A critical look at Nunavut health care — Part Two

A mural painted on a retaining wall at Iqaluit’s new hospital pays homage to Inuit culture. But does the Nunavut health system really grounded in Inuit ways of knowing and understanding wellness? (FILE PHOTO)

GWEN HEALEY

The second critical issue in our health care system is the model upon which it is based — the biomedical care model.

Current biomedical models operate under the assumption that illness is secondary to disease, in other words, that we are sick because a disease is making us sick. Therefore, if one treats the disease, the illness will go away as well.

While there are many strengths of the biomedical model, which have led to its widespread popularity around the globe, there are several criticisms of the model as well.

For example, the assumption that a specific disease underlies all illness has led to the medicalization of some conditions, which are simply part of the human experience, such as menopause or aging. It has also led to disbelieving those patients who present with illness without any demonstrable disease.

The biomedical model is one of the dominant health care models around the globe. However, in recent years, indigenous health care models have been developed and increasingly recognized and implemented in jurisdictions such as in New Zealand and Alaska.

Indigenous wellness perspectives are formulated on understandings of the world, which are based on interactions between people, as well as interactions with the land, animal, and spirit worlds. Illness may originate from a place of disharmony rather than simply disease of the body, and wellness can be achieved by restoring emotional and spiritual balance, as well as treatment of a physical ailment.

This differs from the common biomedical practice of focusing on the individual in isolation, outside of the individual’s place in society or connection to the land, animal, and spirit worlds.

In a study of Inuit women’s perceptions of pollution, the well-known Arctic nurse and researcher, the late Christine Egan [who was killed in the 9-11 attack in New York City], found that Inuit women identified pollution of the land to be linked to mental health and wellness in the community.

From the perspective of participants in that study, changing relationships with the land carried over into changing relationships in the community and substance use, ultimately affecting the health of the community overall.

The biomedical model fails to capture this and other important perspectives related to what Nunavummiut feel we need in order to be well. Today, the tension between western biomedical models of health care provision and Inuit wellness models of care continues to permeate all facets of our health system.

There are a number of different examples of health system models that have been developed to meet the needs of the populations they serve.

In New Zealand, for example, the Maori Ministry of Health developed a health strategy based entirely on Maori conceptions of well-being, the result of which was a multi-faceted approach to health care delivery which placed Maori families, extended families, and kinships at the centre.

In September 2015, one of the Maori health districts began a process to “co-design” their regional health care delivery with participation from patients, families, staff, health providers, government agencies, council, and community to explore how new models of healthcare can be provided for their people.

In south-central Alaska, the “Nuka System of Care” is the name given to a health care system that was created, managed, and owned by Alaska Native people to achieve physical, mental, emotional and spiritual wellness.

In their language, “Nuka” means strong, giant structures and living things. The relationship-based Nuka System of Care is comprised of organizational strategies and processes; medical, behavioural, dental, and traditional practices; and supportive infrastructure which work together — in a collective relationship-based framework — to support wellness.

By putting relationships at the forefront of what they do and how they do it, Alaska’s Nuka System was designed to meet the immediate needs of their communities as well as to continue to develop and expand for future generations.

The creation of Nunavut was about self-determination and self-governance. The health care system is an important part of self-determination and health care systems can and should mirror the values of the people they serve.

In Nunavut, such a system should be embedded in a health care model that is grounded in Inuit ways of knowing and understanding wellness. Such models are a critical part of on-going self-determination and decolonization processes for indigenous communities throughout the Arctic and around the globe.

As a small territory, we have an opportunity to be innovative, creative, and solution-seeking. Nunavut is not a “challenge to be met” – our territory is an opportunity to embrace.

We have strengths, we have capacity, and we are capable. We know and understand the pathways to wellness that work for our people, and we should build on them to implement a health care system that can meaningfully address our health outcomes. We can be global leaders in the creation of a health care system designed for and governed by Inuit.

Truly understanding, and taking action on, the health challenges experienced in our communities requires us to be critical of the models that are conventionally used, to challenge the dominant narratives on the origins of health inequities in our communities, and design systems that reflect the worldview of our communities.

Part One of this series — available here — takes a critical look at health care governance in Nunavut.

Dr. Gwen Healey was born and raised in Iqaluit. She is a community health researcher, an assistant professor at the Northern Ontario School of Medicine, and she continues to live and work in her beloved home of Iqaluit.