29 Introduction

Heather Exner-Pirot

One of the defining features of living in the Circumpolar North is remoteness: distance and separation from people, infrastructure and services. Historically, this has meant that northern communities needed to be self-sufficient in their provision of health care and other services. Communities were not remote so much as they were independent. However, through processes of modernization and globalization, and the introduction of the welfare state, communities and people have become much more interdependent. Modern health care, in particular, with its complexity and division of labour, has been built around a system of increasingly sophisticated practitioners and infrastructure. It is common in many parts of the North to have nurse-led stations or clinics in villages, small physician-led regional hospitals in towns, and large tertiary care centres, in urban centres. Acute or complex illnesses and injuries usually require diagnosis and treatment to be conducted in larger centres.

This model of care has implications for those living in rural and Indigenous communities in the North. Access to specialized health care services are limited by distance, time, and resources. A trip to an emergency room to deal with a trauma, a consultation with a specialist, or dialysis for chronic kidney disease become much more difficult to arrange. Poor weather can delay treatment or leave patients stranded in far off centres, away from their homes and families. Even minor things, such as getting a blood test, can take longer and be more expensive.

These are just the physical barriers. The cultural barriers for many northern and Indigenous residents to seek and access care in Western medical systems are well documented and can include: language difficulties; disregard for spiritual needs and practices; ineffectual treatment plans; and overt racism or prejudice.

While connectivity has created some challenges, it has also opened up many opportunities. Northern practitioners are able to communicate with other health care professionals much more easily. Patient records can be better managed. Overall, northern residents have better access to specialized care and expertise than ever before, even if gaps remain.

One avenue that is particularly promising in improving the access and quality of northern health care is the use of information communication technologies – i.e. the internet – in new and innovative ways. The information age promises to mitigate or erase the effects of time and distance, in affordable ways. Such technologies – telehealth, robotics, artificial intelligence, and informatics – are being applied to the health sector in new and exciting ways. They offer many opportunities for northern residents to access their health care services from their own community, saving time and money and increasing comfort. Yet, like many innovations, they seem to be occurring first and most rapidly in heavily populated and developed urban areas. Effort and attention needs to be applied to extending the application of new health technologies to northern, remote areas, where they are arguably needed the most. This chapter outlines a number of examples of what can be accomplished in northern health care with the use of technology, as well as the barriers to their implementation.

First, speaking from his experience as a practitioner in Labrador, Canada, Michael Jong provides telehealth guidelines in his chapter on How to Use Telehealth  to  Enhance  Care  in  Isolated  Northern Practices. They have been able to use telehealth for a wide variety of services, from point of care ultrasound to leading resuscitation to mental health assessments. Practical issues such as room set-up and training requirements are addressed.  

Heather Exner-Pirot’s chapter, on Challenges to Telehealth Implementation, outlines the potential of telehealth solutions to improving accessibility and quality of northern health care. However, a number of barriers to integrating telehealth into health care systems are identified; some of which are common across geographies, such as changing large systems’ culture and behaviour, resolving payment issues, and securing patient privacy; and some of which are specific to the North, including connectivity/internet issues, the capacity limitations of small northern clinics, and the layers of jurisdiction that can impact efficient adoption and use.

Päivi Juuso, in her chapter on eHealth as a Support for Older Adults at Home, examines the use of eHealth solutions to the growing demographic reality of caring for older adults. In particular, she describes the ethical implications of applying such technologies, including digital literacy and access, privacy concerns, and the need to involve older adults in their care plan.

In addition, two shorter commentaries are provided on specific cases of technology-enhanced health care. Marie-Claude Lyonnais and Christopher Fletcher describe the use of social media, particularly Facebook, in community health in Nunavik, Canada; and Yury Sumarokov summarizes the use of telemedicine in the Russian Arctic.

Health care is once again on the brink of transformation due to the possibilities that information communication technologies are opening up. It is critical that northern practitioners and administrators, and community members themselves, seek out and take advantage of the opportunities such innovations can provide in improving access to high quality health care delivery in the North.