Nunavut’s vicious health care cycle: Less money, more sick people

IQALUIT — The CEO of the Baffin Regional Health and Social Services Board, Jarvis Hoult, says a cash infusion from the government of Nunavut last week has solved the board’s short-term cash-flow crisis.

But he said the Baffin health board is still groaning under an accumulated debt of $4.7 million, and is now looking at a narrow range of options for paying it down.

Those options, Hoult said, break down into two types of solutions deep spending cuts, or generous contributions of new money from the government of Nunavut.

“It doesn’t take a rocket scientist to figure out that there’s only two things left, you either get money at a point that allows you to stop fiscal bankruptcy, or the board has to make certain decisions to avoid fiscal insolvency. We have two choices.” Hoult said. “That’s the crossroads we’re at now at the Baffin Regional Health Board.”

So far, Nunavut Health Minister Ed Picco has been unsuccessful in attempts to find new money for Nunavut’s financially-troubled health boards. That means deep spending cuts may be the only option left.

Hoult said it’s no wonder that the Baffin board is finally breaking under the strain of short-sighted decisions made several years ago under the government of the Northwest Territories, which brought about cuts to employee benefits, cuts to operating budgets and the amalgamation of health and social services.

“It started a chain of events that is beginning to peak. You roll back salaries, you reduce northern allowances, you cut subsidized housing, you take out VTAs, you reduce operating budgets. Sooner or later, something has to give,” Hoult said.

“How many more stressors do you want on the system? Right now, I wish we’d spread them out.”

Less money, more sick people

Although the health board has less money and fewer staff members than ever before, the number of gravely ill people in the Baffin region is rising dramatically.

According to Hoult, there’s been a big increase in what health officials call “lifestyle” diseases. These include STDs, trauma injuries caused by accidents and assaults, and heart disease and stroke.

Because 85 per cent of Baffin women who give birth smoke before, during and after pregnancy, the risk of health problems to Baffin women in their childbearing years is high.

And the average age at which Baffin women give birth to their first child has gone down from 16-18 years to 14-16 years.

The large numbers of younger first-time mothers is presenting a new public health challenge — because young pregnant women are less likely to eat well, get prenatal check-ups, and stop smoking.

This means greater health risks for babies and mothers, and more spending by the health board.

But at a time when the board ought to be boosting its public health education activities to counteract these troubling trends, it’s been forced to reduce public wealth and other “wellness” programs.

“Overwhelmed with illness”

“Are we supplying as many wellness programs as we were this time last year of the year before? No, we’re not. We know that,” said Hoult. “A lot of our community health centres have had to drop certain clinics because they’re just isn’t the time. Our staff is overwhelmed with illness.”

These cutbacks contribute to the Baffin’s spiraling increase in health problems and costs. The more the board cuts back on its “wellness” efforts, the result is more illness.

“It’s a constant contradiction that we’re always faced with,” Hoult said. “At the end of the day you focus on illness, focus on saving the paitent, and other things have to fall by the wayside.”

The Baffin health board receives $42,423,369 from the Nunavut government for its health and social services budget to serve a population of about 13,000 people.

That’s much less per capita than the $37.5 million that the Nunavik Regional Board of Health and Social Services receives from the province of Quebec to serve a population of around 8,000 people. In addition to that, the Nunavik

15 communities are served by resident doctors.
Overall, the Nunavut government spends only about 20 per cent of its overall budget on health and social services. The province of Ontario, by comparison, spends 38 per cent of its budget on health.

Hoult believes a larger investment in Nunavut’s health services will lead to a significant reduction in illness — and savings down the road.

This is the idea that Hoult wants to sell to the Nunavut government and other agencies when he goes looking for more money.

“If I’m unable to secure more money, I’ve been directed to bring back a spending reduction plan that would allow the board to avoid fiscal insolvency,” Hoult said.

In 30 his years as health administrator, Hoult said that he’s never yet seen a health centre close unless there was a consensus that it was the only option.

“We have a long way to go. The numbers are real, the issues are real. We’ll work this out,” he said optimistically. “But working it out is not saying that the government is going to give us more money.”