The need to advance our understanding of the health system context in northern communities has been highlighted at many international and Arctic forums. When the Arctic states’ health ministers met to sign a health declaration that identified shared priorities for international cooperation, they underscored the importance of collaborating to enhance intercultural understanding, promote culturally appropriate health care delivery and strengthen circumpolar collaboration in culturally appropriate health care delivery.

As the pressures of climate change mount and Arctic nations are under more stress, exploration of policy options has become more urgent and national leadership has responded. Canada and the U.S. issued a joint statement on climate, energy and Arctic leadership calling for a shared leadership model which engages Indigenous leadership and solutions that build on scientific and Indigenous knowledge; support for transdisciplinary science and Indigenous and local knowledge is echoed in the U.S.-Nordic leaders’ summit joint statement. Declarations such as the United Nations Declaration on the Rights of Indigenous Peoples recognize Indigenous peoples’ rights to have access to their traditional medicines and health practice.

There has been a lack of study on how health systems situate or optimize performance in the Arctic context. The Circumpolar Health Systems Innovation Team (CircHSIT) came together in 2013 and is one of a number of teams in Canada funded through the CIHR Community-based Primary Health Care (CBPHC) Signature Initiative. CircHSIT is designed to provide research evidence to enable the transformation of Primary Health Care in remote northern communities in Canada.

The CircHSIT’s research explores how health systems respond through a stewardship framework which aspires to more ethical and multisector approaches to health:

• We developed new methods that recognize Indigenous knowledge and western science to broaden our lens.
• We captured Indigenous and national perspectives and enveloped notions of common values — humanity, cultural responsiveness, teaching, nourishment, community voice, kinship, respect, holism and empowerment — which provide a basis for health systems’ comparisons in Arctic nations.
• We used a case study approach to highlight how circumpolar health systems organize and respond through health system stewardship functions to the shared context of impacts due to climate change and environmental and mental effects impacts, geographic remoteness, Indigenous health needs and values, and health equity. 
• We identified policies and strategies within circumpolar nations that respond to shared context and challenges.