Three Decades of Success: Pauktuutit Health Projects and Accomplishments

Pauktuutit Inuit Women of Canada was incorporated in 1984 to act as the national representative organization of Inuit women in Canada, and to address the range of social and health issues being experienced in the 53 Inuit communities spread across the Canadian Arctic. Despite receiving national and international acclaim for its work, much remains to be done to achieve equal health status for Inuit women and their families to that of other Canadians.

Inuit in Canada live in 53 remote isolated communities spread across four geographic regions of the Canadian Arctic. Most Inuit communities are served by a nursing station only and accessing hospital and/or specialized services can require travelling thousands of miles by air from home to larger centres such as Iqaluit, Winnipeg, Edmonton, Ottawa, Montreal or St. John’s. There is a lack of human resource capacity in the communities across the spectrum of health and wellness services. In some cases, like with HIV and AIDS, there are no community based services equivalent to those that can be found across Canada and specialist services, including mental health services, are severely lacking. Pauktuutit has filled a significant gap in that regard, and its activities have provided substantial support and bilingual culturally relevant resources to health workers in the communities.

Inuit still have a much lower life expectancy than other Canadians, with a gap of 10 years for Inuit men in Nunavik compared to southern non-Aboriginal Canadians. Rates of infant mortality are still relatively high, and suicide rates in some regions are up to nine times the national average. Other health disparities include higher rates of chronic illness and infectious disease, heart disease, diabetes, and respiratory illness. The rates of tuberculosis rates for Inuit doubled between 2006 and 2010 to 185 times the rate among non-Aboriginal Canadians. Many of these issues are an outcome of poor socioeconomic conditions in Inuit communities as indicated by high poverty rates, low levels of educational attainment, limited employment opportunities, and inadequate and overcrowded housing conditions. The high birthrate, resulting in over 50 per cent of the Inuit population now being under the age of 25 has significant health policy and program implications.

Improving the health status of Inuit women and their families has been a priority since Pauktuutit’s incorporation in 1984. For example, traditional midwifery was replaced by the imposition of the western medical model in the 1950s and ‘60s, and for some time this knowledge was at risk of being lost forever. Presently many Inuit women still have to leave their homes and families to deliver babies in hospital settings although there is now a resurgence of and increased support for Inuit midwifery in several regions. The Territories have the highest rates of violence in the country, meaning that for Inuit women violence and abuse are significant physical and mental health issues. Sexual health and family planning continue to be priorities for the organization. Pauktuutit continues to be the only national organization addressing Inuit-specific sexual health priorities including HIV and AIDS.

In response to direction provided by its membership and Board of Directors, Pauktuutit has implemented numerous successful health prevention and promotion projects on issues including maternal child health and midwifery, tobacco cessation, HIV/AIDS, substance abuse, FASD, early childhood development, injury prevention, health research and others. Raising awareness and building the capacity of Inuit to deliver health programs is an important part of the work of the health department at Pauktuutit.

Pauktuutit’s work on health is also intended to influence policy and program development to better meet the needs of Inuit women and their families, as well as developing plain language bilingual information resources for use by individuals, front line workers and health care professionals. It uses a population health approach with a holistic view to addressing the social determinants of health including language, culture and gender as central considerations. Pauktuutit considers the unique needs and priorities of women, men, elders and youth in its policy and project initiatives.

Pauktuutit works with many national, regional and community partners including Inuit land claims organizations, regional governments and health boards, Aboriginal organizations and academia. Its work is supported and enhanced by participating in the Inuit Tapiriit Kanatami’s (ITK) National Inuit Committee on Health (NICOH), the ITK Alianait Mental Health Working Group and the National Inuit Public Health Task Group. It also has a formal Memorandum of Understanding with the Canadian Aboriginal AIDS Network and other organizations to support collaborative initiatives on mutual objectives and priorities.

Pauktuutit’s work on health issues is unique in that it seeks advice from Inuit subject matter experts and other partners through advisory committees to its projects. Resources that are developed are intended for use or modification by all Inuit communities, and to the extent possible translated into several dialects of Inuktitut. Much if not all of this essential work will no longer be possible as a result of Budget 2012.

Pauktuutit has never received core funding for health activities such as participating in numerous working groups and providing policy and program advice to different levels of government and other stakeholders such as the National Aboriginal Council on HIV/AIDS. All of the organization’s work on health has been made possible through annual project contributions primarily from the First Nations and Inuit Health Branch of Health Canada. From 2007 – 2011, these project funds have totaled approximately $800,000 per year. Proposals were submitted to FNIHB in December 2011 for the 2012/13 fiscal years for projects anticipated to include Inuit maternal newborn care, HIV community readiness and research, FASD, midwifery, and engagement and consultation. The total budgets for these projects are approximately $730,000.

Pauktuutit’s health projects have addressed both the need for relevant bilingual health information and resources in the communities, as well as build community capacity to deliver workshops and hold other events locally through train-the-trainer projects. Community health workers have told Pauktuutit that the Inuit-specific resources, and support that it provides, gives them confidence in using them in their communities. Pauktuutit has also become recognized among Inuit as a credible source of health information that is more likely to be used than products produced by governments including the federal government. The outcomes of these projects also provide strategic policy advice to the federal government on priorities and appropriate interventions.

Pauktuutit widely distributes its products to health centres and front-line health workers, land claims organizations, regional health board, government partners and other stakeholders. Its work is also widely promoted through conferences and other public events. From 2010 – 2012, Pauktuutit distributed the following:

Resource Distribution (2010 -2012)
Prenatal resources 10,000
HIV condom covers/other products 22,000
Physician fact sheets 5,000
Strategic plans (FASD, sexual health and injury prevention) 200 each (an additional 100 each of FASD and injury prevention were purchased by Health Canada Atlantic Region)
Pregnancy calendar 5,500
FASD training materials 84 workshop manuals and resources
Injury prevention materials 500 posters; 500 PSAs
Tobacco cessation resources 400
Piaranut (Early Childhood Development) 150 English; 150 Inuktitut

There is much that remains to be done. For example, while there is greater awareness of elder abuse in southern Canada, the issue is rarely discussed in Inuit families and communities. Unique factors that contribute to this situation include poverty, weakened kinship systems, acculturation stress, financial dependency of adult children, poor health of elders, the shift away from the value of elders’ wisdom, and changes in community leadership. Overcrowded housing, lack of social services, alcohol and drugs and intergenerational transmission of trauma are additional risk factors. A 2011 Pauktuutit paper on elder abuse in Inuit communities, funded by FNHIB, notes that:

“The problem of Inuit elder abuse is largely hidden, manifested in complex social relations that are, in part traditional, and in part in terms of modern socio-economic realities. The problem is widely recognized as financial abuse perpetrated by grandchildren. Poverty and lack of housing are important contributing factors. The RCMP and others identify drug and alcohol abuse as critical factors. Underlying the abuse is unresolved intergenerational trauma rooted in the residential school experienced that has normalized violence and undermined traditional Inuit values.

“The elder’s values, abilities, and life experiences are important in the context of screening, assessment, and helping. Screening tools and follow-up protocols need to be culturally sensitive and appropriate — Aboriginal elders may have limited health literacy and may require information material in traditional languages.

“Besides the need to identify elder abuse, there is a need to establish the community resources to address and prevent the problem. Screening and assessment tools do not replace the need for resources, education, training, and support. This is an issue in the North where community support services are lacking.”

With regard to Inuit knowledge, attitudes and behaviours about communicable diseases, a 2009 report submitted to Health Canada advised that “There is a need to consider Inuit knowledge and opinions in order to develop communicable disease prevention strategies with appropriate public health interventions… Among many Inuit, the concept of a pandemic may not be clearly understood or distinguished from other potential disasters like avalanches and contaminants. Though there is a history of epidemics and pandemics in Inuit communities, widespread illnesses as a result of communicable diseases may not be viewed as something separate from other tragedies or life-threatening events a community may face. The results of the focus group discussions suggest that comprehension may be linked to knowledge of past episodes of widespread illness. Age may be a key factor — those that are too young, or who no longer have close relationships with Elders, may not know the history of epidemics among Inuit.”

In order to gain a cross-Canada sense of Inuit knowledge, attitudes, and behaviours about HCV, Pauktuutit undertook five focus group sessions involving a total of 43 individuals. The sessions took place in August and September 2011 in the communities of Inuvik, NWT (nine participants), Iqaluit, Nunavut (12 participants), Arviat, Nunavut (nine participants), Kuujjuaq, Nunavik (three participants), and Goose Bay, Nunatsiavut (10 participants). Focus group participants were selected from the general Inuit public. As part of the focus group registration, participants were asked to rank their knowledge or understanding of hepatitis using a five-point scale. The average rating was fair. Over 46% indicated they had a fair knowledge of the disease; less than 5% indicated a very good or excellent understanding. About a third ranked their knowledge as poor. The report, to be submitted to the Public Health Agency of Canada, goes on to identify barriers to testing and recommendations for effective interventions.

External project evaluations confirm the effectiveness of Pauktuutit’s approach and outcomes. Pauktuutit undertook a multi-year project with the Aboriginal Health Transition Fund. The goal of the project was to design, develop and implement a culturally relevant resource tool which would contribute to health care excellence and increase the numbers of child bearing aged women and their partners and/or support systems who have access to pre-natal care and knowledge during their pregnancy; and, to develop Inuit-specific tools and resources to support culturally sensitive health service provision to Inuit communities through public education and health promotion. A 2011 evaluation of the project notes that:

“While the product has received resoundingly positive feedback from Inuit, the challenge remains with the resistance from non-Inuit health care providers who are unsure what to do with the material and are skeptical about materials created outside the formal health system. It is important for the health system to find a way to embrace and integrate the culturally-specific materials effectively and overcome misperceptions and biases about Inuit and traditional health practices.

“The project has been successful in gaining extensive interest and investment in uptake. Pauktuutit has been able to provide 54 communities with a two year supply of resource materials. Feedback has supported the conclusion that the partnership engagement process was an important element of the project and has attributed to a great deal of regional “buy-in” to the product.

“The project has helped to enhance awareness and knowledge of health care issues, barriers to care and service gaps experienced by Inuit women of child-bearing age. The implementation process has helped to enhance awareness and knowledge of culturally-appropriate approaches to maternal and neo-natal care in Inuit communities among those working in the field.

“The project approach can also be considered a good practice in strengthening planning and collaboration with and among key partners and stakeholders, in adapting services to Inuit realities.

Inuit-specific culturally relevant health promotion and prevention resources are essential to address the unacceptable gaps in health status and access to services, and will ultimately result in a reduction in direct service costs. Pauktuutit calls upon the Prime Minister and Minister of Health to restore these very modest resources that have produced demonstrated positive outcomes.