Nothing could have been plainer than the disappointment of the 3 territorial premiers after the first ministers' talks on health reform concluded on February 5. Facing the media before the prime minister made his statement, each took a turn explaining his refusal to endorse the accord. Stephen Kakfwi, premier of the Northwest Territories, said there was “nothing to be proud of” in a deal that failed to address “the deplorable, third-world health conditions” in the North. Nunavut's premier, Paul Okalik, remarked that a lottery could make as much money in a week as the territories had been offered, and Dennis Fentie, premier of Yukon Territory, said, “all we're asking for is the ability to deliver [what] other Canadians take for granted.”
Questions from journalists were cut short as the prime minister and the provincial premiers filed in. Mr. Chrétien was “pleased to tell the Canadian people that we have reached an agreement on fundamental reform of our health care system.” Evidently, the cohesion implied by that “we” did not extend as far as the North, that hinterland of our national consciousness. To Roy Romanow's full chapter on Aboriginal health1 (which is, of course, not an exclusively northern issue, nor is the North exclusively Aboriginal), the outcome document2 of the first ministers' meeting replied with 2 paragraphs on the need for “dedicated effort,” consultation, data infrastructure and annual reports. But what the territorial premiers were asking for was not, as Kakfwi put it, more “commitment to talk.” What they had in mind was a supplemental allotment equivalent to 0.5% of any new funding through the Canadian Health and Social Transfer (CHST) the federal government put on the table. This is hardly an exorbitant request. It costs Nunavut, for example, 3.6 times the national average per capita to deliver health care, and yet the CHST is calculated on a per capita, not needs, basis. At this rate, Nunavut's portion of a promised $12 billion in new money for the CHST would amount to roughly $3 million a year.
Nunavut spends almost $3 million a week on health care, and 20% of that is consumed by the need to transfer patients to facilities in the south. Nunavut has only 1 regional hospital and only 10 physicians living in the territory. Only 5 of the Northwest Territories' 28 communities have a doctor, and only 2 have a birthing centre. The 280 residents of Old Crow, Yukon, have physician services for 2 days a month, at a cost of about $53 000 a year. The health care “renewal” that the premiers were expected to assent to in the new accord cannot be achieved with an additional $3 million a year.
Although Aboriginal people represent 20%, 48% and 85% of the Yukon, NWT and Nunavut populations respectively, most federally administered health care services are not available to these off-reserve populations. It makes sense to create a separate, designated health services fund for the territories. It made sense not only to the territorial premiers, but also to their provincial colleagues, who had endorsed the idea in January. What occurred at the first ministers' meeting cannot be attributed to a lack of solidarity on the part of the provinces. As a spokesperson for the Nunavut premier's office remarked, “There were 14 people at the table, and 13 agreed.” After 2 rather trying weeks for northern officials, the prime minister met again with the territorial premiers and delivered some hope: a special fund of $60 million to be divided between the territories on a schedule to be determined, as well as a commitment to seek alternatives to the per capita funding formulas that have chronically shortchanged the North.
In the final report of his commission, Roy Romanow describes the profound “disconnect” between Aboriginal and northern communities and the rest of Canadian society. Clearly, we have a long way to go in building the kind of “health partnerships” that would consolidate federal, provincial and territorial funding and direct it toward coordinated networks of services tailored to specific regions and communities. Until these structural reforms are achieved, additional funding will remain a much-needed but inefficient stopgap. No one can dispute the prime minister's reference to the need for “better integration of services.” But, in a country where health care is constantly cited as our number one priority while Aboriginal and northern health are treated as an afterthought, it seems that our national priorities are not all they're cracked up to be. — CMAJ
References
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