What if our health care systems embodied the values of our communities? A reflection from Nunavut

A view of Iqaluit, Nunavut, Canada. Photo: Northern Pix

The Arctic has been the subject of increasing resource extraction, research activities, political debate, and press coverage. Media reports often refer to the Arctic as a “vast wilderness,” “barren land,” “untouched landscape”, and “isolated ice-covered world”. Our Arctic is not a barren, untouched, icy wilderness: our Arctic is home. Stories about the Arctic often feature maps, which omit the dots that show where our communities are located. Our people and livelihoods are an afterthought—if they are even a thought at all. We live here, grow up here, love here, and thrive here. We try our best to live in harmony with the wildlife and the lands that have sustained Arctic peoples for millennia. Yes, millennia.

We may have small populations, but we are inventive and resourceful, and we have opportunities in our governance structure to be innovative in how health care models for our communities can be developed and implemented. Discourse about health in Indigenous communities in Canada has largely focused on the application of western or non-Indigenous approaches to understanding wellness. Recently, a growing body of literature has focused on articulating Indigenous knowledge perspectives on wellness, contributing to more meaningful understanding of the challenges experienced by indigenous communities¹⁾Alfred T, Corntassel J. Being Indigenous: Resurgences against Contemporary Colonialism. Government and Opposition. 2005:597-614.; Barnhardt R, Kawagley AO. Indigenous Knowledge Systems and Alaska Native Ways of Knowing. Anthropology and Education Quarterly. 2005;36(1):8-23.; Battiste M. Indigenous knowledge and Pedagogy in First Nations Education: A literature review with recommendations. Ottawa, Canada: Government of Canada, Department of Indian and Northern Affairs (INAC); 2002.; Battiste M, Henderson JY. Protecting Indigenous Knowledge and Heritage: A Global Challenge. Saskatoon, SK: Purich Press Publishing 2000.; Deloria V. Red Earth, White Lies: Native Americans and the myth of scientific fact. New York, NY: Scribner; 1995.; Kovach M. Indigenous Methodologies: Characteristics, conversations, and contexts. Toronto, ON: University of Toronto Press; 2009.; Wilson S. Research is Ceremony: Indigenous Research Methods. Blackpoint, Nova Scotia: Fernwood Publishing; 2008. I come from Nunavut (NU), which is one of Canada’s three territories and is considered part of the country’s eastern Arctic. In the Canadian North, the territorial governments administer most health services, with some exceptions in Yukon where some programs and services have been transferred to First Nations communities.²⁾Young K, Chatwood S. Health care in the North: what Canada can learn from its circumpolar neighbors. Canadian Medical Association Journal. 2011;183(2):209-14. Although the movement to self-determination for Indigenous people has advanced the most in Nunavut and in neighboring Greenland, self-government and control of health services have not translated into better health outcomes.³⁾Galloway T, Saudny H. Nunavut Community and Personal Wellness, Inuit Health Survey (2007-2008). Montreal, OQ: Centre for Indigenous Nutrition and the Environment McGill University.; 2012. And NTI NTI. Annual Report on the state of Inuit Culture and Society: Nunavut’s Health System. Iqaluit, NU: Nunavut Tunngavik Inc.; 2008.

This article will first provide an overview of historic and contemporary events in Nunavut. Then, it will summarize the transition of this Arctic region in the last several decades and the context of Inuit community health and wellness concerns today. Lastly, Inuit concepts are shared, which can be used to inform a model for health care that reflects the values of the people it serves.

Historical Context

Inuit are the Indigenous inhabitants of the North American Arctic, whose homeland stretches from the Bering Strait to east Greenland, a distance of over 6,000km. They live in Russia, Alaska, Greenland, and Canada . And despite the distances between communities, the Inuit share a common cultural heritage, language, and genetic ancestry. Inuit have occupied these Arctic regions for 5,000 years.⁴⁾ITK. 5000 Year Heritage. Inuit Tapiriit Kanatami (ITK); 2005. Of the approximately 150,000 Inuit living in the circumpolar region today, 45,000 live in the four Canadian Nunangat (Inuit lands): Nunavut, Nunavik (Northern Quebec), Inuvialuit (northern Northwest Territories), and Nunatsiavut (northern Labrador). Nunavut, the largest of the Inuit lands, became Canada’s third Territory in 1999.

(Re-)Settlement

Before the arrival of other peoples, Inuit lived a nomadic lifestyle in ilagiit nunagivaktangat or camps.⁵⁾Inuktitut terminology meaning, “a place used regularly or seasonally by Inuit for hunting, harvesting and/or gathering” (QIA, 2010) Although the process of relocation to communities began as a response by Inuit to the presence of traders, explorers, and missionaries, it took new forms with the systematic efforts of the government in the 1950s to “resettle” Canada’s North. At that time, the Canadian government implemented resettlement programs in the Eastern Arctic, moving Inuit to more remote areas to protect Canada’s sovereignty and trade, while also moving Inuit off the land to reduce relief costs—facilitating the provision of supplies, policing education, and to improve healthcare for remote populations.⁶⁾INAC IaNAC. Relocation of Aboriginal Communities. Ottawa, ON: Government of Canada; 1996. And Kirmayer LJ, Tait CL, Simpson C. Mental Health of Aboriginal Peoples in Canada:Transformations of identity and community. In: Kirmayer LJ, Valaskis GG, editors. Healing Traditions: The mental health of aboriginal peoples in Canada. Vancouver, BC: UBC Press; 2009. p. 3-35.

The Report of the Royal Commission on Aboriginal Peoples (1996) noted that in these years government administrators were concerned with the reports of health and welfare coming out of the North, and they came to see the North as being in a state of crisis, which required immediate attention and hastened the government to form settlements ⁷⁾INAC IaNAC. Relocation of Aboriginal Communities. Ottawa, ON: Government of Canada; 1996.. Tuberculosis epidemics among Inuit required immediate attention. Inuit children were enveloped in the residential school system and separated from their families. Early in this period, one high-ranking official wrote that his job was “to hasten the day when in every respect the Eskimos can take their own places in the new kind of civilization which we – and they – are building in their country.” This perspective, which did not take into account the perspectives of Inuit, was never realized.⁸⁾QIA QIA. Qikiqtani Truth Commission Final Report: Achieving Saimaqatigiingniq. 2010. Kirmayer, Tait, and Simpson argued that over the past century, Canadian and American government policies have continued the initial processes of colonization and have destroyed Indigenous cultures and ways of life through forced settlement, the creation of reserves, relocation to remote regions, residential schools, chronic underfunding and poor resourcing of essential services such as health care and education, and bureaucratic control.⁹⁾Kirmayer LJ, Tait CL, Simpson C. Mental Health of Aboriginal Peoples in Canada:Transformations of identity and community. In: Kirmayer LJ, Valaskis GG, editors. Healing Traditions: The mental health of aboriginal peoples in Canada. Vancouver, BC: UBC Press; 2009. p. 3-35. In the process, opportunities arose which allowed Inuit to adapt their own styles of leadership and coordination to the new situation.¹⁰⁾QIA QIA. Qikiqtani Truth Commission Final Report: Achieving Saimaqatigiingniq. 2010.

Resettlement and Imposition of Rapid Transformation without Consultation

The changes imposed on Inuit were rapid. It was not a gradual progression from a traditional to a modern way of life, but a complete transformation.¹¹⁾QIA QIA. Qikiqtani Truth Commission Final Report: Achieving Saimaqatigiingniq. 2010. Inuit were not consulted about the resettlement and education policies that were implemented and many never knew why they were imposed. For their part, the agencies of the Government of Canada that were responsible for the transformation, primarily Indian and Northern Affairs Canada¹²⁾INAC IaNAC. Relocation of Aboriginal Communities. Ottawa, ON: Government of Canada; 1996. and the Royal Canadian Mounted Police, are still not fully aware of their own history in the Arctic or the effects of their decisions and actions.¹³⁾QIA QIA. Qikiqtani Truth Commission Final Report: Achieving Saimaqatigiingniq. 2010.

A few settlements originated as trading posts, so they remained close to good hunting and harvesting areas. For the remaining posts, the single most important criterion for the government was that they were accessible by sea or would fit into planned air routes, therefore many of the settlements were not located near good harvesting areas.¹⁴⁾QIA QIA. Qikiqtani Truth Commission Final Report: Achieving Saimaqatigiingniq. 2010. And INAC IaNAC. Relocation of Aboriginal Communities. Ottawa, ON: Government of Canada; 1996. The community of Arviat, NU,¹⁵⁾Formerly known as Eskimo Point. for example, was built on a coastal swamp, far from the inland caribou herds, which Inuit had followed for centuries and which are still provide essential food for the community today. The Report of the Qikiqtani Truth Commission stated that Inuit have suffered and continue to suffer from this lack of attention to their hunting and harvesting needs, which play a critical role for their wellness.¹⁶⁾QIA QIA. Qikiqtani Truth Commission Final Report: Achieving Saimaqatigiingniq. 2010.

Contemporary Context

Today, there are 25 communities in Nunavut ranging in size from 150 people to a population of 7,100.¹⁷⁾NBS NBoS. Nunavut Population Estimates by Community. Panniqtuuq, NU: Government of Nunavut; 2013. All of the communities are geographically isolated from each other and are only accessible by air, water, or in winter by snowmobile. The population of Nunavut in 2016 was 37,100, of whom approximately 85% are Inuit.¹⁸⁾StatsCan. Provincial/Territorial Profiles: Nunavut, 2011 Census. Fifty-two percent of Nunavummiut speak the Inuit languages Inuktitut or Inuinnaqtun at home.¹⁹⁾StatsCan. Population by home language, by province and territory (2011 Census) (Northwest Territories, Nunavut). Nunavut has a very young population compared to Canada as a whole. In 2011, 57% of the Nunavut population was comprised of those 24 years of age and younger compared to 29% in the whole of Canada.²⁰⁾StatsCan. Provincial/Territorial Profiles: Nunavut, 2011 Census. Today, there is a chronic shortage of housing that contributes to overcrowding among many families with young children in almost every community in Nunavut.²¹⁾Egeland G, Faraj N, Osborne G. Cultural, socioeconomic, and health indicators among Inuit preschoolers: Nunavut Inuit Child Health Survey, 2007-2008. Rural and Remote Health. 2010;10(1365). And StatsCan. An analysis of housing needs in Nunavut: Nunavut Housing Survey 2009-2010. Iqaluit, NU: Statistics Canada; 2010. Influences from sources such as the media, television, education system,²²⁾Condon R., Inuit Youth: Growth and Change in the Canadian Arctic. London, UK: Rutgers University Press; 1987; Condon R., The rise of adolescence: Social change and life stage dilemmas in the central Canadian Arctic. Human Organization. 1990;49:266-79; Condon R., The Rise of the Leisure Class: Adolescence and Recreational Acculturation in the Canadian Arctic. Ethos. 1995;23(1):47-68. as well as residential schooling,²³⁾Kirmayer LJ, Brass GM, Tait CL. The mental health of aboriginal peoples: Transformations of identity and community. Canadian Journal of Psychiatry. 2000;45:607-16; Pauktuutit. Sivumuapallianiq: National Inuit Residential Schools Healing strategy; the Journey Forward. Ottawa, ON: Pauktuutit Inuit Women’s Association of Canada; 2007. settlement into larger communities,²⁴⁾Archibald L., Teenage Pregnancy in Inuit Communities: Issues and Perspectives. A report prepared for the Pauktuutit Inuit Women’s Association. Ottawa, ON: Pauktuutit Inuit Women’s Association, 2004. and related traumas²⁵⁾Curtis T, Kvernmo S, Bjerregaard P. Changing living conditions, life style and health. International Journal of Circumpolar Health. 2005;64(5):442-51.; Waldram JB, Herring A, Young TK. Aboriginal health in Canada: Historical, cultural, and epidemiological perspectives. Toronto, ON: University of Toronto Press; 2007.; Wolsko C, Lardon C, Mohatt GV, E. O. Stress, coping and well-being among the Yup’ik of the Yukon-Kuskokwim Delta: the role of enculturation and acculturation. . International Journal of Circumpolar Health. 2007;66(1):51-62. have contributed to a shift in the traditional way of life in communities.

Pervasive social problems in Nunavut such as poverty, lack of adequate housing and overcrowding, food insecurity, and traumas have a substantial impact on the quality of life for many Nunavummiut.²⁶⁾NDH&SS. Nunavut Department of Health and Social Services Social Determinants of Health in Nunavut – Workshop report March 8-10. Iqaluit, NU: Government of Nunavut; 2005; Healey G, Meadows L. Tradition and Culture: An Important Determinant of Inuit Women’s Health. Journal of Aboriginal Health. 2008;4(1):25-33. Public health services and health promotion initiatives are largely the domain of the territorial Department of Health. These programs consist of maternal-child health supports (e.g. well-baby clinics, immunization clinics, breastfeeding support, prenatal nutrition programs), chronic disease management, environmental health, anti-tobacco use initiatives, sexual health, infectious disease control, oral health, and nutrition and food security initiatives.²⁷⁾Health Do. Dept. of Health, Government of Nunavut Home Page Online: Government of Nunavut; 2014, Available from: https://www.gov.nu.ca/health.

Nunavut has one hospital in Iqaluit and two larger health centers in the regional centers Rankin Inlet and Cambridge Bay staffed by physicians. Health centers staffed by community health nurses service the rest of the communities and physicians make visits throughout the year. Specialized services are accessed at tertiary care facilities in Yellowknife, NT, Edmonton, AB, Winnipeg, MB, or Ottawa, ON, if more advanced or complex care is required.

The association between indigenous self-government, community control of health services and health equity is complex and influenced by a multitude of political, social and economic factors. Funds for health care in Nunavut originate from the federal government.²⁸⁾NTI NTI. Annual Report on the state of Inuit Culture and Society: Nunavut’s Health System. Iqaluit, NU: Nunavut Tunngavik Inc.; 2008. Even though the primary care part of the system is core-funded, its funds are insufficient to pay for a system that is so widely spread out and so heavily dependent on hospitals and medical professionals based in Southern Canada.²⁹⁾NTI NTI. Annual Report on the state of Inuit Culture and Society: Nunavut’s Health System. Iqaluit, NU: Nunavut Tunngavik Inc.; 2008. This unwieldy, fragmented, and logistically stretched primary care system is not sustainable. Nunavut Tunngavik Inc. (2008) has asserted that the health care system must evolve into a truly Nunavut-centered system. This can begin with a primary health care approach, which is based on Indigenous and Inuit philosophical concepts related to wellness. Such an approach would allow the healing and wellness strengths of Inuit culture and society to flourish as integral parts of the health system.

Indigenous Health Care Models

Significant advances have been made to engage Indigenous communities in health care and research. However, there remains a need for health care models that are born from Indigenous perspectives on wellness, from the design to the implementation and delivery.³⁰⁾Healey G, Tagak Sr. A., Piliriqatigiinniq ‘working in a collaborative way for the common good’: A perspective on the space where health research methodology and Inuit epistemology come together. International Journal of Critical Indigenous Studies. 2014;7(1):1-14; Prior D., Decolonizing Research: A shift toward reconciliation. Nursing Inquiry. 2006;14(2):162-8. Current biomedical models operate under the assumption that the presentation of a symptom or illness is secondary to disease.³¹⁾Wade D, Halligan P., Do biomedical models of illness make for good healthcare systems? British Medical Journal. 2004;329:(7479):1398–401. The assumption that a specific disease underlies all illnesses has led to the medicalization³²⁾‘Medicalization’ refers to a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illness and disorders (35). of conditions, which are simply part of the human experience, such as menopause or aging.³³⁾Conrad P. The Medicalization of Society: On the transformation of human conditions into treatable disorders. Baltimore (MD): John’s Hopkins University Press; 2007. It has also diminished the credibility of ill patients who do not appear to have any demonstrable or detectable disease.³⁴⁾Wade D, Halligan P., Do biomedical models of illness make for good healthcare systems? British Medical Journal. 2004;329:(7479):1398–401. Indigenous wellness perspectives are formulated on understandings of the world, which are based on interactions between people, as well as interactions with the land, animal, and spirit worlds.³⁵⁾Chilisa B., Postcolonial Indigenous Research Paradigms. In: Chilisa B, editor. Indigenous Research Methodologies. Thousand Oaks, CA: Sage Publications; 2012. p. 98-127. Illness may originate from disharmony rather than simply being a disease of the body, and wellness can be achieved by restoring emotional and spiritual balance, in addition to the treatment of a physical ailment.³⁶⁾Lavalee L., Physical activity and healing through the medicine wheel. Pimatisiwin. 2007;4:127-53. This differs from the common western practice of focusing on the individual in isolation, outside of the individual’s place in society or in connection to the land, animal, and spirit worlds. In a study of Inuit women’s perceptions of pollution, Egan found that women identified pollution of the land as linked to mental health and wellness in the community. From the perspective of the study participants, changing relationships with the land carried over into changing relationships in the community and substance use, ultimately affecting the health of the community overall.³⁷⁾Egan C., Points of view: Inuit women’s perceptions of pollution. International Journal of Circumpolar Health. 1998;57:550-4.

The concept of relationships³⁸⁾Thayer-Bacon B. Relational Epistemologies. New York, NY: Peter Lang; 2003. is essential to the Indigenous worldview, which is rarely discussed in the biomedical healthcare system. Supporting the relationships between patients and their health care providers is as important in achieving wellness as supporting and understanding the relationship between patients and their broader societal context. In Southcentral Alaska, for example, the “Nuka System of Care” is the name given to the health care system which was created, and is managed and owned by Alaska Native people to achieve physical, mental, emotional and spiritual wellness.³⁹⁾Alaska SFo. Southcentral Foundation: Nuka System of Care Alaska: Southcentral Foundation; 2015, Available from: https://www.southcentralfoundation.com/nuka/. Nuka is an Alaska Native word used for strong, giant structures, and living things. The relationship-based Nuka System of Care is comprised of organizational strategies and processes; medical, behavioral, dental, and traditional practices; and supportive infrastructure which work together to support wellness. By putting relationships at the forefront of what they do and how they do it, the Nuka System was designed to continue to develop and improve for future generations.⁴⁰⁾Alaska SFo. Southcentral Foundation: Nuka System of Care Alaska: Southcentral Foundation; 2015, Available from: https://www.southcentralfoundation.com/nuka/. The Nuka System is a recipient of the Malcolm Baldridge Quality Award, given to US companies that have successfully implemented quality-management systems. The Nuka System of Care demonstrated a decrease in emergency room visits after their system transformation – 36% from 2000 to 2015. In addition, primary care visits continue to decrease – a 25% decrease from 2008 to 2015. By contributing to the overall health of the population, the Southcentral Foundation’s Nuka System of Care has slowed health care spending. Between 2004 and 2009, annual per capita spending on hospital services grew by only 7% while primary care spending remained below the national index. The organization also reports a 95% employee satisfaction rate and a 93% customer-owner satisfaction rate.

Inuktitut Concepts to Inform a Health Care Model in Nunavut

In Inuktitut, several concepts convey the rich wellness perspective of Inuit. These include, but are not limited to, the Inuit concepts of Inuuqatigiittiarniq (being respectful of all people), Unikkaaqatigiinniq (storytelling), Pittiarniq (being kind and good), Inuusiqatigiinniq (the way of being a person) and Piliriqatigiinniq (working together for the common good).

Inuuqatigiittiarniq: Positive and Respectful Relationships

Inuuqatigiittiarniq is the Inuit concept of respecting and caring for others, as well as building positive relationships. When each person considers their relationships with others and behaves in ways that build this relationship, they build strength. This strength is built in themselves, in others, and together as a community. This concept is foundational to Inuit ways of being. In the health context, one part of building and fostering respectful relationships is clearly articulating one’s intentions and motivations. Health care professionals therefore need to be reflexive and be prepared to answer the questions that community members will inevitably ask them: Who are you? Where are you from? Who is your family? What are you doing here? What will happen to the knowledge that I share with you? How can we learn from each other? A commitment to an approach that values the relationships between the health care professionals as system actors and patients as system users could help improve the overall efficacy of the system, because it is based on the values of the people it is designed to serve.

Unikkaaqatigiinniq: Storytelling

Unikkaaqatigiinniq is the Inuit concept related to storytelling, the power of stories, and the role of stories in Inuit ways of being. In an Indigenous context, stories are methodologically congruent with traditional knowledge or knowledge belonging to people from whom the stories originate.⁴¹⁾Wilson S., Research is Ceremony: Indigenous Research Methods. Blackpoint, Nova Scotia: Fernwood Publishing; 2008. Inuit have a rich oral history and culture, which has existed for thousands of years. The telling of stories is an ancient tradition for sharing knowledge, communicating values, morals, skills, histories, legends, and artistry, which still exists today. It is a critical aspect of the Inuit way of life and ways of knowing and allows respondents to share personal experiences without breaking cultural rules related to confidentiality, gossip, or humility. In a study of health determinants for Inuit women in Nunavut, participants drew upon examples and stories from the community to illustrate points about important health issues, such as trauma, family support, and the bonds that bring people together. This further highlighted aspects of the health context involving the community, society, education, and cultural identity.⁴²⁾Healey G, Meadows L., Tradition and Culture: An Important Determinant of Inuit Women’s Health. Journal of Aboriginal Health. 2008;4(1):25-33. Although some knowledge or practices may be disappearing, the use of stories to effectively communicate information remains part of life. It is for this reason that the recognition of the power of stories is particularly important in the context of Inuit health.

Pittiarniq: Being Good

Pittiarniq is the Inuit concept of “being good”, which can mean being ‘good’ in a philosophical and moral sense but also in terms of action such as good behavior (i.e. in the case of the behavior of children). In Inuktitut, two terms have been discussed in the context of ethical conduct in a health or research setting. The first, shared by McGrath, is Pittiaq-, which is related to “being good, kind, or well; doing good or rightly”.⁴³⁾McGrath, Janet Tamalik. 2004. Translating ethics across the cultural divide in Arctic research: Pittiarniq. McGrath argued that the term Pittiaq– refers to both technical and moral excellence. The essence of medical ethics can be reduced to foundational questions: Are our actions good for a patient or good for ourselves? Are we doing good? What does it mean to do good? Without knowledge or experience of Inuit societal values, medical professionals from outside of the culture and epistemology interpret doing/being good (ethics) based on their own worldviews and assumptions about what “good” is.⁴⁴⁾McGrath, Janet Tamalik. 2004. Translating ethics across the cultural divide in Arctic research: Pittiarniq. Although well-intended, those decisions can have a range of negative impacts on their particular interactions with patients or even on Inuit society in general.⁴⁵⁾McGrath, Janet Tamalik. 2004. Translating ethics across the cultural divide in Arctic research: Pittiarniq. One example is in the case of sharing bad news, where some clinicians feel the patient should hear the news alone to protect their privacy, whereas the idea of family, connections, and relationships is central in Inuit communities and isolation from family at such a time would be ethically incongruent with community values.

The second term is Inuuqatigiittiarniq, which is related to the concept of being respectful of others. Both terms refer to behavior—that one’s actions are reflective of one’s intention to do good. In doing so, one will be respectful of other people and the relationships between and among the facets of health care and practice. Above all, everyone must be treated with respect, appreciation, and dignity.⁴⁶⁾Chilisa B. Postcolonial Indigenous Research Paradigms. In: Chilisa B, editor. Indigenous Research Methodologies. Thousand Oaks, CA: Sage Publications; 2012. p. 98-127. A commitment to a healthcare approach that is mindful of and focuses on Inuit context, knowledge, questions, ethics, and perspectives is an integral part of cultivating a health system rooted in reciprocity and respect.

Inuusiqatigiinniq: The Way of Being a Person

Inuusiqatiginniq is the Inuktitut concept of “the way of being a person.” It can have different meanings in different contexts and, in general, is the term used to convey a holistic view of wellness. Holistic caring and healing models aim to treat the whole person, not just the illness in isolation, and take into account the environmental context, behaviors, and relationships, as well as multiple other factors, with the intent of offering a wide range of solutions to improve one’s health.⁴⁷⁾Montgomery Dossey B, Keegan L., Holistic Nursing: A Handbook for Practice. Burlington, MA: Jones and Bartlett Learning; 2013. Holistic caring and healing practices have been promoted widely by Indigenous groups, but have not featured prominently in practice.⁴⁸⁾Montgomery Dossey B, Keegan L., Holistic Nursing: A Handbook for Practice. Burlington, MA: Jones and Bartlett Learning; 2013. In 2014, the World Health Organization (WHO) launched a strategy for improving the integration of traditional and Indigenous medical perspectives and medicines into health care approaches. Approaches including health services and systems, traditional and complementary medicine products, practices, and practitioners.⁴⁹⁾WHO. WHO traditional medicine strategy: 2014-2023. Geneva: World Health Organization; 2014.

These concepts underscore the right of all Indigenous peoples to construct a health system in accordance with self-determined definitions of what contributes to wellness and how to reach that goal over the life spectrum.

Piliriqatigiinniq: Together for the Common Good

Piliriqatigiinniq is the concept for working in a collaborative way for the common good. Multi-disciplinary collaboration strengthens health promoting programs, fosters greater sharing of knowledge among decision-makers, and promotes implementation of promising practices and policies. The Qaujigiartiit Health Research Center⁵⁰⁾‘Qaujigiartiit’ is the Inuktitut word for ‘looking for knowledge’. developed a model for health research, which is based on a multi-sectoral approach to developing and implementing projects. This model was developed in response to the community-identified need for health data and health interventions, which address topics of concern to Nunavummiut. Through this model, information is collected, analyzed, and disseminated in a holistic and collaborative way. The Piliriqatigiinniq model is a representation of the web of relationships individuals have with each other and is built upon the principle that anyone can be involved in health research in some capacity, if all are working for the common good. The model serves as a reminder to look beyond the scope of what is commonly defined as health and research to include knowledge holders and stakeholders from other disciplines and walks of life.

Conclusion

Health care systems can and should mirror the values of the people they serve. In Nunavut, such systems should promote health care models that are grounded in Inuit ways of knowing and understanding wellness. Such models are a critical part of the on-going self-determination processes for Indigenous communities. Truly understanding and taking action on the health challenges experienced in northern communities requires us to be critical of the models that are conventionally used, to challenge the dominant narratives on the origins of health inequities in our communities, and design systems that reflect our worldview.

Dr. Gwen Healey was born and raised in Iqaluit, Nunavut and is currently the Executive and Scientific Director of the Qaujigiartiit Health Research Centre in Iqaluit. Drawing upon existing community strengths and resources, and strengthening capacity to conduct research in the North, is the key to addressing a number of health concerns presently and over the coming years. For this reason, Gwen founded the Qaujigiartiit Health Research Centre with the late Andrew Tagak Sr. in 2006. You can reach Gwen via her e-mail.