IQALUIT - First, his mother died
of cancer and later his sister fell victim to the same disease. Through
it all, Peter Ernerk kept right on smoking.May 27, 1998
Also, in this special report by DWANE WILKIN, Nunatsiaq News:
Tobacco addiction in Nunavut: No one, including health board members, want to do much about it.
IQALUIT - First, his mother died
of cancer and later his sister fell victim to the same disease. Through
it all, Peter Ernerk kept right on smoking.
When he was an MLA in the 1980s, Ernerk smoked two packs of cigarettes a day and turned a deaf ear to mounting evidence that smoking would kill him, too.
It wasn't until the early 1990s, when tobacco claimed his favorite uncle, that Nunavut's recently named deputy minister of culture finally resolved to quit.
"I watched him slowly dying a very inhumane death," Ernerk recalled. "I could see it in his eyes. Whenever he was conscious, he would look at his family members and he wanted to live. But each time he got sick, he was in so much pain."
One morning shortly after his uncle's agonising death, Ernerk woke and, as was his habit, placed a cigarette in his mouth, only to find he'd lost his lighter. He took it as a cue to break his own addiction.
Ernerk remembers how he carried his cigarettes with him that first day, drawing one from his pocket every so often. "I would look at the cigarette and say to myself, 'No I'm not going to smoke anymore and that's my decision,'" placing the smoke back in its pack.
Now, seven years later, Ernerk is an unofficial ambassador for the smoke-free lifestyle, a role model for his fellow Inuit and anyone else who dreams of freedom from the grip of tobacco.
As a non-smoker, he is also very much in the minority in Nunavut.
Cancer killing Inuit
While ever stricter and multiple restrictions on tobacco use in other Canadian jurisdictions have helped bring smoking rates down in recent years, nicotine addiction in Nunavut remains astonishingly widespread and shows no obvious sign of abating. To outsiders - visitors and new arrivals - such anachronistic public acceptance of smoking must seem grossly out of step with the idealism normally exuded by leaders of Canada's Inuit homeland.
The sight of puffing teens and pregnant smokers, an evening spent in the foul gloom of a smoke-filled restaurant or a walk past filthy mounds of cigarette butts at office building entrance ways illustrate what statistics confirm: Arctic communities are under siege by tobacco.
Nearly two-thirds of all adults in Nunavut smoke, a survey conducted for the NWT Department of Health and Social Services in 1996 reveals. Among Inuit, the prevalence of smoking is even greater: 70 per cent of Inuit in Nunavut smoke, a rate of addiction more than two-and-a-half times the Canadian average.
With smoking rates that high, it isn't surprising that tobacco also takes a heavy toll on health.
Cancer and other diseases caused by smoking kill and maim each year a greater proportion of people in the Northwest Territories than anywhere else in the country, and Inuit pay the highest price of all.
According to statistics compiled by the NWT Cancer Registry, fatal lung cancer caused by smoking is three times more prevalent among Inuit men than the Canadian population as a whole. And, for reasons not yet fully understood, tobacco's deadly effects are even more pronounced among Inuit women: lung cancer rates among Inuit women are five times the national average.
"Right now, the Inuit popluation is the only one we know of where the lung cancer rate is higher in women than in men," NWT medical officer Dr André Corriveau said.
"Everywhere else, because men had started smoking earlier than women, the lung cancer rate is higher in men than in women. But in Inuit we have the reverse situation."
Hearing loss exacerbated
While Nunavut children suffer disproportionately from a range of respiratory problems caused by exposure to second-hand smoke, smoking also contributes significantly to hearing loss.
Manon Leblanc, an audiologist with the Public Health Centre in Iqaluit, estimates that 95 per cent of all hearing loss among school-age children in the Baffin region is caused by middle ear infections, which are in turn aggravated by exposure to second-hand smoke.
While hearing problems occur, on average, in about 10 per cent of Canada's poulation, Leblanc said its not uncommon for 20 per cent of Nunavut children she visits to fail their hearing tests at school.
"It is proven that being exposed to cigarette smoke increases the chances of getting ear infection. It's a fact that we all know."
Tobacco smoke interferes with delicate tissues connecting a child's middle ear with her throat, Leblanc explained, irritating and causing swelling and blockage of the eustachian tube, whose function it is to drain fluid away from the cavity behind the ear drum.
Fluid accumulation in the middle ear affects hearing and encourages infection, which in turn can lead to further hearing loss. Many of the children Leblanc sees in her work are compromised by ear infections that recur several times a year, and which are the product of constant exposure to second-hand tobacco smoke.
"We also have more chronic cases of people who have ear infections almost every month," Leblanc said. "So those kids, in a way, can end up most of the time with a hearing loss."
Tobacco embraced by Inuit
Peter Ernerk believes the prevalence of smoking among Inuit can be partly explained by history, although smoking played no role in traditional Inuit culture prior to contact with Europeans.
Tobacco was introduced to Inuit by white traders and its use was subsequently promoted by the Hudson Bay agents, as well as many priests. As the addiction spread, Inuit embraced tobacco as part of their culture, and remained largely unaware of its ruinous effects until quite recently, although the dangers of smoking have been common knowledge elsewhere in Canada for at least three decades.
Tobacco's status benefited from Inuit naming customs, too, Ernerk said.
"If my namesake smoked a lot in his lifetime, then my mother or my father would have given me some tobacco when I was a kid, indicating that my namesake smoked a lot. I would be taught to smoke tobacco at a very early age.
"As people were being brought up in my time, you used to see little kids smoking right in the amautik, maybe two or three years old, in Repulse Bay. That's where a lot of encouragement came also, from our parents."
No local action
With the creation of Nunavut merely months away, it's difficult to imagine that Inuit politicians will be able to ignore for much longer the huge social and economic costs of smoking on their communities. But official efforts to cure the disease of tobacco addiction have to date been unimpressive.
Though each and every town and hamlet council has the power to pass the sort of anti-tobacco ordinances that have discouraged smoking elsewhere on the continent, municipal governments in Nunavut have not shown the least interest in helping to combat smoking in their own communities. As a result, local governments exercise no control over tobacco, and risk having anti-tobacco legislation imposed on them by a higher level of government.
Smoking was banned in GNWT office buildings across the territory about a decade ago, but only the City of Yellowknife has ever extended the ban on smoking into other public spaces.
In Iqaluit, the future capital of Nunavut, the only municipal tobacco regulation is contained in a section of the local taxi bylaw, which forbids smoking in cabs. But as anyone who has ever had to travel by taxi knows, even this meagre restraint gets little respect: passengers and drivers alike routinely violate the no-smoking rule.
With rare exceptions, smokers throughout the NWT also puff unmolested in stores, coffee shops, hotels and, of course, wherever alcohol is served.
Unregulated smoking is encouraged in public dining-areas and outside of Yellowknife. No restaurant owner has ever made a sincere attempt to reserve well-ventilated, separate seating areas for non-smoking patrons.
Little action from health boards?
The force of tobacco addiction in Nunavut is so strong that it has even blinded those community representatives entrusted with responsibility for setting health policy.
Regional health boards in Nunavut have not only taken little meaningful action on their own against smoking, they have failed to support progressive anti-tobacco policy when it was presented to them in the past.
Members of health boards in the Keewatin and Baffin regions, for instance, helped overturn a ban on smoking in public places proposed two years ago by former medical officer Dr Richard Bargen.
Bargen's directive would have banned smoking in all public places, including restaurants, in the Baffin and Keewatin starting October 1, 1996. But the controversial ban was lifted just before it was supposed to take effect, and only after regional health boards vowed publicly to develop long-term no-smoking strategies.
Dr Bargen, whose proposed ban drew the ire of small businesses and bureaucrats alike, was forced to resign soon after the smoking-ban debacle. The health boards, meanwhile, have failed to deliver on their promise.
Although a budget of $50,000 was set aside last year for the Baffin region's no-smoking stragegy, health promotion officer Marcus Wilcke said it wasn't really enough to mount an effective education campaign. A year and a half after the Baffin board endorsed a proposed 10-year plan to create a smoke-free society, Wilcke admits no plan exists.
"I'd say we're another $10,000 away from putting the whole strategy together," Wilcke said recently about the progress of a draft plan he said he's writing.
Wilcke said there are three main obstacles in the way of his no-smoking program: a persistent shortage of funding, the lack of health-promotion staff, and the general lack of support for the anti-smoking strategy among bureaucrats.
"Even if the health board supports it philosophically, by letting me develop a strategy, I just don't have the resources to look for funding elsewhere," Wilcke lamented.
The main products of such inaction are, of course, disease, unsustainable public health costs, pain and premature death.
Needed: more health crusaders
Community leaders at all levels of society in Nunavut will need to add their own voices to the campaign against tobacco if the goal of a smoke-free society in the next century is to be attained. Convincing smokers to quit tobacco and protecting future generations from the disease of addiction doesn't require a great deal of money. But it will require personal commitment.
Anti-smoking activists, for instance, could exercise considerable influence over the course of future tobacco regulation in northern communities by helping local governments pass their own smoke-free ordinances.
"My sense is that it would be really great if the health boards themselves would take the initiative," NWT chief medical officer Dr. Ian Gilchrist said.
"I think that one of the primary roles of health boards is to be proactive, and to take positions on what are really very important health issues."
Everyone ever hooked on tobacco will say that quitting smoking wasn't easy. But most would agree the personal rewards of a tobacco-free lifestyle are well worth the passing discomfort that withdrawal may cause.
"The food starts to taste really good. You no longer are really stinky, and you save lots of money," said Ernerk, who calculates he's saved between $4,000 and $5,000 a year since butting out for good in 1991.
Ernerk said he wishes parents in Nunavut would be more aggressive about dissuading their children from smoking, so that when the new territory comes into existence next year it will not lead the country in new tobacco addiction rates, also.
"It's too late to undo the past," Ernerk said. "But we can do better in the future, by promoting no smoking, a healthy community, a healthy body, a healthy people."
Get that poison out of my face
Why second-hand smoke is an environmental hazard and a threat to community health
IQALUIT - Okay, tobacco fumes offend the
nose and irritate the eyes. But should people fret about breathing second-hand
smoke?
That depends on how much people value their health, and the extent to which communities are willing to tolerate the risks caused by people who smoke in public places.
Research shows that second-hand tobacco smoke is not simply an irritant. It can be as deadly for non-smokers as it is for those who choose to light up.
Which is why clean-air regulations and controls on second-hand smoke are issues for the entire community.
Second-hand tobacco smoke contains more than 50 separate compounds identified as carcinogens, or cancer-causing substances.
Also known as environmental tobacco smoke (ETS), this toxic cloud is a complex mixture of nasty chemicals generated during the burning - and smoking - of cigarettes and other tobacco products.
Many of these chemicals are recognized as hazardous to human health in the U.S. and Canada, and typically include:
Scientific knowledge about the effects of environmental tobacco smoke on human health expanded considerably in North America after the publication of comprehensive reviews by the U.S. surgeon general, the U.S. Environmental Protection Agency and the National Research Council.
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A toll-free cancer information hotline is available in all NWT aboriginal languages, sponsored by the Canadian Cancer Society. Callers can speak with trained medical interpreters, who do their best to answer all questions about cancer and cancer prevention, using resources provided by the Cancer Society. Cancer Information Hotline: 1-800-261-4673. |
Some studies show that a non-smoker living with a smoker has a 30 per cent greater chance of getting cancer. People who work in bars or restaurants where smoking is permitted are 50 per cent more likely to develop lung cancer.
Second-hand smoke has been shown to promote chronic illnesses such as childhood asthma and fatal heart disease and is believed to be one of the factors contributing to Sudden Infant Death syndrome (SIDS), also known as crib death.
Passive smoking - exposure to second-hand smoke - has also been implicated in increased risks for asthma, respiratory infections and attention disorder.
A medical officer in the Baffin and Keewatin regions once estimated that 99 per cent all respiratory problems among children in the eastern Arctic for whom air ambulance services were required result from exposure to second-hand smoke.
Researchers in the U.S. are investigating the links between second-hand smoke and other medical complications for which there appears to be evidence to suggest a strong correlation.
These include spontaneous abortion, cervical cancer, and the exacerbation of asthma in adults.
Public smoking and youth: addicts make bad role models
Given the high rate of tobacco addiction among adults,
including parents, teachers and community leaders, it isn't surprising to
find young people in northern Canada taking up smoking at a rate many times
that of their counterparts in other regions of the country.
But northern youths who spend several hours a day breathing other peoples' tobacco smoke - in the home, at work, in the school yard or on the land - are exposed to much more than direct risks to their health: they are immersed in a tobacco sub-culture whose implied creed is that smoking is socially acceptable, even venerable behavior.
Many northern kids spend their childhood in a perpetual cloud of tobacco smoke at home, which is why the prevalence of smoking among school-age children in Nunavut is so alarmingly high.
Health and Welfare Canada reports that a fifth of all northern children between ages 10 and 14 use cigarettes. Aboriginal youth, in particular, are at great risk of addiction.
A 1993 survey found that 68 per cent of Inuit between ages 15 and 19 smoked, compared to just 30 per cent of non-native youths. Little wonder, then, that Nunavut also leads the nation in adult smoking rates: Health Canada estimates that 77 per cent of Inuit between ages 25 and 44 are currently addicted to cigarettes.
And so the disease of nicotine addiction spreads from one generation to the next: from parent to child, from brother to sister, from pupil to classmate; transmitted to the brain and blood through the eyes like a virulent contagion.
At a time when the vast majority of adults in leadership positions are themselves hooked on tobacco, changing Nunavut's laissez faire views on smoking may at first appear like an impossible goal.
The good news is that communities can begin to change the future now, by enacting and enforcing local bylaws that increase the number of smoke-free public areas. Extending a tobacco ban to restaurants and retail stores would be a good place to start.
U.S. researchers, who looked at the effects of tobacco regulations in the early 1990s, found that banning tobacco in public places had a significant impact on teen smoking behavior, apparently because teenagers tend to be more sensitive to how others view their behavior than adults.
"Stringent regulations are bound to convey to the smoker that his or her behavior is in some sense socially unacceptable," J. Wasserman wrote in his 1991 study, The effects of excise taxes and regulations on cigarette smoking, published in the Journal of Health Economics.
In addition to offering youth protection from second-hand smoke, Wasserman noted that a smoke-free policy had the power to convey the inappropriateness of smoking by removing the "visual cue of adult smoking behavior."
IQALUIT - Restrictions on tobacco have been slow in
coming to Canada's North, with resistance to anti-smoking regulations coming
most virulently from hotel and restaurant owners.