P-106 Nunavik Health and Social Services perspective September 2017 1
Portrait and challenges of the 2 region 2
3 NUNAVIK: POPULATION BY COMMUNITY, 2016 414 1483 633 750 403 567 1779 209 369 942 1757 2754 442 686 Source : Statistics Canada 2017. Census 2016. Catalogue nº 98-316-X2016001. Released August 02 2017. http://www12.statcan.gc.ca/census-recensement/2016/dp-pd/prof/index.cfm?lang=e (Accessed September 10, 2017).
4 Different characteristics distinguish the Nunavimmiut (Nunavik residents): A population spread over a large territory; Tightly knit social fabric and family connections; A very young population with a high demographic growth rate; A society that is subject to major and rapid changes.
5 Our challenge is to better adequately adapt our services to the needs of the population and its Inuit characteristics, while ensuring availability and continuity through various clinical projects and the regional action plan of public health.
6 Vastness and remoteness of the territory (travel, communication) Linguistic and cultural barriers Human resources turnover (18 months) Shortage of housing for employees and lack of workspaces; Lack of qualified Inuit manpower Absence of a post-secondary teaching institution in the region
Overcrowded housing will continue to play a role in: 7 The deteriorating mental health of Nunavimmiut; Substance abuse problems; Physical and sexual abuse; Low academic success and motivation rates; Violence; Transmission of diseases such as tuberculosis, which have for a long time been under control in the Western world; Neglect of children and youth.
Quality and age of the equipment and infrastructure; Inadequate bandwidth available in Nunavik and 8 its direct impact on the region s ability to further develop telehealth services.
9 PLAN NORD capacity of our network to meet the needs of a new clientele. our actual infrastructure can not offer the necessary resources to satisfy the new needs. any development and any increase in the labour pool will require additional healthcare and social services for the new clientele.
Our network 10 10
11 Inuulitsivik Health Centre Puvirnituq Ungava Tulattavik Health Centre Kuujjuaq
Guiding principles Nunavik Health Regional Organization 12 1. Promote the dispensation of a full range of services within the Nunavik health and social services network (Repatriation, development, consolidation, regionalization). 2. Optimization of existing human, financial and fixed assets resources of the Nunavik health and social services network. 3. Planning in accordance with the profile and needs of Nunavimmiut. 4. Develop the autonomy of the Nunavik health and social services. 5. Action upstream of problems and reduction of inequities in health and wellness 12
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Nunavik Health Networks 2015 MSSS Private Partners Tulattavik Health Centre Inuulitsivik Health Centre Illusiliriniqmi Pigutjiutini Qimiruniq Community Organizations 14 RUIS McGill Network Regional and Provincial Associations Northern Villages Partners Federal Partners Parapublic partners
Financial and Human Resources Financial Resources 2016-2017 Descriptions UTHC IHC NRBHSS Total Operation budget * 51 M$ 65 M$ 8 M$ 124 M$ PSOC (Community organizations) 10 M$ SANA 21 M$ ** Total 51 M$ 65 M$ 8M$ 155 M$ Human Resources 2015 15 Descriptions UTHC Total/Inuit IHC Total/Inuit NRBHSS Total/Inuit Total Nb employees *** 872/421 986/496 57/26 1915/ 943 * Regional envelope ** We are expecting an additional expenditure of about 25 M$ to cover the real expenses related to the insured /non-insured services *** Non equivalent full-time positions 15
Medical manpower Descriptions UTHC Total IHC Total Total Full Time 13 13 26 Part time 10 12 22 16 All positions allocated in the Regional Medical Manpower (PREM) have been fulfilled. 16
OUR HEALTH: SOCIAL DETERMINANTS AND 17 STATUS 17
SOCIAL DETERMINANTS OF INUIT HEALTH 18 Source: Inuit Tapiriit Kanatami.Social determinants of Inuit Health in Canada, 2014
SELECTED HEALTH INDICATORS Life expectancy Nunavik =67,5 years Qc= 82 years (2009-2013 ) Level of major crime under alcohol influence Nunavik=70% Level of signalment neglect type Nunavik=64% Qc=22% Standardized mortality rate : non-intentional traumatism Nunavik= 100 /100 000 Qc=28 / 100 000 (2009-2013 ) Pregnancy Rate/ 1000 ( 14-19 years) Nunavik= 122 / 1000 Qc = 27 / 1000 (2005-2009) Suicide standardized rate Nunavik = 82/100 000 Qc =14 (2009-2013) High school diplomation after 7 years Nunavik=17.8% Qc=72.3% Family below poverty line Nunavik=43% Qc=17% Standardized mortality rate: respiratory diseases Nunavik= 239 / 100 000 Qc = 72 / 100 000 (2009-2013) Pregnant women Level of alcohol consumption Nunavik=44% Level of retained signalment Youth Protection Nunavik=69% Qc=40% Number of Medevac 2013-2014 440 Standardized mortality rate: cancer : Nunavik= 519 / 100 000 Qc= 250 / 100 000 19 Binge drinking (2003) Nunavik=68% Qc=18% Level of received signalment/population 2013-2014 Nunavik=49% / Qc=5% Nb of visits at MNQ 2013-2014 5403 visits Incidence rate / 100 000 Gonorrhea : 2149 Genital chlamydia : 4614 (2016) Tobacco smoking rate: 77% vs Québec 14.5% Overcrowded housing Nunavik=68% Qc=17.8% Incident rate of tuberculosis / Nunavik=308 / 100 000 (2016) Infant mortality rate / 1000 Nunavik =26 Qc= 5 (2009-2013) 19 Sources: Green: Infocentre de santé publique du Québec, 12 septembre 2017. Blue: Registre des Maladies à déclaration obligatoire, 7 septembre 2017
Weakening of the social and family structure of the Nunavimmiut causing family values to unravel resulting in serious social problems; Wide-ranging psychosocial and health problems ; Repeated traumas and losses which lead, in 20 many cases, to post-traumatic stress; Children are at risk and this impacts on future generations.
21 It is evident that the prevalence of several psychosocial problems is increasing in Nunavik. These problems are all interrelated and aggravating each other.
Rate / 100 000 22 Incidence rate of genital Chlamydia and Gonorrhea, Nunavik, 2012-2016 5000 4500 4000 3500 Genital chlamydia Gonorrhea 3000 2500 2000 1500 1000 500 0 2012 2013 2014 2015 2016 Year
STBIs remain a major threat to health in the region. Chlamydia 10 times and gonorrhea 30 times higher than Quebec Syphylis outbreak in 2017 23 Exploring new solutions adapted to our communities; 23
Number of cases Incidence rate / 100 000 Number of cases and rate of tuberculosis, Nunavik, 2012-2016 24 80 Number of cases Incidence rate 700 70 600 60 500 50 400 40 300 30 20 200 10 100 0 2012 2013 2014 2015 2016 Year 0
Tuberculosis remains another major threat to health in the region. Ongoing cohesive action is required at all levels of public authority in order to attenuate the risk and control the disease. Intensity of preventive work has to be adapted to local challenges and capacities. 25 Other infectious diseases are on the rise. Chronic shortage of and overcrowded housing is a contributing factor. 25
Our future 26 26
Numerous services are not locally available. Nunavimmiut want to receive care and follow-up services in their own community Having to leave their community to receive certain services or undergo tests is a major inconvenience Too many Nunavimmiut must travel to the South for services that could be provided by one of the two existing health centres or eventually, a true regional hospital. 27 The opening of Ullivik in Dorval has been a major improvement, as patients were not at ease or feeling safe in downtown Montreal. However, dozens of patients have to stay everyday in nearby hotels as Ullivik is always running at full capacity. This reflects that our needs are also increasing, in the context of an aging
Regional health statistics 2014 Most used Specialized services outside of Nunavik 2012-2013 Total Estimated Transportation cost (Nunavik-MTL) Ophtalmology 788 2 088 200 $ 2012-2013 Total estimated amount spent for transportation for specialized services (Nunavik-Montreal) 15 M$ excluding cost for food and lodging. 28 Orthopedics 285 755 250 $ Plastics 260 689 000 $ Obstetrics 254 673 100 $ Antenatal 212 561 800 $ Cardiology 202 535 300 $ ENT/ORL 180 477 000 $ Respiratory 176 466 400 $ Oncology 165 437 250 $ Urology 138 365 700 $ Gynecology 138 365 700 $ Dental 135 357 750 $ Day Surgery 135 357 750 $ Breast Clinic 131 347 150 $ Neurology 128 339 200 $ Physiotherapy 118 312 700 $ Occupational Therapy 113 299 450 $ 28
29 Increase level of specialized services in Nunavik. Optimization of Regional Services Optimization of cost efficiency vs client-interventions More positions available for Inuit manpower Improve offer of services provided in Inuktitut Redirecting of SANA (transportation, food, lodging) expenses into direct health services in the region. Improve access to specialized services (waiting time, follow up, etc.) More efficient facilities (mission, technology, imagery, telehealth, etc.) Reduction of services provided by MNQ (Montreal) 29
Regional Action Plan for Public Health in Nunavik, 2016-2020 (1) Monitoring population s health Qanuilirpitaa? 2017 Health Survey Nunavik attempt and suicide monitoring system Health information reports to decision makers and the population Overall development of youth and children Implementation of Ilagiilluta (SIPPE) Program, Healthy Schools activities and family houses Smoking and substance abuse prevention Good Touch/Bad Touch program to prevent sexual abuse
Regional Action Plan for Public Health in Nunavik, 2016-2020 (2) Lifestyles and healthy and safe environments Regional policy on food security Community mobilization projects Promotion of active lifestyle and traditional outdoor activities Suicide prevention strategy Evaluation of health and social impacts of major projects Initiatives to improve water, ATV and snowmobile safety Prevention of infectious diseases Checkup project to promote STBIs screening among 15-29 years Community mobilization projects for prevention, early diagnosis and treatment of tuberculosis Risk management and preparation for health emergencies
In Nunavik, the Ilusiliriniqmi Pigutjiutini Qimirruniq process (clinical project) was launched in 2009 and had three objectives: 1. Strengthen or develop 9 services identified as regional priorities in the Youth in Difficulty, Mental Health and Addictions files (Orientation committee, June 2010) 32 2. Strengthen partnerships between local and regional organizations because social and health problems are complex; 3. Change the way the services are designed in the region so that Inuit input and leadership are at the centre of the designing and decision making process in the health and social services network.
Our choices for our well-being 33 Ensure a smooth trajectory, from the moment a health problem arises to its complete resolution. Develop service agreements. Ensure health care respects Inuit values and practices. Provide a maximum of care in the North.
Strategic Regional Plan Our current agreement with the MSSS (2009-2016) was extended for 2 years, ending March 31, 2018, to complete the implementation of the previous agreement 34 Fall 2017 start of the negotiation process for the next Strategic Regional Plan for a 5 or 7 year-period 34
Nakurmiik! 35 35