A man enters a health centre in Rankin Inlet, Nunavut, during the flu pandemic in 2009. Nunavut spends upward of 30 per cent of its GDP on health care, according to an article published Monday in the Canadian Medical Association Journal. (CBC)

Health care in Canada's North could be improved by studying or teaming up with other northern countries, according to an article in the Canadian Medical Association Journal.

The article, released Monday, compares health care policy in Canada's North with that in other circumpolar regions, such as Alaska, Norway, Sweden, Finland, Russia and Greenland.

It was written by Dr. Kue Young of the University of Toronto and Susan Chatwood of the Institute for Circumpolar Health Research.

Young and Chatwood found Nunavut spends the most per capita on health care in the world, with health expenditures consuming about 30 per cent of the territory's gross domestic product,

But it has "lower health outcomes" than Scandinavian countries, which have healthy northern populations and relatively modest health expenditures.

"Several questions emerge from circumpolar comparisons: Why are some northern populations healthier than others? What are the policy implications for such disparities, and are there potential strategies to redress them?" Young and Chatwood write.

"Answers to such questions are more likely to emerge if we extend our traditional north-south orientation in policy development and service delivery toward enhancing circumpolar partnerships."

Look north, not south for models

Health care services in Canada's North are "oriented mostly along a north-south axis," meaning they are carried out in partnership with authorities in the southern provinces, says the article.

That north-south axis means less attention has been paid to how other northern countries administer health care.

"The predominance of north–south partnerships has resulted in fragmented administrative and operational services, with Nunavut often being served from regional centres in Ontario, the Northwest Territories being served from Alberta, and Yukon being served from British Columbia," the authors say.

"Inuit people in Iqaluit, Nunavut, would have much more to gain if their service providers looked for collaboration in Nuuk, Greenland, rather than in Ottawa when exploring best practices for prevention, primary care services or research."

More study needed

The article says differences in health spending and policy among northern countries could be explained not only by economic and political factors but also such things as workforce, geographic remoteness and how northern indigenous populations are governed.

"In the Canadian North, the territorial governments administer most health services, except in Yukon, where some programs and services have been transferred to First Nations communities," the article says.

But the authors note that although Nunavut and Greenland have progressed most in achieving their own aboriginal self-governments, their health care services have not necessarily improved as a result.

"The association between indigenous self-government, community control of health services and health equity is complex and influenced by a multitude of political, social and economic factors," say the authors.

More circumpolar studies are needed on the issue, Young and Chatwood say.

The authors call on Canadian health policy-makers to forge circumpolar partnerships through forums such as the Arctic Council and existing national circumpolar health societies.

The creation last year of a health expert group within the Arctic Council, an intergovernmental group that includes Canada and the U.S., is one example of how northern health issue can be addressed, the authors say.