This is page numbers 183 - 236 of the Hansard for the 15th Assembly, 3rd Session. The original version can be accessed on the Legislative Assembly's website or by contacting the Legislative Assembly Library. The word of the day was health.

Topics

Revert To Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters
Revert To Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

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The Chair

The Chair Jane Groenewegen

Thank you, Mr. Miltenberger. Under general comments. Mr. Allen.

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Roger Allen

Roger Allen Inuvik Twin Lakes

Thank you, Madam Chair. I wasn't particularly going to make any comments, although I think

I'm compelled to now in a similar context as Ms. Lee. Certainly it's specific to the issue of the federal government's failure to meet its responsibility, as the Minister has stated. I just want to cross-reference a number of articles and correspondence I've had with the Finance Minister, as well, trying to interlay it with your replies on March 18th, pages 137 through to 143 inclusive. I was beginning, Madam Chair, through just reading an area that I expressed concern on behalf of my constituents and that was to look at capping or suggest to cap the Department of Health and Social Services as a way to mitigate the increased costs in respect of the vastly growing costs. Again, to me it is important that when we have accruals, the non-insured health benefits and the other component you expressed here, I still think if the federal government is capping the department, then obviously they should really consider capping as well an index to that cap to those annual increases. Thus, I think you would prevent yourself from going into some insolvency on a number of the program components. Certainly, the area that intrigued me was the fact that the Member for Range Lake asked you a question in regard to launching some legal action, and although you inferred, Mr. Minister, that there was a court case initiated in the past, the federal government went back to its old ways of just dealing with you on a number of legal fronts. Again, I think this goes back to the very essence of my initial questions about the constitutionality of our North and how we deal with various federal departments, and being somewhat at their beck and call when it comes to delivering the expensive part of our programs, and obviously health is one of them.

Madam Chair, I think it is important, as well, in the overall context that we must look at further articles that the Minister says, and I am going to quote from March 22nd, he states, "Delivering a program on their behalf is putting us in the poorhouse, it is not a good deal for anybody to be carrying the fiscal can for the federal government." We certainly want to support the Minister in trying to convey that very important message to our federal colleagues, because we are at a point in our fiscal situation that requires us to take a more stringent approach to see if we can somehow alleviate some of those increased medical costs. Again, I want to look at whether the northern leaders meeting will resolve this issue. We don't believe so. My constituents believe that the experience we had with the social committee gathering in Hay River is that we are probably going to end up with the same net result, whereas we have no political strategy to approach the federal government in trying to resolve that critical issue of health care costs. Certainly, I don't know if it is in their vested interest to pursue that, other than saying that we need to work with Ottawa in the dispute over what is owed to the Government of the Northwest Territories. I want to assure the Minister that I want him to look at methodologies, so we can support your objective in trying to resolve this. Certainly we feel that the ultimate resolution to this is to return it back to the federal government under either the Department of Indian and Northern Affairs or else Health Canada. I think that is the only way to resolve this issue and show that we do need to protect our sovereignty and that we would have the capability of working with the federal/territorial relations on the matter before us, and the various other matters before us.

I want to perhaps pay a bit of attention to what we suggested to the Finance Minister and the fact that I think we need to really work towards finding a result to not only this situation, but to all the situations that are confronted to the Assembly, especially the 15th Assembly, and deal with it in the context of our fiscal outlook. It is regrettable that health is always being tackled on a number of frontal issues, but again I think the indicator is the fact that we have to ensure that the federal government acknowledges that we have to work in the context of viability and sustainability.

So with that, Madam Chair, I just wanted to convey to the Minister that there is a vast knowledge out in the public that we need to deal with the major concerns that you have expressed in this House, and some of the responses you have made to the ongoing questions. We certainly look forward to working with you in terms of trying to see if we can resolve some of these outstanding issues with the federal government, in particular with how we deal with trying to develop some legal instruments in doing that. Madam Chair, that concludes my remarks to the department. Thank you.

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Revert To Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

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The Chair

The Chair Jane Groenewegen

Thank you, Mr. Allen. Next on the list for general comments I have Mr. Menicoche.

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Kevin A. Menicoche

Kevin A. Menicoche Nahendeh

Thank you very much, Madam Chair. With reference to the opening remarks from the Minister of Health and Social Services, I am really pleased that for the next coming budget year we are able to hang on to what we have. I have always stated that some of the things that affect my riding and the people live in the small communities, it is not so much the quantity of health care that we have, it is the quality of health care that really affects them with that region. With that, I will just make reference to my request the other day for the department to look at some type of cross-cultural training for the new workers coming into the smaller communities, as well as the need to maintain the improvements that have been going on with regard to regular community visits for smaller communities. The people who live in those smaller communities like the visits, but once they become regular then they have some assurance and some confidence in our system. That goes a long way with confidence in the department as well. Some of these regular visits will help with the need, particularly in the community of Wrigley. We believe that there is a demand for a nurse, however, with the increased regular visits I believe that some of their issues and their needs will be cared for. I believe that we can do with what we have here, and it is just a matter of improving the quality of delivering our health care for the next coming year. The Minister assured me previously and I would just like to get his comments on my remarks here today. Thank you very much.

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The Chair

The Chair Jane Groenewegen

Thank you, Mr. Menicoche. Mr. Miltenberger.

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Michael Miltenberger

Michael Miltenberger Thebacha

Thank you, Madam Chair. If I may, I would just like to quickly respond as well to some of the questions and suggestions made by the honourable Member for Inuvik Twin Lakes, as well as Mr. Menicoche. In the issue of capping costs in the Northwest Territories to contain our costs, my suggestion and my opinion is that the best way to control our costs in Health and Social Services is at the front end, and as the Social Programs committee has identified as well, and that is on the personal choice side and getting people to make the right personal choices when it comes to drinking and

smoking, what they eat, and exercising enough so that they maintain their health. That is a savings beyond price, there is a dollar savings, but good health is something that is critical to us all. So capping costs at the other end would just disadvantage, in my opinion, the people we are here to serve and whose wellbeing we are trying to better. This is an issue that is on the table with the broad range of other issues that we are talking about with the federal government when it comes to resources, funding, and structural inequities that have to be fixed so that we have appropriate resources as we sit on one of the hottest economies in the Northwest Territories constantly stand cap in hand before Ottawa shuffling our feet and tugging our forelock, asking for a few more sheckles to help the people. It is not a position I think any of us like to be in. So we have to be vigilant, we have to maintain the pressure.

With regard to the issues raised by the Member for Nahendeh, yes, we have made note of the good issue you raised in this House, and touched on again today about the issue of talking to the authorities about effective cross-cultural training. It is something that I have committed to that we will do. As well as when we do finally get our calendars in sync and we make the tour to Nahendeh, I look forward to sitting down with the Member and the leadership there, and the board, to talk about services in the communities like Wrigley where there was a nurse position at one time, but there is no longer, and what options there are within the resources we have to look at improvements. So I look forward to working with the Member there as well.

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The Chair

The Chair Jane Groenewegen

Thank you, Mr. Miltenberger. Mr. Menicoche. I have Mr. Allen.

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Roger Allen

Roger Allen Inuvik Twin Lakes

Thank you, Madam Chair. To the Minister, I don't think anybody likes to be put into an insolvency position, but I think unfortunately you have been forced into one and that is my point. It is my deepest regret that if you look especially at the health reform policy that is introduced globally, we take a somewhat different approach. I think this is an opportune time to review where we are. As my reply to the opening address stated very emphatically, we need to look at some comprehensive reviews to look at some of the inefficiencies and remove some of those inefficiencies. I can refer back to many of your reports in the last four years that really indicate that there is a need to look at some policy reform, as well as an expenditure reform. I think that will be something that we need to really emphasize at this level.

I think politically speaking, from a constituency perspective, we have to deal with that issue otherwise we are going to continue, but not in terms as your statement says here at a 5.6 percent increase over last year's estimate. We must look from 1999-2000 and we are now in excess of $50 million in real dollars. So that is a contentious issue amongst your patients--if I may just use the word patients--across the North, and I think we need to look at where we can assist you by suggesting that we have to look at certain reform, and that is what we are trying to advocate here. I just wanted to express to you, Mr. Minister, that I understand perfectly well the deficit situation of this government, but if we are looking at an overhaul of our fiscal strategy, we need to have a look at the impacts that the health care costs have upon our residents. Certainly, as we go through your main estimates, I want to emphasize that as my critical point. With that, Madam Chair, I thank you.

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The Chair

The Chair Jane Groenewegen

Thank you, Mr. Allen. Mr. Miltenberger.

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Michael Miltenberger

Michael Miltenberger Thebacha

Thank you, Madam Chair. Madam Chair, I would like to thank the Member for his comments, and indicate that I know that we both share the same goal. As we go through these estimates, and in the coming business plans during the life of this Assembly we will be working collectively to look at the very issues that the Member touched on in terms of efficiencies. As Minister in the department, we have been charged with certain targets within the fiscal framework that have been set by the government and we will be working to meet those. We intend to work very closely with all of the Members to do that. I appreciate the Member's comments and indicate that yes, we will be looking for those efficiencies which he refers to. Thank you.

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The Chair

The Chair Jane Groenewegen

Thank you, Mr. Miltenberger. I have next on the list for general comments, Mr. Yakeleya.

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Norman Yakeleya

Norman Yakeleya Sahtu

Thank you, Madam Chair. General comments for the Minister and his officials. The Minister and myself along with his officials did a tour of the Sahtu region in the early part of my election to the Legislative Assembly, and there were lots of concerns that the Sahtu communities have expressed to the Minister. The high priority of health services in the Sahtu region is something that is in dire straits, I guess I could say, in terms of how we look at our health system here in the Sahtu region. The majority of the people in the Sahtu region are aboriginal people and we want to look at how best to integrate the aboriginal methods of health in combination with the existing system right now. I am glad to see that the Minister has an integrated model of services that he is going to use as a blueprint for health and social services in the Northwest Territories. I want to ask the Minister a question in regard to that integrated service model. Can you just elaborate on this in terms of how it is going to benefit the people in the Sahtu region?

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Revert To Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

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The Chair

The Chair Jane Groenewegen

Thank you, Mr. Yakeleya. Mr. Miltenberger.

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Revert To Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

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Michael Miltenberger

Michael Miltenberger Thebacha

Thank you, Madam Chair. Madam Chair, this is a model. It is very basic in terms of how you do business. We are trying to set up the program areas along the lines that I have heard Members talk about in this House since I have been here, where the systems are structured so there is cooperation and collaboration at the community level among the various health and social services practitioners that we set up and agreed to standards of what services should be available in the various communities of different sizes so that we have a baseline to work from. How do we get the nurse to work with the alcohol and drug worker, to work with the social worker, to work with the homecare people? The model is built on trying to set up those, and the doctors, to do that. How do we structure our services at a regional level where we have specialists in different areas? How do we structure those teams so that they can provide services across the territory to the many communities? How do we bring to bear some services in a coordinated way that are very, very fundamental to the circle of life? How can we do things like birthing services? The integrated service delivery model attempts to do that. We

are very nearly at the final stages where we can bring that document forward. We have been working on it now for the last two years as a system with the authorities. So we have already been doing a lot of the work anyway. The services are already there. It is trying to coordinate and structure them in a more effective and efficient way. We also want to make sure that they are linked in as we get more capable as a department and a system into education as well, and how do we work more effectively with the schools, and the adult educators, as well as the housing people, basically the social envelope areas. So this is very fundamental and is hopefully going to improve services for all of the communities. Thank you.

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The Chair

The Chair Jane Groenewegen

Thank you, Mr. Miltenberger. Mr. Yakeleya.

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Norman Yakeleya

Norman Yakeleya Sahtu

Thank you, Madam Chair. Thank you to the Minister also. I have said in the Sahtu region, health is on the minds of the majority of people and how we deliver health services in our region. A lot of the people in the communities talk about the need to start strengthening and supporting the aboriginal methods of dealing with issues such as sicknesses, diseases, and other things, not only physically, but mentally, spiritually and emotionally. We haven't yet given enough prudence to the knowledge and tradition of our elders with regard to promoting an aboriginal method of dealing with health. We certainly need to look at that in terms of how we deliver health care, at the same time strengthening the existing health system right now and having them work together.

Madam Chairperson, the one issue that we have a high degree of concern with in the Sahtu is with the amount of cancer that is being diagnosed in the Sahtu region, and the potential for some high cases of diabetes in the region. I read in a magazine the other day that some people may have some symptoms of diabetes, but they're not too sure and they are being checked. I appreciate the Minister's quick response and the government's response on the Meningitis issue in our region. People were very happy to hear that this government took quick action in terms of any further fatalities in our region.

What I would like him to look at is integrating the aboriginal way of dealing with health and sickness in our communities. There are some really good people who are still in the Sahtu region who have those skills and have that knowledge to deal with sickness; not only physically, but mentally, spiritually emotionally also. I would like to suggest that this department push for the aboriginal concept of dealing with health in our communities, and not only rely on the physicians or nurses who are trained and disciplined to deal with health. Take into consideration the aboriginal way of looking at health issues. That method is important, Madam Chair. I would like to ask the Minister if he would let his officials communicate that somehow down to our health care workers in the Sahtu region.

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The Chair

The Chair Jane Groenewegen

Thank you, Mr. Yakeleya. Mr. Miltenberger.

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Michael Miltenberger

Michael Miltenberger Thebacha

Thank you, Madam Chair. Madam Chair, the Member and I have had a number of discussions with regard to the issue of traditional health practices in healing. A couple years ago I had the good fortune to go to Whitehorse for the first time, and while I was there I managed to take a look at the hospital in Whitehorse. They had, at that time, a separate wing that was set up for traditional medicine and healing. I would be interested, once I get a chance to sit down with committee, to talk about the interests that before we go much further along, to go over and take a look. It's one place I know that's very close. It's our northern neighbour and they have already made some investments in this area. They have recognized the value of looking at all parts of healing that are out there and medicine. We want to move on this. I would like to do it in conjunction, at this point, with the Social Programs committee. So when we have a chance to meet, I would be interested in talking about the possibility of going over and taking a look firsthand at what is being done in our neighbouring territory to see if there is some value there, which I think there is. I found it very interesting when I was there. Thank you.

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The Chair

The Chair Jane Groenewegen

Thank you, Mr. Miltenberger. Mr. Yakeleya.

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Norman Yakeleya

Norman Yakeleya Sahtu

Thank you, Madam Chair. The big push for our health in the region is to have some influence through one example is the Northern Stores and the products they sell. A lot of our children are, I guess through promotion and education, buying healthy foods, but the cost of healthy food is fairly high. So a lot of pop, chips and candy are being sold to our kids out there, and pretty soon we wonder why our kids are so overweight and some of them may be prone to early diabetes, dental problems, and all kinds of other sickness that goes along with not eating healthy foods. I think that's something that this government or this department could look at and encourage having some incentives for communities to direct them to eat healthy foods and live a healthy lifestyle. I hope that through the life of this government we can do that: promote healthy lifestyles in our communities.

The potential of the Mackenzie gas pipeline down the Northwest Territories corridor is scary because of the high degree of potential diseases that could have an impact on the communities. For myself, in terms of this department, the direction is to get down to the brass knuckles and start having some really good, solid health programs in the communities that they can buy into and get involved in terms of promoting healthy lifestyles to our people and our children, and also at the same time, supporting our health care workers and giving them the proper support to look at difference ways of delivering health. We have some good ideas in the Sahtu in terms of how health should be dealt with, but sometimes we run up against the wall of bureaucracy or the system. It doesn't make sense sometimes, and I think that's something we could be looking to. The people in the Sahtu and the department had some unique discussions in terms of how health should be done. Some of the issues in the Sahtu; for example, Colville Lake, on the Minister's tour that we look at Colville Lake as one nursing station that certainly could use some help from this department. There is a lack of nurses available in the Sahtu region, and I think the amount of work the nurses do and the burnout that the community could help. I believe the communities can help our health care workers, just give us the opportunity to be involved in the health care system. That's all I have to say, Madam Chair, for my comments. If the Minister wants to respond, it will be up to him. Thank you.

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The Chair

The Chair Jane Groenewegen

Thank you, Mr. Yakeleya. Mr. Miltenberger.

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Michael Miltenberger

Michael Miltenberger Thebacha

Thank you, Madam Chair. As the Member has pointed out, we are faced with many challenges in the Northwest Territories in our constituencies. While we have many more problems that we do have resources, we do have a significant amount of resources on the table sometimes that are maybe not used as effectively as they could be or could be put to needs that are more pressing than others. That's something we have to look at.

The issue of getting people to make the right personal choices is a very difficult one. As the chair of Social Programs pointed out, the health indicators are still going the wrong way and we are spending a fair bit of money trying to convince people to make those choices but it's not a battle we can win alone. We are all, in our own way, role models. In our communities we have to convince the adults and the young people to make those choices so that the children, most of all, are born healthy.

We also have the capacity with the board structure and authorities set up as we have for regions and leadership in regions to bring, in my opinion, significant pressure to bear on the stores that provide services in our communities. That if there's a decision and pressure to sell healthy foods, then stores are in the business to make money and if there's money to be made because it makes sense as it does with the Atkins diet or whatever, it will happen. As well, we have to accept the challenge. I believe the mayor of Inuvik put the challenge out when we were up in Inuvik that health should match education, where there is no junk food and schools are considered junk food-free zones. I think that's a challenge that we can't help but accept, because it's in keeping with everything that we talk about in terms of the right choices and healthy living and proper diet and those types of things. So there are a lot of practical things we can do, as well, that don't necessarily cost money but require us to step up and engage the people in our communities. Thank you.

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The Chair

The Chair Jane Groenewegen

Thank you, Mr. Miltenberger. Under general comments next I have Mr. Pokiak.

Revert To Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters
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March 22nd, 2004

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Calvin Pokiak

Calvin Pokiak Nunakput

Thank you, Madam Chair. Just a couple of general comments for the Minister, Madam Chair. I'm glad to see that he's going to maintain the existing programs and services we have in place now. I remember bringing up a Members' statement sometime back in December or January when I talked about escorts for elders, and also about translations when they travel outside of the communities. I'm sure hoping that your department can continue these services for people outside of the smaller communities.

I am also wondering, Madam Chair, about the recruitment process for the registered nurses in the communities. I know it's a difficult process, but I sure hope your department can recruit the necessary health care workers we need in our small communities, because we know they do get overtired, as I stated some time ago.

Another comment; I think also with regard to mental health workers for the smaller communities, when they do come into our communities they should have all the training culturally and get to know the people well.

Madam Chair, with regard to the comment made by the Minister about DIAND's two percent ceiling. Again that's just another one to deal with. If DIAND says that's going to be the limit, that's the cap we have to deal with.

Looking in the newspaper which I read a couple of days ago, where the Premier talked about health and social services contributions, that we're trying to get from the federal government. Where do we go from there if we can't get the money from the feds? Are we willing to give that responsibility back to the feds? Again it's something we have to talk about. These are just some general comments I'm making, Madam Chair. Thank you.

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The Chair

The Chair Jane Groenewegen

Thank you, Mr. Pokiak. Mr. Miltenberger, would you like to respond to any of those comments?