Nunavut’s approach to cancer is unacceptable

In November 1992, after a one-sided, high-pressure publicity campaign, the Inuit of Nunavut were manipulated into voting yes to the Nunavut Land Claims Agreement.

In doing so they also voted yes to Article 4, a promise by the federal government to divide the Northwest Territories and create a new territory called Nunavut, bounded, for the most part, by the land claim settlement area.

An essential element of that promise was that the government of that new territory would offer programs and services comparable to those that other Canadians receive from their provincial and territorial governments.

Former Prime Minister Brian Mulroney, whose Progressive Conservative government negotiated all the foundational Nunavut agreements, said so in a 1990 letter written to the Tungavik Federation of Nunavut: comparable programs and services.

That promise has not been kept, especially in health care.

The latest evidence to support this can be found in a report last month from the Canadian Cancer Society.

The Cancer Society found that Nunavut residents actually develop cancers at a rate that is lower than for Canadians living in most other places. And that’s taking into account Nunavut’s high lung cancer rates, which really are higher than elsewhere.

So despite what you hear, health statistics reveal the overall incidence of cancer in Nunavut is not abnormally high.

It’s the cancer death rate that’s abnormally high. National statistics show that if you develop cancer in Nunavut, you’re far more likely to die of it than Canadians living in other jurisdictions.

For example, colorectal cancer is treatable in 90 per cent of cases — if it’s caught early.

But in Nunavut you’re twice as likely to die of colorectal cancer than people elsewhere, according to the 2011 Nunavut Report on Comparable Health Indicators.>

Don’t forget: that was a Nunavut-generated report that tended to play down the territory’s poor health outcomes. For its part, the Canadian Cancer Society estimates the death rate for colorectal cancer in Nunavut is likely worse: four times greater than Canada’s for men and women alike.

This likely contributes to another recent finding — that Nunavut suffers the highest rate of avoidable deaths in Canada.

MLAs, over the years, have tried to ask various Nunavut health ministers about this, usually in clumsy, unfocused questions that go nowhere.

The standard complaint, which Inuit in the small communities have made for years, goes like this. A patient shows up at a nursing station, complaining of a lump in his or her body. The patient is sent home and told not to worry. Eighteen months later, the patient dies of a metastasized cancer.

In other variations of this story, patients learn of their cancers after their cancers have already reached stage three or stage four. With such diagnoses, they have no choice but to go home to prepare for an untimely death.

Many Nunavut residents blame nurses for this, mostly because the health care system doesn’t give them anyone else out there to blame. But this is grossly unfair. Nurses are not trained or empowered to diagnose or treat complex diseases.

Only doctors are able to do that — and it’s likely that Nunavut doesn’t employ nearly enough doctors, whether they be general physicians or specialists.

The Canadian Institute for Health Information reports that the Northwest Territories government employs twice as many doctors per capita as Nunavut. Yukon employs more than five times as many doctors as Nunavut.

In Nunavut, only 12 to 15 general physicians are likely to be working at any given time, to serve a population of 33,000.

This may explain why, unlike virtually every other jurisdiction in Canada, Nunavut does not have a cancer care and early detection strategy.

There’s little doubt that Nunavut’s lung cancer death rates — five times the national rate for women and four times the national rate for men — are linked to the large numbers of people who still smoke cigarettes.

To that end, the anti-tobacco public health campaigns that the Government of Nunavut runs are laudable and essential.

But patients also need access to quality health care, which includes early detection of cancer.

As Rankin Inlet resident Ellie Cansfield pointed out in a recent letter to Nunatsiaq News, the territory’s health department does not provide Nunavut residents with detailed information on Canadian standards for cancer screening.

And she discovered that the Nunavut government’s health department doesn’t even have the ability to generate up-to-date cancer statistics for the territory.

That’s not acceptable. Blaming the patient is no substitute for quality health care comparable to what all other Canadians receive. And when Inuit agreed to surrender their aboriginal title in 1992, a substandard health system was not part of the deal. JB