Nunavut demands equal treatment

We want equal treatment.

That’s the message the Nunavut government and three Inuit organizations brought this week to Roy Romanow, the head of the federal government’s one-person commission on the future of health care in Canada.

“Simply stated, there is an absence in the basic range of health services in Nunavut that are taken for granted in the rest of Canada,” Ed Picco, Nunavut’s minister of health, told Romanow at a public hearing in Iqaluit April 8.

In April 2001, Prime Minister Jean Chrétien appointed Roy Romanow, a former NDP premier of Saskatchewan, to head a commission aimed at finding ways of fixing Canada’s dilapidated health-care system.

Romanow will likely issue a final report sometime next year.

It’s too early to say what Romanow will recommend, or whether Chrétien and his government will heed his recommendations.

But it’s clear that the Nunavut government and Inuit organizations, who don’t always see eye-to-eye, agree on at least one thing: Ottawa’s health policies are failing in Nunavut.

“Inuit leaders are concerned that the [health] problems have already reached crisis proportions,” said John Lamb, Nunavut Tunngavik’s director of implementation.

Lamb said the federal government may not be living up to commitments made in Article 2 of the Nunavut land claim agreement, which state that Inuit are entitled to all the rights and benefits available to other Canadian citizens, and to participate in government programs aimed at aboriginal people.

“What’s really needed is some nation-building,” Lamb said. “Canada must live up to its commitments to bring Nunavut into Confederation.”

Mental health an Inuit priority

The Qikiqtani Inuit Association, represented by John MacDougall, a QIA policy analyst, told Romanow that Ottawa should develop a separate “Inuit health policy.”

“There is a need for an Inuit-specific health policy made by Inuit themselves,” QIA says in its submission, called “The Seven Qulliqs of Inuit Health Renewal.”

Another QIA submission, prepared by Amanda Ford, QIA’s health liaison officer, says mental health is the highest priority health issue for Nunavummiut.

Nunavummiut feel they are left alone to deal with the grief of suicide, domestic violence, sexual abuse, alcohol and drug addiction, and most importantly, the development and decision-making in the Health Policy Act,” her submission said.

In his presentation, Ed Picco cited a long list of shocking statistics that show the health status of Nunavummiut is worse than it is for people in some Third World countries.

“The deplorable health realities speak for themselves,” Picco said.

For example, he said 80 cases of respiratory synctial virus, or RSV, have been reported in Nunavut since January. There is no vaccine or treatment for RSV, which causes severe breathing problems for infants and spreads rapidly among people living in overcrowded housing.

Picco cited what he called a “shocking study” by Dr. Anna Banarji of the B.C. Children’s Hospital, who found that Inuit children are admitted to hospital for lung infections during their first year of life at a staggering rate — 484 admissions for every 1,000 children.

“This rate is higher than many developing and Third World countries and 50 times higher than the Canadian national average of 10 admissions per 1,000 children,” Picco said.

Tuberculosis rates in Nunavut are 13 times the national average, and there have been community outbreaks of TB in Arviat and Iqaluit, with sporadic cases in eight other communities.

“This is not acceptable”

And the deadly TB bacillus still lurks within the bodies of the young. Picco said data collected in 2000 show that in the Baffin region alone, seven per cent of children in kindergarten to Grade 5 have tested positive for TB.

“This is not acceptable in a G8 country like Canada,” Picco said.

Nunavut’s infant mortality rate is three times the national average, and the suicide rate is eight times higher than any other Canadian jurisdiction. Alcohol and substance abuse are also major problems in Nunavut, and reflect the territory’s poor social conditions, Picco said.

Saying that there are 50 per cent more residents per dwelling in Nunavut than in the rest of Canada, Picco told Romanow that Nunavut’s housing crisis only worsens Nunavut’s numerous public health problems.

“The cycle of illness in such overcrowded conditions makes it even more difficult for our health-care system to have a lasting impact on the health status of Nunavummiut,” he said.

To deal with these health issues, Nunavut is making do with inadequate infrastructure.

“As you saw for yourself, Nunavut has only one regional hospital. It is almost 40 years old and requires immediate replacement,” Picco said.

There are only 10 doctors residing in all of Nunavut, Picco said, and all but one of them lives in Iqaluit.

That means 90 per cent of primary health-care services in Nunavut are delivered by nurses.

“They operate on a 24-7, 365-day basis. The per-visit cost to see a community health nurse in Nunavut is much higher than to see a physician in the South.

Picco told Romanow about the delibilitating costs of sending patients to the South to see doctors and receive specialized treatment not available in Nunavut — $18.2 million a year in payments to out-of-territory hospitals and physicians.

On top of that, Nunavut must also pay $28.5 million a year for medical travel to southern centres. Picco said one medevac can cost anywhere from $12,000 to $15,000 and that it can take up to five hours to get a critically ill patient to an acute care centre in the South.

Federal policies “asinine”

In 1999, Nunavut spent $6,869 per resident on health care, compared with the national average of $1,904. But Picco said Nunavut needs more.

“Those who suggest that we are already doing a lot and spending too much should be reminded that whatever the federal government and Nunavut is spending now and whatever we are doing is not enough,” he said.

And he criticized Ottawa for introducing federal aboriginal health programs that ignore Nunavut and Inuit.

For example, he said that it’s “asinine” for Ottawa to exclude Inuit from a recently announced $125-million initiative to help aboriginal children with FAS and special needs. That program is aimed only at on-reserve First Nations people.

He also said a federal-provincial-territorial agreement in the fall of 2000 that increased Ottawa’s annual health and social transfers to the provinces and territories by more than $3 billion a year brought only a pittance to Nunavut — about $3.2 million a year.

That’s because CHST transfers are calculated on a per-capita basis, so that Nunavut always loses out because of its small population.

And when Nunavut attempts to get more program money, Ottawa threatens to reduce the money it provides the Nunavut government under the formula financing agreement, Picco said, so that Nunavut would get a net gain of zero.

Romanow, who toured Baffin Regional Hospital and the Pangnirtung health centre with Picco the day before, told Picco that he sees the Nunavut health-care system as a “remarkable product of commitment, dedication and will-power.”

“You must have one of the most difficult jobs in the country,” Romanow told Picco.