Cappon: Health PromoUon in Baffin }()I) COMMUNITY HEALTH AND HEALTH PROMOTION IN BAFFIN ISLAND Paul Cappon Department of Community Health, Montreal General Hospital, School of Social Work, McGill University, Montreal, Quebec, Canada INTRODUCTION the community health system; but they also provide opportunities to employ cultural attributes to During 1988 and 1989, a community health status strengthen existing or to generate new regional pro· assessment of Baffin Islanders (1) was carried out grammes. bythe McGill University/Baffin programme and the Putting community health and health promotion Northern Quebec Module of the Department of priorities in perspective requires mention of some Community Health of the Montreal General Hospi­ of the findings of the evaluation of health status. In tal. The intent of the Baffin Regional Health Board, describing these indicators, I wish to acknowledge which asked for the study, was to use the results of the work of Robert Choiniere, a demographer at the the evaluation of community health status to deter­ Montreal General Hospi~I, Department of Com- mine future community health and health promo­ munity Health. • · tion priorities for the Region. Salient features regarding mortality data were as The results of that study have led to broad conclu­ follows: sions with regard to thinking about health priorities in Baffin in the 1990s. While I acknowledge that each l. life expectancy citcumpolar region has its particularities, I do be­ Overall Inuit life expectancy, calculated using the lieve that some of these conclusions maybe gcner­ years 1983-1987, was (,6.6 years, compared with 76.3 ali7.abJe in the discussion of comparative views of for Canada as a whole in 1986. Northern Health Services. The particular context of the Baffm study is one in 2. Crude death rate which substantial changes are underway in the man­ The crude death rate per 1,000, adjusted for age agement of the health system in the Northwest Ter­ and sex, was 4.9 for Baffin Inuit and 2.5 for Canada. ritories. Responsibility for northern health had ' The Baffin rate was therefore twice the Canadian originally been assumed by the federal government rates for crude death. in Ottawa. Recently, power has been devolved to territorial level. 3. Infant mortality rates There has been a concomitant recognition of re­ 1be infant mortality rate for 10,000 was 81 for gional diversity among major areas in the vast Canada and 202 for Baffin Inuit. The rate for Baffin Northwest Territories, differences caused by geog­ Inuit was therefore 2~ times higher than the Cana­ raphy, climate, vegetation, ethnicity and economic dian rates variation. Consequently, it was determined that health conditions and needs also could vary mark­ 4. Analysis of major causes of death c4ly among the regions; and that health strategies Analysis of major causes of death shows that, even should fully reflect the particularities of the region. though mortality from infec.tious disease declined The composition and sphere of activity of the Baffin dramatically among Baffin Inuit since the 1960s, due Re~nal Health Board results from this growing to the precipitous decrease in death due to tubercu­ regional responsibility. losis and the success of some immunization pro­ . In terms of community health, the Baffin Region grammes, their mortality from infectious disease is JS unique. Demographically, it is a region with over unusually high. The adjusted mortality ratio be­ 80% Inuit population, spread ovcra large landmass. tween Baffin and Canada for infectious disease is !Jiis means that health history and health statistics 6.6. This means that Inuit of same age and sex as 1n the region have tended to resemble Canadian southerners have 6~ times the death rate from nonns less than those of areas like Fort Smith or infectious disease. This statistic is closely related to ~uvik Regions. Socially and culturally, the Region public health and sanitation conditions in Baffin. IS also unique, and its differences are reflected in its Overcrowded housing conditions contribute not health system. Baffin is the region which has been only to excessive mortality but also to the spread of ~rting most successfully to preserve Inuit lan­ non-fatal communicable disease like middle ear in­ guage and culture. The region publishes children's fections. In this respect. the Yellowknife Confer­ books in lnuktitut, and the Board of Education's ence on Health Priorities, which was held in June CUitural awareness programme is well supported. 1989, was correct in identifying housing as the most ~a community health perspective, these cbarac­ important health priority for the North. leristicg are important. Not only do they require Crowded housing conditions and primaiy and sec­ knowtedgc and sensitivity to language and culture in ondary smoking are main contributors to the 110 Inuit/Canada adjusted mortality ratio of 5.6 for re­ a service-integrated health promotion team based in spiraJOry disease, which is the third most common Iqaluit and drawing also on resources ofthe Ministty cause of death among Baffin Inuit. of Health in Yellowknife. The objective ofthe health These same preventable factors - together with professionals and of ministiy resources would be to aCC111turation - appear to account for excessive Inuit provide the yearly assessment of community health death due to neoplasm: an Inuit/Canada mortality indicators for Baffin, from which a list of general ratio of 1.7. priorities in health would be derived. It is at the local The Baffm Region also has high death rates from level, at the level of Inuit Health Promotion Com­ injuty and poisoning, which account for 26% of all mittees, that choices would be made from amonpt deatm and is the principal cause of mortality among the priorities in accordance with local views and Baffin Inuit. The Inuit/Canada mortality ratio of 3.3 concerns. If, for example, professionals in the field demonstrates that, even in a countiywhere there are identified for next year 10 general priorities for many deathli from injuiy, the risk of dying from this health, local health committees or health promotion cause is much higher in ~n. It is even more groups in any one village might select two or three striking for children aged one to 14 who, in Baffin, of the&e for their own work. In this way, best use can have 3l'Z times the Canadian death rate from injuiy. be made of the expertise of southern professionals, For this age group, injuty accounts for almost the while responsibility for the ultimate choice and suc­ entire difference between Inuit and Canadian mor­ cess of priorities and programmes rests with the tality rates. Ourstudy showed that the average num­ people whOl!ie heallh is affected. ber ofyears or life lost from this entirelypreventable cause, injuty and poisonin:g, is48.2 years. The risk of 2) Violent deaths dying from this cause is related to a series of health Again consistent with studies in other circumpolar and social problems,. including home and workplace regions, violent deaths are a major problem. These safety; alcohol abuse, mental health problems asso­ deaths are entirely preventable, account for most ciated with low self-roncept; and family dysfunction. years of life lost among the population, and should Many of these problems are best addressed by pre­ be considered the mOlit urgent community health vention and by health promotion. priority in Baffin region. 5. Comparative advantage 3) Empowerment Community Health assessment of Baffin Inuit Empowerment through Community Develop­ showed one area ofcomparative advantage of Baffin ment is an essential feature of successful health Inuit - deaths from circulatoiy disease. Here, the promotion. Locally-initiated health promotion mortality rate is significantly less for Baffin Island­ should concentrate on areas 9f comparative advan­ ers than for southern Canadians. It is thought that tage for Inuit in order to build a positive sense ol these tower rates are linked to several factors, and accomplishment and ability to control their own perhaps especially to lower serum cholesterol levels lives. Our data showed, for example, that the Inuit relating to ~nsumption or Inuit traditional foods traditional diet is superior through its tower fat which have diminished levels of veiy low density content and results in lower rates of amfioyasCUlar lipoproteins, compared to southern foods. disease. This comparative advantage can be further This cursmy overview of the f"mdings of the com­ strengthened through health promotion pro­ munity health status assessment of Baffin Inuit leads grammes and shown widely as an example of what to three types ofconclusions with respect to commu­ control the Inuit people can achieve over their own nity ht;alth and health promotion priorities for the health, and perhaps, by extension, over other facets futuri of collective life. It is important to note that this view is the ~te 1) The limits of medical intervention of that which advocates concentrating on educating Consistent perhaps with other circumpolar situa­ people with respect to major problems. We - and tions, direct medical intervention is reaching its lim­ they - already know what the major problems aie. its in affecting health status of Baffin communities. Concentrating and educating exclusively with re· Medical intervention and primaiy prevention as­ spect to those problems assumes that individua!IY sisted the rapid improvement in Inuit life expectancy initiated change is likely in a difficult psyc~ between 1960 and the present. Future improvement and physical environment. In other words, 1t as· will be due mainly to successful community health sumes that an information processing or health~­ and health promotion programming. lief model of health promotion will be succe&Sful di In the light of this assertion, I believe that health the North. I have grave doubts that such would be promotion should be provided principally by Inuit the case. community leaders, either through existing health I believe that in Baffin, as in other ~ committees or through small groups established for regions, we need to c:oncenttate further effortS ~ that purpose.