1. Spotlight on Canada Debbie Reid, Health Canada
Jonathan Thompson, Assembly of First Nations
Elizabeth Ford, Inuit Tapiriit Kanatami

2. Perspectives on the North
In Canada, the North is characterized by its geographical, cultural, and political perspectives.
To some the North is defined as North of about 53 degrees latitude (taking in the Territories and the Northern regions of provinces).
To others it means North of 60 (where the Territories and the Arctic begin).
The North is the traditional homeland to Inuit and First Nations, as well as a defining feature of the Canadian identity.
Politically, it is a region of intertwining jurisdictions: territorial, provincial, federal and Aboriginal - a vast expanse rich in resources but also environmentally fragile, sparsely populated and costly to service.
With climate change, security and sovereignty issues, and economic development opportunities, a lot of attention is being paid to the North.
There are important differences in the two interpretations of the North noted here.
North of about 53 includes the Northern regions of provinces and it includes Nunatsiavut (in Labrador); Nunavik (in Northern Quebec); Nunavut; and the Inuvialuit Settlement Region of the Northwest Territories. Each of these four Inuit groups have settled land claims.
Despite being a defining feature of our collective Canadian identity, most Canadians will never get the chance to visit the North. However, with increasing economic development, more people are coming from the South.

3. Jurisdictions and Organizations
Government of Canada
Indian and Northern Affairs Canada
Health Canada, Public Health Agency
Other departments including Human Resources and Social Development
Indigenous Governments and Organizations, including:
Assembly of First Nations
Inuit Tapiriit Kanatami
Council of Yukon First Nations
Provincial and Territorial Governments
INAC is one of the federal government departments responsible for meeting the Government of Canada’s obligations and commitments to FN/I and Metis, and for fulfilling the federal government’s constitutional responsibilities in the North.
Health Canada works closely with our Indian and Northern Affairs, with other federal departments and with our non-government partners to support FN/I health. Together with National Aboriginal Organizations like AFN and ITK, we carry out many activities aimed at helping FN and I peoples stay healthy, and prevent chronic and contagious disease.
Health Canada works with the Public Health Agency of Canada to support the Agency’s delivery of Children and Youth programming through a program called Aboriginal Head Start in Urban and Northern Communities.
Health Canada also works with the Agency on a number of pan-Aboriginal programs and pandemic planning activities
Health Canada’s role in First Nations and Inuit Health goes bask to 1945 when Indian health services were transferred from the Dept of Indian Affairs.
In 1962, Health Canada began to provide direct health services to FN people on reserve and Inuit in the north. By the mid 1980s, work began to have First Nations and Inuit communities control more health services.
To support great FN/I control over their health system, many health programs and services are provided in collaboration with FN/I communities. A number of these programs and services are developed through collaborative efforts with our NAO partners (the AFN and ITK).

4. Health and Jurisdiction
Provinces and territories provide:
hospital and physician services
community and public health programs
supplemental insurance
long term care
regulation
Responsibility for the health of First Nations and Inuit is shared by provinces, territories, the federal government, and First Nations and Inuit.
Canada’s publically-funded health care system, known as Medicare, provides universal coverage for medically necessary health care services. These services are provided on the basis of need, not on the ability to pay.
The system is really ten provincial health insurance plans and three territorial health insurance plans. Provinces and territories administer and deliver hospital and physician services, which they fund with assistance from the federal government through the Canadian Health Transfer.
As noted here, provinces and territories provide:
hospital and physician services to all residents, including First Nations and Inuit
community and public health programs to all residents except those living in First Nations communities on reserve
supplemental insurance for drugs, dental, vision for specific populations such as seniors and social assistance recipients, including First Nations and Inuit
long term nursing homes and home & community care
regulation of health professionals and health services.

5. Health and Jurisdiction
Federal government provides or funds:
community health programs in First Nations communities (primary care, communicable & chronic disease control)
environmental health, mental health & addictions, children & youth
Non-Insured Health Benefits (drugs, dental, etc.) for all registered First Nations people and Inuit
Community health programs: funding is provided to FN/I communities for programming focussed on:
Providing children with a health start in life;
Community mental wellness;
Youth suicide prevention;
Healthy nutrition and activity promotion;
And many others.
NIHB: provides a limited range of medically necessary goods and services to First Nations and Inuit regardless of location or income level.
Based on medical need;
100% coverage;
No client premiums, co-payments, or deductibles; and
No annual maximum.

6. Canadian Perspective
Delivering health services in the North is particularly challenging due to remoteness and high cost of delivering such services.
Inuit and First Nations play a key role in delivering health services in the North.
Improving the health status of FN/I requires collaboration across jurisdictions and sectors.
The Government of Canada provides funding through Contribution Agreements to the Governments of Nunavut, Yukon and NWT to administer numerous health promotion and illness prevention programs.
In many other cases, Inuit organizations administer health programs and services through federal funding agreements (e.g. Nunavik Regional Board of Health and Social Services; Nunavut Tunngavik Incorporated; and the Nunatsiavut Government).

7. 2007 Projected Registered Indian Population
8,347
17,743
53° Latitude
127,533
105,592
130,335
131,910
72,565
178,080
33,645
Total: 805,750

8. First Nations Varying cultures and languages;
Face higher rates of disease & life expectancy is 5-7 years below national average;
Living conditions is ranked 63rd or amongst Third World conditions;
FN communities in northern regions of provinces face similar health challenges as those north of 60.

9. Challenges for First Nations
F/P/T jurisdictional disputes - cost of health services, i.e. Jordan’s Principle;
Geography & Remoteness;
High cost of living and food security;
High rates of diseases and addictions;
Lack of infrastructure – inadequate housing/water;
Lack of/Limited health human resources; and
Addressing “intergenerational impacts” from abuses suffered in Residential Schools.

10. Opportunities for First Nations
Foster collaborative partnerships with F/P/T’s which focus on building capacity of FN’s to govern and administer health services;
Tripartite agreements that integrate F/P/T health services to better meet health care needs of FN’s;
Joint development of policy and programs; and
Tele-health/medicine can assist with limited health services in the north.

11. Inuit Across the Arctic
Approximately160,000 Inuit in the Northern Circumpolar Region
Sharing a common culture and heritage across the Arctic
approximately 150,000 Inuit of Alaska, Canada, Greenland, and Chukotka (Russia). 11

12. Inuit Nunaat
There are approximately 55,000 Inuit in Canada. We live in the Inuvialuit Settlement Region in the Northwest Territories; Nunavut the new Territory created in 1999; Nunavik, in northern Quebec; and Nunatsiavut, in northern Labrador.
Inuit have concluded four modern land claims agreements that collectively encompass regions traditionally and continuously used and occupied by Inuit predating Canada as we know it today. The settlement areas of the four Inuit land claim agreements comprise a geographic homeland called “Inuit Nunaat.” 12

13. Challenges to Health Delivery Inuit Nunaat
Geography and remoteness
Population sparse and widely dispersed
HHR Recruitment & Retention
High cost of living
Lack of infrastructure
Lack of Inuit-Specific data
There are many factors that impact the delivery of health care in Inuit Nunaat. The geography and remoteness of Inuit communities impact access to health care services. In some of our regions it is still necessary to fly to a regional centre to obtain a simple Xray. It is the norm for women to leave their communities 4-6 weeks prior to delivery of the baby- again because for most this service is provided in regional centres or in some cases in Southern hospitals. Inuit population is extremely young with the median age being 22. This greatly impacts our health care system and of course health care needs.For example Inuit suicide rates have been estimated at 11 times higher than the Canadian average and most of these are among young men. Birth rates remain high, and in many cases the reports of chronic disease are low because of our young population however this provides us an opportunity to focus on prevention and health promotion programming. Although present in our communities prevention and promotion programming have their own unique issues given the health human resource issues in our communities. Some regions report percent vacancies in the health care field at any given time. This makes it difficult to focus on anything but the illness treatment part of health care. Although geography and remoteness may impact ability to attract southern based professionals to the Arctic a bigger challenge may be attracting Inuit to enter health care fields. The graduation rate – although climbing remains low, and it has been documented that there are inequities between not only health care and other occupations but between Inuit and non Inuit compensation. High cost of living is an important factor in not only the health of the population but the abiliity to attract and obtain a workforce. Food insecurity is a major issue and impacts all aspects of wellbeing- physical health, mental health, ability to learn and succeed in education, etc. Imagine paying 3-5 times more for your groceries than your southern neighbors. Add to this the shortage of houses for health providers. In fact there is a shortage of housing in all Inuit regions. Inuit are ten times more likely than the non-Aboriginal population in Canada to live in crowded homes. Inuit, especially those in Inuit Nunaat, live in some of the most crowded conditions in the country. There is a growing percentage of Inuit living in homes needing major repairs (which includes defective plumbing, wiring, structural repairs to walls etc.) In 1996, 19% lived in homes needing major repairs but this climbed to 28% in For the non-Aboriginal population, the figure remained about the same over time and was 7% in This infrastructure need of course impact the health and wellbeing of communities and respiratory illness including TB is significantly higher in Inuit communities. There are other infrastructure needs as well such as need for addictions facilities, for facilities for elders, for recreation facilities to name a few. Despite the few stats I have been able to provide a significant challenge experiences by Inuit Nunaat is “telling the story” because of the lack of Inuit specific data. I can not confidently tell you what the life expectancy of Inuit is, I cant tell you what our cancer rate is. 13

14. Life Expectancy
The health info that we have does not always present a positive picture. The life expectancy gap between those in Inuit communities and all Canadians is about 13 years and is likely widening. This data is not Inuit life expectancy but life expectancy for all residents- Inuit and non Inuit in the 53 communities. 14

15. Opportunities for Collaboration
Promoting increased awareness and sharing amongst the federal, provincial, territorial and Inuit partners regarding Inuit realities and health priorities, including the importance of Inuit children and youth;
We are optimistic though that through collaboration, working together, developing partnerships that we can begin to address the health realities in Inuit communities. We recognize the need for sharing between all levels of government and non government organizations if we are going to address the Inuit health prioirities of mental health, food insecurity, chronic diseases as well as the determinants of health such as housing, climate change, human resource issues.
We believe there is an opportunity for promoting increased awareness and sharing amongst the federal, provincial, territorial and Inuit partners regarding Inuit realities with a focus on our largest demographic- Inuit children and youth; 15

16. Opportunities for Collaboration (Continued)
Applying an Inuit-Specific Lens using Inuit-Specific Data
Sharing best practices & models
Addressing jurisdictional challenges
Using a social-determinants model and partnering with other sectors
Some concrete ways we believe would result in positive outcomes are:
Ensuring that we can tell the real story supported by data, learning from the successes and challenges others have experiences, focusing on the outcomes and making an impact versus who is responsible to provide the services and fund the programs, and addressing the unique social determinants that I have described throughout this presentation.
Thank you. 16

17. Any Questions?

18. Thank you