Perspectives on the Health of the Labrador Inuit
Dr. Maureen Baikie
It is difficult to describe the health of the Labrador Inuit-difficult because the statistics are combined with those pertaining to non-Inuit residents in Labrador and, in many cases, with those of northern Newfoundland as well; difficult because it is hard to know which are the best indicators to monitor. However, the health care delivery system is comparable to that of any other isolated northern community in this country.
But health care delivery systems, while essential, are only a small contribution to well-being in body, in mind, in spirit, and in the community. Health is inextricably tied to social, economic, and environmental factors; unemployment statistics, housing conditions, and historical factors are as valid indicators of health as mortality rates or cases of active and reactive tuberculosis.
Regardless of the criteria health professionals choose to employ, the Inuit of Labrador end up with an unfavourable assessment; in fact, the statistics on social problems in northern Labrador have been described as a provincial and national disgrace. Water and sewage systems range from virtually non-existent to adequate; infant mortality rates and accidental deaths are higher than the national averages for Canadians and for native peoples; and the high rates of suicide, tuberculosis, and alcoholism have caused a great deal of concern.
None of this is surprising. Aboriginal people across this country suffer poor health and socio-economic conditions. Ironically, the residents of our communities certainly do not feel their situation is a provincial or national disgrace-and may, in fact, be insulted by such a description.
Particularly as it relates to health conditions and services, the history of the Labrador Inuit is quite different from other aboriginal groups. The Inuit looked after their own health needs until the Moravians offered limited care, a service later assumed by the Grenfell Mission. Sir Wilfred Grenfell, founder of the International Grenfell Association (IGA), had a holistic approach to medicine long before it became the catchword it is today. IGA was a charitable organization operating in remote northern Newfoundland and Labrador, an area benignly neglected by the powersthat-be in the British colony of St John's until Newfoundland joined Confederation in 1949. Grenfell not only catered to medical needs; he did his best to improve social conditions and spur economic development by promoting craft production, reindeer herding, and education.
Dr Grenfell's successors were delighted with the post-Confederation era of native health care. In his book, From Sled to Satellite: My Years with the Grenfell Mission, Dr Gordon Thomas describes the health-related changes he witnessed after Confederation:
We in the Grenfell Mission, deeply involved in the social, economic as well as the medical well-being of this area, soon began to see dramatic changes. Family allowances, old age pensions, and disability pensions brought a flow of new cash to a society founded on debt, where cash had been painfully scarce. Children ate better and wore better clothes. Rickets and beriberi disappeared. People built themselves new homes in all the outports. The provincial government placed welfare officers in communities to see to the needs of the indigent. Gradually our orphanage emptied because widows who formerly had to give up their children could now afford to keep them at home.
In the northern region, one of the great benefits of Confederation was that the native people of Labrador became the responsibility of the federal government, so the IGA was subsidized in its treatment of native TB patients.
In actual practice, this meant that the federal Department of Health and Welfare paid a daily rate for each Indian and Inuit TB patient under treatment at North West River or St Anthony hospitals. It also meant that new nursing stations were built at Makkovik, Hopedale, Davis Inlet, and Nain, with funds coming entirely from the federal government.
However, the question of who was actually responsible for the native people of Labrador became quite controversial. Despite Dr Thomas's optimism, the terms of union between Newfoundland and Canada made no reference to Indians and Inuit, resulting in the rather difficult and vexatious debate over just who is legally and financially responsible for native people in Labrador. While the federal government was contributing substantial amounts of money to Inuit communities in other parts of Canada, they were only exchanging letters and opinions, and forming limited agreements with the Province of Newfoundland regarding capital expenditures and federal funding of health services for the native peoples of the province. Part of this legacy, however, did result in the Canada/Newfoundland Native Peoples Health Agreement, which helps to fund the salaries of public health nurses and cover the operating costs of nursing stations as well as non-insured health benefits, such as medical transportation.
As federal dollars began filtering in, as the standard of living improved, and as the provincial government assumed greater responsibilities for health and social programs in northern Newfoundland and Labrador, the IGA gradually phased out programs not related to health delivery. However, it was not until 1981 that the IGA became Grenfell Regional Health Services and the international board of directors turned over its assets and responsibilities to a board with representatives from throughout the region. The end result is the current health care delivery system which addresses direct provision of health facilities and personnel.
The government agencies in northern Labrador which took on the socioeconomic development role once filled by the Grenfell Mission proved to be ineffectual substitutes. Health facilities and related services-housing, economic development, water and sewers-became unco-ordinated and out of touch with each other.
This has begun to change: the Labrador Inuit Association (LIA) is working on health problems, and on the difficulties posed by funding mechanisms, in its own quiet, patient way. Rather than concentrate on the federal-provincial health agreement, the LIA negotiated directly with the federal government for programs which other native groups had already received. In 1982, the LIA set up an affiliate called the Labrador Inuit Alcohol and Drug Abuse Program (LIADAP) with direct funding from the federal government. In 1985, LIA was successful in negotiating additional federal funding to hire an interpreter/translator and to operate a community health representative program; similar programs have been available to other native groups for many years. The Labrador Inuit Health Commission (LIHC) operates these initiatives. In January 1989, LIHC became one of only a handful of native groups in Canada to take on the administration of the Non-Insured Health Benefits Program.
Both LIADAP and LIHC have their respective boards of directors chosen from LIA members, a provision designed to maintain local control. LIHC's goals and objectives revolve around two main philosophies. The first has already been alluded to-that health is influenced by a complex of social, environmental, and economic factors whose impact goes far beyond the health care delivery system and technological breakthroughs. The other is that better health can only be achieved by health education, and community involvement and consultation.
LIHC is currently turning its attention back to the Canada/Newfoundland Native Peoples Health Agreement which is up for renegotiation. There is no longer a need for such an agreement. Instead, funding should be direct, as it is for other programs. The next step will be to tackle other concerns-social services, family and child welfare, and the current program in health education. LIA and its affiliates are also addressing housing, education, and economic development.
None of this is easy. The legacy of the terms of union and its ambiguities on the question of responsibility have plagued LIA efforts to address these concerns. But the will is there, and so is the knowledge that, to make a difference-especially in health-a broad spectrum of related problems must be met with a co-ordinated solution.
Maureen Baikie is a physician working in North West River, Labrador, and Health Advisor to the Labrador Inuit Association.