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Nunavut Report on Comparable Health Indicators 2011

Report Prepared by: Tchouaffi B. Paul MSc., DSc. Health Information Analyst and Isaac Sobol MD, CCFP, MHSc. Chief Medical Officer of Health With assistance from staff members in Department of Health and Social Services Health Protection Health Information Communications

Message from the Minister of Health and Social Services I am pleased to present to you the 2011Nunavut Report on Comparable Health Indicators the fourth report of its kind produced by Nunavut. The report gives the status of both the health of Nunavummiut as well as the performance of our health care system. The Government of Nunavut is committed to providing high quality health care, and health prevention programs and services that meet the needs of Nunavummiut and a document like this helps to keep us accountable. You will find that in some areas we are healthier than Canadians as a whole and in other areas we are not as healthy. As a Department we continually work to improve our health in some areas and maintain our positive health in other areas. As you read this report, you will be able to compare the health of Nunavummiut with the health of other Canadians, and you may find the results surprising. Nunavummiut deserve to know how both their health and health care services compare to the rest of Canada. With that in mind, it is my pleasure to release the 2011 Nunavut Report on Comparable Health Indicators. I would like to express a heartfelt thank you to Nunavuts health care professionals for their dedication and commitment to keeping Nunavummiut healthy. Nakurmiik,

Honourable Tagak Curley Minister of Health and Social Services

Nunavut Report on Comparable Health Indicators 2011

Managements Responsibility for Nunavut Report on Comparable Indicators 2011 It is the responsibility of the Government of Nunavuts Department of Health and Social Services to ensure the integrity of the 2010 Nunavut Report on Comparable Health Indicators. This responsibility includes maintaining systems and controls to ensure that information is objective, complete and accurate in accordance with the reporting requirements approved by the Conference of Deputy Ministers of Health held in 2000. To the best of our knowledge, this information is reliable and free from error. Each year we improve the health indicator data that we collect. In the preparation of this report, the Department of Health and Social Services has relied on data from external sources and indicated so throughout the report. The Departments responsibility for information provided by external sources is limited to being reasonably confident that it is free of significant misrepresentation. The health indicators in this report comply with the definitions, technical specifications and standards of presentation approved by the Conference of Deputy Ministers of Health. The report states and properly describes any departures from what was approved. It has been seven years since our last Report on Comparable Health Indicators and I am pleased to release the 2011 edition. If you have any questions, suggestions, or ideas that you would like to share with us, please feel free to bring these to your local health centre, or send a note to the Office of the Chief Medical Officer of Health, Department of Health and Social Services. Sincerely,

Alex Campbell Deputy Minister Department of Health and Social Services

Nunavut Report on Comparable Health Indicators 2011

Table of Contents
List of featured indicators Executive summary Introduction Health status Life expectancy at birth Life expectancy at age 65 years Perceived health Perceived mental health Health conditions Adult body mass index Diabetes Low birth weight Injury hospitalization Deaths Infant mortality Total mortality by selected causes Lung cancer mortality Colorectal cancer mortality Acute myocardial infarction mortality Stroke mortality Potential years of life lost (PYLL) Non-medical determinants of health Health behaviours Type of smoker Frequency of drinking Physical activity Sense of community belonging Exposure to second-hand smoke at home, in vehicles and public places Health system performance Patient satisfaction Influenza immunization Pap smear Caesarean section Ambulatory care sensitive conditions Community and health system characteristics Home care Health surveillance Tuberculosis (TB) 5 7 8 9 9 10 10 11 12 12 13 15 15 16 16 17 16 18 19 20 21 22 22 22 24 24 25 26 27 28 30 31 32 33 34 34 34 35 35 36 37 39 40 42 43

Chlamydia Gonorrhea HIV


References Glossary Limitations Exclusions

Nunavut Report on Comparable Health Indicators 2011

List of featured indicators Health status


Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. Figure 8. Figure 9. Figure 10. Figure 11. Figure 12. Figure 13. Figure 14. Figure 15. Life Expectancy at Birth, Three-Year Rolling Averages, Canada and Nunavut, 19962005 Life Expectancy at Age 65 Years, Three-Year Rolling Averages, Canada and Nunavut, 1994 2005 Perceived Health of the Population Aged 12 and Over, Canada and Nunavut, 2007 Perceived Mental Health as Very Good or Excellent of the Population Aged 12 and Over, Canada and Nunavut, 2009 Body Mass Index (BMI) of Population Aged 18 and Over, Canada and Nunavut, 2007 Age-Standardized Prevalence Percentage of Diagnosed Diabetes among Population Aged 1 Year and Older by Province and Territory, Canada, 20032008 Proportion of Live Births with a Birth Weight at Least 500g and Less than 2,500g (Low Birth Weight), Three-Year Rolling Averages, Canada and Nunavut, 19962007 Age-Standardized Injury Hospitalization Rate per 100,000 Population, Canada and Nunavut, 20052006, 20072008 and 20082009 Infant Mortality Rate per 100,000 Population, Birth Weights 500g or More, Three-Year Rolling Averages, Canada and Nunavut, 19962007 Age-Standardized Lung Cancer Mortality Rate per 100,000 Population, Three-Year Rolling Averages, Canada and Nunavut, 19932004 Age-Standardized Colorectal Cancer Mortality Rate per 100,000 Population1, Five-Year Average, Canada and Nunavut, 20002004 Age-Standardized Acute Myocardial Infarction Mortality Rate per 100,000 Population1, FiveYear Average, Canada and Nunavut, 20002004 Age-Standardized Stroke Mortality Rate per 100,000 Population1, Five-Year Average, Canada and Nunavut, 20002004 Potential Years of Life Lost due to Suicide, Population Aged 0 to 74 Years, Three-Year Rolling Averages, Canada and Nunavut, 20022006 Potential Years of Life Lost due to Unintentional Injury, Three-Year Rolling Averages, Population Aged 0 to 74 Years, Canada and Nunavut, 20022006 Percentage of Population Aged 12 and Over Report Current Smoking (Daily or Occasional) Canada and Nunavut, 2003, 2007 and 2008 Percentage of Population Aged 1219 Years Who Report Current, Former or Non- Smoking Behaviours, Canada and Nunavut, 2005 Percentage of Population Reporting Five or More Drinks on One Occasion at Least Once a Month within the Last Year, Canada and Nunavut, 2008 Percentage of Population Aged 12 and Over, Physically Active, Moderately Active and Physically Inactive, Canada and Nunavut, 2007 Percentage of population with Sense of Community Belonging, Canada and Nunavut, 2007 Percentage of Population Reporting Exposure to Second Hand Smoke at Home and in Vehicles and in Public Places, Canada and Nunavut, 2008

Non-medical determinants of health


Figure 16a. Figure 16b. Figure 17. Figure 18. Figure 19. Figure 20.

Health system performance


Figure 21. Reported Satisfaction with Health Care Services Received in the Past 12 Months, by Sex, Population Aged 15 and Over, Canada and Nunavut, 2005 Figure 22. Reported Satisfaction with Community-Based Health Care Services Received in the Past 12 Months, by Sex, Population Aged 15 and Over, Canada and Nunavut, 2005 Figure 23. Reported Satisfaction with Hospital Care Received in the Past 12 Months, by Sex, Population Aged 15 and Over, Canada and Northern Territories, 2005 Nunavut Report on Comparable Health Indicators 2011 5

Figure 24. Figure 25. Figure 26. Figure 27.

Percentage of Population Reporting Influenza Immunization Less than One Year Ago, Canada and Nunavut, 2007 Percentage of Female Population Aged 1869 Reporting a Pap Smear within the Previous Three Years, Canada and Nunavut, 2003 and 2005 Percentages of Population Reporting Caesarean Section, Canada and Nunavut, 20072008 and 20082009 Age-Standardized Hospitalization Rate per 100,000 for Ambulatory Care Sensitive Conditions, Canada and Nunavut, 20082009 Number of Home Care Clients by Client Type, All Ages, Nunavut, 20072008, 20082009 and 20092010 Reported New Active and Relapsed Tuberculosis Incidence Rate per 100,000 Population1, Three-Year Rolling Averages, Canada and Nunavut, 20022008 Reported Chlamydia Rate per 100,000 Population, Three-Year Rolling Averages, Canada and Nunavut, 20022008 Reported Gonorrhea Rate per 100,000 Population, Three-Year Rolling Averages, Canada and Nunavut, 20022008 HIV Positive Test Rate per 100,000 Population Age 15 and Over, Three-Year Rolling Averages, Canada and Nunavut, 20022008

Community and health system characteristics


Figure 28.

Health surveillance
Figure 29. Figure 30. Figure 31. Figure 32.

Nunavut Report on Comparable Health Indicators 2011

Executive summary Federal, provincial and territorial governments have developed widely accepted indicators to compare the health of one group of people with the health of others. You may have heard of some of these health indicators, such as life expectancy, infant mortality rate, or rates of certain illnesses, such as heart disease, stroke, or cancer. In this report, we describe the health status of Nunavummiut compared with the health of other Canadians. In some areas, the health of Nunavummiut is not as good as that of other Canadians. The life expectancy of people born in 2005 in Nunavut (70.4 years) was less than that for Canada as a whole (80.4 years). Deaths very early in life, as well as deaths from illness later in life, contribute to Nunavuts lower life expectancy. The infant mortality rate in Nunavut was much higher during 2005 to 2007 (14.5 deaths per 1,000 live births) than the rate for the rest of Canada (5.2 deaths per 1,000 live births). The increased infant mortality rate in Nunavut is mostly due to increased deaths of infants between the ages of 28 days to one year of life. Nunavut had one of the highest rates of lung cancer in Canada in 2008 (225.4 per 100,000 population), higher than the rate for Canada as a whole (50.0 per 100,000 population). From 2002 to 2004, the death rate from lung cancer in Nunavut (211.5 per 100,000 population) was over four times that reported for Canada (47.1 per 100,000 population). We know that most cases of lung cancer are caused by the use of tobacco products, so these rates go hand in hand with our high rates of smokingthe highest in the country. From 2006 to 2008, Nunavut reported a rate of tuberculosis (147.3 per 100,000 population) that was 30 times the Canadian rate (4.9 per 100,000 population). Although our rates are high, we have an effective TB treatment program. Nunavummiut with active TB are being treated and cured. From 2008 to 2009, Nunavut had a lower percentage of births by Caesarian section (6.9 per cent) than that for Canada as a whole (26.9per cent). Most other regions in Canada are trying to lower their rates of Caesarian section, so we are fortunate to have these low rates.

Nunavut Report on Comparable Health Indicators 2011

Introduction In 2002, all provincial, territorial and federal governments released their individual comparable indicators reports. This was the first time that all health ministries reported at the same time on a set of jointly agreed upon indicators about the performance of the health care system and the health status of Canadians. Since that time, Nunavut has produced reports on comparable health indicators. These reports allow Nunavummiut to be informed about our health status, and the state of our health care system, compared to the rest of Canada. As in prior reports, the 2011 Nunavut Report on Comparable Health Indicators has been designed to highlight those indicators which the Department of Health and Social Services believes will be of particular interest to Nunavummiut. In all cases, we have used the latest information available to us.

Nunavut Report on Comparable Health Indicators 2011

Health Status
Health status indicators provide insight into the health of Canadians, and include well-being, human function and selected health conditions. This report will focus on select indicators pertaining to wellbeing, such as life expectancy; perceived health and perceived mental health; health conditions including adult body mass index (BMI), diabetes, low birth weight infants and hospitalization for certain conditions; as well as deaths from selected causes. Life expectancy Life expectancy is a prediction of the average number of years an individual born in a particular place and time will live. Life expectancy provides an indication of a populations overall health as well as the quality of healthcare people receive when they are ill.

90 85 80
Years

75 70 65 60

1996 78.2

1997 78.4

1998 78.6

1999 78.8

2000 79.1

2001 79.3

2002 79.6

2003 79.7

2004 79.9

2005 80.2

CANADA NUNAVUT

70.4

70.0

68.6

68.6

67.7

68.7

68.6

68.8

69.1

69.8

Figure 1. Life Expectancy at Birth, Three-Year Rolling Averages, Canada and Nunavut, 19962005 (Source: Statistics Canada, 19962005 (CANSIM table 102-0511))

The overall life expectancy of Canadians born in 2005 was 80.2 years, while in Nunavut the life expectancy was 69.8 years. Life expectancy in Canada increased two years from 1996 (78.2 years) to 2005 (80.2 years), while in Nunavut life expectancy decreased 0.6 years, from 70.4 years in 1996 to 69.8 years in 2005, during the same time period.

Nunavut Report on Comparable Health Indicators 2011

Life expectancy at age 65 Life expectancy at age 65 is an estimate of the average number of remaining years of life expected for those who have reached 65 years of age.
25

20

Years

15

10

0 CANADA NUNAVUT

1996
18.1 15.0

1997
18.2 15.1

1998
18.2 14.6

1999
18.3 14.4

2000
18.5 13.3

2001
18.8 14.1

2002
19.0 13.7

2003
19.1 14.3

2004
19.3 14.0

2005
19.4 15.0

Figure 2. Life Expectancy at Age 65 Years, Three-Year Rolling Averages, Canada and Nunavut, 19942005 (Source: Statistics Canada, 19962005 (CANSIM table 102-0511))

In 2005, a person in Nunavut 65 years of age was expected to live an additional 15.0 years; this was lower than the national life expectancy of 19.4 years. Life expectancy at age 65 years in Canada increased from 18.1 years in 1996 to 19.4 years in 2005. Life expectancy at age 65 years in Nunavut was unchanged at 15.0 years between 1996 and 2005. Life expectancy at age 65 years in Nunavut remained below that for Canada across the entire time period.

Perceived health Perceived health is a measure of how an individual feels about his or her own health. It refers to the perception of a persons health in general, and means not only the absence of disease or injury, but also physical, mental and social well-being. In general, the way a person feels about his or her own health closely matches what health care professionals find out about that persons health by examination or laboratory tests.

Nunavut Report on Comparable Health Indicators 2011

10

100 90
Per centage of Population

80
70 60 50 40 30 20 10 0 Excellent Very Good or Excellent 59.6 57.4

Very Good 37.6 34.4

Good 29.0 32.0

Fair or Poor 11.3 10.6

CANADA

21.9 23.0

NUNAVUT

Figure 3. Perceived Health of Population Aged 12 and Over, Canada and Nunavut, 2007 (Source: Statistics Canada, 2007 (CANSIM table 105-4022))

In 2007, 23.0 per cent of Nunavummiut considered themselves to be in excellent health, 57.4 per cent considered themselves to be in excellent or very good health, and 10.6 per cent considered themselves to be in fair or poor health. These numbers were consistent with what was reported for Canada in the same year. Perceived mental health Perceived mental health provides a general indication of the population suffering from some form of mental disorder, mental or emotional problems, or distress.

Nunavut Report on Comparable Health Indicators 2011

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100 90

Per centage of Population

80 70 60 50 40 30 20 10 0 Per cent CANADA NUNAVUT

73.9

70.5

Figure 4. Perceived Mental Health as Very Good or Excellent of Population Aged 12 and Over, Canada and Nunavut, 2009 (Source: Statistics Canada, 2009 (CANSIM table 105-0501))

In 2009, 73.9 per cent of Canadians reported that their mental health was "very good" or "excellent" compared with 70.5 per cent of Nunavummiut.

Health conditions
Adult body mass index Body Mass Index (BMI) is a measure of how fit a persons body is, based on the self-reported height and weight of people over age 18* BMI is expressed in specified categories, ranging from underweight to obese. BMI less than 18.5 (underweight) BMI between 18.5 and 24.9 (normal weight) BMI between 25 and 29.9 (overweight) BMI of 30 or more (obese).

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*excluding pregnant females, and individuals at the extreme ends of the height spectrum (i.e. less than three feet or taller than six feet 11 inches). BMI is calculated by dividing weight in kilograms by height in metres squared.
100 90
Per centage of Population

80

70
60 50 40 30 20 10 0
Normal Weight (BMI 18.524.9) 44.4 42.7 Overweight (BMI 25.029.9) 32.4 30.4 Obese (BMI 30.0 or Higher) 16.0 15.6

CANADA NUNAVUT

Figure 5. Body Mass Index (BMI) of Population Aged 18 and Over1, Canada and Nunavut, 2007(Source: Statistics Canada, 2007 (CANSIM table 105-4009))
1

Excludes pregnant women. Underweight data not presented, as data are considered too unreliable to be published.

From 2003 to 2007, 42.7 per cent of Nunavuts population reported a normal BMI; 30.4 per cent had a BMI that classified them as overweight, and 15.6 per cent were considered obese; these percentages were similar to those reported for Canada during the same time period. Obesity has been identified as a major risk factor contributing to a number of chronic illnesses, such as diabetes and heart disease. Health promotion initiatives that address healthy nutrition and active lifestyles, as well as healthy public policies and a healthy built environment, are important components that assist in achieving a healthy body weight. Diabetes Diabetes is a chronic disease in which the amount of sugar in the body is not properly controlled. It can lead to long-term complications including heart disease, stroke, kidney failure, limb amputations, blindness, and can contribute to premature death. Overweight, obese and physically inactive people are considered at risk for developing diabetes. Diabetes prevalence in this report includes both type one diabetes and type two diabetes; gestational diabetes is excluded.

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10 9

Percentage of Population

8 7 6 5 4 3 2 1 0 2003 4.5 1.2 2004 4.8 1.5


1

2005 5.0 1.9

2006 5.2 2.1

2007 5.5 2.3

2008 5.8 2.5

CANADA NUNAVUT

Figure 6. Age-Standardized Prevalence Percentage of Diagnosed Diabetes among Population Aged 1 Year and Older by Province and Territory, Canada2, 200320083 (Sources: Public Health Agency of Canada, Report from the National Diabetes Surveillance System (NDSS): Diabetes in Canada, 2009 and Nunavut NDSS Data. Office of the Territorial Epidemiologist, Department of Health and Social Services, Population Health Information Division)
1 2

Age-standardized to the 1991 Canadian population. Data for Canada excludes Nunavut. 3 Canadian prevalence percentages for fiscal years 2007 and 2008 are estimates.

In 2008, Nunavuts diabetes prevalence percentage (2.5 per cent) was less than half the rest of Canada (5.8 per cent). In Canada, diabetes prevalence increased by 30 per cent between fiscal years 2003 and 2008. In Nunavut, diabetes prevalence increased by 110 per cent during the same time period. *

*Note: Prevalence measures the number of cases in a population in a certain period of time. This includes both new cases as well as cases which are not new, but still present. For example, for illnesses such as diabetes, a person who develops this condition usually has it for the rest of his/her life, so the prevalence is much greater than the incidence (which is just the number of new cases in a certain period of time). For an illness such as influenza, which generally lasts for just a week to ten days, the prevalence and incidence will be almost identical over a given period of time.

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Low birth weight Low birth weight is defined as the proportion of live births with a birth weight between 500 and 2,500 grams. Low birth weight is an indicator of newborn babies general health, and a predictor of how healthy the infant will be in the future. Research has shown that low birth weight is associated with poor maternal health, lifestyle and economic circumstances. Many specific factors for low birth weight have been identified, including maternal smoking, alcohol and substance abuse, poor nutrition, limited physical activity, low prepregnancy weight and inadequate weight gain during pregnancy.

10

9
Proportion of Live Births

8 7

6
5 4 3 2 1 0 CANADA NUNAVUT 1996 5.7 1997 5.7 1998 5.7 1999 5.6 2000 5.6 2001 5.5 2002 5.5 2003 5.6 2004 5.7 2005 5.8 2006 5.9 2007 5.9

7.9

7.3

6.4

6.9

6.9

7.6

7.5

8.1

7.4

7.7

7.9

7.7

Figure 7. Proportion of Live Births with a Birth Weight at Least 500g and Less than 2,500g (Low Birth Weight), Three-Year Rolling Averages, Canada and Nunavut, 19962007 (Source: Statistics Canada, 1996-2007 (CANSIM table 102-4005))

In 2007, 7.7 per cent of infants born in Nunavut were of low birth weight, higher than the proportion reported for Canada (5.9 per cent). In all years from 1996 to 2007, Nunavut reported a higher proportion of low birth weight births than the proportion reported for Canada overall. Injury hospitalization The injury hospitalization rate is defined as the age-standardized rate of acute case hospitalization due to injury (excluding poisoning and other non-traumatic injuries).

Nunavut Report on Comparable Health Indicators 2011

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1400
Rate per 100,000 Population

1200 1000 800 600 400

200
0 CANADA 543.0 541.0 534.0 NUNAVUT 1201.0 1216.0 1154.0

2005-2006 2007-2008 2008-2009

Figure 8. Age-Standardized Injury Hospitalization Rate per 100,000 Population1, Canada and Nunavut, 2005 2006, 20072008 and 20082009 (Sources: Trauma Registry, Canadian Institute for Health Information, Canadian Institute for Health Information (CIHI), Health Indicators 2010 (Ottawa, Ont.: CIHI, 2010))
1

Age-standardized to the 1991 Canadian population.

During 2008 to 2009, the rate of hospitalizations due to injury in Nunavut (1154.0 per 100,000 population) was more than twice the rate reported for Canada (534.0 per 100,000 population). Nunavut had a higher rate of hospitalizations due to injury than was reported for Canada in each of the years with available data from 2005 to 2009. Injury hospitalization rates in the North have been higher than those in southern Canada for many years. Although Nunavuts rates have been higher than those of Canada, our rates are comparable to those of the two other Territories.

Deaths
Infant mortality The infant mortality rate refers to the number of infants who die in the first year of life; the infant mortality rate is one of the most widely used measures used to compare the health of one population with that of another. Infant mortality rates reflect both medical and social factors*; the rate reflects not only child health, but also the well-being of a society.

*Social factors which have been associated with higher infant death rates include poverty, tobacco smoking in the home,
overcrowded housing, and poor parenting skills.

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20 18 16
Rate per 1,000 Live Births

14 12 10 8 6 4 2 0 1996 5.3 17.9 1997 5.0 16.6 1998 4.7 17.6 1999 4.6 16.3 2000 4.5 15.5 2001 4.4 13.9 2002 5.3 13.4 2003 5.3 15.9 2004 5.3 15.6 2005 5.3 15.3 2006 5.2 13.2 2007 5.2 14.5

CANADA NUNAVUT

Figure 9. Infant Mortality Rate per 100,000 Population, Birth Weights 500g or More, Three-Year Rolling Averages, Canada and Nunavut, 19962007 (Source: Statistics Canada, Vital Statistics, Birth and Death Databases, 19962007)

In 2007, Nunavuts infant mortality rate (14.5 per 1,000 births) was more than twice the rate for Canada (5.2 per 1,000 births). The Canadian infant mortality rate remained consistent between 1996 and 2007. In Nunavut, infant mortality rates appeared to have a downward trend, although rates were higher than Canadian rates across the entire time period. Most of the infant deaths in Nunavut have occurred between the age of 28 days and one year. This means that social factors, rather than the medical care system, make a significant contribution to our infant mortality rate.

Total mortality by selected causes


Lung cancer mortality Lung cancer mortality rate is defined as the number of deaths from cancer of the lung.

Nunavut Report on Comparable Health Indicators 2011

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300

Rate per 100,000 Population

250

200

150

100

50

0 CANADA NUNAVUT

1995 50.3 171.8

1996 49.9 117.8

1997 49.2 131.7

1998 49.3 138.2

1999 49.3 173.5

2000 48.9 198.6

2001 48.2 209.5


1

2002 47.4 238.7

2003 47.4 210.8

2004 47.1 211.5

Figure 10. Age-Standardized Lung Cancer Mortality Rate per 100,000 Population , Three-Year Rolling Averages, Canada and Nunavut, 19932004 (Source: Statistics Canada, Vital Statistics, Birth and Death Databases and Demography Division, 19932004)
1

Age-standardized to the 1991 Canadian population.

The lung cancer mortality rate was higher in Nunavut than for Canada overall across the entire time period from 1995 to 2004; since 1997, mortality rates in Nunavut have been approximately four times higher than that seen for the rest of Canada. For many cancers, there are not tests which can be used to discover the illness early in order to prevent serious illness or death. Lung cancer is one such cancer. With no way to test for it at a very early stage, many cases of lung cancer are discovered too late to be cured. We do know that there are ways to prevent lung cancer. Tobacco smoking has been linked with most cases of lung cancer. Stopping smoking, or never smoking in the first place, is a proven means of preventing lung cancer.

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Colorectal cancer mortality


45
40
Rate per 100,000 Population

35
30

25
20

15
10

5
0 2000-2004 CANADA 18.7 NUNAVUT 39.3

Figure 11. Age-Standardized Colorectal Cancer Mortality Rate per 100,000 Population1, Five-Year Average, Canada and Nunavut, 20002004 (Source: Statistics Canada, 2000-2004 (CANSIM table 102-0126)
1

Age-standardized to the 1991 Canadian population.

The average colorectal mortality rate in Nunavut (39.3 per 100,000 population) was more than twice the Canadian rate during the period 2000 to 2004 (18.7 per 100,000 population). Acute myocardial infarction* mortality
60
55
Rate per 100,000 Population

* Also known as heart attack

50 45

40
35 30 2000-2004

CANADA 49.9

NUNAVUT 42.8

Figure 12. Age-Standardized Acute Myocardial Infarction Mortality Rate per 100,000 Population1, Five-Year Average, Canada and Nunavut, 20002004 (Source: Statistics Canada, 2000-2004 (CANSIM table 102-0126)
1

Age-standardized to the 1991 Canadian population.

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The average acute myocardial infarction mortality rate in Nunavut (42.8 per 100,000 population) was lower than the Canadian rate during the period 2000 to 2004 (49.9 per 100,000 population).

Stroke mortality
60
50 40

Rate per 100,000 Population

30
20 10 0 2000-2004

CANADA
32.7

NUNAVUT
49.7

Figure 13. Age-Standardized Stroke Mortality Rate per 100,000 Population1, Five-Year Average, Canada and Nunavut, 20002004 (Source: Statistics Canada, 2000-2004 (CANSIM table 102-0126)
1

Age-standardized to the 1991 Canadian population.

The average stroke mortality rate in Nunavut (49.7 per 100,000 population) was higher than the Canadian rate during the period 2000 to 2004 (32.7 per 100,000 population). The term stroke refers to the result of a lowering of blood supply to a part of the brain, which can result in temporary or permanent loss of some functions of the brain or body. Sometimes, people who have strokes make a total recovery, while in other cases, they may lose the ability to speak or walk. In the most severe cases, a stroke results in death. High blood pressure is a significant controllable risk factor for stroke. Other controllable risk factors include smoking, physical inactivity, high cholesterol, stress, obesity, and diabetes. Bringing high blood pressure back to normal can prevent strokes. Many people with high blood pressure do not feel sick, and will only know that their blood pressure is high if checked by a health care professional.

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Potential years of life lost Potential years of life lost (PYLL) is the number of years of life lost when a person dies prematurely from any cause (for example, suicide or unintentional injury), before age 75. A person dying at age 25 for example, has lost 50 years of life. Potential years of life lost due to suicide
6000 5000 4000 3000 2000 1000 0 CANADA NUNAVUT

Rate per 100,000 Population

2002 395.8 4586.7

2003 391.2 4885.6

2004 382.1 4637.4

2005 379.9 4405.2

2006 361.7 3408.2

Figure 14. Potential Years of Life Lost due to Suicide, Population Aged 0 to 74 Years, Three-Year Rolling Averages, Canada and Nunavut, 20022006 (Sources: Statistics Canada, 20022006 (CANSIM table 102-0110))

In 2006, Nunavuts rate of potential years of life lost (PYLL) due to suicide (3408.2 per 100,000 population) was more than nine times higher than the rate for Canada (361.7 per 100,000 population). The rate of PYLL due to suicide in Canada was stable between 2002 and 2006; in Nunavut, the rate of PYLL due to suicide was higher than the Canadian rate across the entire time period, but decreased from 4586.7 per 100,000 population in 2002 to 3408.2 per 100,000 population in 2006.

Potential Years of Life Lost Due to Unintentional Injuries Unintentional injuries include, but are not limited to, drowning, motor vehicle crashes, falls, smoke inhalation and burns, and accidental poisoning.

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6000 5000 4000 3000 2000 1000 0 CANADA NUNAVUT

Rate per 100,000 Population

2002 644.6 1653.9

2003 628.4 2842.6

2004 614.6 2477.4

2005 607.1 2375.5

2006 605.3 1766.0

Figure 15. Potential Years of Life Lost due to Unintentional Injury, Three-Year Rolling Averages, Population Aged 0 to 74 Years, Canada and Nunavut, 20022006 (Sources: Statistics Canada, 20022006 (CANSIM table 102-0110))

In 2006, the rate of PYLL due to unintentional injury in Nunavut (1766.0 per 100,000 population) was nearly three times the Canadian rate (605.3 per 100,000 population). The rate of PYLL due to unintentional injury in Canada remained stable between 2002 and 2006. The rate of PYLL due to unintentional injury in Nunavut was variable during this time period, increasing from 1653.9 per 100,000 population in 2002 to 1766.0 per 100,000 population in 2006.

Non-medical determinants of health


Non-medical determinants of health reflect factors outside of the health care system that affect an individuals health. This report will focus on smoking, heavy drinking, physical activity, personal resources and environmental factors as relevant non-medical determinants of health.

Health behaviours

Type of smoker The type of smoker is the population aged 12 and over who reported being either a current smoker (daily or occasional) or a non-smoker (former or never smoked). The type of smoker does not take into account the number of cigarettes smoked.

Nunavut Report on Comparable Health Indicators 2011

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100 90

Percentage of Population

80

70
60 50 40 30 20 10 0 2003 2007 2008 CANADA 22.9 21.9 21.4 NUNAVUT 64.8 58.5 54.2

Figure 16a. Percentage of Population Aged 12 and Over Report Current Smoking (Daily or Occasional) Canada and Nunavut, 2003, 2007 and 2008 (Sources: Statistics Canada, Canadian Community Health Survey, 2003 and 2007, Canadian Institute for Health Information, Health Indicators 2010 (Ottawa, Ont.: CIHI, 2010))

In 2008, the percentage of smokers among all Nunavummiut over age 12 (54.2 per cent) was more than twice the proportion reported for Canada (21.4 per cent). The percentage of current smokers reported for Canada decreased from 22.9 per cent to 21.4 per cent between 2003 and 2008. In Nunavut, the percentage of current smokers decreased from 64.8 per cent in 2003 to 54.2 per cent in 2008, however, in 2008, greater than half of the population of Nunavut self-identified as current smokers.
100 90
Percentage of Population

80 70 60 50 40 30 20 10 0 Current Smoker (Daily or Occasional) 12.1 43.0 Non-Smoker (Former or Never Smoked) 87.5 55.3

CANADA NUNAVUT

Figure 16b. Percentage of Population Aged 1219 Years Who Report Current, Former or Non- Smoking Behaviours, Canada and Nunavut, 2005 (Source: Statistics Canada, 2005 (CANSIM table 105-0427))

In 2005, Nunavut reported a percentage of current smokers aged 12 to 19 years (43.0 per cent) over three times the proportion reported for Canada overall (12.1 per cent). Nunavut also reported a
Nunavut Report on Comparable Health Indicators 2011 23

smaller proportion of individuals aged 12 to 19 years who were former smokers or had never smoked (55.3 per cent) than what was reported for Canada (87.5 per cent). Frequency of drinking Frequency of drinking was recorded for the population aged 12 and over who were current drinkers and who reported drinking five or more drinks on at least one occasion per month during the previous 12 months.
100 90

Percentage of Population

80 70 60 50 40 30 20 10 0 CANADA 16.7 NUNAVUT 25.1

Both Sexes

Figure 17. Percentage of Population Reporting Five or More Drinks on One Occasion at Least Once a Month within the Last Year, Canada and Nunavut, 2008 (Source: Canadian Institute for Health Information, Health Indicators 2010 (Ottawa, Ont.: CIHI, 2010))

Prevalence of regular heavy drinking among current drinkers was 25.1 per cent in 2008 in Nunavut compared with 16.7 per cent in Canada during the same year. Physical activity Physical activity was based on the population aged 12 and over who reported a level of physical activity, based on their responses to questions about the frequency, nature and duration of their participation in leisure-time physical activity.

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100 90

Percentage of Population

80 70 60 50 40 30 20 10 0 Physically Active 25.2 20.8 Moderately Active 23.7 19.6 Physically Inactive 48.2 52.9

CANADA NUNAVUT

Figure 18. Percentage of Population Aged 12 and Over, Physically Active, Moderately Active and Physically Inactive1, Canada and Nunavut, 2007 (Source: Statistics Canada, 2007 (CANSIM table 105-4033))
1

There is much discussion regarding the validity of these data as pertaining to Nunavut. Many Inuit activities (e.g. hunting) are not considered to meet the definition of physical activity, even though the activities are physical in nature.

In 2007, 20.8 per cent of Nunavummiut were considered physically active, less than the 25.2 per cent reported for Canada overall. 52.9 per cent of Nunavummiut were considered physically inactive, greater than the 48.2 per cent considered physically inactive for Canada overall.

Sense of community belonging A positive sense of belonging to the local community is associated with both physical and mental health. People who feel a strong sense of community belonging generally feel that they have good or excellent physical and mental health.

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100 90

Percentage of Population

80 70 60 50 40 30 20

10
0 CANADA 62.0 NUNAVUT 72.4

Both Sexes

Figure 19. Percentage of Population with Sense of Community Belonging, Canada and Nunavut, 2007 (Source: Statistics Canada, Canadian Community Health Survey, 2007)

In 2007, 72.4 per cent of Nunavummiut reported a sense of community belonging; higher than the percentage (62.0 per cent) reported for Canada.

Exposure to second-hand smoke at home, in vehicles and public places Exposure to second-hand smoke at home was defined as the non-smoking population aged 12 and over who reported that at least one person smoked inside their home every day or almost every day. Exposure to second-hand smoke in vehicles and public places was defined as the non-smoking population who reported being exposed to second-hand smoke in private vehicles and/or public places everyday or almost every day during the previous month. Exposure to second hand smoke has been recognized as a carcinogen, which means it is a cancer causing substance.

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100
90

Percentage of Population

80 70 60 50 40 30 20 10 0 CANADA NUNAVUT

Exposure at Home Exposure in Vehicles and Public Places

6.6
14.7

17.6
17.4

Figure 20. Percentage of Population Reporting Exposure to Second Hand Smoke at Home and in Vehicles and in Public Places, Canada and Nunavut, 2008 (Source: Canadian Institute for Health Information, Health Indicators 2010 (Ottawa, Ont.: CIHI, 2010)

In 2008, the percentage of the population in Nunavut reporting exposure to second hand smoke at home (17.6 per cent) was more than twice that reported for Canada (6.6 per cent). The percentage of Nunavuts population reporting exposure to second hand smoke in vehicles and public places (17.4 per cent) was also higher than that reported for Canada (14.7 per cent) in 2008. Bill 33, Nunavuts Tobacco Control Act was passed in November, 2003 and came into force in February 2004. Nunavummiut have benefitted from this Act, which prohibits smoking in all indoor public spaces. However, it will require efforts on the part of individuals, families, and communities to reduce the levels of exposure of Nunavummiut to second hand smoke at home.

Health system performance


Health system performance provides insight on the quality of available health services, including accessibility, appropriateness, effectiveness and patient safety. This report will focus on patient satisfaction with health care services; influenza immunization; regular Pap smears; caesarean section rates; and ambulatory care sensitive conditions as indicators of health system performance.

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Patient satisfaction Patient satisfaction was defined as the population aged 15 and over who had received health services in the previous 12 months who rated their level of satisfaction with those services as either very satisfied or somewhat satisfied.

100

Percentage of Population

90 80 70 60 50 40 30 20 10 0 Very or Somewhat Satisf ied (Both Sexes) 85.0 78.0 Very or Somewhat Satisf ied (Male) 85.7 79.2 Very or Somewhat Satisf ied (Female) 84.3 76.9

CANADA

NUNAVUT

Figure 21. Reported Satisfaction with Health Care Services Received in the Past 12 Months, by Sex, Population Aged 15 and Over, Canada and Nunavut, 2005 (Source: Statistics Canada, 2005 (CANSIM table 105-4080))

In 2005, 78.0 per cent of Nunavummiut reported that they were very or somewhat satisfied with health care services received in the past 12 months; lower than what was reported for Canada overall (85.0 per cent).

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100 90

Percentage of Population

80
70 60 50 40 30 20 10 0 Very or Somewhat Satisf ied (Both Sexes) 82.0 77.0 Very or Somewhat Satisf ied (Male) 83.0 81.0 Very or Somewhat Satisf ied (Female) 81.1 73.8

CANADA NUNAVUT

Figure 22. Reported Satisfaction with Community-Based Health Care Services Received in the Past 12 Months, by Sex, Population Aged 15 and Over, Canada and Nunavut, 2005 (Source: Statistics Canada, 2005 (CANSIM table 105-4083))

In 2005, 77.0 per cent of Nunavummiut reported being very or somewhat satisfied with communitybased care, less than what was reported for Canada overall (82.0 per cent). In Nunavut, hospital care for residents of the Baffin region may be received at the only hospital, Qikiqtani General Hospital, in Iqaluit. For more complex hospital care, Baffin residents may be referred to a hospital in Ottawa. Residents in the Kivalliq Region may be referred to hospital care in Winnipeg and Kitikmeot Region residents may receive hospital care in Yellowknife or Edmonton.
100 90 80 70 60 50 40 30 20 10 0 Very or Somewhat Satisf ied (Both Sexes) 80.8 89.0 Very or Somewhat Satisf ied (Male) 82.3 88.0
1

Percentage of Population

Very or Somewhat Satisf ied (Female) 79.6 89.6

CANADA NUNAVUT

Figure 23. Reported Satisfaction with Hospital Care Received in the Past 12 Months , by Sex, Population Aged 15 and Over, Canada and Nunavut, 2005 (Source: Statistics Canada, 2005 (CANSIM table 105-4081))
1

During 20042008, out of territory hospitalizations averaged 59.6% of all Nunavut hospitalizations over the five-year period (Source: Office of the Territorial Epidemiologist, Nunavut Department of Health and Social Services, Population Health Information Division).

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In 2005, 89 per cent of Nunavummiut reported being satisfied with hospital care received in the past 12 months. This was higher than what was reported for Canada, and was the highest reported in the Northern territories.

Influenza immunization Influenza immunization was defined as the population aged 12 and over who reported when they had received their last influenza immunization. In the fall of each year, Nunavut offers seasonal influenza vaccine to all residents, free of charge.
100 90

Percentage of Population

80

70 60
50 40 30 20 10 0 CANADA 30.4 NUNAVUT 34.9

Both Sexes

Figure 24. Percentage of Population Reporting Influenza Immunization Less than One Year Ago, Canada and Nunavut, 2007 (Source: Statistics Canada, Canadian Community Health Survey, 2007)

In 2007, 34.9 per cent of Nunavummiut were vaccinated with seasonal influenza vaccine, higher than the Canadian proportion of 30.4 per cent in the same year. Pap smear test Pap smear screening was defined as the percentage of women aged 18 to 69 who reported when they had their last Pap smear test. A Pap smear test is a test for women which can be done in a local health centre by a nurse or a doctor. A sample of cells from the cervix, the bottom of the womb, is taken and sent to a laboratory for testing. The test looks for changes which could, over time, turn into cancer cells. If these changes are found, there are simple methods of removing these cells so that cancer can be prevented. All women who are sexually active should be having a Pap smear test on a regular basis.

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100 90 80
Percentage of Population

70 60 50 40 30 20 10 0 2003 74.0 71.3 2005 72.8 79.3

CANADA NUNAVUT

Figure 25. Percentage of Female Population Aged 1869 Reporting a Pap Smear within the Previous Three Years, Canada and Nunavut, 2003 and 2005 (Source: Statistics Canada, 2005 (CANSIM table 105-4042))

In 2005, the percent of Nunavuts females who reported a Pap test in the previous three years was 79.3 per cent, higher than the proportion reported for Canada (72.8 per cent).

Caesarean section Caesarean section rates are often used to monitor clinical practices with an assumption that lower rates indicate more appropriate, as well as more efficient, care.
100 90

Percentage of Population

80 70 60 50 40

30
20 10 0 2007-2008 27.7 6.7 2008-2009 26.9 6.9

CANADA NUNAVUT

Figure 26. Percentage of Population Reporting Caesarean Section, Canada and Nunavut, 20072008 and 2008 2009 (Sources: Hospital Morbidity Database and Discharge Abstract Database, Canadian Institute for Health Information, Health Indicators 2010 (Ottawa, Ont.: CIHI, 2010)) Nunavut Report on Comparable Health Indicators 2011 31

During 2008 to 2009, the caesarean section rate in Nunavut (6.9 per cent) was more than three times lower than the rate for Canada (26.9 per cent). Nunavummiut should be proud of our excellent low rates of Caesarean section. Ambulatory care sensitive conditions Hospitalization rates for conditions which may often be cared for in the community are an indicator of appropriate access to community-based care. Ambulatory care sensitive conditions are long-term health conditions which can often be managed with timely and effective treatment in the community, without hospitalization. These conditions include, but are not limited to: diabetes; asthma; alcohol and drug dependence or abuse; neurosis; depression; and hypertensive disease.

1400

Rate per 100,000 Population

1200 1000

800
600 400 200 0

CANADA 320.0

NUNAVUT 1181.0

Both Sexes

Figure 27. Age-Standardized Hospitalization Rate per 100,000 Population1 for Ambulatory Care Sensitive Conditions, Canada and Nunavut, 20082009 (Source: Canadian Institute for Health Information, Health Indicators 2010 (Ottawa, Ont.: CIHI, 2010))
1

Age-standardized to the 1991 Canadian population.

During 2008 to 2009, the hospitalization rate for ambulatory care sensitive conditions in Nunavut (1181.0 per 100,000 population) was more than three times higher than the rate reported for Canada (320.0 per 100,000 population). Most communities in Nunavut are very small; they lack the range of programs and services which are more easily put in place in larger communities and that reduce the rate of hospitalizations for conditions which could be cared for in the community in other jurisdictions.

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Community and health system characteristics


Community and health system characteristics provide useful contextual information, rather than direct measures of health. This report will focus on home care provision as a descriptive measure of the community and the health system.

Home care Nunavuts Home & Community Care (HCC) program provides health care and support services based on assessed need to people who require extra attention due to illness, poor health, or disability. The HCC program supports the efforts of Nunavummiut to care for themselves with help from family and community. The program is funded by the First Nations and Inuit Health Branch (FNIHB) of Health Canada.

1600 1400
Number of Clients

1200 1000 800 600 400 200 0 Total Clients Acute Care Replacement 295.0 279.0 275.0 Chronic Disease Management 559.0 528.0 667.0 Long Term Care Replacement 187.0 174.0 231.0

Palliative Care 29.0 40.0 55.0

Post Hospital Care 206.0 158.0 186.0

Other 80.0 91.0 93.0

20072008 20082009 20092010

1356.0 1270.0 1507.0

Figure 28. Number of Home Care Clients by Client Type, All Ages, Nunavut, 20072008, 20082009 and 2009 2010 (Source: Government of Nunavut, Home and Community Care Database, 2010)

In the 2009 to 2010 fiscal year, the majority (44.3 per cent) of home care clients in Nunavut were referred for chronic disease management. Chronic disease management also accounted for the majority of home care clients in Nunavut during 2007 to 2008 and 2008 to 2009. Health surveillance Tracking the numbers of cases of illness which can be passed from one person to another (called communicable or infectious diseases) is one of the essential tasks of public health. There are ways to either reduce or eliminate the numbers of cases of these illnesses; in order to focus efforts in
Nunavut Report on Comparable Health Indicators 2011 33

the proper areas, public health needs to be informed of which illnesses are the most common in Nunavut. Data on several of these communicable diseases are presented below. Tuberculosis Tuberculosis (TB) is an illness which can be treated and cured by antibiotic medicines. However, it can be difficult to treat; persons infected with TB must take several medicines for often long periods of time in order to cure the infection. Factors that contribute to TB infections include living in overcrowded housing conditions, housing with poor air circulation, nutritional status, smoking status and socioeconomic factors.
160

Rate per 100,000 Population

140 120 100

80
60 40

20
0 CANADA NUNAVUT 2002 5.5 135.7 2003 5.4 86.7 2004 5.1 75.3 2005 5.1 94.0 2006 5.1 138.6 2007 5.0 135.8
1

2008 4.9 147.3

Figure 29. Reported New Active and Relapsed Tuberculosis Incidence Rate per 100,000 Population , ThreeYear Rolling Averages, Canada and Nunavut, 20022008 (Source: Tuberculosis Prevention and Control Community Acquired Infections Division, Public Health Agency of Canada, 20022008)
1

Data are crude rates and not age-standardized.

In 2008, the rate of new TB cases in Nunavut (147.3 per 100,000 population) was more than 30 times the Canadian rate (4.9 per 100,000 population). TB rates in Nunavut were higher than those reported for Canada across the entire time period of 2002 to 2008. Canadian TB rates remained constant across this time period; rates in Nunavut were variable, but increased from 135.7 per 100,000 population in 2002 to 147.3 per 100,000 population in 2008.

Chlamydia Chlamydia is the most common sexually transmitted infection (STI) reported in Canada. Chlamydia is an infection which can affect both men and women, and is easily transmitted from an infected person to his or her sexual partner during sexual activity, including oral, vaginal, or anal sex. Although this infection can be treated with antibiotics, if it is not treated promptly, it has the potential to result in a severe infection that can lead to infertility in women.
Nunavut Report on Comparable Health Indicators 2011 34

4500 4000

Rate per 100,000 Population

3500
3000 2500 2000 1500 1000 500

0
CANADA NUNAVUT

2002
163.9 2519.4

2003
176.7 2503.5

2004
189.7 3016.1

2005
198.4 3292.3

2006
206.1 3690.2

2007
214.0 3747.3

2008
228.4 3937.2

Figure 30. Reported Chlamydia Rate per 100,000 Population1, Three-Year Rolling Averages, Canada and Nunavut, 20022008 (Source: Surveillance and Epidemiology Section, Community Acquired Infections Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 20002008)
1

Data are crude rates and not age-standardized; due to the age distribution of Nunavuts population, presented rates may not be representative of true incidence in the territory.

In 2008, chlamydia rates in Nunavut (3937.2 per 100,000 population) were more than 17 times higher than Canadian rates (228.4 per 100,000 population). Chlamydia rates were higher in Nunavut than Canadian rates across the period 2002 to 2008; rates in Canada increased from 163.9 per 100,000 population in 2002 to 228.4 per 100,000 population in 2008. Chlamydia rates in Nunavut increased each year from across the time period, from 2519.4 per 100,000 population in 2002 to 3937.2 per 100,000 population in 2008. Gonorrhea Gonorrhea is a sexually transmitted infection (STI) passed from an infected person to his or her sexual partner during sexual activity, including oral, vaginal, or anal sex. Gonorrhea can also cause severe infections in women, which, if not treated, can lead to infertility.

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700

Rate per 100,000 Population

600
500 400 300 200 100 0

2002 21.8 294.9

2003 23.8 253.7

2004 26.2 214.2

2005 27.9 188.2

2006 30.8 225.8

2007 33.1 334.1

2008 36.3 655.5

CANADA NUNAVUT

Figure 31. Reported Gonorrhea Rate per 100,000 Population1, Three-Year Rolling Averages, Canada and Nunavut, 20022008 (Source: Surveillance and Epidemiology Section, Community Acquired Infections Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 20002008)
1

Data are crude rates and not age-standardized; due to the age distribution of Nunavuts population, presented rates may not be representative of true incidence in the territory.

In 2008, gonorrhea rates in Nunavut (655.5 per 100,000 population) were more than 18 times higher than Canadian rates (36.3 per 100,000 population). Gonorrhea rates in Nunavut were higher than Canadian rates across the time period 2002 to 2008. The Canadian rate increased from 21.8 per 100,000 population in 2002 to 36.3 per 100,000 population in 2008. The rate in Nunavut in 2008 (655.5 per 100,000 population) was more than twice the rate in 2002 (294.9 per 100,000 population). HIV HIV, Human Immunodeficiency Virus, is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). This virus can be transmitted in a number of ways, including unprotected sex with an infected individual, blood-to-blood contact with an infected individual (for example, through needle sharing) and from an infected mother to her baby (for example, during pregnancy, delivery or breastfeeding).

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10

Rate per 100,000 Population

9 8 7 6

5 4
3 2 1 0 2002 8.8 1.8 2003 9.2 3.6 2004 9.5 3.6 2005 9.4 1.8 2006 9.3 1.6
1

2007 9.1 1.6

2008 9.1 1.6

CANADA NUNAVUT

Figure 32. HIV Positive Test Rate per 100,000 Population Aged 15 and Over , Three-Year Rolling Averages, Canada and Nunavut, 20022008 (Source: Surveillance and Epidemiology Section, Community Acquired Infections Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 20002008)
1

Data are crude rates and not age-standardized.

In 2008, the rate of positive HIV tests in Nunavut (1.6 per 100,000 population) was more than five times lower than the Canadian rate (9.1 per 100,000 population). Reported HIV positive test rates in Nunavut were lower than Canadian rates across all years from 2002 to 2008.

Chlamydia, gonorrhea, and HIV are all sexually transmitted infections which can be prevented by practicing safe sex. The Department of Health and Social Services provides education, counseling, and materials to assist Nunavummiut to prevent sexually transmitted infections. We recognize that rates of sexually transmitted infections remain high, in spite of our past efforts, and we are engaged in the development of a Healthy Sexuality campaign for the Territory to address this concern.

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References 1. Health Canada, Healthy Canadians A Federal Report on Comparable Health Indicators, 2008 (Ottawa, Ont.: Health Canada, 2008) 2. Statistics Canada, Health Indicators 2008 (Ottawa, Ont.: Statistics Canada 2008)

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Glossary Acute Myocardial Infarction: A sudden loss of functioning heart tissue due to decreased blood flow to an area of the heart; also known as a heart attack. Age-Standardized: A statistical calculation that adjusts for differences in the age distributions between two groups, permitting comparisons across different groups. Ambulatory Care Sensitive Conditions: Health conditions where hospitalization could likely be avoided through early disease management in a primary care setting such as a doctors office or community clinic. They include conditions such as diabetes, depression, hypertension and asthma. Body Mass Index (BMI): An index that relates a persons body weight to their height. The body mass index (BMI) is a person's weight in kilograms divided by their height in meters squared. A BMI between 18.5 and 24.9 is considered ideal. Canadian Community Health Survey (CCHS): A cross-sectional health survey administered every two years by Statistics Canada to a representative sample of Canadians aged 12 years and older. Chlamydia: A sexually transmitted infection (STI) caused by bacteria called Chlamydia trachomatis. Chronic Disease: Diseases that are expected to require a long period of supervision, observation, or care. They include conditions such as cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease, asthma, and mental illness. Community-based services: Health services that are not delivered in an acute care or hospital setting. These services are typically delivered in clinics, or in a persons home. Epidemiology: The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems. Distribution refers to analysis by time, place and class of persons affected. Determinants are all the physical, biological, social, cultural, and behavioral factors that influence health. Incidence: The number of new events (e.g., new cases of a disease in a defined population) within a specified period of time. Incidence Rate: A measure of the frequency with which a new event occurs in a population over a period of time. The numerator is the number of new events that occur during a given time period; the denominator is the population at risk of experiencing the event during this time period. Infant Mortality: The number of infants (weighing at least 500 grams at birth) that die within the first year of life. Life Expectancy: The average number of years that a group of people of the same age and gender are expected to live assuming constant mortality rates.
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Low Birth Weight: The proportion of live births with a birth weight between 500 and 2,500 grams. Morbidity: The state of being sick, or of having a disease. Mortality: The death rate. The mortality rate is the ratio of the total number of deaths to the total population. Non-response bias: Systematic distortion of results arising when those asked to respond to a survey have different characteristics that make them less likely to answer a survey or a particular survey question. Prevalence: The number of persons in the population who are living with a particular condition over a specified period of time. Primary Health Care: The first level of contact with the health system where services are mobilized to promote health, prevent illnesses, care for common illnesses, and manage ongoing health problems. Rate: A measure of the frequency with which an event occurs. It is calculated by dividing the number of events (ex: deaths from lung cancer) by the population at risk of experiencing the event (ex: the total population) over a particular unit of time. Screening Test: Screening is usually concerned with chronic illness and attempts to detect disease that has not yet been identified. Screening tests sort out apparently well persons who probably have a disease from those who probably do not have the disease. A person with positive or suspicious findings must be referred to a physician for diagnosis and any necessary treatment. Self-Reported Health Status: A persons perception of how healthy they think they are. It is generally measured using a rating scale of excellent, very good, good, fair or poor. Standardization: A set of techniques used to remove the effects of differences in some factor (such as age) when comparing two or more populations. Standard Population: A population in which the age and sex composition is known precisely.

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Limitations The indicators featured in this report are derived from databases, surveillance data and surveys (often self-reported). Self-reported data is subject to influences including the respondents sociodemographic characteristics, cognitive ability or memory, perceived stigma associated with indictors in question and non-response bias. Data in this report comes largely from Statistics Canada and the Canadian Institute for Health Information (CIHI), and is presented according to the Health Indicator Framework.2 In all cases, the latest available information is presented; most data spans the years 2003 to 2008. Data availability varied with the indicator; some data is more current than others. When possible, three-year rolling averages of rates are presented. Nunavuts population is very small in number; minor changes in the numbers in any one year may make a large difference in the calculated rates. The use of threeyear rolling averages creates data that is more representative of the true picture. With the exception of lung cancer mortality, cancer data is not presented in the Nunavut Report on Comparable Health Indicators 2010. The Department of Health and Social Services plans to audit the Nunavut cancer registry in 2011, and subsequently develop a stand-alone report on cancer in Nunavut. The Nunavut Report on Comparable Health Indicators 2011 presents thirty separate indicators, compared with thirty-one included in the 2004 Report. Caution should be exercised when attempting to identify or describe trends using the information and data found in this report; data covering a sufficiently long period was often not available to reach any conclusions about trends. As well, any observed changes do not indicate what might be causing the change, or explain the reasons behind the change.

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Exclusions
The following indicators are not included in this report because Nunavut was not included in the applicable surveys, data was not available or there were data quality issues:
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 46. Difficulty obtaining routine or ongoing health services Difficulty obtaining health information or advice Difficulty obtaining immediate care Proportion of population that reports having a regular family physician Perceived quality with overall health care services Perceived quality with community-based care Patient satisfaction with telephone health line or tele-health services Perceived quality with telephone health line or tele-health services Proportion of population reporting contact with telephone health line Proportion of women aged 50-69 obtaining mammography in the past two years Home care clients per 100,000 population, aged 75 plus Wait times for cardiac bypass surgery Wait times for hip replacement surgery Wait times for knee replacement surgery Self-reported wait times for surgery Self-reported wait times for specialist physician visits Readmission rate for acute myocardial infarction (AMI) Readmission rate for pneumonia 30-day in hospital acute myocardial infarction (AMI) mortality rate 30-day in hospital stroke mortality rate 365-day net survival rate for acute myocardial infarction (AMI) 180-day net survival rate for stroke Patient perceived quality of hospital care Prescription drug spending as a percentage of income Wait times for radiation therapy for prostate cancer Wait times for radiation therapy for breast cancer Self-reported wait times for diagnostic services Patient satisfaction with physician care Patient perceived quality of physician care Health-adjusted life expectancy (HALE) Mortality rate for prostate cancer Mortality rate for breast cancer Five-year survival rate for lung cancer Five-year survival rate for prostate cancer Five-year survival rate for breast cancer Five-year survival rate for colorectal cancer Incidence rate for lung cancer Incidence rate for prostate cancer Incidence rate for breast cancer Incidence rate for colorectal cancer Incidence rate for invasive meningococcal disease Incidence rate for measles Incidence rate for Haemophilus influenzae b (invasive) (Hib) disease Incidence rate for Verotoxigenic E. Coli Prevalence of depression

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