In Iqaluit, the Minister of State met approximately 24 Nunavut health stakeholders.

Minister Bennett's Roundtable on Public Health
Sunday March 14, 2004
Parish Hall
Iqaluit, Nunavut

Structure of the Meeting

• Participants arrived between 1:45 p.m and 2:00 p.m.
• Translation service was available - Inuktitut and English.
• Minister Bennett arrived with Deputy Minister of Health, Department of Health and Social Services, Nunavut; Regional Director, Northern Secretariat; Communications Officer, Ontario / Nunavut Region; Senator Adams; MP Nancy Karetak-Lindell and one of her office staff.
• The roundtable was called to order by Vasanthi Srinivasan, Director Policy and Planning, Ontario / Nunavut Region, and participants were advised of the general rules of engagement for the roundtable.
• Liberal Minister, Nancy Karetak-Lindell commented on Minister's Bennett keen interest in the North and willingness to hear the concerns and challenges faced by its people.
• The roundtable concluded at 5:15 p.m.

Participants

There were 20 participants and approximately 12 - 15 observers. Also present were the Liberal MP for Nunavut, Nancy Karetak-Lindell and Senator for Nunavut Territory, the Honourable Willie Adams. The Honourable Ed. Picco, Minister of Education and previous Minister of Health, attended part of the session and brought greetings from the present Minister of Health, the Honourable L. Brown.

Minister's Introductory Comments

Minister Bennett thanked all participants and observers for giving of their time to attend the roundtable on a lovely Sunday afternoon in Iqaluit. She identified the important contribution the New Perspective on the Health of Canadians, the Lalonde Document, had to play in defining health as more than health care. She went on to say that health should be considered through the lens of the health determinants.

Other comments were:

• Health and Health care is everyone's responsibility;
• Health care is the repair shop;
• Canada needs a sustainable public health system;
• Public health is the "Niki" portfolio;
• There is a need to seek local wisdom and knowledge and empower - Per capita funding does not work in the territories;
• There is a need to continue to build relationships in the territories; and,
• There is a need to know what Nunavut wants to see in a Public Health Agency of Canada.
  The minister went on to state that the process of choosing a Chief Public Health Officer for Canada has begun. She also stated that the Agency will be a network that will build on existing public health strengths and filling identifiable gaps in public health. Legislation is needed to be able to establish the Agency.

Remarks from participants

• Public health system is only as good as its weakest link and Nunavut is one of the weakest links;
• Public health is everybody's business;
• Frontline workers are often addressing illness issues with little or no time for public health;
• Nunavut public health legislation needs updating;
• Surveillance and prevention issues are paramount in addressing some of the public health challenges facing Nunavut;
• Recognition that socio-economic factors are significant contributors to health, this has been confirmed in Lalonde and in the Romanow's Commission report.
  One-size health system does not fit all Canadians;
• Adequate financial resources for the health system is a major issue. Nunavut needs more resources for health and the extra $20 M from the 2003 Health Accord is not enough to fix the health system in Nunavut;
• Nunavut has ten doctors for a population of 30,000. This expresses the severity of the problem facing the territory;
• The issue of insufficient physicians is causing long waiting time for patients to get medical treatment or to be referred out for treatment;
• Staffing shortages are pronounced. There is a need to recruit and retain but also to train nurses in the territory;
• The incidence of cardio-vascular diseases and diabetes are increasing over time which will cause additional stress to the system;
• Presently Nunavut has the following number of patients receiving health services outside of the territory, 100 cases to Ottawa, 150 in Winnipeg, 80 in Edmonton and 40 in Churchill;
• Sustaining medical transport cost for these cases is burdensome;
• Requesting financial support from the federal government for health facilities in Nunavut;
• Nunavut supports the creation of a Public Health Agency of Canada and the appointment of a Chief Public Health Officer for Canada;
• Nunavut supports federal leadership in public health;
• Responses to communicable and chronic diseases control and prevention is a federal responsibility;
• There is a need for a seamless system for a fully functional system that is creative;
• The acute system presently drives out the public health system. Therefore, it should be funded reasonably well;
• Overcrowding because of insufficient housing is a leading cause of the increases being observed in some communicable diseases and respiratory tract infections, as well as a contributing factor to suicide;
• Nunavut needs 3,000 new homes;
• Safe drinking water and waste disposal are critical public health needs;
• Changes in dietary habits are creating health-related problems;
• Nunavut needs adequate funding for public health. Presently, it does not have the fiscal resources to deliver good quality public health programs;
• Inequity is accentuated in Canada as national and urban needs seem to frequently take precedence over the needs of remote areas;
• Time for the federal government to pay attention to public health needs in the territories;
• Environmental pollutants are adversely affecting country foods and breast milk;
• Nunavut's communities need to have access to long term funding for community programs;
• Federal government needs to move away from proposal-driven program funding;
• Thirty cents of every health dollar go towards medical transportation, interpreters and providing escorts for inter-provincial health services. This has a negative impact on the health budget;
• 60,000 boarding house days and 20,000 airline tickets issued for 2003. This cannot be sustained;
• Nunavut needs to repatriate health services and get support from the federal government to make the transition;
• On-off-reserve issue has an impact on Inuit programs in Nunavut because it is considered that many programs available to on-reserve populations may not be available to Nunavut. Territorial Aboriginal communities are not considered reserves. An example is the allocation of resources for an on-reserve immunization and TB strategy that was not available for First Nations and Inuit in the territories;
• More resources needed for health education, particularly for the training of laboratory technicians, home care providers and midwives so that more birthing can occur at home and in communities;
• Increased help for family violence prevention is needed;
• Telehealth has been good for communities by providing opportunities for training to remote communities;
• More flexibility is required in the pharmaceutical system. Presently it requires too much paperwork and is not meeting the needs of patients (The Minister requested that the participant send her a specific letter on this issue);
• Public health must focus on recruitment and retention of health human resources for Nunavut;
• Health human resources and nurses - a significant difference in the number of nursing graduates from Nunavut will not be noticeable until approximately 10 years;
• There is presently a 48 percent nursing vacancy rate in Nunavut;
• Much support is needed for the mature student who wants to become a nurse (Minister requested that the Deputy Minister of Health write a note on suggestions to increase capacity in HHR);
• Federally funded community-based positions could alleviate some the pressures faced;
• Role model program should be expanded and public health could be considered as an area for such a program;
• Public health nurses could do immunization clinics in the pharmacies;
  Pharmacy could provide a sentinel function for tracking and surveillance of product utilization;
• Needs some tracking on the productivity years lost because of mental illness;
• More assistance needed in suicide prevention;
• Often suicide is associated with breakdown in relationship and over crowded living conditions;
• There is a need for a national strategy on suicide;
• Reproductive health and sexuality is a public health issue as there is a high incidence of teen pregnancies and very young mothers;
• Telehealth opens up opportunities for continuing health education and training;
• Resources need to be made available in the language of the people in greatest need;
• High incidence of auditory problems; and,
• Rickets is a problem in Nunavut.

Themes

1. Support federal leadership in public health
Many participants support the federal government's leadership initiative in public health. They consider the public health capacity in Nunavut as less than ideal and look to the federal government to provide the infrastructure and technical expertise that Nunavut can use to enhance their public system in areas of surveillance and other basic public health needs. Nunavut considers itself a weak link in the Canadian public health system.

2. Determinants of Health
Participants confirmed the importance of a public health system that considers the determinants of health. This is of particular importance in a territory where there are significant housing shortages that lead to severe overcrowding. Nunavut is experiencing outbreaks of TB and increases in upper respiratory tract infections which may be attributed to poor housing. Education and employment are other determinants of health that participants felt needed be addressed if significant improvements in public health are to be realized.

3. Support in the area of Health Human Resources
Nunavut is experiencing overwhelming shortages in the area of recruitment and retention of health care professionals in all sectors of the health care system. This issues has been raised at the November 2002 Conference of Ministers of Health in Halifax. The territory is still looking to the federal government to provide assistance in this area. There are only 10 doctors for a population of thirty thousand. This situation highlights the severity of the problem facing the territory.

4. Funding
The present per capita health funding does not begin to address the health needs of a sparse population distributed over a large land mass where the only mode of transportation in and out of a community is by air. Over 300 patients were sent south for medical treatment in 2003 and all had to transported by air. Escorts and accommodation had to be provided in many cases.

5. Need for a seamless Canadian Public Health System
Canada needs a seamless public health system; this is a priority. Health information systems should be compatible across Canada. Standardizing immunization systems and providing support is essential.

6. Environmental Health
Lack of adequate waste disposal and safe drinking water are public health issues facing many communities in Nunavut.

7. Nursing Education
There is a need for more public health nurses that are educated in Nunavut. Support systems need to be in place, however, as many nursing students are mature students with special needs for child care. Bridging courses are also needed so that potential nursing students can meet the required entrance levels.

8. Telehealth
Telehealth is seen as an excellent tool to address some of the pressing needs in continuing health education and diagnostic procedures.

Issues

The following are main issues:

• Funding - the cost of providing health services in Nunavut;
• Health human resources - recruit and retention; and,
• The determinants of health - employment, housing and education.
  Federal vs. Territorial Roles
• The federal government must take the leadership role in public health and provide support to the territorial government in its effort to meet its many public health challenges; and,
• The federal government needs to provide more financial resources to Nunavut for it to meet its health service and public health needs.

Recommendations

• That the public health system, in its broadest sense, be designed in a way that helps bring controls on the acute care system;
• That the public health system raison d'etre also include the determinants of health; and,
• That the federal government take the leadership role in public health.
  Minister's Closing Remarks

The Minister concluded the session by thanking the participants and observers for giving of their time on a beautiful Sunday afternoon in Iqaluit. She also thanked those who participated by teleconference from other communities in Nunavut.

She also noted the fact that a number of participants highlighted the importance of the determinants of health during their comments. The main goal was to reduce the usage of the acute care settings thereby lowering the medical transportation costs. Public health success in Nunavut could be measured by the number of tickets purchased to access health care in the south.

Minister Bennett stated that there is a need to customize needs and that the Agency could act as a clearing house by providing better coordination across jurisdictions, and identifying best practices. She also acknowledged that a "one-size-fits-all" health system does not work.