An old message falls on deaf ears
When Aqqaluk Lynge, the Greenlandic vice-president of the Inuit Circumpolar Conference, said last week that Arctic governments should spend less on doctors and more on public health, he said nothing that his audience of health workers and researchers would find new or controversial.
Lynge acknowledged this himself. “The principles of community health and preventive medicine are not new. They go back a long way in most Arctic countries and, indeed, the world over,” he said in a brilliant speech made before the International Congress on Circumpolar Health in Nuuk last week.
In a nutshell, Lynge said that spending more money on more doctors, more hospital beds and more diagnostic equipment will not cure the appalling health issues that afflict northern residents.
Instead, he said, governments should invest much more in public health and public education campaigns aimed at changing the disastrous lifestyle choices that make so many northern people sick.
“Communicators, educators, and media people may be more instrumental in dealing with our health challenges in Greenland than doctors, expensive diagnostic equipment, and hospital beds,” Lynge said.
So far so good. Though we have some reservations, we agree with almost everything Lynge said.
The root causes of Nunavut’s health problems can be divided into two categories. The first is reckless personal behaviour — smoking, alcohol and drug abuse, bad diet, unsafe sex, and family violence. The second is social and economic deprivation — overcrowded housing, poor education, joblessness, poverty and the lingering effects of racism and colonialism.
The concept of “public health” is also two-fold. It includes the public circulation of information aimed at persuading people to do things that are good for their health. It also includes interventionist programs aimed at giving people things to help them cope with the worst effects of poverty and ignorance – such as school breakfast and lunch programs, home care, vaccination campaigns, and the distribution of free condoms.
Northern health workers — most of whom are employees of northern governments — have been urging governments to put more emphasis on public health for a long time.
It’s northern leaders who haven’t been getting the message.
For example, in 1996, Dr. David Kinloch, then the chief medical officer for the Northwest Territories, produced a report that reviewed health conditions in the NWT, including the three Nunavut regions.
Kinloch concluded that northern health conditions are so bad, the entire apparatus of territorial government should be transformed into a health and social development project. No one paid much attention to him.
Also in 1996, Dr. Richard Bargen, then the medical officer for the Baffin and Keewatin health boards, issued a ban on smoking in all public spaces within his jurisdiction. Regional leaders responded by rescinding his order, and getting him fired from his job.
To be fair, people in Nunavut are finally making a connection between Nunavut’s high rates of cigarette smoking and Nunavut’s high rates of lung cancer. The legislative assembly is likely to pass Health Minister Ed Picco’s tobacco control act, and MLAs have allowed him to spend money on a modest anti-tobacco campaign.
But those belated efforts, useful though they may be, aren’t even close to what we need. The devolution of health care from Ottawa to the territories, completed in 1988, must be deemed a failure.
One reason is the calculated cynicism of Canada’s federal government, which has used health-care devolution to evade its constitutional obligation to pay for aboriginal health care North of 60.
But another reason is the naive attitudes of northern regional and community leaders, who were, and are, unprepared to handle the policy and program responsibilities associated with running a health-care system — especially the kind of public health campaigns that Lynge advocated in his speech. That’s the real reason that Nunavut’s three regional health boards, created after the devolution of health care, were such a pathetic failure.
There’s no doubt that Nunavut’s bare-bones, Third World health-care system could use a few more doctors and nurses.
But what we need a lot more of are activist, interventionist programs. They include feeding programs for the young, more aggressive campaigns against substance abuse, family planning campaigns, and so on.
In short, it means government must stick its nose more deeply into people’s lives — something that Nunavut residents — and many Nunavut leaders – have always resisted.
The common-sense truth that lies within the heart of Aqqaluk Lynge’s message will not fade, however. And its encouraging to see that message coming from a political leader for a change. JB