NUNAVtK REGIONAL BOARD OF HEALTH AND SOCIAL.SERVICES RÉGIE RÉGIONALE DE LA SANTÉ ET DES SERVICES SOCIAUX NUNAVIK a_CO / PUBLIC HEALTH / SANTÉ PUSLIOUr Regional Action Plan Public Health Department 2003-2014 INSTITUT NATIONAL DE SANTE PUBLIQUE DU QUEBEC CENTRE DE DOCUMENTATION MONTRÉAL September 2003 Phone : (819) 984-2222 P.O. Box 900 Fax: (819) 964-2814 Kuujjuaq, Québec J0M1C0 Web Site : http7/www.rrsss17.gouv.qc.ca PROJECT TEAM, CONTRIBUTORS AND INDIVIDUALS CONSULTED Coordination • Serge Déry (Nunavik Public Health Director) • Stéfanie Houde (Community Health Resident Université de Montréal) Development, Social Adjustment and Integration Component • Diane Pépin (Nunavik RBHSS) • Johanne Morel (Montreal Children's Hospital) • Maureen Cooney (Nunavik RBHSS) • Pierre Rioux (Nunavik RBHSS) Lifestyles and Chronic Diseases Component • Kathy Snowball (Nunavik PHD) • Merry! Hammond (Nunavik PHD) • Roger Bélanger (Nunavik PHD) • Suzanne Paradis (Nunavik PHD) Unintentional Injuries Component • Brian Jones (Kativik Regional Police Force) • Elena Labranche (Nunavik RBHSS) • George Okpik (Kativik Regional Police Force) • Marc Guenard (Kativik Regional Police Force) Infectious Diseases Component • Brian Miller (Nunavik PHD) • Jean-François Proulx (Nunavik PHD) Section on Sexually Transmitted and Bloodbome Infections • AJine Roy (Inuulitsivik Health Centre) • Annie Savard (Inuulitsivik Health Centre) • Barbara Northrup (Inuulitsivik Health Centre) • Érika Poirier (Ungava Tulattavik Health Centre) • Faye Le Gresley (Ungava Tulattavik Health Centre) • Jean-François Proulx (Nunavik PHD) • Lina Noël (Nunavik PHD, INSPQ) • Marléne Julien (Ungava Tulattavik Health Centre) Environmental Health Component • Susie Bemier (Université Laval) Occupational Health Component • Andrée Racine (Nunavik PHD) Corrections and layout • Vincent Gilbert (Nunavik PHD) ACKNOWLEDGEMENTS We would like to express our heartfelt thanks to Dr. Stéfanie Houde, resident in Community Health at the Université de Montréal. Her relentless and professionalism during her all too short internship with us made it possible to produce this preliminary version of the first Nun- avik regional action plan in public health. We would also like to thank everyone who, as contributors or individuals consulted, have- helped to improve the content of this proposed first action plan. Lastly, we would like to thank in advance those who will agree to review our proposal and whose comments will help to improve the contenL Serge Déry, M.D. Public Health Director TABLE OF CONTENTS PROJECT TEAM, CONTRIBUTORS AND INDIVIDUALS CONSULTED II ACKNOWLEDGEMENTS Ill LEGEND IX ABBREVIATIONS X INTRODUCTION 2 WHY SHOULD THERE BE A PUBLIC HEALTH ACTION PLAN FOR NUNAVIK ? 2 GENERAL HEALTH PORTRAIT OF NUNAVIK 3 FROM THE QPHP TO A REGIONAL PLAN 4 Strengthen the potential of individuals 4 Support community development 4 Improve living conditions and support vulnerable groups 4 Favour consultation and integrated approaches (participate in intersectoral action that promotes health and well-being) 5 Encourage the use of effective clinical practices in prevention 5 COMPONENT 1 - DEVELOPMENT, SOCIAL ADJUSTMENT AND INTEGRATION 6 ASSESSMENT OF SITUATION 6 Substantial natural growth, high fertility 6 High fertility among teenagers and number of single-parent families is increasing 6 Low birth weight babies, preterm births and intrauterine growth restriction 6 Health of children aged 0-5 years 6 Socio-economic status of the region 7 Substance abuse and illegal drugs 8 Alcohol ....... 8 Solvents 9 Cannabis derivatives 9 Other illegal drugs 9 Violence 9 Sexual abuse 10 Suicide and mental health 10 Seniors 10 Priorities of action by target population 10 CHALLENGES AND OPPORTUNITIES 12 Children 0-5 years old 12 6r25 years old 12 Adults : 12 OBJECTIVES 13 REGIONAL ACTION PLAN 14 Foster health and development of newborns and pre-school aged children (0-5 years) 14 Foster the development, social adjustment and integration of youth aged 6 to 25 years 16 Foster the development, social adjustment and integration of adults 18 Nunavik Public Health Department L !••»• •»•-• .-u-f »•-»»• ••...m.——- iv COMPONENT 2 - LIFESTYLES AND CHRONIC DISEASES 19 ASSESSMENT OF SITUATION 19 Diet ...19 Food insecurity 20 Dietary deficiencies 20 Sedentariness.. 21 Obesity . 21 Diabetes 21 Cardiovascular diseases 21 Cancer 22 Smoking . 22 Dental health 22 CHALLENGES AND OPPORTUNITIES 24 General issues 24 Nutrition and physical activity 24 Smoking ; 24 Cancer ........: 25 Dental health 25 OBJECTIVES., 26 REGIONAL ACTION PLAN 28 Adoption of healthy eating habits and regular physical activity - General population 28 Adoption of healthy eating habits and regular physical activity - Young people aged 5-24 31 Smoking reduction - General population... 32 Smoking reduction - Elementary and high school students 34 Smoking reduction - Pregnant women 35 Cancer prevention.. 36 Oral-dental diseases - Preschool-aged children 37 Oral-dental diseases - School-aged children and adolescents 37 COMPONENT 3 - UNINTENTIONAL INJURIES 38 ASSESSMENT OF SITUATION 38 Motor vehicles 38 Drowning 39 Poisoning ...; 39 Fire 39 Hypothermia 39 Firearms 40 Falls .....40 Sports accidents 40 CHALLENGES AND OPPORTUNITIES : 41 OBJECTIVES 41 REGIONAL ACTION PLAN 42 Unintentional injury prevention - General population 42 Unintentional injury prevention - Young people (0-24 years old) 44 Nunavik Public Health Department atmmr 2871 COMPONENT 4 - INFECTIOUS DISEASES 45 PART I : GENERAL 45 Infectious diseases - Surveillance 45 Infectious diseases - Protection 46 PART II : DISEASES PREVENTABLE BY IMMUNIZATION 47 ASSESSMENT OF SITUATION 47 Vaccination against tuberculosis 47 Diphtheria - Tetanus - Poliomyelitis 47 Haemophilus influenzae type b 48 Whooping cough 48 Bacterial meningitis 48 Measles - Rubella - Mumps 48 Pneumococcus 49 Hepatitis A : 49 Hepatitis B ; 50 Influenza 50 CHALLENGES AND OPPORTUNITIES 51 OBJECTIVES 52 REGIONAL ACTION PLAN 53 Immunization - General aspects 53 Immunization of preschool-aged and school-aged children 55 Immunization at the old adults and people 56 PART III : SEXUALLY TRANSMITTED AND BLOODBORNE INFECTIONS (SBBI) 57 ASSESSMENT OF SITUATION 57 Sexually transmitted and blood borne infections 57 Preserving the fertility of Inuit women 58 Young people who attend school outside the communities 58 Inuit who are incarcerated outside the Nunavik territory 58 Inuit who are highly marginalized outside their communities 59 Drug and alcohol use 59 Partners in prevention 60 Reference framework 60 REGIONAL ACTION PLAN 63 HIV/AIDS and sexually transmitted infections (STIs) 63 Surveillance - Research - Evaluation 64 Prevention among adolescents and adults belonging to vulnerable groups - General population 65 Prevention among adolescents and adults belonging to vulnerable groups - Youth in school and outside the school system 67 Prevention among adolescents and adults belonging to vulnerable groups - Partners in prevention 68 Prevention among adolescents and adults belonging to vulnerable groups - Men who have sex with men 69 Prevention among adolescents and adults belonging to vulnerable groups - Incarcerated persons 69 Needle exchange to prevent hepatitis B virus, hepatitis C virus and HIV transmission - General population 70 Needle exchange to prevent hepatitis B virus, hepatitis C virus and HIV transmission - Injection drug users 70 Recovering used needles (hepatitis Bt hepatitis C and HIV) - Institutions concerned 70 Nunavik Public Health Department u.^-^. ,»,^^,,.,.....,^,,,^. .«i,,..,,.»,..-.,...^,,),,^,, ,IIU- yj Organization of integrated testing and prevention services related to STI, HCV and HIV/AIDS - General population 71 Organization of integrated testing and prevention services related to STI, HCV and HIV/AIDS - Surveillance - Research - Evaluation 72 Free-of-charge medication to treat sexually transmitted infections - General population ; 72 Post-exposure prophylaxis (HIV and HCB) - Health institutions concerned 73 Support for clinical preventive practices through systematic STI, HIV and HBV testing of pregnant women - Partners concerned 73 Promotion of preventive behaviours by raising public awareness of the consequences of HIV/AIDS, HCV and STIs - General population 73 Promotion of preventive behaviours by raising public awareness of the consequences of HIV/AIDS, HCV and STIs - Surveillance - Research - Evaluation 74 Ensure access to services adapted to the needs of HIV-positive persons in the territory 74 Ensure regional concertation regarding the implementation of the plan of action on STIs, HIV/AIDS and HCV - Partners in prevention 74 PART IV : OTHER INFECTIOUS DISEASES 75 ASSESSMENT OF SITUATION 75 Enteric and foodborne diseases 75 Bacterial and parasitic infections of fecal-oral transmission 75 Botulism 75 Diseases transmitted through direct contact or respiratory tract 76 Tuberculosis 76 Respiratory infections among children.. 76 Vectoral diseases and zoonoses 76 Rabies 76 Trichinellosis. 77 Toxoplasmosis 77 West Nile virus 78 Other zoonoses 78 Nosocomial infections 78 Travel health.... 78 Antibiotic resistance 78 CHALLENGES AND OPPORTUNITIES 79 OBJECTIVES 79 REGIONAL ACTION PLAN 80 Enteric and foodborne diseases 80 Enteric and foodborne diseases - Botulism 81 Diseases transmitted through direct contact or respiratory tract - Tuberculosis 82 Vectoral diseases and zoonoses - Rabies 83 Vectoral diseases and zoonoses - Trichinellosis 84 Vectoral diseases and zoonoses - West Nile virus 85 Vectoral diseases and zoonoses - Nosocomial infections 85 Vectoral diseases