Canada’s national health system, the envy of many people in other countries, including in the United States, is being more scrutinized from Canadians as reports reveal serious health-service gaps in the territory of Nunavut, a self-governing province populated by mostly Inuit people.
Critical reports of deprivation and neglect emerging from Nunavut paint a picture of a vast but poor Arctic region where people have little access to quality medical care while also suffering from the effects of poor nutrition and living in smoke-filled, overcrowded homes that foster disease.
According to official Canadian data, Nunavut has high rates of lung cancer — more than 60 percent of its people are smokers — as well as tuberculosis, other respiratory infections and diabetes. The territory has the highest rates of infant mortality in Canada. Incidents of suicide run high, and life expectancy is lower than the national average.
Added to this list of phenomenal hurdles faced by people on the northern fringe of one of the world’s most developed and socially conscious countries, the advisory Qulliit Nunavut Status of Women Council notes the high incidence of domestic and community violence and homelessness among women. The Council was established in 1999 when the territory was given its current enhanced political status.
In recent years, there have been numerous studies about the vulnerability of the female indigenous population and the causes of abuse of women. A continuing survey has been mandated by Canada’s national government to determine what has happened to more than 1,000 recently murdered or missing indigenous women and girls across the country. The findings were expected to be published by the end of 2018.
On May 7 in Ottawa, Canada’s capital, the United Nations special rapporteur on violence against women added her voice to the growing condemnation of the country’s treatment of indigenous women and girls. Delivering her preliminary findings after a 13-day visit to Canada, the rapporteur, Dubravka Simonovic, who was appointed in 2015 by the Human Rights Council, said that violence against women in Canada remains a “serious pervasive and systematic problem.”
“Indigenous women face marginalization, exclusion and poverty because of institutional, systemic, multiple, intersecting forms of discrimination that has not been addressed adequately by the State,” she added.
Canadian demographic data show that about 1.8 million people from more than 30 ethnicities consider themselves to be indigenous. Only three are officially recognized: the Inuit, First Nations (formerly called Indians) and Métis. Indigenous people live in ethnic clusters in remote areas as well as in big cities. In Nunavut, about 85 percent of the people are Inuit, with most other residents of European descent. The Inuit Tapiriit Kanatami, a nonprofit group promoting the Inuit, produces videos, like the one below, on life in the territory, among other projects.
The living conditions in Nunavut, with a population of about 36,000, have been at the forefront of official and media attention among Canadians for several years. Last year, in February, Prime Minister Justin Trudeau and Inuit leaders created the Inuit-Crown Partnership Committee to “advance shared priorities” between Inuit and the Canadian government on such issues as Inuit land claims agreements, social development and reconciliation between Inuit and the national government.
On Sept. 21, 2017, Trudeau also admitted to the UN General Assembly that Canada’s “colonization” of indigenous populations, including the forced movement of people, was “a history of humiliation, neglect and abuse.”
A month before, Trudeau appointed a physician and former minister of health, Jane Philpott, as Minister of Indigenous Services, a new post in a new ministry. In a speech in Ottawa on Feb. 23, 2018, Philpott acknowledged the severe deprivations indigenous people face.
“In Canada today there are 1.7 million First Nations, Inuit and Métis,” she said. “When compared with non-Indigenous Canadians, life expectancy is as much as 11 years shorter for Inuit. Infant mortality rates are two to three times higher than non-Indigenous Canadians for First Nations and Inuit. The prevalence of diabetes among First Nations on reserve is almost four times higher, and in some cases more than that.
“The prevalence of tuberculosis among Inuit is a stunning 270 times higher than it is for the Canadian-born, non-indigenous population,” Philpott continued. “Addressing that endless list of health inequities requires more than better healthcare. It requires better housing, education, roads and so much more.
“In my role as Minister of Indigenous Services, I need to dig even deeper — yes, beyond biomedicine but even beyond the social determinants of health. How did we get to a place where Indigenous peoples do not generally enjoy the same health outcomes as non-Indigenous Canadians?”
In February as well, the British medical journal The Lancet devoted a whole issue for the first time in its history to one nation: Canada. While the articles and commentaries included in the special issue recorded Canadian successes and achievements in national and international health fields over the years, it also featured articles on the challenges and hopes still to be met among the indigenous populations. Philpott referred to the Lancet articles in her speech.
In the summer of 2017 Stephen Lewis, a former Canadian ambassador to the UN who is co-director of AIDS-Free World — a nongovernmental organization that has branched into other diseases and situations, such as sexual abuse connected to UN peacekeeping missions — traveled to Nunavut to study the incidence of tuberculosis. His unofficial report was dire.
“First, there is a TB crisis in Nunavut at this very moment,” he wrote. “There are fourteen out of the twenty-five disparate communities wrestling with active and latent cases, many of them children.”
In one village he visited, Igoolik, with 2,000 people, “there are eleven active cases and a significantly higher number of latent cases,” a pattern repeated in many hamlets.
“The latent cases, which also demand treatment, require contact tracing, sometimes hundreds of contacts in order to avoid further transmission,” Lewis calculated. “In a situation of twenty-five communities, spread over a land mass of two million square kilometers, it’s a herculean task to keep TB under control.”
Lewis cited shortages and persistent turnovers of medical workers as well as cultural barriers, which he calls the “the colonial inheritance.”
“Far too often, the health system must rely on nurses from the south, who often come for as little as six weeks, who don’t have particular training in TB Even more important, it seems to me, is the fact that these imported nurses don’t speak Inuktitut,” he wrote. “And language is everything . . . the fevered destruction of language and culture lies at the root of every contemporary Inuit struggle.”
The forced movement of Inuit to the south for TB diagnosis and treatment in the 1950s and 60s tore many of the people from their roots, their language and their cultural touchstones, Lewis noted.
“It’s a chapter of Inuit history that is largely unknown in the rest of Canada. Yet it ranks with the horror of residential schools, the missing and murdered Aboriginal women, and the diabolical baby scoop in parts of Canada between the 1960s and 80s.”
Lewis, who has also served at deputy executive director of Unicef, faults the Canadian national government. “Nunavut is part of Canada; it’s not some peripheral adjunct,” he wrote. “I sometimes wonder how they sleep at night in Ottawa.”
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Barbara Crossette is the senior consulting editor and writer for PassBlue and the United Nations correspondent for The Nation. She is also a member of the Council on Foreign Relations. She has also contributed to the Oxford Handbook on the United Nations.
Previously, Crossette was the UN bureau chief for The New York Times from 1994 to 2001 and previously its chief correspondent in Southeast Asia and South Asia. She is the author of “So Close to Heaven: The Vanishing Buddhist Kingdoms of the Himalayas,” “The Great Hill Stations of Asia” and a Foreign Policy Association study, “India Changes Course,” in the Foreign Policy Association’s “Great Decisions 2015.”
Crossette won the George Polk award for her coverage in India of the assassination of Rajiv Gandhi in 1991 and the 2010 Shorenstein Prize for her writing on Asia.