[Witness speaks in Inuktitut]
Good afternoon. I wish to thank the Standing Committee on Health for the opportunity to speak today representing Inuit Tapiriit Kanatami and the Canadian Inuit on the issues of H1N1 and its impact on us.
I am an Inuk public health nurse currently working as director of health services in Nunatsiavut, northern Labrador, and the current chair. I speak from a place of knowing.
Inuit Nunangat, our Arctic homeland, comprises 40% of Canada's land mass and 50% of its coastal shoreline. We number only 50,000 people living in 53 remote and isolated communities across the north. Most of our communities have no roads or hospitals, doctors or pharmacies. We live with significant issues of overcrowding, which creates an environment for disease spread and challenges the ability to reduce the risk to others. We have very poor general health and a much lower life expectancy than other Canadians.
We have a huge generational divide, with 35% of our population under the age of 15, compared with 18% for non-aboriginal Canadians. Young people and pregnant women, two of the high-risk groups identified for the current circulating H1N1 virus, are highly represented among Inuit. For the pregnant Inuit women, the risks are increased by having to travel in their last few weeks before delivery away from family and familiar health care providers to larger centres where they may be in communal accommodations.
Inuit fear H1N1, a fear generated not by media attention but rather by the very real history of the impacts of previous pandemics on Inuit. In Okak, northern Labrador, where I live, the Spanish flu wiped out nearly the whole community in a matter of days. Inuit are aware as well of their vulnerabilities created by geography, weather, and co-morbidities. Not for us the comfort of knowing that access to health care is nearby. As wonderful as the nurses are in the clinics in our communities, should we fall ill and our condition worsen, there must be a plane to the next level of care, and that is totally dependent on the weather.
The Canadian pandemic plan does not specifically address the unique issues pertinent to pandemic planning in Inuit regions as it does for first nations on reserve. In fact, it does not give the attention warranted to remote and isolated communities in Canada where guidelines created do not fit and use a language that is full of false assumptions and hints of colonial bureaucracy. In June the board of directors of Inuit Tapiriit Kanatami met in Nain, Labrador, and passed a resolution calling for an Inuit-specific appendix to the Canadian pandemic plan. They consider that given the high risks for contracting H1N1 and other viruses, having a pan-Inuit strategy would be an important step in the prevention and management of current and future pandemics.
The challenges for planning for Inuit are further complicated by jurisdictional issues, with land claims in two territories and two provinces and the lack of clarity around the role of Health Canada and the Public Health Agency of Canada. The relationships between federal, territorial, and provincial governments reflect the changing nature of politics and require a more concentrated focus on the people they serve. We have heard back from Dr. Butler-Jones a willingness to begin discussions of such a plan, and we are aware that this will not be until the pandemic is over.
In the interim, we are working on a trilateral work plan for H1N1. The plan must be written by us and not for us. Inuit must be engaged so that what is written is culturally relevant, and we can take our realities and include what we have learned from our journey with H1N1 and our pandemic planning efforts to date and create a meaningful document that can guide us in the future to the level of preparedness that we deserve.
Our human health resources are a great concern. We have communities where there is only one nurse, and his or her priority will have to be the provision of primary care. The logistics are daunting. With both staff and supplies having to be flown in, and the vaccine itself protected against the extreme temperatures that we face in the Arctic, by the time this vaccine is ready, we cannot be efficient. Immunizing a community of 250, given our resources, could take several days once you factor in the flight schedule and the weather.
Consideration must be given to support access to the vaccine for Canadian Inuit. We cannot change the social determinants in our immediate future. Right now, vaccine is our only defence against spread. We have no capacity for alternate care sites and will have to use home isolation.