Recovery of Nunavut’s health-care system painfully slow
Although its condition has stabilized, Nunavut’s ailing health-care system isn’t yet ready to be taken off life support.
As his department prepares to take on the responsibility of paying for the leases on three new regional health facilities, Nunavut’s health system is still “on life support,” Health Minister Ed Picco says.
Lack of money is largely responsible for the Nunavut health-care system’s poor condition, Picco said, because federal government health money transferred to Nunavut doesn’t account for the high cost of care in the North.
These transfers are based on the territory’s population, instead of what it actually costs to treat patients in Nunavut.
“One million dollars for Nunavut is the same as $600,000 in the South,” Picco said.
As a result, Picco said his short-changed department may rack up a $3-$4 million deficit this year.
But lack of money is only one reason that the territorial health system is struggling to stay alive.
Finding qualified and keen administrators is another challenge, and this means Picco’s head office is still only at 40 per cent of full strength.
Picco said health issues in Nunavut are difficult for employees to deal with because of their urgent nature, which is why so many employees burn out and leave the department.
Even the turnover in provincial and territorial health ministers is high. Picco now says he has more seniority than any other provincial or territorial health minister — and he’s only been on the job for two years.
Keeping medical manpower on the front lines is tough, too. It’s even hard to retain staff in Iqaluit, where several essential positions are sitting empty.
Picco said his department plans to continue a more aggressive retention and recruitment strategy for health-care staff, and will train more local community health representatives and nurses.
But the poor state of health among Nunavummiut is also contributing to the territory’s health- care woes.
As it stands now, Nunavummiut aren’t doing very well in all the major health indicators.
Low life expectancy
The average life expectancy for men in Nunavut is only 67.8 years, and 71.2 years for women.
That’s 10 years lower than in many other regions of Canada, and even lower than in Nunavik and Labrador. At the same time, infant mortality is still three times higher in Nunavut than in southern Canada.
Other statistics for killer diseases are equally grim: Nunavut’s rates for tuberculosis are 10 times higher than the Canadian average, and rates for lung cancer in women are four times higher.
Rates for suicide, respiratory illnesses, and injuries are also several times higher in Nunavut than for Canada as a whole.
According to a Statistics Canada report on life expectancy, higher education and more employment can improve longevity and general health. The report concludes that “non-medical factors may play a role” in the poor health of people living in places like Nunavut.
This is why Dr. Ann Roberts, Nunavut’s chief medical officer, believes money should be spent in the right way if the goal is to help Nunavummiut become healthier.
Public health the key
Roberts suggests that dealing with poverty, providing basic public health programs, and training Inuit health workers is a better long-term investment than building new health facilities.
“You can’t bring in tons of folks like me to run affairs in a remote territory. More should be invested in training programs,” Roberts said. “I don’t ask for a new hospital. I ask for training programs so people can be the masters of their own destiny.”
Roberts said Nunavut’s current state of health is like that of impoverished city dwellers in New York City in the 1920s and 1930s.
During this economically depressed period, basic public health programs, including infant feeding, succeeded in building up population health and turning the situation around.
“Health promotion is one of our most potent weapons,” Roberts said.
But that’s not how it is now in Nunavut. At understaffed nursing stations and clinics, there’s little time left over for nurses to think about public health programs.
“The ill pour in and what little time there is afterwards is put into programs.” Roberts said.
Without the money or staff to tackle public health issues, Nunavut’s health department can only focus on a few major issues such as smoking, dental care, mental health and nutrition, and hope for the best.
Change will take time
The cumulative effect of these efforts, suggested Picco, may take a few years to bear fruit.
“I use the system,” Picco said. “So I suffer the same problems as everyone else. I want to see a better system in place.”
Picco said he’s made progress in some areas, and has resolved longstanding problems, left over from the government of the Northwest Territories.
Picco points to the dissolution of the three regional health boards, the creation of community health committees, and the launch of a nurse-training program at Nunavut Arctic College as his most tangible accomplishments.
Yet Picco still defends supporting the construction of new health care facilities. He hopes they may save some travel money and that patients will be happier, and perhaps recover more quickly.
In any case, Picco said they’re now necessary due to the growth of the communities — and the deplorable state of the Baffin Regional Hospital.