Research with Arctic Peoples:
Unique Research Opportunities
in Heart, Lung, Blood and Sleep Disorders
Meeting
Summary
Bethesda, Maryland
July 28-29, 2004
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TABLE OF CONTENTS
Introduction
The National Heart, Lung, and Blood Institute (NHLBI) and the Canadian Institutes of Health
Research (CIHR) co-sponsored a Working Group entitled "Research with Arctic Peoples: Unique
Research Opportunities in Heart, Lung, Blood and Sleep Disorders" to address three objectives
related to research with Arctic Peoples. The meeting was international in scope with investigators
from Greenland, Iceland and Russia as well as Canada and the United States. Other United States
agencies sending representatives included the Fogarty International Center, the State Department,
the Indian Health Service, the National Cancer Institute, and the Department of Agriculture.
Canadian health agencies represented included the CIHR -Institute for Aboriginal Peoples'
Health, CIHR - Institute of Circulatory and Respiratory Health, and CIHR - Institute of Gender
and Health, and CIHR - Rural and Northern Health Research Initiative. Also attending were
representatives from the International Union for Circumpolar Health (IUCH) and the National
Indian Health Board. A list of the working group members, NHLBI staff, and observers
participating in this Working Group is provided in Appendix I.
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Background
Arctic peoples are spread over eight countries and comprise 3.74 million residents of
whom 9% are indigenous. Of the eight Arctic countries, Iceland is the only Arctic country
entirely within the region traditionally defining Arctic people (the region north of 60
degrees north latitude). Other Arctic countries include Greenland (Denmark), Canada, Norway, Finland,
Sweden, Russia, and the United States. Although Arctic peoples are very diverse, there are a
variety of environmental and health issues that are unique to the Arctic region and research
exploring these issues offers significant opportunities as well as challenges. For the remainder
of this document, the terms Eskimo (preferred by Natives in Alaska) and Inuit (preferred by
Natives in the remaining Arctic countries) will be used to refer to the same Yupik/Inupiat
people.
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Working Group Objectives
The day and a half day agenda was divided into three sessions to allow time to address
each of the objectives in separate sessions and then to review results as a group to refine
recommendations and set priorities. The three Working Group objectives were:
1) Identify and prioritize scientific opportunities for research on heart, lung, blood, and sleep
disorders that may be uniquely addressed with Arctic Peoples: Population-based research that might
be pursued with Arctic peoples comprises two areas: observational studies and clinical
trials/intervention studies. It was useful to identify how these particular designs may be
utilized to address research hypotheses that are uniquely addressable in Arctic Peoples.
Given the logistical difficulties and high expense, research objectives in the Arctic should
be pursued in large part because they can not be done in areas more hospitable to research.
Among the research questions that can be addressed most appropriately or uniquely with Arctic peoples,
many derive from the unique risk profile of the inhabitants, their geographical isolation, limited
dietary choices, high exposure to some contaminants, limited health care delivery (in some areas),
and extreme living conditions. To identify research priorities, it was considered essential to
obtain a perspective from both the Native Arctic Peoples and the primarily non-Native scientific
investigators.
2) Identify obstacles to implementation and methods to address them: Formidable obstacles
to health research with Arctic Peoples account, in part, for the dearth of data documenting health
problems and offering solutions to those problems. Physical obstacles include harsh weather, the
low density of the population, and the lack of options to transport personnel, equipment and samples
to and from villages where many Native people reside. Infrastructure problems include lack of
trained researchers and research institutions in the regions of opportunity and lack of biomedical
research infrastructure including clinic space, imaging equipment, laboratories, freezer space,
trained technicians, and housing. Finally, the cultural differences and previous negative experiences
of the Eskimo and Inuit people with research offered special challenges to investigators in conducting
culturally sensitive and effective research that is scientifically meritorious and of true benefit
to the participants and the overall community.
3) Facilitate international comparisons: Since Alaska is the only Arctic state within the
United States, U.S. research with Arctic peoples must focus on Alaska. However, the value
of international comparisons with the other seven countries with interests in Arctic Research was
acknowledged. In fact, this was a major reason for the creation of the International Union for
Circumpolar Health (IUCH). Comparisons among the member countries reflected their shared interests and understanding that common research objectives and problems may best be addressed with cooperation,
collaboration and standardization. Many members of the IUCH have more extensive experience in
biomedical research with Arctic Peoples than has been supported within the United States.
Factors that will facilitate international comparisons were addressed to determine how countries
can promote a common agenda that will be mutually beneficial.
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Working Group Presentations:
Charge to the Working Group: Dr. Barbara Alving, Acting Director, National Heart, Lung,
and Blood Institute, provided opening remarks and the charge to the Working Group.
She stressed the importance of current efforts between the United States and Canada to
build partnerships and collaborations and that the common interest in Natives of the
Arctic may offer an additional opportunity. She noted that some of the issues regarding
research among Alaska Natives are common to Natives in the lower 48 states as well.
She suggested there are multiple opportunities for research and collaboration and that this
Working Group would help to prioritize those opportunities. Finally, she thanked
the CIHR-Institute for Aboriginal Peoples' Health for co-sponsoring the Working Group and
hoped that it would lead to further collaborative efforts with NHLBI.
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Session on Research Priorities
The first speaker, Ms. H. Sally Smith, co-chair of the Working Group and a Yupik Eskimo, is the current
Chair of the National Indian Health Board. She provided a broad
overview of the health of Alaska Natives and urged the participants to recognize how the
interests of NHLBI and CIHR may or may not overlap with those of the Native community.
She focused the group's thinking by noting the total population of Alaska is 627,000 people;
half live in Anchorage. Natives represent 19% of the state's population and represent a
diverse group including Eskimos, Indians and Aleuts. She contrasted the health priorities
in 1950 with those of today noting the decrease in infectious diseases, continuing high rates
of injuries and accidents, and the increase in chronic diseases including cardiovascular
disease. She noted that rates of cardiovascular disease have remained stable in Alaska
while declining for two decades in the lower 48 states. Citing results from the Behavioral
Risk Factor Survey, she explained that half of all deaths in Alaska Natives can be related to
lifestyle choices including high cigarette smoking, rising obesity and diabetes, declining
physical activity, and changing diets from subsistence to market foods. In contrast,
community concerns focused more on alcohol and substance abuse, declining traditional
lifestyle, and the effects of contaminants. She stressed that current needs include a system
to monitor the health behaviors of tribes, a surveillance system to monitor chronic disease
including disease registries, and intervention studies to prevent and treat diseases with
rising incidence.
Barriers to research in Alaska are numerous. Historically, research is seen as not offering
much benefit and, perhaps, harming the community. Distrust increased because of investigators
taking and never giving back to the community. Often, research results were shared with the scientific
community before being shared with the Native community. Other factors creating barriers to
research with Arctic Peoples include poor education leading to a lack of understanding of research,
limited supply of Native scientists, lack of educational programs to train students interested in
biomedical research, and a dearth of mentors to train and inspire students. Potential solutions
include creation of mentorships, development of advanced degree programs in Alaska educational
institutions, simplification of the grant application and reporting processes, emphasis on
community partnerships for research projects, and more rapid response for funding decisions.
Distance learning programs may offer a solution to the formidable barrier of geography.
Natives have made great progress in managing their health care. Now they want to manage
their health research.
Dr. Jeff Reading offered a Native perspective from Canada. As Director of the CIHR -
Institute for Aboriginal Peoples' Health (CIHR-IAPH), he presented the conclusions of a report
entitled "Dialogue on Northern Research" summarizing a meeting held in early 2004 on priorities
for research in Northern Canada. The meeting included Aboriginal representatives, researchers
and government agency representatives. He noted that the CIHR-IAPH is very interested in
collaborations and partnerships. Several have been developed in the past three years. Requests
for applications have been released through the latter for small planning grants as a forerunner
to larger grants for actual research. This may offer a model for future collaborations between
the United States and Canada. Recommendations from the cited report included increasing capacity
within the communities regarding research, giving greater weight to traditional knowledge in
reviewing applications, establishing community-based research, and developing an integrated
northern policy. Specific needs included better integrated policies, more infrastructure and
people for research, more educational alternatives within northern communities, establishing a
community relevance review as a necessary step in the research approval process, and consulting with
the communities earlier in the process.
Dr. Peter Bjerregaard presented the results of research with the Inuit in Greenland, which
represent 90% of the population of Greenland. Unlike the United States, the government of Greenland
is run by the Inuit, thus, decisions on research are made by the Greenland government and the
researcher. Conditions for research are similar to Northern Alaska and Northern Canada. There
are no roads between villages; all transportation is by air or by boat. Health priorities are
related to lifestyle: suicides, alcohol, tobacco and the metabolic syndrome. Research priorities
include societal development and health, social inequality, child health, interventional research,
and human biology and disease. The main obstacle to research with the Inuit in Greenland is a lack
of infrastructure. For example, many of the Inuit speak only Greenlandic so interviews must be
done in that language. In addition, the low density of the population and high travel costs lead
to high costs of research.
Dr. Kue Young presented results from research with the Inuit in Canada. Early data indicated
ischemic heart disease of the Inuit was 50% of the rate for whites, cholesterol levels and triglycerides were low,
diabetes prevalence was low and dietary intake of polyunsaturated fatty acids was high.
Diabetes rates were very low in Canadian Inuit compared to First Nations (Indian Tribes of Canada). Obesity rates were
lower for Inuit than those for First Nations but higher than those for Canadian whites.
Obesity did not seem to confer the same degree of increase in lipids and blood pressure as for
non-Natives. The proportion of the Native population currently smoking cigarettes was very high
compared to non-Natives. Genetic risk factors varied but in both directions, e.g., ACE high risk
alleles were less frequent, but ApoE high risk alleles were more frequent.
Dr. Hakon Hakonarson reported on the efforts of deCode Genetics, to mobilize the
resources within Iceland to address genetic causes of disease. The strength for genetic research
in Iceland is the phenomenal genealogical database. Records have been linked to genotype and
phenotype data including medical records to produce a data base that can quickly and thoroughly
explore scientific questions linking many distant relatives. Genotyping included 1200 markers
per subject for more than 100,000 subjects. The goal was to identify genes that at least double
risk and account for a large percentage of patients. Iceland is an excellent population for this
type of research because of its isolation for the past 11 centuries and its elaborate genealogical
and medical record systems. However, deCode continues to look for collaborators with extensive
genealogical and medical records to facilitate additional research and to replicate findings
from the Iceland Study. Since the Iceland population is not Native, there is an opportunity to
explore gene-environment interaction by collaborating with studies of the Eskimos/Inuit.
Dr. Larisa Tereshchenko provided results of analyses on the Native population in the
Tyumen Region of Siberia, Russia. The indigenous population includes about 38,000 Natives
comprising Khants, Selkups, and Yamal Nenets. Diseases with high incidence/prevalence include
tuberculosis, rheumatic fever, and congenital heart disease. The prevalence of alcoholism is very
high among non-nomadic Yamal Nenets but not among the nomadic Yamal Nenets. The prevalence of
hypertension is lower than in the non-Native population. Coronary artery disease incidence is
low with few MIs. The prevalence of obesity is low compared to non-Natives. There is an interesting
observation of rapidly rising hypertension rates and higher left ventricular hypertrophy for recent
non-Native immigrants to the region.
Dr. Barbara Howard presented results from the GOCADAN Study. The study included
examinations on 1,214 Eskimo men and women ages 18 and older from the Norton Sound Region of Alaska.
Data indicate a high prevalence of atherosclerotic plaques. The prevalence of diabetes,
insulin resistance, and the metabolic syndrome are low, particularly compared to American Indians.
Hypertension rates were low. Cholesterol levels are about the same as the U.S. population with
lower LDL levels and significantly higher HDL levels than the U.S. population. The prevalence
of cigarette smoking is very high among Eskimos. Inflammatory markers (high sensitivity C-reactive protein (hsCRP) and fibrinogen)
are high and the infectious disease burden is high.
Dr. Elizabeth Nobmann presented data on diet of Alaska Natives, primarily from the GOCADAN
study. One major risk factor that differs between traditional Alaska Natives and the U.S.
population is diet. Fish consumption among Alaska Natives is six times the consumption of the
general U.S. adult population. This difference in fish as well as sea mammal consumption accounts
for higher levels among Natives in monounsaturated fatty acid consumption and omega-3 fatty acid
consumption, which may be protective. Dietary sources differ by generation with younger generations
relying more on market foods. The younger generation has a diet higher in carbohydrates but
lower in fat intake, polyunsaturated fatty acids intake, and omega-3 fatty acid intake. Dr. Nobmann indicated that little
data are available on the changes in dietary intake by season. She also indicated that there needs
to be a commonality of the nutrient data base for foods across countries since items such as fish
as well as market foods differ between countries which will make standardization of methods more
difficult.
Dr. Laurie Hing Man Chan presented dietary data from the Center for Indigenous Peoples'
Nutrition and Environment (CINE) in Canada, with particular emphasis on contaminants.
He presented results from three dietary surveys including more than 3,600 Native individuals.
Diets are a blend of subsistence or traditional foods and market foods. Analyses show a higher
consumption of carbohydrates, sucrose and saturated fat in meals that do not include traditional
foods. Traditional foods also contribute to contaminant exposure including mercury, toxaphene and
chlordane with higher exposure among the Inuit. However, traditional
foods also offer important sociocultural benefits that define Inuit people. Thus, consumption of
traditional foods represents a balance of risks and benefits that must be addressed in partnership
with the Native communities.
Dr. Peter Bjerregaard presented results from collaborative efforts for studies of the Inuit
in Greenland and other countries. He explained that Arctic populations are very diverse.
In North America, there are hundreds of recognized tribes, including Inuit, Athabascan Indians,
and Cree. In Eurasia, there is even more diversity. However, the Inuit ranging from eastern
Siberia, northwest Alaska, Northern Canada and Greenland are more similar and have become the
focus of collaborative international efforts. Although simple descriptive statistics were
possible, the limited comparability of data circumscribed their application. Data suggest
that the pathology of cardiovascular disease is more complex than originally assumed.
HDL levels are high across studies. The relation of obesity with lipids varies from the
non-Native populations. The metabolic syndrome appears to show gender differences in
relation to westernization. The small size of the Inuit populations in any one country,
and the homogeneity within country and the heterogeneity among countries in environment, support
the need for a circumpolar Inuit study. Obstacles to the existing and future efforts include
the lack of synchronization and common protocols among studies across countries, and the need to
standardize protocols within country to previous work. International leadership is needed to
develop a more coordinated effort.
In discussion, two consistent messages were delivered. First, protocols vary across studies.
Second, in spite of differences in methods, distribution of risk factors and disease suggest compelling
research opportunities. A carefully focused effort to establish a central
database and to synchronize longitudinal surveillance may be the most efficient approach.
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Barriers and Solutions to Arctic Research
Dr. Ruth Etzel described the organizations delivering health care to Natives in Alaska.
Alaska Natives have made more rapid progress in self determination than many other Native
groups in the United States. They have assumed ownership and management of their hospitals
and health care centers and are now assuming more responsibility for health research done in
their communities. There has been a long history of research with Alaska Natives including
the establishment of the Alaska Native serum bank that has been in existence for decades. Another advantage for
health research includes the centralized computerized medical record system for all health
care for the Alaska Native population initiated many years ago by the Indian Health Service.
Dr. Etzel noted the different value systems of traditional Alaska Native communities and
non-Native researchers. For example, where Natives lean toward sharing, cooperation and
humility, researchers are more inclined to ownership, competitiveness and achievement.
As a result, Alaska Natives may view the conduct of research differently from outside
researchers. Alaska Natives prefer research that is rooted in the community, not implanted
in the community. They seek research that is driven by community needs rather than the
researcher's needs.
Dr. Andre Corriveau presented results and perspectives on research from the Northwest
Territories (NWT) in Canada. The NWT includes 34 communities and about 41,000 inhabitants;
about half are Aboriginal. Eight official languages and another 15 non-Aboriginal languages
are spoken there. The government is a consensus-style public government. The population is young
but projections over the next two decades indicate those over 45 years old will be the fastest
growing component. Thus, chronic diseases are expected to increase. The prevalence of cigarette
smoking is much higher in the NWT than all of Canada but declining with time as a result of effective
community interventions. Mortality from circulatory diseases is somewhat lower than Canada, cancer
mortality is about the same though varying by location and Native status, and mortality rates
from injury and respiratory diseases are higher. The incidence of tuberculosis is almost eight
times higher in the NWT than all of Canada. Alcohol consumption is higher for all ages for both
men and women in the NWT. With regard to health research, the government has moved to issuing
research licenses based on ethical and community-support considerations that are required to
conduct research or collect specimens within the NWT.
Dr. Sven Ebbesson provided his perspective of barriers and solutions to research with
Arctic Peoples based on his work in the Alaska Siberia Project and in the GOCADAN study in Norton
Sound Eskimo villages. Barriers to research include the small numbers of researchers in the North,
inadequate infrastructure, logistic and climatic difficulties, and unfamiliarity with the needs and
customs of the Native population. He stressed the importance of working with and through the village
councils for approvals and guidance for research. Most important, he emphasized the need to return
meaningful research results to the participants and their community. This will build long term
relationships that will lead to better research over time. Dr. Ebbesson stressed the importance of
investigators spending adequate time in a given village in order to develop an understanding of the
needs, sensitivities and customs of the people. It takes time to understand how villages are organized
and to be accepted within the village. He also noted that once the community understands that a
primary goal of the research is to reduce health problems, the enthusiastic support follows.
The discussions with villagers logically lead to studies to identify risk factors for specific
diseases, especially ethnic specific risk factors, to be followed with intervention and prevention
studies.
In the extended discussion on barriers and solutions, it was emphasized that training of
community members to work on the research project enhances the data collection quality, builds
capacity within the community, and enhances communication with participants, and between communities
and the researchers. It was pointed out that there is a tension between the Native and the NIH
view of research. Researchers base funding decisions on academic credentials and research experience.
Natives believe that cultural understanding is at least equally important to the success of research
projects within their communities. This needs to be understood by the review committees. Additional
efforts need to be made to develop accessible training programs for community people to
establish stronger clinical and research credentials for future studies. Grants need to be
restructured to begin with planning grants to build collaborations, seek approvals, and plan
studies in partnership with Native communities. Time barriers need to be recognized and
accommodated.
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Facilitating International Comparisons
Dr. Natalie Tomitch, speaking on behalf of the Fogarty International Center (FIC),
provided an update on the expanding role of the FIC as the coordinating agency for all Arctic
research for the National Institutes of Health. The mission of FIC was to support research and
training internationally to reduce disparities in global health. Most support goes to
collaborative projects in low and middle income countries. Research grants to other countries
to build capacity and establish collaborations are an important component of the FIC mission.
Carl Hild represented the American Society for Circumpolar Health and the International Union
for Circumpolar Health (IUCH) for this meeting but noted he had additional perspectives through his
affiliations with the Alaska Native Tribal Health Consortium and the University of Alaska Anchorage.
He explained that the IUCH, established in 1986, offered an existing organization devoted to
collaboration among the eight countries with interest in the Arctic. IUCH also has a journal
(International Journal of Circumpolar Health) that is highly relevant to the interests of the
Working Group participants. He reviewed the history of international collaborations related to
the Arctic and to the development of the IUCH. He suggested there were many other organizations
with similar aims related to Arctic research but there was little communication among them and few
outcomes as a result of their efforts. He recommended that the Fogarty International Center (FIC),
as lead contact for health programs to the Arctic Council, should create an NIH Arctic Research
Coordinating Committee to address health disparities and regional capacities and to conduct coordinated
circumpolar investigations.
The three person panel to discuss the facilitation of international comparisons included Dr.
Bjerregaard, Dr. T. Kue Young, and Dr. Sven Ebbesson. Dr. Bjerregaard reiterated the primary
reasons for international collaborations: (1) Inuit/Eskimos are in small numbers scattered through
several countries, and (2) collaborations will result in larger numbers and more variation in
environmental exposures. The two most important issues for international collaborations are
continued exchange of experience and the development of comparable survey instruments for items
such as surveillance, diet, physical activity, anthropometry and social network. Dr. Young
suggested there was a need for an international network for circumpolar health to promote research,
facilitate communication and dissemination, and strengthen health information. He recommended
a web site as the best mechanism for communication and data management. He noted it would serve
a different purpose from the IUCH because it is focused on the needs of researchers and it would
promote collaboration. Dr. Ebbesson urged investigators to get more involved in the community in
their efforts to conduct research there. The result is likely to be requests for help with their
health problems in the form of intervention and prevention programs, which is the community's
main priority. He suggested that there is a need for initial funding for coordination among the
interested countries under the sponsorship of a government agency or international organization
that wants to assume a leadership role.
The general discussion uncovered the need for seed money and leadership to get international
collaborations started, to develop a web site, and to standardize methods. It is clear there are
many organizations established but little progress to date as a result. Another idea was to start
collaboration by encouraging one country to fund a coordinating center for a specific project and
then a principal investigator from each country would seek funding for data collection within his/her
country's borders. Immediate opportunities for collaborative efforts may be enhanced by establishing
international agreements between health research organizations of relevant countries. An opportunity
for such a collaborative agreement may be possible between Canada and the United States. FIC may be
able to help facilitate a collaborative agreement although it does not provide funds for such efforts.
The meeting concluded with a list of ten recommendations covering research priorities, barriers
and solutions to Arctic Research, and facilitating international comparisons. The recommendations
are not presented in priority order.
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Recommendations for Research Priorities
1) Primary prevention/intervention studies can be initiated immediately to reduce the
incidence of cardiovascular disease (particularly stroke) and respiratory disease (particularly
tuberculosis and COPD), and to prevent the development of impending risk factors such as
obesity and diabetes.
2) Unique clinical outcomes with unusual prevalence/incidence that may benefit from further
epidemiological investigation include high incidence/prevalence of congenital heart disease,
rheumatic heart disease, SIDS, RSV, infection and inflammation, anemia and low incidence of deep
vein thrombosis (DVT).
3) Risk factors with unusual prevalence that may benefit from further epidemiological investigation
include the development of obesity and its relation to CVD risk factor changes, low prevalence of the
metabolic syndrome, high levels of HDL, high intake of omega-3 fatty acids, long-term effects of
infection/inflammation on atherosclerosis, gender differences in the insulin resistance syndrome
in relation to westernization, and the health effects of contaminants and indoor air pollution.
4) Extremes in the physical and social environment offer research opportunities on the effects
of contaminants and the effects of season changes including cold, extended light/dark cycles, and
dietary patterns on CVD risk factors, on sleep patterns, and on psychological well being.
Northern communities also offer some homogenous populations suitable for genetics research and
many isolated communities suitable for randomized community-based intervention trials.
5) Methodological research is needed to develop protocols and data collection instruments to
standardize surveys of Native populations across countries for recruitment, dietary assessment,
definitions of health status, physical activity assessment, socioeconomic status,
modernization/westernization, criteria for obesity, and culturally-sensitive interventions.
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Recommendations for Barriers and Solutions
6) To assure that future research efforts are conducted in a culturally-sensitive and
respectful way, follow guidelines already established by Indigenous Peoples such as the
WHO-CINE guidelines (http://www.cine.mcgill.ca/IA.htm#indigenous) or the Alaska Federation of
Natives Guidelines (http://www.ankn.uaf.edu/afnguide.html ) or the NSF guidelines
(http://www.arcus.org/guidelines/pdf.html).
7) Develop training programs that are easily accessible to Natives seeking to broaden their
career goals to become clinicians and research investigators.
8) Promote hiring and training of Native staff as a component of all research funded with
Native populations as a way of building capacity within research populations and improving the
conduct and quality of research studies.
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Recommendations for Facilitating International Comparisons
9) Encourage the Fogarty International Center to lead an effort in organizing an
international consultation for the purpose of establishing a collaborative study of
Arctic Peoples.
10) Establish international agreements of cooperation to initiate a circumpolar Inuit
Study to overcome the high costs of research and the small samples within any one country,
and to incorporate the diversity of environment among Inuit communities that exists across
circumpolar countries.
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Summary
By design, this Working Group focused primarily on heart, lung, blood and sleep disorders
because of the mission of the sponsoring agencies. Larger, more coordinated, efforts that
expand the scope of investigation to other chronic diseases may be much more efficient given
the high cost and formidable barriers to research within and among countries with interest
in Arctic Research. The Working Group participants would welcome such an omnibus research
effort. However, in the absence of such an effort, the Working Group acknowledged that the
interest and leadership provided by the current Working Group participants represented the
most promising opportunity to address research with Arctic People. It is hoped that these
recommendations will be explored by health agencies, both individually and collaboratively,
within and among Arctic countries in the coming year to enhance the research agenda with
Arctic Peoples.
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Members
Working Group:
Co-chairs:
Barbara Howard, Ph.D., MedStar Research Institute, Washington D.C., USA
H. Sally Smith, Chair, National Indian Health Board, Dillingham, Alaska, USA
Members:
Peter Bjerregaard, M.D., National Institute of Public Health, Copenhagen, Denmark
Hing Man Chan, Ph.D., Center for Indigenous People's Nutrition and Environment, McGill University, Canada
Andre' Corriveau, M.D., Department of Health and Social Services, Yellowknife Northwest Territories , Canada
Sven O.E. Ebbesson, Ph.D., University of Virginia, Charlottesville, VA, USA
Ruth Etzel, M.D., Ph.D., Anchorage Native Primary Care Center, Anchorage, AK, USA
Hakon Hakonarson, M.D., deCODE Genetics, Reykjavik, Iceland
Carl Hild, Institute for Circumpolar Health Studies, University of Alaska Anchorage, Anchorage, AK, USA
Elizabeth Nobmann, Ph.D., IDM Consulting, Anchorage, Alaska, USA
J Redding, M.D., Canadian Institutes of Health Research - Institute of Aboriginal People's Health, Victoria, BC, Canada
L Tereshchenko, M.D., Washington University, St. Louis, MO, USA
Natalie Tomitch, Ph.D., Fogarty International Center, National Institutes of Health, Washington D.C., USA
T. Kue Young, M.D., Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
NHLBI Staff:
B Alving, E. Bookman, J De Jesus, RR Fabsitz, C Jaquish, D Lathrop, T Manolio, J Olson, PJ Savage, P Sholinsky, P Sorlie, R Tracy
Observers:
P Chen, L Commanda, A Gordon, P Pehrsson, CR Perry, JT Petherick, C Ryan
NHLBI Planning Group
Richard R. Fabsitz, Ph.D., Division of Epidemiology and Clinical Applications
Carl Hunt, Ph.D., National Center for Sleep Disorder Research
Jared Jobe, Ph.D., Division of Epidemiology and Clinical Applications
David Lathrop, Ph.D., Division of Heart and Vascular Diseases
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