Sunday, June 28, 2009

Wednesday, June 24, 2009

Paternalism and prevention

This appalling story comes via the Globe and Mail: medical supplies were withheld from Manitoba reserves while health officials debated the risks of sending alcohol-based hand sanitizer into the fly-in communities.

It's easy to make fun of the public work-up about H1N1, but in some places it really has reached the level of a pandemic; Northern provincial and Southern territorial reserves host the largest outbreaks in the country and some of the fastest transmission rates. The flu is travelling in Nunavut, and here as elsewhere it has been happening predominantly in the fly-in communities (although that description catches Iqaluit too - and there have been a few cases here).

No matter how you spin it, this delay should never have happened.

Alcoholism and other addictions tend to be major problems on reserves, but this is true of lots of other identifiable, easy-to-target communities in Canada. I don't think Health Canada would have hesitated to send these supplies into non-reserve Northern Ontario towns, or Vancouver's East side.

There are major problems with alcohol and drug abuse in urban centers too, but none of the provisions that I have found in the Canadian Pandemic Influenza Plan make any reference to limiting access to sanitizer to people with past or current problems with alcohol. If this is a legitimate concern - theoretically - then shouldn't Health Canada be as worried about non-reserve alcoholics as they are about alcoholics living on reserve? As a potential future white, urban alcoholic, I resent that!

Furthermore, this would not be the first time people living on these reserves were ever exposed to hand sanitizer. It's available in drug stores, and lots of people there probably use it. Anyone who was ever going to abuse it has already had ample opportunity, although I continue to think that most people - even First Nations people! - have the good sense to understand that drinking hand sanitizer is dangerous.

There is an Annex to the Canadian Pandemic Influenza Plan that deals specifically with First Nations reserves. It's here. I've skimmed it, and while it recommends in a couple of provisions that hand sanitizer be used, it does not contemplate complications arising from potential abuse. If concerns over abuse were based on good evidence from Health Canada, this issue would have been worked into the Plan. It's not.

Which signals, to me, that this is no more than paternalistic hand-wringing of the kind that so often plagues public health debates. These debates almost always have a racial/class-based dimension, which is only more explicit here. The same issues, manifested differently, arise in arguments about everything from condom distribution to public funding of methodone clinics.

But let's be cold-hearted about this. Let's permit the assumption that white and urban people understand the subtleties of hand sanitizer in a way that Canadian Aboriginal people don't. Let's take the human factor out and look at the numbers. Sure.

In the time these supplies weren't being sent out to communities, "dozens" (says the article) of Aboriginals got sick enough that they needed to be flown into more urban centres for hospitalization. At one point, the article notes, "two thirds of all flu victims on respirators in the province were aboriginal." So for all those people, the province of Manitoba flew them in for hospital treatment and has supported elaborate medical care for them, when prevention measures would have cost no more than a few dollars per person. Even if, theoretically, a small number of people got sick as a result of ingesting the sanitizer, I doubt this would approximate the financial or human cost of all these flu victims in either frequency or severity.

And this is why the paternalistic approach to public health fails and the harm reduction approach wins. Help people get what they need to protect themselves, and they will.

So. What's the stupid to evil ratio on this? I'll go with 50-50 - half ignorance, half indifference.

At least the G&M had the good sense to disable comments.

Tuesday, June 23, 2009

Thursday, June 4, 2009


Oh, alright. Here are some photos I took the day I arrived.

In sequence:

1. My house. Kitchen and living room on top floor with walk-out; my bedroom window is the bottom-left.
2. The view of town from my porch (I live on the edge of the city, at the top of the ridge above the bay).
3. The bay as seen from my yard.
4. A good approximation of how dark it gets at night. I think this photo was taken at about 1am.

Blogging is fun! Don't skip the serious post below.

Wednesday, June 3, 2009


In Iqaluit, I live in a red house at the top of a hill. On the inside of my window is a modern, well-kept space with nice hardwood and a big kitchen; on the outside is Frobisher Bay, which will thaw over the next few weeks. On the other side of that are rolling hills still covered in ice and a smoky horizon that never blows clear.

In Iqaluit, I have my first legal job. I wear jeans and converse sneakers in the office and spend my days reading about aboriginal law and environmental regulation in the Canadian arctic. I feel very much like myself, only less inclined to complain about law school.

Except that I'm already leading you astray. Inuit are not aboriginals, for one thing, and aboriginal law does not apply to them. Their history is entirely different; no 18th-century collaborations with European settlers, no treaties made under duress in the 1800's, no reserves. While Inuit were classified as Indians for the purposes of the Indian Act and Aboriginal for the purposes of the Charter's s. 25 Aboriginal rights (and, over the years, pretty much whatever else they had to be classified as for federal development, military, and mining to go ahead unimpeded), in 1993 the Inuit of the area now called Nunavut voted to permanently exchange the majority of their legal entitlements (including all coverage under the Indian Act) for the provisions set out in the Nunavut Land Claims Agreement, a treaty negotiated over a decade by the Tunngavik Federation of Nunavut (on behalf of Inuit) and the federal government of Canada, which has found the NLCA rather hexing ever since.

That, it seems, is where I come in. The government committed itself to some pretty remarkable things (which, to be fair, were bought at a high price in a gesture of trust on behalf of Inuit that I can't quite wrap my head around). Some of those things have worked out better than others. Most major areas of governance in Nunavut are now subject to shared jurisdiction, with sovereignty by and large resting with a large network of joint Inuit/federal-government tribunals. If you like acronyms, this is the place for you. A little forbidding to the uninitiated. I'm starting to get my bearings.

In addition to this completely novel model of governance (which I will discuss at length with interested poli sci nerds), the government of Canada agreed to a few other things. One of them is to bring the representative levels of Inuit in government jobs in line with representative levels in the territory - 85% of the general population - across all types and levels of employment (Article 23 of the NLCA). Given that 41% of Inuit have not completed the eighth grade, one wonders what the crap our Dear Leaders could possibly have been thinking.

But here's the great part: they really have bitten off more than they can chew. What can you do, when you're committed by law to constitute 85% of your workforce from a broadly dispersed workforce that hasn't broadly adopted traditional education? You can do three things:
(1) Re-examine every position you have, question whether the educational and experiental 'qualifications' you've listed are really necessary, and strip all requirements down to their most basic parts;
(2) Create an entire system of targeted training, recruitment, on-the-job education, and innovative, flexible post-secondary schooling; and
(3) Look at other barriers that prevent your key demographic from taking the jobs you want them to take, and introduce specific flexibility measures that will allow them to live out their values while still getting the job done (eg. flex hours to accomodate family and elder care, and employee assistance program that is culturally appropriate enough to actually be helpful).

The federal government is trying to do all three. As a result, from what appears to be nothing more than a commitment to affirmative-action, Nunavut is getting a major boost in infrastructure, community support, and innovative education. Solid!

Of course, how well this all gets implemented depends on lots of things - in a very minor way, I'm one of them. Still, pretty cool.


Nunavut is really big. Like, really big. Like 2, 093, 000 km2 - roughly the size of Western and Southwestern Europe taken together (if you use the UN's definition). It's population is 31, 550. That works out to 0.015/km2 in terms of population density - or one person for every 67 km2. That means if the population of Nunavut was evenly distributed across the territory, each person would have a plot of land 20% larger than Manhattan.

The city of Iqaluit is on a small hill - like in Montreal, you're always walking uphill or downhill. People are beyond friendly - I've had 3 invitations to dinner from complete strangers, each of whom has insisted that that's normal here. I'm saving them for the weekends which I think might get a bit lonely otherwise. I'm alone in the house for another week and a bit until the owners return - a young couple with a three-year-old daughter who seem really great.

The roads are paved but the sides are sand and scree. Already a lot has melted since the day I arrived - even the hills across the bay are showing bare land. There is long grass everywhere but there are no trees. CanLit scholars, think A.J.M. Smith's nature scenes and Al Purdy's frontier towns. For a sense of what's been on my mind, think P.K. Page's "Stories of Snow."

There's more - there's always more - but I'll save it for later.

Let me know how you are.