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What we can all learn from Nunavut Add to ...

As a rookie MP, Leona Aglukkaq comes to Ottawa with little political baggage. But Canada's new Health Minister has some fascinating carry-on baggage in the form of her record as the Minister of Health and Social Services in Nunavut.

To begin with, take note of her former title: Nunavut has the good sense to recognize that health and social services are intimately linked.

Until 1996, Canada had a Minister of National Health and Welfare. While welfare has become a dirty word, the contribution of social programs (and the income distribution policies at their root) to health remain unassailable.

The countries with the healthiest populations are not those that spend the most on sickness care, but those with the most carefully woven social safety nets, those that recognize that good (or bad) health is intimately linked to socioeconomic circumstances.

That point of view is front and centre in Nunavut's public health strategy, titled "Developing Healthy Communities."

"I know that, in addition to caring for people when they are ill, it is just as important to develop policies, programs and services which keep people from becoming ill," Ms. Aglukkaq wrote in the preface to the report.

Nunavut, a sprawling, sparsely populated territory, gets little attention on the national stage. What distinguishes it in the health field is that most of its measures are well below those of Canada as a whole.

Life expectancy in Nunavut is 10 years less than the national average. Infant mortality is four times the Canadian average. More than anything, this is a testament to Canada's shameful neglect of aboriginal peoples.

What is too often overlooked is that, in addition to massive health challenges, Nunavut has a crackerjack team of public health officials, led by chief medical officer of health Isaac Sobol. It is also tackling the challenges as well as anyone, with the most elaborate and thoughtful public health goals in the country.

At this point, it's worth remembering that, a few years back, Canada set out to develop national public health goals, but the exercise - led by former public health minister Carolyn Bennett and former Manitoba minister of healthy living Theresa Oswald - was quietly shelved. (Ms. Oswald is currently Health Minister for the province.)

What is left is a series of draft public health goals "for discussion purposes only" that, with some effort, can be located on the website healthycanadians.ca.

They read as follows:

Overarching public health goals

1) Improve the length and quality of life of Canadians

2) Eliminate health inequalities among Canadians

Public health goals

1) Participation and influence in society

2) Economic and social

security

3) Secure and favourable conditions during childhood and adolescence

4) Healthier working life

5) Healthy and safe environments and products

6) Health and medical care that more actively promotes health

7) Effective protection against communicable diseases

8) Safe sexuality and good reproductive health

9) Increased physical activity

10) Good eating habits and safe food

11) Reduced use of tobacco and illicit drugs, misuse of alcohol, a society free from doping and a reduction in the harmful effects of excessive gambling.

Even someone with a casual interest in public health will recognize that these goals are so vague and platitudinous as to be virtually meaningless.

That is because the exercise is only half done. Public health goals, to have meaning, need to be followed by specific targets and progress reports.

The public health goals in Nunavut have a lot more edge, and many are backed up with clear targets.

For example, the goal of increasing "healthy birth outcomes" includes getting 80 per cent of pregnant women to take prenatal vitamins (including folic acid and vitamin D) by 2013. The goal of "increasing the number of children achieving age-appropriate developmental milestones" is backed with several fixed targets, too, including increasing breastfeeding rates by 5 per cent, reducing the incidence of child injury by 5 per cent and cutting by half the rates of rickets and anemia.

Most importantly, Nunavut's public health goals explicitly acknowledge the important role that poverty, education and family and community supports play in health. The social problems that plague the territory - alcoholism, sexual abuse, astronomical rates of traumatic injury, babies born with fetal alcohol syndrome and birth defects caused by poor nutrition - all have their roots in the breakdown of social structures, and rebuilding those links is also stressed.

Finally, Nunavut's public health goals speak of the "prerequisites for success," including the need to build more public health capacity at the local level and to reconfigure organizational structures so that public health, sickness care and social services can work together.

Ms. Aglukkaq has an unenviable task as the Minister of Health during an economic crisis. Health, after all, is the department that eats everybody else's lunch.

But as political leaders mull over how to best stimulate the economy with new approaches, Ms. Aglukkaq should remind them that new thinking is in order in the health field, too.

It's not enough to have a $172-billion-a-year repair shop; we need to invest in creating healthy populations and do so with specific goals and targets in mind.

We need to bring a little bit of Nunavut to the rest of Canada.

 

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