A critical look at Nunavut health care — Part One
“There is no meaningful community-level input into our health care”
In Nunavut, health care delivery has recently been a topic of intense discussion.
In the wake of the coroner’s inquest into the high rate of suicide in Nunavut, followed by the release of the independent investigator’s report on the death of an infant in Cape Dorset, a critical look at the origins and future direction of our health care system is needed.
There are two important issues that I believe require meaningful discussion to address many of the challenges we are currently facing in our health care system:
1) the governance of the health care system, and,
2) the health care model that forms the basis of the system.
Nunavut has one hospital, in Iqaluit, and two larger health centres in the regional centres of Rankin Inlet and Cambridge Bay, which are staffed by physicians.
Health centres staffed by community health nurses serve the rest of the communities, and physicians make visits to these communities throughout the year. All these care centres are run by the Government of Nunavut.
Specialized services are accessed at tertiary care facilities in, for example, Yellowknife, Edmonton, Winnipeg or Ottawa, if more advanced or complex care is required.
Public health services and health promotion initiatives are also largely the domain of the GN. These programs consist of maternal-child health supports (well-baby clinics, immunization clinics, breastfeeding support, prenatal nutrition programs,) chronic disease management, environmental health, anti-tobacco use initiatives, sexual health, infectious disease control, oral health, and nutrition and food security initiatives.
In our territory, the governance and implementation of our health care system is encapsulated entirely within the GN.
But if one were to examine the governance of wildlife in Nunavut, for example, there are multiple layers of consultation and oversight.
There are community-level organizations, regional wildlife organizations, territorial organizations and government, and federal departments, which are each afforded the opportunity, in some form, to contribute to the oversight of the management of wildlife in our territory.
The same opportunities to contribute to the management of the health and wellness of our people do not exist in the current health care system.
There is no meaningful community-level input into our health care. There are some active community health committees, however their operations vary widely and their perspectives are not necessarily incorporated into the health care system.
There is no meaningful regional-level governance of our system because the regional health boards, which once existed, were eliminated when Nunavut was formed.
There is no independent oversight of our hospital or health centres, whereas in most jurisdictions in Canada, hospitals have independent governing boards. Our hospital and health centres are all governed by the Department of Health.
There are collaborations with federal health departments for specific programs, such as the Non-Insured Health Benefits (NIHB) program, the funding transfers for specific programs, and for surveillance purposes.
Therefore, there are no formal avenues for Nunavummiut to have input into our health care system unless it’s through legislative means — by contacting one’s member of the Legislative Assembly or the health minister.
The end result is that if one has an opinion about a process or a protocol or a policy or treatment in our health care system, there is no independent board to inform or to turn to for advice.
Without independent layers of oversight and accountability, how can our system function? How can this system meet the needs of our communities when we are not permitted to participate in its oversight and implementation?
Part Two of this series — available here — takes a critical look at the health care model used 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.