*3.4. Categorization of the Territories*

Categorization based on the level of pollutant emissions, the proportion of market food in the diets, and the per capita consumption of meat and fish allowed to classify four types of territories (Table 9).



Source: authors' development.

Type 1 territories were those most intensively explored by Russian hydrocarbon and mineral companies. The group included the territories of Yamal-Nenets Autonomous District and three areas of Krasnoyarsk Krai-Norilsk and Taimyr Dolgan-Nenets municipal areas and Turukhansk district, where the highest level of air pollutant emissions was registered. The percentage of households with access to quality-assured sources of water was low. In territory 6, the volume of wastewater discharge into the surface and underground water sources was the highest in the Russian Arctic.

Type 2 included the territories of Murmansk and Archangelsk oblasts adjacent to the biggest cities and seaports in the Russian North, Murmansk, and Archangelsk, respectively. In Type 2 territories, people had predominantly westernized type of nutrition with a low proportion of traditional foods in their diets. Due to the low standards of living in Type 2 territories (in 2017, the proportion of the population living below a minimum subsistence income was 18.0%, 15.0%, and 13.5% in Komi Republic, Arkhangelsk, and Murmansk regions, respectively), there was registered underconsumption of meat and dairy products and vegetables.

Inland territories of Russian Arctic relatively remote from either urban or industrial agglomerations were recognized as Type 3 (Republic of Sakha) and Type 4 (Chukotka and Nenets autonomous districts). In Type 3 and 4 territories, diets of people were more traditional compared to the western parts of the Russian North, with a predominance of reindeer meat, fish, and marine mammals. The Yakuts are historically semi-nomadic hunters engaged in animal husbandry, focusing on reindeer herding [114], while people in Type 4 territories depended on fishing. In Chukotka, per capita consumption of meat was the lowest in the Russian Arctic—44 kg/year in 2017.

Despite the relatively similar reliance of diets on traditional food in Type 3 and Type 4 territories, the average incidence rates of diseases under study varied widely (Table 10). This finding supported the assumption that in different types of circumpolar territories, public health parameters are affected by different combinations of factors, nutritional ones being but a few of them.


**Table 10.** Incidence rates of *Yn* diseases and related health problems across the territories of the Russian Arctic, average in 1997–2017, cases per 1000 people.

Source: authors' development.

### *3.5. Revealing the Correlations*

To reveal the determinants of varying incidence rates across the four types of territories, the impacts of *Xn* factors were graded on a scale from high positive to extremely negative. Based on the previous results of collinearity checks and categorization of the territories, the following independent variables were eliminated from the models: in Type 1 territories—*X*<sup>2</sup> and *X*4; in Type 2 territories—*X*<sup>4</sup> (*X*<sup>6</sup> and *X*<sup>13</sup> were considered in territory 4 only, *X*5—in territory 1); in Type 3 territories—*X*<sup>15</sup> and *X*16. The highest positive impact on public health was exerted by the quality of nutrition (consumption of fish and marine mammals and vegetables) in Type 1 and Type 3 territories, economic variables of income, poverty, and food expenditures in Type 2 and Type 3 territories, and quality of running water supply and wastewater treatment in Type 3 and Type 4 territories (Table 11).


**Table 11.** Positive effects of *Xn* variables on the reduction of *Yn*.

Note: HP—high positive, P—positive, MP—moderately positive. Source: authors' development.

The most negative impact on public health was exerted by low percentage of households with the running water supply in Type 1, 2, and 4 territories, wastewater discharge into surface and underground water reservoirs in Type 4 territories, consumption of meat products in Type 1 and 2 territories and bread in Type 2 territories, and low economic standards of living in Type 3 and 4 territories (Table 12).


**Table 12.** Negative effects of *Xn* variables on the reduction of *Yn*.

Note: EN—extremely negative, N—negative, MN—moderately negative. Source: authors' development

The revealed correlations between *Xn* variables and *Yn* health parameters allowed to test the hypotheses:

**Hypothesis 1 (H1):** *partly confirmed. Out of the environmental variables X1–6, the quality of running water and wastewater treatment have the most positive e*ff*ect on the reduction of incidence rates of certain infectious and parasitic diseases; neoplasms; diseases of the nervous system; diseases of the skin and subcutaneous tissue; congenital malformations, deformations, and chromosomal abnormalities. Improvement of the access to the quality-assured sources of water decreases incidence rates of endocrine, nutritional, and metabolic diseases; diseases of the circulatory, respiratory, and genitourinary systems; diseases of the musculoskeletal system and connective tissue.*

**Hypothesis 2 (H2):** *not confirmed. The most negative e*ff*ect on the public health parameters is caused by the low quality of drinking water and the low percentage of households with running water available in their homes. Economic factors also negatively a*ff*ect public health. As the economic accessibility of food decreases, nutritional habits of consumers change from high-fat animal products to bread, macaroni products, and low-nutritious starches. Per capita consumption of meat, dairy products, and vegetables is well below both the national average and Russia's national standard of healthy nutrition [115]. In some of the territories, higher values of nutrition variables X7–12 correlate with the emergence of the diseases of the nervous system; diseases of the skin and subcutaneous tissue; diseases of the musculoskeletal system and connective tissue; congenital malformations, deformations, and chromosomal abnormalities (all four—increase in X7); certain infectious and parasitic diseases (increase in X8). The proportion of market food in the diets is the highest among the territories of the Russian Arctic, but due to low living standards, people cannot a*ff*ord themselves consuming market foods of high quality. Available vegetables, dairy products, meat, and fish are frozen and with a high content of food preservatives to extend the shelf life.*

**Hypothesis 3 (H3):** *confirmed. Low income, poverty burden, and a high proportion of food expenditures in households' budgets (economic variables X13–16) along with the prevalence of traditional food in the diet exert a negative influence on the majority of Yn diseases in Type 3 and Type 4 territories. Low diversified meat-based and fish-based diets result in the increase in the incidence rates of diseases of the digestive system, diseases of the skin and subcutaneous tissue, diseases of the musculoskeletal system and connective tissue, and infectious and parasitic diseases. The growth of real value of cash incomes and reduction of the proportion of population living below a minimum subsistence income may allow reducing the incidence rates of the diseases of the circulatory system; congenital malformations, deformations, and chromosomal abnormalities; neoplasms; diseases of the blood and blood-forming organs; certain disorders involving the immune mechanism; endocrine, nutritional, and metabolic diseases.*

#### **4. Discussion**

Across Arctic communities, public health outcomes are affected by different combinations of environmental, nutritional, and economic factors. Both the modes and degrees of the influence are determined by a location of a territory, level of industrial development, economic and social situation, and patterns of life and food consumption.

Environmental factors, primarily, air pollution, are commonly recognized as the sources of the most serious toxicological impacts on human health, including respiratory and cardiovascular diseases, neuropsychiatric complications, and cancer [116,117]. In the Russian Arctic, previous studies identified such emissions as sulfate aerosols from metal smelting [118] and flaring associated with oil and gas extraction [119] but found no evidence of direct health implications from air pollutant emissions [2,120]. In this study, the negative influence of air pollution on health parameters was revealed across all types of circumpolar territories. Among the most notable consequences were increased respiratory ailments – the incidence rates of *Y*<sup>9</sup> were unacceptably high across all four territory types (Table 10). Syurin and Burakova [121] found that the development of respiratory pathology patterns (primarily, chronic bronchitis and chronic obstructive pulmonary disease) was closely associated with the locations of harmful industries in the western part of the Russian Arctic. In those Types 2 and 4 territories, people experienced increasing susceptibility to air irritant agents (*X*<sup>1</sup> and *X*2) and the quality of water supply systems in the cities (*X*<sup>5</sup> and *X*6). This corresponded with the recommendations to improve access to clean water to reduce respiratory morbidity made by Kovesi [122,123]. Miller and Gaudette [124] suggested that a lack of vitamins (particularly, vitamin A) in the diet might be a possible co-factor of higher lung cancer in northern communities, while Tse et al. [125] reported household crowding and living conditions to be significantly associated with respiratory infections among indigenous people. In relation to our findings, it seemed that the adequacy of nutrient intake (*X*<sup>7</sup> and *X*11) along with the degree of outdoor physical activities (*X*13, hunting and fishing) had positive effects on the reduction of *Y*<sup>9</sup> incidence rate. Other health issues for which a correlation with environmental factors was revealed included eye irritation, increased cardiovascular morbidity, and carcinogenic effect of pollutants. This finding supported earlier results of Li and Mallat [126], Vermaelen and Brusselle [127], and Chen and Kan [8].

Among environmental factors, air pollution was recognized as moderately negative, the most negative being the quality of water and the volume of wastewater discharge. This corresponded with Hennessy et al. [17], Thomas et al. [16], and Wenger et al. [128], who all demonstrated a direct correlation between clean water in sufficient quantities and significant reductions in the occurrence of illness and hospitalizations due to infectious disease. Our finding also supported Nilsson et al. [129], who reported that over one-third of the population in the circumpolar territories of Russia used drinking water from non-centralized sources; Bressler and Hennessy [130], who recognized poor access to safe water among the causes of gastrointestinal illness and water-washed infections, such as respiratory tract infections and skin infections; as well as Daley at al. [131], who associated inadequate domestic water quantities with transmissible diseases and bacterium infections in indigenous communities. According to Hennessy and Bressler [132], the burden of inadequate water and sanitation services on public health is higher among rural and indigenous populations in the Arctic. In contrast with this opinion, our study demonstrated extremely negative health effects of poor water supply systems and water pollution not only in the eastern parts of the Russian Arctic but also in urbanized Type 2 territories and industrialized Type 1 territories. In this part, our results corresponded with the data of Dudarev et al. [133], who discovered that 51% and 19% of water samples taken from the centralized water sources in Type 2 territories did not comply with hygienic norms in terms of chemical and biological contamination, respectively. In the industrialized territories of Type 1, the coverage of households by public water supply exceeds 80%, but the majority of water supply facilities have not been properly repaired, cleaned, and disinfected for a long time [133]. Centralized water sources and drinking water are highly contaminated by chemical and biological agents. In Type 1 and Type 2 territories, water of low quality is delivered through the outdated supply system to the majority of households, which results in the growth of incidence rates of endocrine, nutritional, and metabolic diseases; diseases of the circulatory, digestive, and genitourinary systems; diseases of the musculoskeletal system and connective tissue.

High pollution load increases the level of contamination of wildlife, a premier source of food for indigenous peoples in the Arctic. According to Vinokurova [134], Greaves [135], and Ignateva [136], pollution destabilizes the ecological base of the High North and threatens food and nutrition security. Previously, it was demonstrated that traditional food consumption patterns might benefit various health parameters in indigenous communities [32,77–83,137]. As distinct from these studies, we revealed the negative health impacts of traditional food in some indigenous habitats in Type 3 and 4 territories. This corresponded well with earlier findings of Jeppesen et al. [84], Bjerregaard et al. [85], and Jørgensen et al. [89] that traditional dietary pattern was associated with lower β-cell function and a higher risk of impaired fasting glucose and type 2 diabetes mellitus. It was found that undiversified meat and fish-based diets in Type 3 and Type 4 territories, respectively, correlated with higher incidence rates of endocrine, nutritional, and metabolic diseases and diseases of the circulatory and genitourinary systems.

In the indigenous communities and rural territories of Type 3 and Type 4, diversification of the diets may impact public health in a positive way, but the economic accessibility of market food among rural people is low. Dudarev et al. [36] complained about the prohibitively high cost and limited availability of market food across the Arctic zone of Russia. Wesche and Chan [80], Ford [138], and Guyot et al. [139] found that low levels of income and high food costs resulted in changing diets and neglecting healthy nutrition. Poverty forces people to seek a substitution to the expensive market food in traditional hunting and fishing, but the contribution of traditional economic activities to the improvement of public health is minor. There are economic barriers reported by Lambden et al. [32] and Goldhar et al. [140], such as high costs of hunting and fishing, tightening food sharing networks, and hunting and fishing regulations.

In industrialized and urbanized territories of the Arctic Zone of Russia, on the contrary, we registered the increase in the proportion of market food in the diets, which was in line with the emergence of "nutritional transition" previously conceptualized by Egeland et al. [141] and Kuhnlein et al. [31] in the case of the Canadian Arctic. Young et al. [142] supposed such transition to contribute to an increase in diabetes and other diseases among northerners. Receveur et al. [143] and Nakano et al. [144] recognized an increased consumption of market food as a contributing factor to a higher incidence of overweight and obesity. Our findings demonstrated that in the territories where the proportion of market food in the diets was above the Arctic average, the negative impact of the transition was limited to the increased incidence rates of the diseases of the digestive system, immune diseases, and neoplasms.

#### **5. Conclusions**

This study attempted to convey the existing complexity of public health impacts in the case of the Arctic zone of Russia. It was investigated how various factors were interrelated with the incidence rates of major diseases in different types of circumpolar communities. The establishment of the set of environmental, nutritional, and economic variables allowed for a particularly useful analysis of the variations within the groups of health impacts and thus made the levels of exposure to certain diseases comparable across the territories. The territories were grouped in four types based on the respective levels of influencing groups of factors: (1) industrial sites, the most negative health impacts of air and water pollution; (2) urban agglomerations, the most negative health impacts of nutritional factors; (3) inland and (4) coastline indigenous communities, the most negative health impacts of economic factors.

The testing of the three hypotheses resulted in the identification of positive and negative effects on selected health parameters. The relationships between the regressands and corresponding regressors were discovered individually for eight territories of the Arctic Zone of Russia and generalized for the four types of the territories, given the alternations between the highest positive and most negative influences on the dependent variables. In Type 1 and Type 2 territories, poor quality of running water along with low access to the quality-assured sources of water increased the exposure to infectious and parasitic diseases, neoplasms, diseases of the circulatory, respiratory, genitourinary, and nervous systems, and endocrine, nutritional, and metabolic diseases. In Type 3 and Type 4 territories, low diversified diets based on traditional food correlated with the increase in the incidence rates of nutritional and metabolic diseases. Underconsumption of milk and vegetables resulted in a lower intake of vitamins and mineral nutrients, including calcium, phosphorus, magnesium, and zinc. Declining economic accessibility of adequate diets further exacerbated nutrition-related health problems.

The set of environmental, nutritional, and economic variables applied in this study as regressors was open-ended and discussible. The six-stage regression analysis that involved collinearity checks based on the VIF and BSA methods allowed to build regression models in which regressands' variations were well explained by independent variables. However, due to the ongoing environmental, climate, and economic changes in the Arctic, a further focus on finding the most feasible influencing factors of public health could place the issue in the larger context of social-ecological change that is affecting the resilience of the Arctic and health and well-being of its inhabitants. In such respect, further studies of health impacts in the High North should involve comparisons with other Arctic countries except Russia. Effectively addressing emerging health-related challenges require continued research into health risk factors and trends in order to facilitate the identification of priority areas for policy interventions.

**Author Contributions:** T.G. designed a research framework; V.E. conceptualized the methods, performed the data collection, analyzed the data, and wrote the paper. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research and the APC were funded by the National Social Science Fund of China (grant no. 18BGJ004).

**Conflicts of Interest:** The authors declare no conflict of interest. The founding sponsor had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

#### **References**


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