Arctic towns fed up with the Nunavut government's poor record on health care want the territory to shift more control over services to them.
"When we look at what's happened over the last 10 years, we look at problems that not only don't seem to be solved, but are getting worse," said Ron Mongeau, administrator of the Baffin Island community of Pangnirtung.
"It's hard not to look at the government and say, 'There's the problem.' "
In May, the Nunavut Association of Municipalities passed a resolution – its second in as many years – condemning the territory's handling of its many health-care issues and calling for more local control.
"There is no transparency and no accountability in addressing health care concerns, resulting in a widespread loss of confidence and distrust in the public health system," the resolution said. It went on to ask for regional health boards, similar to those in place before Nunavut's 1999 creation.
The territorial government has not yet replied to the association's demands. "We're preparing a response," said spokeswoman Pam Coulter, who did not give a timeline.
Nunavut's health-care problems have been well-documented in reports by governments and academics from Canada and around the world.
More than one-quarter of Inuit are considered obese by the Public Health Agency of Canada.
British scientists have reported that Inuit-inhabited areas of Canada have stillbirth rates nearly three times higher than the rest of Canada.
Canadian researchers have found that rates of respiratory syncytial virus, a serious infection which can be fatal and puts one in four infant sufferers on life support, are many times higher than in the south.
Last spring, a flu-like illness swept through half of Nunavut's communities and was suspected in at least two infant deaths. More than 50 inhabitants from one community of 750 had to be flown to southern hospitals.
An editorial in The Canadian Medical Association Journal said Nunavut suffered 100 new and active cases of tuberculosis in 2010, the highest number in the territory's 10-year history and an infection rate 62 times the Canadian average. Most of the new cases occurred in younger patients, suggesting the disease is being spread actively.
A 2009 report by an Inuit group found Inuit men between 15 and 24 kill themselves at a rate roughly 28 times that of their peers in southern Canada. The overall suicide rate for Inuit is 11 times the Canadian average.
Earlier this year, Canada's chief dental officer reported over 85 per cent of preschoolers and 98 per cent of adolescents had tooth cavities.
Mr. Mongeau said the association recognizes the territory is young and still developing its health-care system. But he said the department is widely faulted for not listening to communities.
"When people have a concern, they don't know where to go. There's no clear accountability. Services are not transparent."
Instead, Mr. Mongeau said Nunavut opts for expensive Band-Aid solutions, such as bringing in nurses from the south on short-term contracts.
"You get a nurse that stays inside and treats patients," he said. "That's not what we need. We need nurses that are making a commitment to this community, that are going to live here, that are part of the community, that are outreaching to the community."
Some services are simply unavailable. Pangnirtung's 1,600 residents have a doctor in town for one week a month. There are very few mental health services anywhere in the territory and no live-in addictions treatment facilities.
Mr. Mongeau also accused Nunavut of being inflexible. He says when his community worked out a deal to bring in chiropractors paid for by the Canadian Chiropractic Association, territorial bureaucrats blocked it.
Nunavut's mayors have concluded they need to return to something resembling previous regional boards, with representatives from all communities running health care services in the eastern Arctic.
"It wasn't perfect, but I believe we had a system that was transparent, accountable and responsive," said Mr. Mongeau.