Question Period Note: Supports to Nunavut

• The health and wellbeing of Nunavut residents remains our top priority.
• The Government of Canada is committed to ensuring that the Government of Nunavut and Nunavut Tunngavik Incorporated have the resources needed to continue responding to challenges presented by COVID-19.
• To support Nunavut throughout the course of the COVID-19 pandemic, ISC has provided funding, personal protective equipment, health human resources, and rapid antigen tests.

Nunavut faces many significant challenges in delivering health care to its residents, particularly due to its geography and small population. As a result, basic health care taken for granted elsewhere is not available or easily accessed close to home for most residents – i.e., support for births, mental health and addictions treatment, diagnostic imaging, surgeries, and dental care. Virtual care is available in limited ways, but there are real technology barriers (e.g., lack of bandwidth, availability of satellites) that must be addressed to make further progress. Additionally, Nunavut residents have poorer health status compared to other provincial and territorial jurisdictions, despite considerably higher per capita health spending, which further strains the health care system.

Jurisdictional responsibility for health services
The Government of Nunavut is responsible for delivering insured health services to all residents of Nunavut. The federal government, specifically through ISC’s First Nations and Inuit Health Branch, supports Indigenous health and wellbeing in Nunavut through a variety of programs and initiatives, including: the 10-year (2017-2027), $240 million trilateral Nunavut Wellness Agreement, which funds: community-driven wellness programming and home care services across Nunavut; coverage for a range of supplementary health benefits to status First Nations and recognized Inuit through its Non-Insured Health Benefits Program; and, mental wellness programs and services in five key areas. These are the Indian Residential Schools Resolution Health Support Program; the Non-Insured Health Benefits Program Mental Health Counselling Benefit; the First Nations and Inuit Hope for Wellness Helpline; Jordan’s Principle and the Inuit Child First Initiative; and, support for the construction and operation of the Nunavut Recovery Centre, for which a trilateral Memorandum of Understanding was signed in October 2020 and a contribution agreement was signed in August 2021.

Medical travel in Nunavut
Medical transportation by air is a key and inevitable component of Nunavut’s health system. Nunavut is a vast territory made up of 25 small and isolated communities, none of which are connected by roads. Each community has a health centre staffed by nurses with occasional visits by physicians. There is only one hospital in the territory, located in Iqaluit, which provides services to approximately 40% of Nunavut residents. Because of these realities, costly air travel is required for residents to access many health services, both within and outside of the territory. The majority of Nunavut residents are Inuit (approximately 85%) and therefore eligible for the Non-Insured Health Benefits Program, which includes coverage for medical travel expenses. In Nunavut, this program is administered directly by ISC, as well as via a contribution agreement with the Government of Nunavut, including the delivery of the Program’s medical travel benefit. When eligible Non-Insured Health Benefits clients access insured services from Nunavut, the Program reimburses the Government of Nunavut a co-payment on behalf of its clients, as well as the cost of meals and accommodations. When Non-Insured Health Benefits clients access non-insured services (e.g., dental services), the Non-Insured Health Benefits Program reimburses the Government of Nunavut for the full cost of the trip (e.g., eligible transportation, meals, accommodations).

In January 2019, the Government of Nunavut informed ISC that it could no longer afford to cover the cost of medical travel for its population, and that it expected ISC to begin paying the full cost of medical travel for the territory’s Inuit population. In 2020-21, interim federal funding of $58 million was provided to the Government of Nunavut to help address health care cost pressures. Planned intergovernmental discussions on a longer-term arrangement for medical travel were delayed due to the COVID-19 pandemic. In 2021-22, the Government of Nunavut accepted another one year of interim funding to support its health care cost pressures and enable discussions on a longer-term solution for medical travel to continue. That arrangement includes: $58 million in new funding to address heath care delivery, including medical transportation; the continuation of an increased medical travel co-payment (which began in 2020/21) for eligible Non-Insured Health Benefit clients from $125 to $715 per direction, plus an additional $1 million to administer the medical travel benefit; and, the renewal of Health Canada’s Territorial Health Investment Fund of $13.5 million in 2021-22 and 2022-23. A third year of interim funding for 2022-23 in the amount of $58 million was offered to the Government of Nunavut in February 2022. It is anticipated that the Government of Nunavut will sign the agreement that is currently before their Legislative Assembly and that this will allow for discussions on a longer-term solution for medical travel to conclude in the 2022-23 fiscal year. Nunavut Tunngavik Incorporated, the Inuit rights-holder under the land claim agreement in Nunavut, will also be included in the discussions regarding a longer-term solution for medical travel.

If pressed on Out of Territory Elder Long-term Care
• The Government of Canada values Indigenous elders and the knowledge they hold to bring about positive change to Indigenous health and wellness.
• The Government of Nunavut has jurisdiction over healthcare, including long-term and continuing care.
• ISC is working closely with Nunavut to provide the required assistance to address the health needs of Nunavummiut.
• ISC will be working with Nunavut partners to co-develop a distinctions-based Indigenous Long-term and Continuing Care Framework to ensure residents can receive services closer to home.

If pressed on support to the territory
• To date, Indigenous Services Canada has provided Nunavut with $238.4 million in health support funding to respond to the COVID-19 pandemic.
• This includes funding to address increased health system pressures and to support Inuit communities directly.
• The Government of Canada will continue to support the Territory and its partners to provide assistance as required.

If pressed on mental wellness needs in Nunavut
• We are working in close partnership with the Government of Nunavut and Nunavut Tunngavik Incorporated to respond to the mental wellness needs of Inuit in the territory.
• Through this partnership, we are contributing $240 million over 10 years through the Nunavut Wellness Agreement for community wellness initiatives.
• Through ISC’s contribution agreement with Nunavut Tunngavik Incorporated, $14.7 million is provided to Inuit communities and organizations to support mental wellness initiatives.

If pressed on COVID-19 Cases in Nunavut
• As of March 15, 2022, there are 319 active COVID-19 cases in Nunavut due to Omicron-driven outbreaks in several communities. Nunavut has reported a total of 3,331 confirmed cases.
• Public health measures continue to ease as of March 21, 2022, except in Gjoa Haven, Kugaaruk, Igloolik and Taloyoak, where measures will remain until cases stabilize.
• The current public health emergency is set to be lifted by April 11, 2022, shifting resources and integrating COVID-19 response into the regular health care system.

If pressed on vaccines in Nunavut
• As of March 15, 2022, 81 percent of the eligible population is fully vaccinated. 81 percent of residents aged 12-17 are fully vaccinated, and 37 percent of children aged 5-11 are fully vaccinated.
• Nunavummiut can access the COVID-19 vaccine through community health centres and public health units. First and second dose vaccinations continue to be offered to the five and over population, and booster vaccinations continue to be offered to the 12 and over population.

If pressed on health services in the North
• We are working with territorial and Indigenous partners to advance the health and safety of First Nations and Inuit in the North.
• While territorial governments are responsible for the delivery of health care in the territories, we work in partnership to ensure First Nations and Inuit communities have access to culturally safe supports and services, including on the land activities.
• In 2020-21, $40.4 million was allocated to support mental health programming and services in all 72 First Nations and Inuit communities in the three territories.

If Pressed on health services in the North during COVID-19
• Our government is supporting Indigenous communities to implement culturally relevant emergency measures to promote on the land physical distancing.
• Last year, Canada invested more than $117 million in mental health and wellness supports related to the COVID-19 pandemic, of which $10.6 million of this funding was allocated across the three territories.
• In response to COVID-19, a pan-territorial Indigenous working group is in place and will continue to work with Indigenous partners to help them protect their health and safety during this pandemic.

Medical Transportation in Nunavut
• The Government of Nunavut has advised Canada that it can no longer afford to cover the cost of medical travel for Inuit residents accessing insured services.
• This year, in recognition of these costs, the Government of Canada is providing Nunavut with $58 million of interim funding for health care delivery, including medical transportation.
• The Government of Canada will also engage the Government of Nunavut and Nunavut Tunngavik Incorporated on a longer-term solution to address medical travel costs.

If pressed on federal funding for medical travel in Nunavut
• The Government of Canada supports Nunavut’s medical travel costs through several programs, including:
o $58 million in funding to support health delivery cost pressures in 2021-22;
o $715 for every one-way medical travel flight for eligible Inuit and First Nations clients of the Non-Insured Health Benefits Program; and
o $13.5 million in 2021-22 and 2022-23 through the Territorial Health Investment Fund.

If pressed on Tuberculosis in Inuit Nunangat
• Our Government is working with partners to eliminate tuberculosis across Inuit Nunangat by 2030, and reduce active tuberculosis by at least 50 percent by 2025.
• Budget 2018 announced $27.5 million over five years to support the Inuit-specific approach to tuberculosis elimination; this is in addition to the $640 million over 10 years announced in Budget 2017 and 2018 to address Inuit Nunangat housing needs.
• We will continue to work to support innovative and community led approaches that address factors contributing towards tuberculosis.