advisories in areas such as contamination of indoor and outdoor air, drinking water, water in swimming pools and traditional foods, as well as sanitary conditions, industrial pollution, waste management and so forth.

Potable water
Swimming pools
Reportable diseases of chemical or physical origin (chemical MADOs)
Carbon monoxide
Mercury
Lead
Cadmium
Mould
Arenas
Environmental emergencies
Climate change
Bed bugs

Potable Water

The municipalities are responsible for the distribution system in each Nunavik community. For the purpose of quality control of potable water, they are required to take samples or have samples taken of the water distributed, in accordance with the provisions of the Regulation respecting the quality of drinking water. The Kativik Regional Government (KRG) receives the results of these tests weekly and forwards them to the Nunavik Department of Public Health. When a test reveals that a water sample does not meet established quality standards, the laboratory must notify the municipality, the KRG and the director of Public Health. Under the KRG’s supervision, the municipality must then undertake the necessary measures to remedy the situation and, if applicable, protect all users against potential risks. The municipality must also notify, without delay, the users of the system when the water is declared unfit for consumption. The director of Public Health must also receive information concerning deviations from the norm and the measures taken to rectify such situations as well as, where applicable, boil-water advisories. In exceptional situations, the director of Public Health may issue a boil-water advisory should the municipality delay in its actions and if there is evidence of a health risk.

The environmental-health team supports the director of Public Health in assuming these responsibilities. It is also tasked with preventing public exposure to problems related to drinking water. It must proceed with an investigation rapidly when it receives reports of cases of diseases potentially related to water in order to identify the risks and specify the protective measures to set up.

For further information, consult the Regulation respecting the quality of drinking water.

Swimming Pools

Swimming is a physical activity that should be encouraged as it can contribute to the improvement of health. However, the promotion of safety habits before and during swimming is essential. Such habits can in effect protect users and their children against infectious diseases that can spread through the water in swimming pools as well as avoid contaminating pools with microorganisms.

Several pathogenic microorganisms carried by swimmers can contaminate water, such as Cryptosporidium, Giardia, E. coli O157:H7, Shigella and others. These microorganisms cause diseases that often manifest as diarrhea that can be accompanied by fever, loss of appetite, nausea, vomiting and abdominal cramps and which can sometimes be severe, especially among babies and children.

Each swimmer shares the swimming pool’s water with all the other swimmers present. If someone with diarrhea contaminates the water, ingesting that water can make others sick. That is why the Department of Public Health recommends that individuals with such symptoms refrain from using swimming pools for the entire duration of their symptoms.

The good news is that most microorganisms that cause diseases that can spread through the water in swimming pools are destroyed by the chlorine used in pools. However, chlorine does not act immediately. A certain period of time is required to destroy those microorganisms, and some of them, such as Cryptosporidium, are resistant to chlorine and can survive for several days in swimming pools. That is why even the best-maintained pools can spread diseases.

In Québec, application of the Regulation respecting water quality in swimming pools and other artificial pools is up to those responsible for the pools (i.e., all owners or operators of a swimming pool or other artificial pool covered by the regulation), who are required to offer their clientele safe, clean and stable pool water at all times and in accordance with the established norms.

For further information, consult:

Reportable Diseases of Chemical or Physical Origin (Chemical MADOs)

The Regulation under the Public Health Act presents the list of diseases, infections and intoxications that must be reported to public-health authorities by the physicians and laboratories. As with certain infectious diseases, the ministère de la Santé et des Services sociaux (MSSS) considers that certain diseases and intoxications caused by chemical or physical agents (chemical MADOs) must be monitored by public-health authorities. These reports serve, among other purposes, to identify the actions toward avoiding, when possible, the occurrence of other cases or aggravation of the situation.

Consult the list here

In accordance with the powers conferred on him by the Public Health Act, the director of Public Health may conduct an investigation, often through a survey questionnaire, and issue recommendations (nutritional advice, follow-up examinations, etc.). The environmental-health team supports him in carrying out these tasks.

Carbon Monoxide

Carbon monoxide (CO) is a hazard to human health, as it is invisible, odourless and tasteless, irritates neither the eyes nor the respiratory system but can have serious effects on health.

All means of transportation, heating systems and other equipment that run on fuel such as gasoline, diesel, wood, propane, natural gas, heating oil, naphtha, kerosene and coal produce carbon monoxide. If such equipment is not used properly, for example, if used in a closed or poorly ventilated location or if inadequately maintained, it can involve a risk of carbon-monoxide poisoning. All generators, camping stoves, heating systems that burn wood, chainsaws, barbecues, four-wheelers, snowmobiles and so forth are sources of carbon monoxide.

Carbon-monoxide poisoning appears on the list of reportable diseases, infections and intoxications (MADOs).

For further information, consult:

Mercury

Mercury (Hg) is a toxic heavy metal that occurs in three forms: elementary, inorganic and organic, the latter also known as methylmercury (MeHg). When mercury released into the atmosphere ends up in aquatic ecosystems, it is transformed into MeHg by microorganisms and accumulates in the tissues of living organisms. MeHg has a very high affinity for proteins and tends to accumulate in the muscle tissue, i.e., meat, of those animals.

Most traditional foods in Nunavik contain low levels of mercury. Beluga meat (raw, cooked and dried or nikku) is the item that contributes most to blood mercury among Nunavimmiut, particularly on the Hudson Strait, the region where it is consumed most often. Beluga liver and kidney, seal liver and kidney, and lake trout (the oldest individuals) are also characterized by elevated levels.

A blood sample taken from an individual permits documenting his exposure to mercury as well as other contaminants. If the mercury exceeds the reporting level for a reportable disease (MADO) in Québec, both the physician who received the result and the accredited laboratory that tested the sample are required to report the MADO to the director of Public Health. In accordance with the powers conferred on him by the Public Health Act, the director of Public Health may conduct an investigation, often through a survey questionnaire, and issue recommendations (nutritional advice, follow-up examinations, etc.). The environmental-health team supports him in carrying out these tasks.

Lead

Exposure to lead is a hazard to human health which has long been recognized. First proven in relation to occupational settings, exposure to lead was then linked to environmental contamination through various means: through inhaled air (lead in gasoline), through drinking water (old distribution systems built of or welded with lead), through contaminated soil (industrial waste), through ingestion of flakes of paint containing lead, through food (lead used for sealing canned goods), etc.

First revealed by the Health Québec Survey (1994), the Nunavik population’s exposure to lead was confirmed by the study of samples of umbilical-cord blood (1993-1996). That study enabled identification of the origin of elevated lead levels in blood. All the evidence indicates that use of lead shot constitutes the primary source of exposure to lead among Nunavimmiut, notably children, who consume small game. It is therefore possible to reduce exposure to lead among the Nunavik population through action at the source of the problem, i.e., by avoiding the use of ammunition containing lead shot for hunting.

A blood sample taken from an individual permits documenting his exposure to lead as well as other contaminants. If the lead exceeds the reporting level for a reportable disease (MADO) in Québec, both the physician who received the result and the accredited laboratory that tested the sample are required to report the MADO to the director of Public Health. In accordance with the powers conferred on him by the Public Health Act, the director of Public Health may conduct an investigation, often through a survey questionnaire, and issue recommendations (nutritional advice, follow-up examinations, etc.). The environmental-health team supports him in carrying out these tasks.

For further information, consult:

Cadmium

Cadmium from both natural and anthropogenic sources can accumulate in lichens and other vegetation that, when consumed by caribou and moose, results in the buildup of this metal in those animals’ kidneys and livers. Consumption of those organs by the Inuit could result in increased concentrations of cadmium in the blood. However, it is generally acknowledged that the concentrations measured in human blood are largely due to tobacco smoking.

A blood sample taken from an individual permits documenting his exposure to cadmium as well as other contaminants. If the cadmium exceeds the reporting level for a reportable disease (MADO) in Québec, both the physician who received the result and the accredited laboratory that tested the sample are required to report the MADO to the director of Public Health. In accordance with the powers conferred on him by the Public Health Act, the director of Public Health may conduct an investigation, often through a survey questionnaire, and issue recommendations. The environmental-health team supports him in carrying out these tasks.

Mould

Moulds are a type of fungus which appear in different colours. They can grow in homes where there is a sufficient level of humidity and where the nutrients they require, such as wood, cardboard and gypsum plasterboard, are present. They are often found in humid environments, for example, around bathtubs and windows.

In small quantities and if eliminated regularly, moulds generally pose no serious problems. On the other hand, when they develop in large amounts, moulds can release minute, airborne particles that, in certain cases, can cause health problems.

For further information, consult Health Canada’s Web site

Arenas

Last April, more than 140 persons were overcome by a toxic gas during a bantam hockey tournament at the Kangiqsualujjuaq arena; 30 of them received oxygen therapy and 7 required evacuation to Kuujjuaq for medical observation. The results of tests for gas concentrations as well as the symptoms felt by the affected individuals point to nitrogen dioxide emitted by the resurfacer (Zamboni) as the probable cause. A combination of factors likely contributed to the event, such as the higher-than-normal amount of the gas emitted by the resurfacer, its more-frequent use due to a hockey tournament and problems involving ventilation procedures and the gas detectors installed at the arena.

Numerous cases of poisoning have been reported elsewhere in the world. In Québec, from 2000 to 2012, 15 incidents that occurred in arenas were brought to the attention of seven regional departments of Public Health. Certain situations identified the cause as the ammonia in the ice-cooling system, whereas others involved carbon monoxide or nitrogen dioxide from combustion engines, principally resurfacers. In all cases, a certain number of individuals present in the arena, in general those using the ice surface (players, skaters), were affected. The symptoms varied in severity, but some individuals had to be admitted to intensive care.

Pursuant to the incident in Kangiqsualujjuaq, the Department of Public Health of the Nunavik Regional board of Health and Social Services (NRBHSS) drew up a plan of action to document the problem in the arenas of all the Nunavik communities as well as to inform and raise awareness among the arena managers relative to the importance of monitoring the quality of indoor air and the actions to carry out to protect the public health.

That preventive measure aims to support the municipalities in fulfilling their responsibility of ensuring the health and safety of persons who use the arenas.

For further information, consult the Kangiqsualujjuaq incident report, April 2015

Environmental Emergencies

The environmental-health team plays a role in prevention and emergency preparedness for incidents that may occur on the territory of the Nunavik communities. It also assumes responsibility during and after an event (application of emergency measures, population follow-up and statement of operations).

For further information, consult:

Climate Change

There is very broad scientific consensus that the earth’s climate is changing. According to Ouranos, climate-change predictions include rising temperatures throughout the territory of Québec, which are projected to be more pronounced in the winter in northern regions, as well as the occurrence of several extreme and increasingly unpredictable meteorological phenomena. Annual precipitation and ground accumulations of snow are expected to increase in Québec’s most-northerly regions. In general, the consequences of climate change, such as heat waves, floods, melting permafrost, landslides, erosion, forest fires, contamination of water and food, zoonotic diseases and so forth could have effects on health. For example, in Arctic Québec, cases of diseases transmitted by insects or animals are likely to occur more frequently. Major impacts may also be observed on infrastructures and buildings as well as in the natural environment.

For further information, consult:

Bed Bugs

Bed bugs are tiny insects that can be seen by the naked eye; they are brown, oval and wingless and resemble flattened apple seeds. They are active and visible especially at night and are generally found along mattress seams. They are biting insects that feed on the blood of humans as they sleep. If not controlled, these insects reproduce and spread rapidly.

Bed bugs do not transmit disease. The principal health risk is related to their stings, which sometimes occur in large numbers. They can cause severe itching and affect quality of life by disrupting sleep and causing stress and anxiety, even social isolation.

For a number of years, bed bugs have proliferated in Québec as elsewhere in the world. This problem is presently emerging in Nunavik. Several factors can explain the presence of bed bugs in a building, and the most-infested dwelling is not necessarily the origin of the problem. The causes behind the proliferation of bed bugs are:

  • more-frequent human travel (relocations, tourism, etc.);
  • use of second-hand items (sale or exchange of second-hand furniture and clothing);
  • lack of knowledge on bed bugs leading to use of ineffective extermination methods.

The fear of being identified as one responsible for a bed-bug infestation may discourage certain individuals from reporting the presence of these insects in their home, which could result in worsening the problem. It is important to understand that bed bugs do not discriminate and can infest any home: rich and poor, non-Inuit and Inuit can all be infested. We must neither accuse others nor feel ashamed, as everyone is at risk. What is important is to act as soon as possible.

Getting rid of bed bugs requires complex solutions and intensified efforts from the community and individuals. Inappropriate use of insecticides against bed bugs can also represent a health risk.

Both tenant and owner have responsibilities. It is important to follow the instructions listed in these pamphlets. Moreover, tenants are responsible for informing owners when they find insect pests in their units.

For further information, consult: