guidelines, some new regulations, and that sort of entered in at the end of it. what's your perspective on the inner agency dynamic and your cooperative relationship with the department interior as you work on these issues? >> thanks, heather. we have an incredibly robust, as many of you are aware, inner agency dialogue but also an incredible amount of collaboration. particularly with the office of oil and gas at doe and the department of interior, various agencies, for example, in the aftermath of the deep water horizon event. many of the learnings that have been taken up have been developed in collaboration with our office as well as the research partnership for secure energy america, which involves about 140 companies and technology firms. like wise we have as directed by the president's blueprint for secure energy future which calls for an all of the above energy strategy, we have a

multiagency strategy for understanding and working to develop the science to mitigate the impacts of unconventional oil and natural gas production and this is with our office and usgs and epa and like wise you see the l recommendations that are pointed to doe. and this report really points back to that role for the arctic as well. in one way the way i think about the work of our office is we're the office of science for federal and state regular lay to rs. we were in alaska last week and i can tell you state regulators in alaska are very much focused on these questions and understanding what the science says in an unbiased and neutral manner about this activity can proceed. and those are the same questions that our partners are asking at other federal agencies, and we're the the office that they turned to understand what the center of the science understands. and it's a vital role that government research plays and providing policymakers with an unbiased view of science,

technology, and its performance. so that we can move forward in these areas. so there's a very robust collaboration between our office and other agencies, and the recommendations here provide us sort of a road map forwards on what we should be looking at next in the area of science and technology. >> carol, what surprised you the most about this study? you went into this, and i think if i may tell my little tale out of school. i think carol was surprised at the world of washington policy sausage making. a canadian herself, she was looking at this going, why do you do that? well, why does that happen sf i love that. because it was hard to explain why. but what took you by surprise the most about the study? >> oh my gosh. it's hard toe pick one thing. i guess what i would say -- i mean, you hit on it, heather, we just learned -- those of us in

the industry just learned a lot about the history of our arctic policy and also about the challenges in integrating the many different -- the many different aspects of arctic policy that are important to all stake holders. i would say when we came together to undertake this question, each of us probably came to the table with our own perspective of what was most important, and i think truthly each of us from our own corners of the room so to speak were thinking of this, heather, pretty simply and as we conducted the dialogue over those many months, the scope of the problem started small and got bigger and then we tried to synthesize and bring it together in a meaningful way.

and so i mean, i just learn sod much in terms of the importance of listening fully and not letting your own biases stop you from hearing what someone else was trying to say. i learned that the exxon mobile project management culture sometimes clashes with the very focused on schedule and execution. sometimes clashes with the fulsome debate, and question learn to tolerate the strengths each of us brought to the team. but what i would say is we started out the journey together with people saying hello, i'm paula from the department of energy and i'm caroline from exxon mobil and on the way we moved from being individuals representing you are respective interests and we became a team that was about trying to really understand the secretary's question and understand the

broader context behind his question. so i'm very pleetzased with what we delivered. if i look back on what helped us be successful others will judge if they think it was sug seszful or not. two critical success factors, was one establishing a transparent schedule which we agreed early on. the second was the selection of the right team at the coordinating sub committee. leaders like are in the room with us today and sitting at this table with me. i'm just incredibly grateful for everyone's support and the opportunity. >> thanks so much, i'm going to ask you a question. i would have loved to ask nart senator murkowski, and we ran out of time. from the state perspective and your legislative career, the alaskan state economy has really been battered. on the one hand we can celebrate low energy prices, boy, the budget has taken a hit. this is -- i -- this is an

urgency in alaskan voices about their future economic growth model and concerns senator murkowski expressed as production declines needing to find new opportunities having legislation is white house pulling offshore onshore land away from exploration. what's the mood? and tell us because what's going to be interesting, the next two year there is will be a lot of meetings with the arctic council. they're all going to be in alaska. they're going to hear an alaskan perspective on this. and i would like you to preview that perspective. >> well, it will be loud. you know the legislature is supposed to adjourn under statutory requirements sunday night, at midnight. and i'm not sure they're going to get out of town on time. one of the things that is battering us in particular at

the moment is the fact that is doub down so low at this point, running around 500,000 barrels a day from the original 2 million barrels a day. in the past, including when i was chairing the senate finance committee and oil dropped to $9.50 a barrel even though the state budget depends over 90% on the revenues that we get from our oil and gas resources, and from the production of those resources, we were able to get through the times of really low oil prices because we had a robust -- in taps frankly. we've seen production come back up. that's excellent. but that continued drop in taps is really battering the budget, and will continue to for the future until we can figure out a way to get more oil into what is not just an alaska important infrastructure but it's a

national energy security infrastructure that needs to be protected for the nation's benefit, not just for alaskans. the mood is somber, but alaskans are resilient. goodness knows so many alaskans have as i i've said, they've been there for thousands of years and they've been adapting for that entire time. so there's a resiliency. but there's also -- i would say a hopefulness that together alaskans can come through make some changes to our base budget but also see opportunities in the future that will help provide continued jobs for alaskans and for our children and grandchildren, but also support the budget. it's never bad to look at budgets and see where there may be some bloat. and that is happening. but the legislature and the governor will be careful not to try to go too deep.

the former lieutenant governor is smiling at me. >> i sense mead may have a question when we turn to the audience. infrastructure is exactly where i want to go. but carol because the report did have a reflection on infrastructure, if you could just share a brief thought on that. and paula, you have been focusing on transportation and infrastructure now that's obviously from shale gas and i would love your reflections on this. >> so we do have oon entire chapter in the report dedicated to logistics and infrastructure and recognize it's a significant challenge to progressing with the development in the alaskan argument. with record to exploration, the infrastructure needs are much lower, as the industry moves forward -- as shell moves guard with their plans they will be bringing all the required equipment with them in order to safely and responsibly execute the program. including the oil spill response

vessels and so forth that they have sub many itted to ed tosubmitted to the regulator and they're required the to bring by permit. with regard to the longer infrastructure needs, the report does a very good job of cataloging the current state of infrastructure. what's available today, what the gaps and opportunities are, and then make some recommendations to move forward. probably the most important one is that we see merit in continued emphasis on joint scenario planning, including the federal government the state government, the local communities, probably most importantly and they likely would be in the best position to lead such an activity. but also fisheries, tourism et cetera, infrastructure is a shared resource so a joint scenario plan could potentially open up the opportunity for

partnerships in particular areas in government industries, public and private partnerships, as the senator was talking about earlier. >> sure, thanks, heather. >> in here in the lower 48, we talk about the revolution and the knowledge that we have great rocks and that comes in really handy. and the other reason we're the envy of the world is we have an incredibly robust delivery. and we have 2.4 million miles of gas pipeline alone. so with this in mind the president has commissioned the review that will be released very shortly, and the first year is focused on delivery infrastructure. and understanding what our needs are going forward in an integrated manner and as that begins to roll out soon, you'll see, i think a key learning from that is that energy

infrastructure, the infrastructure that secures our energy is not just pipes and tankers. it's what underpits our economy whether here in the lower 48 or alaska. and you see incredible focus in the the senator's remarks this morning, as well as in our visit to alaska, a tremendous -- i mean, there was a great deal of priority and debate being focused on a natural gas pipeline, for example, in alaska as well as the future of taps and how to ensure it. and it goes hand in hand to develop the the resource and the knowledge you can move the resource to markets where it's valued. whether in alaska and in other places. so this all combined with the changing nature of the climate and new challenges that climate change on coastal communities and ports as well as roads.

whether they're traditional roads or ice roads and new challenges with being able to maintain them, as well as the pipeline infrastructure. this is something i think we're going to be discussing quite robustly over the coming years because there are tremendous investments that we need to make. onshore as well as offshore and thinking about data and communications as well as in securing maritime shipping lanes. this is the age of infrastructure. and we should all be very focused on thinking of the ways we can support the development, because this is the underpinning for our economic and energy security. >> well said. it's time for the audience to engage in the discussion if you have any questions or comments please raise your hand and give us your name and affiliation. if you're too shy, mead, i'm going to put you right on the

spot. so i think i will put mead treadwell right on the spot. i'll introduce you so you don't have to, mead. >> thanks, heather. my afillfiliation is heather and i are working on bringing investment to the arctic, and pleased to be here today. and thank you for your report. i'm sorry i missed your presentations on alaska last week. i can tell you one of our last meetings as chair is at the white house just about the time the spill was happening. we had come up with suggestions on how the u.s. could better structure its support for oil and gas or oil spill research. what did you find as you looked at both the public/private partnership that's happening in norway on oil and ice recovery, and what should we be doing specifically to meet the goal

where you saw deficients here in this report? >> thanks for the question. oil spill prevention and response is the top topic on the mind of all stakeholders, and you know i mentioned in our recommendation that we really want and need to see the department of interior specifically join with the industry in collaborating in this important area, like the example that you cited in norway. for two reasons. the first is bessie has spent a lot of money and they have a lot to bring to the table. they have a lot of expertise. and the second is they are importantly independent of the industry. it's not enough for the industry to say that this particular

response performed this way. we really need that independent view. what we think needs to happen is for the department of interior to join that group, bring their research to the table we need to move forward with field tests in our arctic conditions. some of those have been advanced in other countries. but getting permits to do a field test of an oil spill response exercise is particularly difficult because no one wants to champion that. so we also see a need to move forward with permits necessary in that regard. there are discussions about building a specialized facility to test oil spill response in new foundland. those are a couple of thoughts about what can be done in that very important area. >> just quickly doe has focused

our research to a great extent on prevention of loss of control. we do a lot of work on integrity, understanding how your cement performs. understanding the ocean currents and the stresses that puts on risers and translating that to our work on basic material science to understand what the risers are made of. for example. there's also, i think in the study, some recommendations that we'll be considering next. so we've been focused on the front end of the bow tie f you will. but there's also opportunities on the right side as carol set ut for us to with the department of interior to demonstrate the effectiveness of some of the technologies that are available to prevent or deal with loss of control of oil. so while today we've been focused on preventing that, your best way to prevent an oil spill is to design your well really

well and never lose control of it to begin with. but if you do there have emerged an array of technologies to deal with it. and what we need to do is make sure we're demonstrating and testing those ways in ways that people have confidence in. that's what we'll be looking at in doe, how we can participate in that through our national apps. >> one of the things that i learned and those of us who worked on the study who were neither industry and/or federal government is that there's not as much collaboration as we might expect or think or just thought was happening. for example, industry has an arctic joint industry project for slow response technology that the u.s. government is not party to. why? i was surprised by that. that bessie and others had not actually joined.

so we saw lats of opportunities. i came in with the belief there needs to be better understanding by everyone of all the work that is being done and all the work that has been done and the technology that is out there and whether we're practicing and it whether we're exercising it as well as we should is a different question. particularly in the u.s. where it's hard to get a permit to do a spill exercise. but there's kind of a step two which is education, which is something that csis and other institutions like that might want to focus on. how do we get the word out there? what is truly happening. i would also say it provides an opportunity for the publish/private partnerships that we're talking about. it's not just industry and the government. there are private companies around the world that are working on swell technology every day and have some really bright minds working on it. so there are real opportunities, and we should push forward to make those work for us. >> i'll add my two cents.

the arctic council is is the international perspective here. they have been working on oil spill prevention. and i think they will be presenting a framework for that. but it's going to be u.s. chairmanship that's going to have to work the issue. i think it does such amazing work. great assessments. marine shipping investment and then fabulous recommendations. and then okay. who makes sure the national governments really focus, really implements and bring those to fruition? this is going to be challenge for the u.s. i think the arctic economic council will have a big focus on energy and those implications. again, we're developing these good tool ls. we need collaboration. >> and just one final point. dr. mike myers who when we began the study as the university in charge of research. is when we ended the study is now the commissioner for the state told us time and time again that everybody can do all

of their research at the university of alaska fairbacks where they're actually building facilities for this type of research. so once again, bringing it home. >> you had a quick follow-up and then i'll let others get in here. we'll get a microphone. >> no, no, here. yeah, yeah. zblf the oil pollution act of 1990 created an interagency committee on coordinating oil police and research. as we founded it we called it the intergalactic. but i would urge industry to play a much larger role in that committee. i would urge doe to play a much larger role on that committee. understand the work of the coast guard because they have the the internal work. there is a way that we can come together, and i find the issue with oil spills is people who want to go ahead and drill want

top print they don't happen. they can happen. we know they can happen, and we have to constantly be pushing that edge forward. scene that committee needs greater attention to the white house, and it needs greater participation by the federal agencies. >> yes one of the key findings was to secure public confidence in the development of oil and gas. and senator murkowski was touching upon the aspect of you know residents in the arctic being -- want to see development, while those outside want to preserve it. how do you address that giving the observation dprfrom many of the environmental ngos? >> well i just want to point

out one of the difficulties of trying to address it. so clearly you need public acceptance to move forward. but if you look at the accidents that have happened in terms of oil and gas-related industry in alaska and around the world, you'll find most of those are related to transportation, not to exploration phase and not to development phase. however, when you look at the new bessie arctic that came out last month arguably because of the time lines that are written into, it pushes exploration rigs into a two-season event. rather than being able to go in, drill your well and actually do your testing in one year and then get out. if the real risk is during the the transportation phase, it does not make sense to push into two years where you have to stage twice. up and back and up and back.

because you have more ships in the water and more opportunity to have a transportation accident. so i think that what we need is a dialogue to understand what are the real risks and what are the opportunities? and then we all have to accept that your risk is never going to be zero. just as mead said. we don't live in a zero-risk world. >> henry hedger, retired government researchers. perhaps you heard of botley plants for fresh water in finland where they use icebergs. the arctic has that tremendous amount of ice and of course with the the climate change, they indicate it will melt. once it's melted, it's no longer serviceable. it becomes salt water in the ocean. the fresh water is a great resource, and botling plants would be needed, say in alaska. one of our own areas let alone

canada. if they can reduce the amount of ice that's fresh or well and good, then less of a problem with the rising sea level. also job creation. thousands of jobs could be created. and not just bottles of water, but barrels of water could be shipped to areas of great concern like california, and you would have fresh water. do you have any comment? >> oh my goodness. drew? go for it. >> you know there was just an article in the anchorage paper, maybe yesterday, that fresh water shipments are starting out of alaska to the lower 48. now that's not arctic water, but it's water. it's fresh water. so all the the way back to government hickhle, but governor hickle had the greem of bringing alaska's fresh water resources south. various entities have picked up on that and have actually licensed some opportunities. i think you will see people move

forward, and looking at the water resources that we have in alaska as being a very important resource to the state. we're seeing that right now as fledgling industry in alaska. >> hi. john farrell, arctic research commission. i have a question for dr. gant. i was curious why secretary money's commission was studied. he will receive this report, and he will provide a response to the report, the remscommendations in the report. is there anything at this point you can foreshadow as to what you can say in receiving the report and how he may consider the recommendations and begin to act on them? >> john, you know i like my job

and i would like to keep it. i'm not going to be so bold as to suggest what the secretary might say. we're very pleased with the quality of this report, and it's 550 pages of a lot of great science consolidated there. and we expect it will be a great resource for people as they come to the arctic. with regard to -- there are a number of remss that relately to doe. and where we might pursue science and research. and almost all of those -- not only do they speak to the core mission and core capabilities. but they are also implicitly represent our collaboration with other agencies, as well as our work, and the work that the commission has going on as well. so as the secretary considers these recommendations and next steps, we will be working with

our inner agency partners and other federal partners involved in the study efforts and recommendations to understand not only which piece of these recommendations seem -- because we can't do everything at once -- the most imperative in priority from a time perspective, but which should be done through vehicles like our national labs. which should be done in direct partnerships with other agencies. which should be done through the arctic research council our other agencies, or through partnerships at the state level. as drew mentioned, the university of alaska fairbanks has tremendous capabilities in the area and they're already a great partner for us. so we'll be looking for input as we move forward. and i'll let the secretary speak for himself when he does. thanks for the question. >> i would like to make a comment. i really appreciate the question as well. we want the report to be read

and have impact. but i want to integrate that question with the question we had over here on how to november gait the complex question that the senator laid out for us. should we progress with development, and how do we balance that with concern for the changing climate? i think the answer is in a debate that's rooted in science and research. not the sound bites that come across on twitter. not the st statistics that are short quotes without the technical data to back up what they mean. you know, you could -- you could identify -- in our report we say the risk of a well controlled event in the arctic with new technology is extremely remote. how do i reconcile that with a quote that says the risk of an

oil spill is 70%? the risk of an oil spill this summer is not 70%. the data behind that calculation is that risk is over the next 70 years. penal don't say that on twitter. but what we really need to do is get the scientific community together. john's organization, the industry experts paula's team together to explore the findings in this report. do you agree with them? if not what more science and technology is needed in order to move forward? and as paula outlined in her opening questions only then can we have good science good research, inform good policy. and that's how i think we can find some middle ground between these very polarized opinions a and move beyond them being someone's personal opinion. >> well, unfortunately the time is close. i'm going to have to cut it off

here. but as you can tell, what a privilege it was to be a part of the team of such thoughtful people trying to wrestle with extremely tough complex questions. and we know the stakes are enormous. i think when you showed richard glenn's quote, we need a little rock 'n' roll concert. we need to jazz up our conversation on the future of the development of the arctic. please join me in thanking our panelists for a great presentation. now don't go away. we're going to very switch panelists and conclude tw the arctic health discussion. thank you.

we will have live coverage continuing here. they'll be back shortly with a discussion on health issues facing people living in the arctic region. they'll hear from the doctors of the national institute of health and the centers for disease control. all of this ahead of the u.s. beginning to chair the arctic council. regarding drilling and other issues. eight countries are members of the council. the u.s., finland, iceland

norway russia and sweden. and we'll continue live coverage on c-span 3. and the group heard earlier today from alaska senator lisa murkowski. you can find that online at c-span.org. it's the center for strategic and international studies. they'll be back shortly with their discussion on the health issues facing people in the

arctic region. they open the form with comments from alaska senator lisa murkowski, who chairs the senate committee on energy and natural resources. we'll show you her comments as we wait for the event to resume live here on c-span 3. >> heather, thank you, and good morning to you all. it's always a good morning when we can gather together to talk about places of great opportunity. and i can of no other place on planet earth where we have more opportunity than the the arctic. as was mentioned, and as we all know, those that are focused on the area of opportunity, next week, a week from today, the united states will assume the chair of the arctic council for the next two years no now. this is truly an exciting

opportunity for us. for those of us who have been pushing for some time now to really place the arctic in a space of greater national priority. certainly, heather those of you here at csis have embraced that position and i really thank you for your continued interest the advocacy on the arctic issues. not only today, but in the years leading up. but your presence today those of you who have joined us those who are joining by the internet you're showing your interest again in a topic that is really quite keen right now. and i probably don't need to impress upon you why the arctic matters to the united states. i would suggest to you that perhaps the biggest challenge that we face right now on arctic policy is not with other members

of the arctic council, including russia. it's not with the rest of the international community, which is taking a very interested focus on the far north. it's not with a permanent participant groups representing the indigenous people of the arctics, who are truly impacted more so than anyone else by the decisions of the arctic nations. but i would suggest to you that the biggest challenge for the united states is the united states itself. we face hurdles both at a public interest level and a government policy level. from the public interest perspective, i think it's a fair question to ask, why should -- why should somebody from alabama, or from arizona care about the arctic?

i suppose there will be those that say well, why should alaskans care about policies that relate to using corn for ethanol or the security of our southwest border. i would argue back these are all national priorities national impacts. well we know, we repeat it all the time. we are an arctic nation because of alaska. but every state. every state in our union has some kind of stake in the arctic. whether it's from trade, nearly 20% of the u.s. exports go to the seven other arctic nations. that's significant. we have the research activity. the national science foundation has provided arctic research grants to entities based in 44 different states, plus the district of columbia. i remember having a conversation with my colleague from iowa some

years ago. and it was kind of a trick question to him about arctic and arctic policy, and i was able to remind him in one of his iowa state institutions they host an ark theic research program there. kind of caught him by surprise. but that's important that they recognize their connection. but there's also the national security matters the arctic toughs. every corner. the arctic touches every corner of our nation. and we must remind everybody of this. from a security perspective, the arctic is centrally located for multiple areas from the asian pacific to the north american to europe and russia. our ability to reach each area, via the arctic significantly reduces response times with increased activity in the arctic, at both the commercial and the military levels. our ability to project power and

have rapid response capability in the region is of even greater importance. of course from an economic standpoint, we talk about the shipping routes and the advantages between europe and asia or the west coast with the potential to cut seemingly 12 to 15 days off of transit schedules, allowing for quicker delivery of goods reduced maritime emissions, overall lower costs to consumers for all americans. so again a benefit regardless of where you come from in the country. our natural resource potential. we talk about it a lot in alaska. but we recognize that the resource potential in the arctic is very very high. usgs estimates roughly 412 billion barrels of oil and oil equivalent natural gas lois

there in the arctic. the dredge hauls we have seen suggest high concentration of rare earth elements. our neighbors. russia to the west. canada to the east. they continue with very, very purposeful national plans combined with state interest to develop arctic resources and really pushing to advance congress in the north and their plans are helping to create jobs, we're seeing economic growth in areas that have historically faced extraordinary challenges. even the nonarctic nations are embracing the opportunities that come with diminished polar sea ice. and i think this is one area that grabs the attention of folks here at home. because they're looking at these nonarctic nations and saying what interest does india have here? and they should be straching

their heads about that. they should be asking that question. because if there's an interest from nonarctic nations, then why here in this country are we not looking with greater interest? but when you think about the the nonarctic nations, they're reaping the transit benefits. they are looking to possibly move forward with exploration and development activities. and so, when you think about the u.s. position and whether we engage or whether we don't engage, we need to appreciate that this level of activity is going to continue whether the united states engages or not. increased access in the arctic also means enhanced scientific opportunities, to better understand the region, its environment, its eco system and how it may impact other areas of the nation and the world.

we talk about maintaining the arctic as a zone of peace to allow for greater international cooperation in a harsh environment that requires specialized skill and equipment. so areas we can be collaborating and working together are important. so really regardless of where you live in this country or what your interests may be, there's a nexus. there's a connection out there to the arctic that explains why our arctic priorities should matter to the entire country. but our challenge here is enabling this nonalaska portion of the arctic to recognize that nexus. so heather mentioned that senator king and i have joined together. we're kind of bookending the country between alaska and maine. we formed a senate arctic caucus. not only to look at the the national arctic policies and

priorities, but really to place a greater focus on each individual state and how it's connected to the arctic. we think this is something that other colleagues can take home and use to highlight our arctic opportunities with individuals and communities. so when we sent letters of invitation to the other members it was not just, let's focus on arctic together. it was accompanied with a white paper that was put together by a great arctic intern. i'm going to do a shoutout to kail here who has done great work for us. >> we'll run until 1:00 p.m. focus is on health. and we have a great array of speakers here today. i want to first of all congratulate heather connelly and carolyn roloff colleagues here at csi, as for the

production of this report, which i hope you've all had a chance to get, and which is available electronically online. this is a terrific and very timely piece of work that brings together, as we'll hear from heather in one place, a lot ofday that a lot of analysis situated all in the context of what has been going on up to this time in engagement in the the arctic on the health. what do we know and what are the possibilities here? terms of concreted a the ed ad a additional action by the u.s. government in the chairmanship of the arctic council over the next two years which begins, as hetather pointed out, next week. we're delighted to partner, and heather and carolyn can produce this excellent piece of work. so thank you. thank you for doing that. congratulations. that's terrific. senator murkowski this morning in her speech made a very powerful point.

and that was that all action by the u.s. government and other governments in the the arctic need to put the human reality, the individual and the community at the center stage in discussing the future and in discussing that are going to be taken. and so with -- i think this gives us a wide open door for talking about these issues and where we are going to go. the way we're going to do our business here today, we're going to ask heather to give a quick synopsis of the report and what it contains. then we're going to move in sequence, we're going to have pamela collins, who is a psychiatrist and an m.d. director of the office for research on disparities in global mental health at the national institute of mental health. pamela came to us. we've known each other a little bit over the years. roger glass, who is with us today. roger, thank you for joining us. roger kindly connected us and

thank you pamela for coming and being with us. pamela will roll through eight or ten minutes of presentation on the work that nimh is leading in this area. we will then move to dr. michael bruce, bruce, -- program for cdc based in anchorage. michael, thank you so much for taking the time to be with us today. he will walk through the cdc program in some detail as well. we're using this really as an occasion for getting these two lead u.s. agencies to tell us what they do, tell us what has -- what the major challenges and issue focus will be, and what the future might look like in terms of continued work, intensified efforts in this area. dr. bruce is the emidemiology health leader and has put a

predominant focus on a wide range of research and studies on chronical diseases health disparities, chronic disorders, so we're thrilled that michael is with us. our fourth speaker is dr. timothy hiliniack who is a research professor and leading polar expert. he's a migration expert and demographer who has been working on geography and polar environments for his entire career. he's one of the contributing authors to the the newly completed and newly issued about month ago, arctic human development report, which i hope some of you have had a chance to look at. it's a very comprehensive ten-year study built on the 2004 study. it comes out. it's full of enormous amount of insight and detail.

and we were very fortunate through heather's intervention to enlist timothy to come down and be here with us today. so thank you for making the journey to be here with us. once we roll through the presentations, we'll have a bit of a conversation amongst ourselves. but we're going to move to you all very rapidly to get your opinions and comments. so please be ready for that. and heather the floor is yours. >> thank you so much steve. and it is wonderful to be table to have such a great partner. steve and i, our offices are right beside each other, and i'll tell you how this idea came about. we were talking and i had sort of gotten the nickname at the office the polar princess the arctic queen because i do so much on the arctic. he said we should do something together. we should collaborate together, having the health program be a part of the conversation. funny you should ask. health is not an issue in the policy space that we focus on as much. we know the u.s. chairmanship, one of the mayor themes is the economic and the livelihoods of people in the north, a focus on that.

and we really need to pull this information together. what do we know? what is the united states doing about it? and then, i said, of course, the timing is perfect because we know the arctic human development report, which first issued in 2004 so as it was issued, it was a 2014 report that was issued a little bit later in february of 2015. we'd have ten years to see what has changed. where is the focus that we need to do? so all of these elements came together, and really encouraged us to put this report together. so many thanks to the global health program for being part of that. and of course my colleague caroline roloff was absolutely instrumental in developing this report as well. you're so sick of hearing from me today. i'm going to be extremely brief and i really want to hear from our panelists. this is part of -- i'm going to take my notes and be copious. i'm going to learn a lot here too. but i just want to do a couple of highlights in the report.

i think the first thing that strikes me, i think it strikes anyone that doesn't know this topic and begins to read it is the huge challenge of mental health and suicide prevention. a recent -- this -- this comes from our report, a recent study has found that every five degrees of increased northern latitude, suicide rates increase by 18%. now, just to bring this home closer for the state of alaska and alaskan natives, the rates of u side increased 500% since 1960 with rates four times higher among 10 to 19-year-old alaskan natives than their nonnative appear nonnative nonnative peers, there contributing factors, substance abuse and violence and there's a whole issue of mental health challenges that are profound. if there's one thing we hope the

study does is reinforce that urgency and bring must focus to it. there's other pressing issues that just require continued focus. the change in food habits, food security seeing increased rates of obesity and diabetes and also heightened impact on the food security of environmental contaminants and mercury. and some of the things from the changes in the climate but also as the food cycle so dramatically changes, but the arctic picture is a complex one because there is no one model. you have a very different health spectrum in the sir couple polar arctic where nordic countries is far different from what we see from other -- another communities. the challenge for the arctic council as it's developing its

thinking, there's not one size fits all, how do you bring the information together. so there's lots of information in the report welcome you to read it. i wanted to conclude by highlighting some recommendations and, two i think are provocative to our state department colleagues. i'm a proponent of really rethinking the arctic counsel's governance structure in light of the 20th bishlgrthday, it was designed in 1996 for one purpose. but as we've just talked about over the last three and a half hours, so much has changed. do we have the right alignment in our working groups? do we have the right alignment in how the arctic council meets these challenges. we very provocatively recommend that the arctic council should think about having a working group designated for arctic health and well being. if people are at the center of this policy, which they are we

have a flora and fauna working group, i would like to see a very focused working group on health. if we think it's important, we put it out there. so as i said, i no that will -- that's a pretty provocative recommendation but we think it's the one thing that could perhaps be a legacy for the u.s. chairmanship and moving forward. the second linkage, as you heard from our discussion on energy resource development, what we really found in our report, there is a link between economic development and growth and mental wellness and well being. maybe we should be a little bit more specific about that linkage where people have livelihood, their living standards are increasing. can we make that linkage? can the arctic economic council have a direct role in how the private sector, public private

partnerships are engaging in these pressing health issues for arctic communities. and of course as part of all of this is how do we engage traditional knowledge in working towards an improved arctic health and well being picture. i think again, the working group, a new working group could bring that traditional knowledge in. we have other recommendations, obviously, it is our hope that the u.s. chairmanship focuses like a laser beam on these issues. we know mental health suicide prevention is part of it and i know our colleagues will give us great insights on what the work of their agencies are doing. we want to raise this up and highlight it and certainly want to impress upon policy makers that this is a critical issue that demands our full attention. senator murkowski talked about the young people and their enthusiasm, we haven't have arctic young people not seeing a promising future and committing suicide. with that steve thank you so

much. >> thank you, pamela. >> thank you and thank you for the introduction. it's a pleasure to be here. the many opportunities and challenges we've heard discussed this morning, i'll focus in on one of those, which is the area of suicide and suicide prevention. just to orient all of you, this graph -- i'm pressing the wrong one. this graph shows you some data on suicide rates in the united states over the last 20 years. the red line shows you homicide rates in the united states, which you can see have dropped substantially. suicide rates have increased by 17% from 2002 to 2012. and in 2013 there were about 41,000 sueicides in the u.s. to give you a sense of when we're talking about the communities, where do we stand? the bottom red arrow shows the

u.s. suicide rate in comparison to other countries and subcommittees in the arctic. the top red arrow shows you the suicide rate in alaska. one of the main takeaways from this point is first of all to orient you, the yellow bars represent nordic communities and regions and nordic countries enregions and green represents greenland. the blue represents russia and regions in russia. and the red is north america and regions so the -- as i mentioned, the bottom red bar is the united states suicide rate and the other by the red air toshiorow is alaska. and if you -- what you can also note from the slide is is that as you go higher, the bars that are the higher rates often represents indijen nous

communities, there's variation within countries with indij nus groups often at the higher rate for suicide. these are data from alaska specifically. and again because -- to orient you to what the lines are, the bottom line in yellow shows nonnative alaskans and these are females. suicide rate the next line that went around -- the brown line, nonnative males in alaska and top line represents alaska native young men and men. again, huge differences by ethnicity with -- and certainty regional variation within alaska too where there are certain communities in alaska that have higher suicide rates than others. this is a complex problem not performed everywhere but clearly this group of men and young men in particular are the group that are at the highest

risk among alaskan natives. >> the conversations about -- thank you, the conversations about suicide prevention in the united states are happening at an open tune time. the u.s. just published this agenda for suicide prevention in 2014. with an ambitious goal of feeling that suicide can be reduced over the next five years should the research end result in policy services intervention be implemented, and ambitious goal of seeing 40% reduction over the next ten years in the united states. given that we can implement what we know needs to happen. at the same time who published earlier in 2014 it's world suicide report. also setting ambitious targets and looking at what are the regional differences around the world and what can we learn as a

global community to address suicide. >> i just want to highlight a couple of cost cutting things that are relevant to arctic countries. one is a positive approach testing approaches that nish yaf and maintain healthy behaviors that can lead to reduction and risk. testing interventions aimed at reducing risk factors but using technology to facilitate social connections and health seeking. and using practical trials to determine the benefits of quality improvement in health care systems and recognizing that these interventions need to happen in the context of quality mental health service delivery and quality health care delivery. and finally recognizing that these are interventions that need to take place interest

sectly. i spent some days, a few days ago, the canadian institutes of health research sponsored a meeting of report out on the mental wellness project that they did underneath the canadian chairmanship. and it was a great discussion. the canadians sponsored a couple of teams to do an environmental xaj of aavailable interventions that are being implemented in communities and communities find promising, particularly looking to see what is it that indigenous communities find most important and what do they consider practice -- prominent interventions and what were the evidence based interventions. and some of the lessons that came from this conversation were

that solutions need to be cultural grounded. they need to be community based and community driven. there was a lot of discussion to realize this was not a one size fit's all, these need to be adapted for context. what's the importance of cultural appropriately shared interventions across communities. how can one learn from simply implementing the mental health services needed for example, how can we learn from cooperation that would benefit multiple communities. another takeaway was the solution studies of these problems need to be solution focused instead of problem focused again how do we focus on health and strengthening health. even while we're trying to reduce risk and reduce bad outcomes. communities and clin igss and governments and others needs to know what works in order to know

what to implement more widely. a number of questions arose, how do we do that? how do we know how communities define what works? that's not always the same as the researchers define what works. how do decision workers define what works and where do they intersect. >> finally as i mentioned, they noted there were two studies of interventions with the rigorous evaluation. opportunities that we see from the u.s. perspective first of all acknowledging that these problems need shared knowledge and tailored efforts. when we're tailering interventions, how can we be sure others are learning from intervention. if they are successful, what's required for implementation. and once an intervention is implemented, how can one ensure that the irn ter vengs can be

sustained. how can the results of successful interventions to aid sustainability and one answer may come in how we approach testing the efficacy of these interventions and that includes figuring out how can we harm onize to provide a shared language to community to different stake holders. >> an important issue arose in the conversations and that is that if we want to think about wellness and health there are many slices to the pie. focusing on the health sector alone is not sufficient one has to think about the economic sector and we talked about this economy, physical environment climate and also remembering social history and how that influences the way the people respond to current challenges. so the u.s. proposed project

under the arctic council was called reducing incidents of suicide and indigenous groups or rising sun. the context for this was remembering that as i've shown you in the first slides, there's an elevated risk of suicide in these remote arctic communities. we're talking about communities with significant cultural diversity and very small populations. so the standard approaches that researchers tend to use to evaluate the efficacy and effectiveness of interventions is quite challenging. what might be a way to get around those things? there are also important assumptions and those are that efforts also have to continue, of course, beyond what's proposed under the u.s. chairmanship and under the sustainable development working group specifically and that these proposed projects like rising sun can move the agenda forward but they have to happen in concert with broader ongoing

efforts for service delivery for research and these other interventions as well. some of the questions that rising sun hopes to answer are can lessons about the impact of suicide prevention interventions be learned from information across more than one arctic community? would this be facilitated by identifying common measures to discuss outcomes and what are the underlying themes that are most frequently measured across these interventions. some of which were highlighted in canada and those interventions target policies and health systems and some are clinic based and some more community level interventions focusing on bringing youth in particular back to -- back in touch with their cultural traditions and some of them are focused at individual levels. what we hope to do is prepare a

tool kit that takes into account these various levels of intervention and meaningful outcome measures. that can be used to harm onnize the evaluation and enable communities to measure what's relevant to their needs and would enable the sharing and comparing of data across studies of effectiveness. and this we hope will be able to be amenable for kmupt use that will -- and take into consideration what communities value in terms of outcomes that will take into consideration the kinds of data that subnational governments are currently using in value in terms of outcomes and will also use the expertise of searchers working on methods appropriate for this kind of evaluation. thank you. [ applause ] >> thank you very much, pamela

dr. bruce. >> can we pull up the slides? thanks very much for having me here to speak to you about cdc's role in regards to human health in the arctic ks subarctic. i'm going to work off a series of slides. this is a slight that shows you sort of cdc's assets in the arctic ab i work with the arctic investigations program, 33 people total, we also have a quarantine station there focused on fektous diseases. we have a national institute of safety and health office there and have an atsdr office. so our mission at arctic investigations program is to prevent infectious disease of people in the arctic and

subarctic, with a specialty on high concern among indigenous people. our priority areas are surveillance of infectious diseases and emerging diseases and reducing health disparties and leadership in cicumpolar health. one of them is international surveillance and we're the headquarters for a circumpolar network across the artic, that map shows you in the darker color, the countries that participate and we've recently added tb russia would be included also. some of the things that can come out of this network we've been able to identify outbreaks of infectious diseases across the different countries and been

able to identify new emerging infections and we've been working over the past decade to identify a new infection that has a case if a talt rate of about 10% in our children. we worked closely to work on this issue. and we also work with the international union for health, i'm the former president of the union and work with american society and also the former president of and mainly through through a variety of working groups that fall within the union's purview. we also work with the u.s. interagency arctic research policy committee. there's a cdc rep from our office that co-chairs that meeting and dr. roger glass, i believe also co-chairs from nih

and he's here today. we also work with arctic council particularly we have a representative dr. tom hennessey my boss and director of the arctic investigations program. and the they advice the sustainable development working group of the arctic council. then we've been working on a number of health initiatives in alaska. one is the alaska water and sewer challenge. and i'll tell you more about that in subsequent slides but one of the things we're trying to do is take a local alaska specific initiative to improve water distribution and sewage system availability to people and internationalize and expand it to our

in the u.s. we went from 55% in 1940 up to 100% in lower 48 states alaska is pretty high. but in rural alaska as of 2010 draw a line across we're where the u.s. was in 1959 in terms of plumbing. we're pretty far behind.

about 25% of villages in rural alaska have no running water or sewer. the picture on the upper left is a person going to a water distribution point filling a plastic bucket with water and then in the upper right, he dumps it in a big plastic garbage can and that's the water source in the home. that's where they pull their water out of. in the lower left is the toilet. that's what we call a honey bucket. it's a bucket with a toilet seat on it. you can see the right side picture next to it someone is emptying that in a receptacle they have to carry it and slosh it around and spill and dump into receptacle. in the winter it gets cold and they dump froze an blocks in sewage lagoon and in alaska we called those poopsicles if you're rationing water in the village, your priority will be for drinking and cooking and

much lesser priority for personal hygiene and washing clothing and cleaning the home. when people think about water borne disease, most people think of pathogens in the water causing illness. we think in alaska water washed diseases are probably of greater importance. that is people rationing water they are not washing their hands, there's lack of water for hygiene and that allows for person to person transmission of a variety of different fektous diseases. we've done a number of different studies in alaska. this is one slide on the -- you can see proportion of homes served with piped water on the y axis and rates of illness in children less than 50 in alaska and see that in villages with less than 10% of running water, the invasive rates are high 400

per 100,000. as the water service increases the rates of disease go down. we've seen this for a number of other diseases also. so increasing the proportion of alaskans with access to waste water services is quite important to alaskans and one of the 25 leading health indicators for healthy alaskans 2020. and bat baseline in 2012, 78% of rural homes had running water. the target for 2020 is 87%. when i pulled this off the web that red stop sign signal means we're not on target to reach our 87% of water distribution systems to rural homes, which is a bit alarming. one of the things that we've done in response to this that actually isn't me it's the department of environmental conservation at the state of

alaska, has put forth the alaska water and sewer challenge. this is the website at the bottom if you want more information. this is a challenge that was put out to ask for teams to come together and propose decentralized water distribution systems for rural alaska. there are many places in rural alaska that will never have piped water where the substrate, you can't put in pipes. there are other places where it probably isn't affordable. we need some alternate technologies, in innovative technologies to help us with this. these teams, the work they do is private sector driven. they need to be able to provide sufficient water for health. it needs to be affordable for the homeowner and long term operability and they need to get

using input from communities. right now they are evaluating the six teams and will hone it down to three. those three teams proposals are going to be implemented in rural villages and we're going to look over a period of years to see how they do in terms of health outcomes and engineering and did it work and then in terms of acceptability within the community. and so that's actually ongoing right now. and then this is just one of my last slides just thinking about the upcoming u.s. chairmanship of the arctic council and water and sanitation initiative, i guess some of the deliverables that we have for this are -- we're planning on a white paper looking at water and sanitation across the arctic, looking at populations within home water service and challengers and proposed solutions. we're going to be traveling less than two months to the finland

international congressman and discuss with our international partners and planning on a water and sanitation conference bringing together circumpolar partners and internationalizing the challenge for all of the arctic. we're sponsoring that in anchorage, in september of 2016 looking for innovations in water distribution for small communities. we have many partners in this effort that i have listed up here and for the sake of time i'll say thank you and that's it. [ applause ] >> thank you very much michael. timothy?

>> go the other way. always the technology challenge. you start your presentation and we'll catch up. >> i've been asked to talk about the artic human development report which recently came out as heather said it was i guess it came out a couple of months ago but dated 2014. this is the second arctic human development report and first

published in 2004. one of the things -- well going through my slides already, it was put together by a number of different teams or some 27 authors and three leave editors, very international team drawing from across the arctic. here we go. across the arctic. this is not a research report necessarily, it's more of a review of research that other people have done so yeah done under the auspices of sustainable development. we have a number of target developments and one was the arctic council and policy makers in the arctic and others in the arctic like yourselves. what we found is from the first arctic and development report, colleges and universities use this report rather extensively, these are the different chapters in the arctic human development

report. i'm the lead author on the migrational poll but i'll focus on the chapter of human health and well being. we have had a number of guiding questions of the author and author teams were asked to address, one was how does the arctic differ from outside world and corps of the arctic states? certainly look at issues of ethnicity and how those affect populations of the arctic. climate change was a factor also. and certainly regional variations among the different parts of the arctic and i'll height highlight those and how did the changes over roughly the first decade of the 20th century since the first arctic human development report. but focusing on health disparities or health and issue

of disparities,disparityies is an issue. the previous speaker is highlighted and in this chapter that's a trend highlighted in a number of different places, dissparedis disparties between indigenous and nonindigenous people. i pulled in section from the report and i think in heather's report, this different grouping, nordic country's overall high health indicators not large disparities between the different peoples and then the kind of western-northern american arctic, rather good health indicators overall but between indigenous and nonindigenous, greenland, regions high disparities between those places and canada and denmark. then the russian arctic which

i'll highlight overall poor health indicators in general. this is from -- just one of the short exams from the health at las. what he does he contrasts infant mortality between greenland and denmark and the story is greenland is 30 years behind denmark in reducing infant mortality, the two lines converge rather nicely but 30-year generation gap, this is from my chapter again, highlighting these regional disparities among the 27 or so arctic regions. you can see here there's a huge difference between the fair islands, ice land, some of these places and then going down -- international -- according to the u.n. definition. this huge difference and where

you have a life expectancy of 58 years, large difference between men and women. and one of the factors that drives a lot of the overall disparities is the differences between men and women. on the left side are the russian regions where men -- women outlive men by over a decade. and these are some extremely large differences possibly some of the largest in the world. and the point is, when you have roughly half of your population with a low life expectancy, you're going to have low overall life expectancy. infant mortality shows somewhat the same trends. the highest rates of infant mortality are in some of these prominently indigenous regions or countries, greenland going down to places like iceland and some of the nor tick countries

which are really having among the lowest levels of infant mortality in the world. but just one thing i want to highlight, i put the whole world in less developed countries to show even though these are high relatively to some of these countries, the arctic and arctic regions actually you know exist within highly developed high income countries. there's possibly some hope or something that can be drawn upon there. apologize for the quality of this but basically the point of this shows the trends in tb across the circumpolar regions. you can see the large declines in tb but kind of continued disparities in tb. this -- one of the previous speakers talked about suicide. this is from some work that jack hicks has done.

looking at suicide rates in canada and then among the inuet you can see relatively flat and the trend in nunavut continued to grow up. jack is a rather cheerful guy and this is depressing research to do. he correlates this with various historic alleyal events and clustering of sueicides. this is from some work i did. this shows the sex ratio of males to females in russia. this is 1989 prior to the break-up of the soviet union. you can see most of the arctic, northern regions have much higher male sex ratio than the rest of the country. this is because the demands of industry and industry can draw more men than women.

as the -- i do a lot of research on migration looking at the changing sex ratios in the arctic, i'll be telling a migration story and men with cope with down sizing and arctic and northern economy, mygrating out. you can see declining male sex ratio, only a quarter is due to migration. three quarters of it due to the fact that men are dying in larger numbers than women in russian north. if we keep going down, this male sex ratio continues to decline. these gaps in life expectancy, russia overall has among the highest female advantages and life expectancy and some of these regions it's extraordinarily high. i speculate that is probably among the highest in the world. the first arctic human development report really focused on health in the chapter was called health and well

being. it tries to stress that and look more broadly at that all indicators of wealth being, looking at what the health or welfare sector can do. charts on the right show the trends in gdp and trends in life expectancy over the first decade of the 20th century. and green shows improvement and red shows decline. most of the arctic countries, generally been an improvement in life -- improvement in both in life expectancy and in gdp. and there's -- what the arctic human development reports, subsequent reports to that they take the u.n. human development index through three components of that but then they try to add

others that are kind of arctic specific, control cultural identity or language or tension closest to nature, things that are important particularly to people in the arctic. so to conclude, in has been a lot of research on health and health well being of indigenous people. previous speakers talked about this in the chapter and the report talks about that. there's been a number of different research intervention efforts underway to improve the health and well being of people in the arctic. one of the takeaway messages in the report is that there has been considerable improvement in a lot of areas of health. i pointed out life expectancy and others. but there are issues health issues in the arctic that remain rather intractable. when i showed them about suicide and tb and some others some sexually transmitted diseases and domestic violence, just don't really show any sign of

improvement i think in the report talks about the warming climate and how this may impact water, food security certainly some infectious diseases and things like that. lastly, senator murkowski talked about the importance of educating the next generation about the arctic and i think some other speakers mentioned that as well. i'll finish with this slide. this shows my young 2-year-old daughter looking at the arctic human development report when it came in. notice the smile on her face and the thrill with this. she was actually born and raised during my writing of this whole thing. so i'll stop there and take any questions you may have. [ applause ] thanks very much we heard a lot about suicide, heard a lot about water and sanitation, both

with respect to the work on your way specific to alaska but also work that is under way in the broader arctic council context. i take that to mean from certainly the cdc and nih perspective that these are the areas where there's the greatest promise and there's an agenda formed up and away forward. i also took away from listening to your presentations and listening to tim that we need to be quite realistic that there are -- there are some significant barriers to really carrying forward that agenda or other broader infectious diseases agendas. the huge variation as you pointed out huge variation culturally demographically, and geeographically

geographically, across these different communities and sovereign entities. we didn't talk much about what the political barriers might be in terms of getting cooperation within the council on some of these very sensitive and culturally based problems and we didn't hear much about the questions of prioritization across the constituent governments that we're talking about to what degree are these issues. some issues within a broader health spectrum, to what degree are these becoming prioritized and is there political well and financial resources and commitments to try to move this agenda forward. so on the one hand, we have the u.s. coming into the chairmanship next week. we have these -- this body of work out there we have the human development report out, there's a lot of new content to move forward. there's a lot of active ongoing work. but what can we -- what should we realistically expect in the

two-year the period of the two-year chairmanship in moving the aagain da forward. maybe i could ask pamela and michael to stay a few words about sort of what your hope is given that mix of both opportunities that have arisen all of the good works that you've done and some of the questions around what is this environment? what are we likely to see in this period? how do we set our compasses in a realistic way? pamela and michael? >> i think one important aspect of the chairmanship is bringing attention to these issues the mental health needs in the arctic and alaska specifically and attention to where the risks are and what resources we have

to build on. that's one important issue. from the nih certainly will continue to fund research to answer these questions in alaska specifically and as well as in other -- in other sites as relevant. but i think that's a big one. and i think the opportunity to have a mental health project as one of the sustainable development working group projects invites this collaboration across countries to address these issues. as i mention the presentation, the project in sustainable development working group is one such thing but within nhs with respect to mental health interventions, the substance abuse and mental health services administration continues to support work on service delivery for mental health as well as for substance abuse and suicide prevention.

they in fact just released an rfa earlier this month for tribal communities on suicide prevention intervention. so to make a long story short, there are many things happening in concert but i think this is a great platform to bring attention to an area that often does not get the kind of attention it needs in the global health context particularly and with respect to thinking about the disparities in mental health that are clearly evident. >> you do feel that the -- the groundwork has been done in terms of the rising sun, a consensus among the constituent governments of the arctic council, that this framework -- there is a buy-in for this framework, preliminary buy-in to move this forward? >> when you say groundwork so yes, this hash a proposed project that has been reviewed by the various members of the arctic council. and that at this point, we do

have buy-in from countries that would like to join us in this work. we're looking forward to it. >> what is it going to take in your estimation to bring it to life and carry it forward? >> so for that specific project, there will be -- it will take country partners that will commit funds to move that project forward and i think we're expecting some of those kinds of commitments to occur and we'll certainly hear more about this after the u.s. officially -- commitment of expertise and commitment of helping us to gain access to those networks out there that bring access not only to the experts but also to the community members who we hope to engage in this process as well. >> michael, can you say a few words about how much consensus exists today and what is it going to take to really move

this forward in the next two years? >> sure, yeah i guess i would second pam's comments in terms of increasing and strengthening our collaboration with our international partners. i've been working in arctic for my 16th year. when we started the circumpolar surveillance system, it focused on infectious diseases there's more to it out there and broadening that with our partners is very important. but with a focus on health. and so we've tried to address many of the health -- number of different health issues in alaska, but current focus is on water and sanitation. one of the reasons for that i said a little bit about it earlier. we have piped water to about 78%

of those rural villages but there's a significant portion that don't have it. and may never get it. so what do we do? one of the interim steps we had taken was to develop small hall water systems into these villages. so if you have a small hall tank in your home, you can truck water to the home and fill the tank and you can have faucets and have a shower and have some water in the home in that respect. as it turns out, that model doesn't deliver a lot of water into the home. so what we've learned is that homes that have honey buckets that have basically no system other than a central watering point where you go fill up buckets, they deliver 1.5 gallons of water per person per day. if you have a small hall system

they deliver about 2.5 gallons of water per person per day. the w.h.o. recommends a minimum of 13 to 15 gallons per person per day. if you look at what the use is in the united states in general, we generally use about 50 gallons per person per day. so our villages in alaska are doing extreme, extreme water rationing and we know that this isn't just true for alaska. there are other areas in the arctic some of our other neighbors in the arctic and northern canada and greenland and northern russia, also have issues with remoteness and water and sanitation and so what we're hoping to do -- and we've done this with surveillance we're hoping -- we've learned many things from our partners. we're hoping that this alaska initiative on water and sanitation that i explained to you a little bit earlier can potentially be used as a model

and help in pushing that model forward to develop these technologies across the arctic. >> tim, this 10-year study, the new study for the first time in a decade, it's very comprehensive and ensigh cloe paidic. how is it going to be used by the leadership of the arctic council to move an agenda forward? >> well not exactly sure but it's -- i think one of the things we were supposed to do is to highlight some of these differences and to put this out there in front of them and say, you know especially since this was the second arctic human development. the first was really kind of a stock taking. there wasn't a lot known. like i said this wasn't necessarily new research. it was kind of pulling together

existing data and pulling together from a number of scientific studies and like i said one of our mandates was to look at some of the trends over time. all of of the chapters do that economic chapter, my chapter, certainly the health chapter. he think what we've done is we've looked basically over the first decade of the 20th century since the first report and said okay, we identified and hope flip i brought these out, these are the areas that there's generally been improvement. things are getting better in certain areas but this chapter is certainly highlighted areas where there hasn't been improvement and hasn't been improvement in specific arctic regions and the issue of suicide and these others that i've mentioned are intractable diseases, the issue of domestic violence keeps coming up, again and again. so hopefully the arctic council

an other people interested in the arctic can look at this and say, okay, these areas are getting better but there's -- there's other areas that are actually not getting better and those are maybe the areas that we need to -- there needs to be some focus on. >> could you say a few words about the u.s. calculation in this. you know the policy environment here you know the history of the u.s. engagement on these arctic issues. you talk all the time with the administration around these issues. what can we hope for in this next phase in terms of prioritization and leadership on these issues. and will they take up your recommendation? >> well, here's hoping. well you know i think that the really disappointing thing i guess is about 12 or 18 months ago, it was put forward to the office management budget to create a budget for the u.s.

chairmanship so there would be extra funds. it would be given to implementing some of these key priorities and fortunately they said that was not a good idea and that budget did not exist. what is happening is we have these fantastic priorities but agencies, this is again the theme we raise for senator murkowski, going to have to use existing resources and try to squeak reprioritize and we know in this budget scarcity, this is really difficult. that was step one. we missed a huge opportunity that i think what the u.s. chairmanship is going to be is a lot of really good projects and highlighting projects and modeling projects we'll show case but quite frankly the funding will not be sufficient to boost them. great work being done but boy, they need turbo charged government. the white house did -- has a new body in place, the arctic executive steering group which

is led at very senior levels. they have been charged with doing a gap analysis. it's -- if you dare to read the white house's implementation plan for the national strategy for the arctic region, short little title, we do see where in the implementation plan there are clear outlines for -- and i yoet, to coordinate better comprehension of the articctic indigenous people. i hope this gap analysis says we have the u.s. chairmanship theme is arctic improvements and arctic economic and living and well being conditions. we have great things but there are not funding. we are going to prioritize this and put funding. i would argue for the state of alaska, it is an absolute tragedy to hear some of the figures that you've cited. it's appalling.

it's unacceptable, leadership begins at home. you need to start focusing our time and attention on americans that are suffering from these conditions. and then exactly we need to pull this out and provide that leadership effort circumpolar. my concern about the sdwg, it is the mothership of the working groups, it's a monster working group and that's where it gets stuck because it does so much. it's absolutely vital that we pull this out and say, look if we're serious about this we're going to put those resources and hold those arctic governments to account and say let's put that money in and my frustration quite frankly with the arctic human development part it's not an arctic council product. it's not. that's a problem because if it's not a product, you go that's a lovely report thank you very much and then keep going to our regular business. this is exactly what we need

these wonderful assessments and reports, we need to hold governments accountable for how are they moving the measure. i love that stop sign. the arctic council needs that graph and stop signs. you promise this, you ministers you sign and said we agree with this but our governments have done nothing about who's holding them accountable. this is part of the arctic council's governance requirement but it comes from lead areship from national councils. i think we have an opportunity here and it's -- to raise public awareness absolutely but we must start making the tough budget choices, show me show me that money. and so far we've said it's important but we haven't reflected it's important in our budgets. it begins with our budget. i would encourage them to be much more generous, so easy for me to say, we've got to start addressing these challenges. >> thank you very much. let's move to our audience we've

got 15 minutes, let's collect several bundled together several interventions, we have one here and one here and one there. yes, sir, please identify yourself, be very such sink and offer a quick comment or question. >> first of all, i completely support your recommendation. i would take health out of sdwg as fast as i could. they have too many things in it and also structural, it should not in my personal opinion be head of delegation and have a service officer brand spanking new. the other industries do the same thing. we need to get subject matter experts for this and specifically on how dr. colins, thank you so much. i'm so pleased to see you involved in this activity.

it's a challenge. part of the tyranny is the small numbers of people. you can have discussions in full in other places and they will point to the large numbers of deaths in subis a hair ra africa. if you're all locating funds, you try to go with numbers of people, but these are citizens. a question for you you mentioned rigorous evaluations. some people would argue that's really not looking at the root cause researchwise in terms of suicidality. at the commission we tried to get an institute of medicine study focusing on that and we failed because we did not engage with communities in developing this and explaining what the study was and how committees are formed and how editorial control is done. do you think an iom study if we

tried again would be a useful way to do a rigorous evaluation of this issue in the north? and loaded on that question is very hard to get capacity, even if you have money oriented towards these problems, hard to get capacity, no medical school in alaska not a lot of investigators to keep people interested in grant in this kind of work. ion and how do we build capacity even if there is funding? >> thank you. >> sir? >> good afternoon, charles newsted, state department and hasten to add i'm speaking for myself not the department find myself in the basement without a telephone. i'm very impressed by the broad scope and expertise that this panel represents. it's truly impressive.

and i'm also very impressed with the way that you and your colleagues have drawn international cooperation into play in dealing with the -- that's vitally important. the main thing is money and bottom line. found -- and i think most people would agree with this international scientific cooperation is a great multiplier how much you can do with your budget. i applaud your efforts in that way. and now my specific question, i'm wondering if the panel could compare in the various different fields the health situation in russia, various regions, compared with that in the west with alaska and canada and greenland, et cetera and final question is has mr. putin made -- he's trying to become a

czar again as we all know. has he had some effect on the arctic yet? is that discernible? and is that good or bad? >> thank you so much. >> linda fernandez. i have a question combined with a suggestion. you did mention a circumpolar water sanitation conference scheduled for next years perhaps as what would be a result of the alaska and sewer challenge that's going to be magnified. i guess i have a suggestion as well as a question. are you teaming up efforts with all the international collaborators during world water week that's convened in sweden every year? has great buy in across a lot of

international countries. it's clear to me that while you made great strides in having the partners involved, some of what you're suggesting has been addressed in other settings with the far ners engaged differently. i'd make a suggestion and question whether you can synchronize that and join in with that group? >> thank you very much. are there any other comments and questions at this time? >> i'm michelle learner coming from a different perspective. i work for bread for the world institute. we work on hunger and malnutrition. my question is just in general would you consider that malnutrition or food insecurity, lack of money, who doughhow do you

think that's impacting the people? >> what's the comparison russia versus the west? i think we'll turn to tim on that although everyone will have somebody to contribute on that and who impact putin. what about tieing water week to sweden and then the food and security issue. michael, why don't we start with you. >> i think it was a question from the gentleman from the state department about the health situation in russia versus others in polar nations. i have to say i know very little at least in regards to water and sewer in russia. we had some collaborations with the russians on a number of

variety of different of infectious diseases. i can't tell you for sure. the next question was are we teaming up with partners of the world wear week in sweden. ooip like to speak do you more about the world water week in sweden. i'm not wareaware of that meeting and we probably should be attending. i'd be very interested in learning more and we should attend that meeting. thank you.

from the woman at the barefoot world institute, -- i'm sorry. food insecurity is not something i'm a specialist in. i know it's an issue in rural alaska. many of the people put food in food lockers buried in the ground as the permafrost. those food lockers are failing. i think i went through the questions. >> i'll start with the research capacity.

i think that's critical. in place where is you don't have a lot of researchers. we need to see more research career development in the context of alaska. i would support that. that means figuring out how to establish mentoring or students that the idea of pursuing research as a career options becomes a feasible and realistic idea. it means working with institutions in order for them to develop an adequate infrastructure and wasilla. i agree that would be important particularly in the context of mental health research.

some of the efforts are underway where there are initiatives that focus on american indiana building and we need to continue those efforts. with respect to the iom meeting i would probably ask you again, that sounds like how many buy in is there in the local context. that seems like it would be one starting place to make sure you got all your stake holders in alaska being of a single mind about pursuing something in that direction but whatever avenues whether it's an iom report or a mother avenue to bring attention to the needs and to rigorously document where we are with respect to effective interventions in these contexts it would be an interesting intervention. >> thank you. wonderful questions. two quick comments. first a preview of coming

attractions. we'll be releasing in june, hopefully a study on the russian arctic. you heard in the energy panel russia has enormous economic stakes in the arctics. they have a long history of writing comprehensive and detail strategies. some of them quite interestingly and caitlin has been a great student of studying these strategies. they do have a robust, sustainable development component. we need to understand what's important. why is the arctic so important to russia and my thesis with we seen some significant and disturbing changes in russia's arctic policy particularly after the crimea annexation.

thank you for your question, coming to you soon in a comprehensive report. countries working together in the imo were so instrumental in pushing through a new mandatory polar code. we're going to see a similar arctic caucus. those are my words at the paris climate summit at the end of this year. we have to think where issues cross and let's gather the eight

arctic county till members and the observers if they have a role to play. >> thank you. tim. >> i'll address the question about the comparisons between russia and the united states in terms of health indicators life expectancy. russia seems to be susceptible to economic downturns. things improved and they got

worse with the '98 global crisis. i think there's been some increase in the death rates over the last year or so with this economic downturn. it's hard to say why. it just seems to be more so than most other countries. we had our financial crisis in the late 2000s. overall life expectancy in these arctic regions.