this week, the following article from Nunavik on the Inuit Health Survey is typical of the nutritional dilemma faced in most Inuit hamlets I have worked in...again the photos are mine
crowberries and liverwort and yellow oxytrope. With its beach glass and fossil-crusted stones, the shoreline would be picturesque, too, 
if it weren't littered with broken bicycles, Pepsi cans, Gobstopper wrappers and potato chip bags. Caribou-hunting season has begun, so older men with rifles saunter down muddy, rain-soaked streets. But young Inuit have other things to do nowadays, like hot-rodding through town on 4x4s, or staring out the doorways of weather-beaten houses smoking cigarettes.
Down at the Salluit Co-op, 
a utilitarian depot that sells motorcycles, fox pelts and Kool-Aid, the food selection is sketchy and prices exorbitant. A lone head of iceberg lettuce, its leaves wilted and black, sits in the vegetable case. A dozen eggs cost $4.29. Three litres of long-life milk sells for $10.39. Not so surprising that grocery carts are a nutritionist's nightmare, loaded with sugary snacks and ready-made frozen dinners.
In little more than a generation, life in remote northern communities like this one has changed radically. But as these once nomadic people put down stakes, cope with shifting weather patterns, adopt sedentary habits and trade traditional "country" foods for a sweet and starchy southern diet, health experts are getting nervous.
"If you were to go to a grocery store in the north, it's basically three times more expensive than down south here in Montreal," McGill University epidemiologist Grace Egeland said.
"You add a high unemployment rate and low cash flow through the homes, and that will affect purchasing behaviour," Egeland said. "And if you don't have access to country food - you don't have a hunter in the home or perhaps because of changes in the climate there's not the same access - the dollars may not stretch as far in terms of replacing country food with healthy market food alternatives.
"Fast food for Inuit has historically been easy and good for you, where it would provide all the nutrients you needed through the marine mammals and land animals. The stomach contents of a caribou is probably their tossed salad. ... You would need 50 hot dogs to get the same amount of iron as a little piece of seal meat that would fit in the palm of your hand."
On board the Amundsen icebreaker since Aug. 17, Egeland is leading the Inuit Health Survey, a comprehensive look at the health and welfare of Inuit in Nunavut, the Northwest Territories and Labrador's Nunatsiavut communities. Éric Dewailly, a public health investigator at Centre Hospitalier Universitaire de Québec, got things going in Nunavik three years ago, using the Amundsen as a base to see how changing diet and exposure to contaminants were affecting the health of Quebec Inuit, focusing on heart disease, diabetes and cancer.
Starting in Sanikiluaq, an outpost of the Northwest Territories( my correction Sani is part of Nunavut ) deep in Hudson Bay, Egeland's 40-member team - nurses, nutritionists, dietitians, lab technicians and bilingual interviewers - has been using the ship as a travelling medical centre, collecting blood samples, testing glucose levels and bone density and looking for evidence of chronic diseases or contaminants.
"The logistics of doing state-of-the-art biomedical tests is really hindered in communities if you don't have a support system," Egeland said. "What's nice with the ship is that everything can be handled in a timely way, prepared and stored in minus 80 degree freezers and then packaged in a sound way and shipped for more analysis down south."
Heeding requests from Inuit leaders and with major funding for International Polar Year, Egeland broadened the scope to include mental health issues, like addiction, depression and suicide, and social conditions, like household crowding and hidden homelessness.
Researchers have been asking participants whether there were visitors staying in their home who had nowhere else to live. "We have heard of people saying that homes are so crowded that people sleep in shifts."
The long list for public housing 
means it's not uncommon to have several generations living together, an accomplishment in communities where houses are tiny and the birth rate is high. "If you have flu or a respiratory problem, it can spread quite easily in a more crowded home environment."
Geraldine Osborne is deputy chief medical officer for the Nunavut government, a key partner in the travelling health study. Until now, Osborne said Inuit have been shielded from chronic illnesses like diabetes and heart disease that have clobbered so many First Nations communities. Experts have long credited those healthy hearts to the traditional Inuit diet of fish and marine mammals drenched in omega-3 fatty acids. But as more families move away from traditional food, Osborne said, "we feel those chronic diseases are right around the corner."
The impact of diet change is already evident in children. In Nunavut, for instance, cases of rickets are increasingly common. "The southern diet people are adopting is not one rich in vitamin D. Milk is very expensive and many people are lactose intolerant," Osborne said.
"There's a push to get people to make smart choices, eating more eggs and oily fish, but it's not always an easy sell."
"Older people tend to eat better because they still rely on country food," said Chantal Parent, a Montrealer who has been nursing at the CLSC in Puvirnituq for three years. "When they try, they don't really know how to cook our food. So it's much easier for them to eat things that are ready made - pizza, chicken nuggets, candy and sugary soft drinks."
In the tidy clinic, adjoining the Hudson Bay Hospital Centre, Parent and nurse Émilie Fréderic are already seeing the consequences - adults and children who are malnourished yet overweight. "Diabetes is not as common as it is in Indian communities, but it is starting to be an issue," Fréderic said.
Dental health is another big concern. "Babies fall asleep with the bottle in their mouths, so even if they don't have their teeth yet, it affects them as they are teething," Parent said. "Then they eat a lot of candy and soft drinks. We often see women who are 25 years old who don't have any teeth."
Dietitian Nancy Faraj, a member of the advance team that visited Sanikiluaq before the Amundsen dropped anchor nearby, was taken aback to see children as old as 4 or 5 who were still drinking formula from a bottle - and Carnation Evaporated Milk at that. But Faraj said their job was to collect data and offer suggestions, not pass judgment. And she said the Amundsen proved to be an icebreaker in more ways than one. People who'd initially refused to take part in the study changed their minds after the ship arrived - and it wasn't only because the crew offered rides in the Amundsen's motorized Zodiac raft. "I got the feeling they realized that this was something monumental, a once in a lifetime event, and they wanted to be part of it."
Christine Iqilak, a local volunteer in Sanikiluaq, said it was also an occasion for nurses to learn something. When a visiting nurse said seal blood was rich in iron, Iqilak asked how much her friend would need to take to go without iron pills when pregnant. "The nurse did not have a clue. So I think it's a good idea to teach them about differences in culture and what you are brought up with."
Egeland said that as recently as the 1970s, Inuit families were moving in from their far-flung camps to settle in towns and villages. Now climate change is adding another wrinkle to disrupt their concept of what's normal. "If the ice is breaking up earlier or setting in later, that has an impact on whether they can get out on the land to hunt."
Eventually - full results won't be ready for two years - Egeland hopes this most comprehensive baseline study of Canada's Inuit will provide the tools needed to shape policy and health awareness campaigns, while allowing for scientific comparison with Inuit in Alaska, Greenland and Denmark.
"When you work with other cultures, they hold a mirror up to your own," Egeland said.
She noted much of our present understanding of the role of good nutrition in health stems from a landmark study that showed the low rate of heart disease among Greenland Inuit compared with Danes and other Western cultures. "That has led to a lot of interest in omega-3 as it relates to heart disease. Now it's time to give back to them."
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