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Building Community Wellness Hubs: A Case Study of Qaujigiartiit Health Research Centre’s Social Enterprise Initiative 

Gwen K Healey Akearok 

Introduction 

In Canada’s northernmost regions, Inuit populations face unique challenges in accessing healthcare and wellness services. The Qaujigiartiit1 Health Research Centre embarked on an innovative initiative to establish a social enterprise business and community development corporation to address a systemic public health need – infrastructure for community health programs. This development corporation aims to cultivate/ create spaces for community wellness programs and non-profit housing that serve as vital centers for various health and wellness programs, early childhood education, and Inuit pedagogical practices. This case study examines the journey of Qaujigiartiit Health Research Centre in creating the first of these spaces – the Inuusirvik Community Wellness Hub in Iqaluit, Nunavut, and early impact on the community’s wellbeing. 

Context: Overview of Nunavut 

Inuit are the Indigenous inhabitants of the North American Arctic, whose homeland stretches from the Bering Strait to east Greenland, a distance of over 6,000 km. Inuit live in Russia, Alaska, Greenland and the Canadian Arctic and, despite the distances between communities, share a common cultural heritage, language and genetic ancestry. Inuit have occupied these Arctic regions for more than 5,000 years.i  

Geography 

Nunavut is Canada’s largest and northernmost territory, encompassing a vast and sparsely populated area in the Arctic region. It is situated in the northern part of Canada, bordered by the Northwest Territories to the west, Manitoba to the south, and the Canadian provinces of Quebec and Newfoundland and Labrador to the east. To the north, Nunavut is bounded by the Arctic Ocean, while Hudson Bay lies to its southeast. The geography of Nunavut is characterized by a diverse landscape comprising tundra, mountains, fjords, coastal plains, and numerous islands. The territory is 2.2 million km2 of predominantly Arctic wilderness, with ice caps, glaciers, and permafrost covering much of the land. The presence of the Arctic Ocean and numerous bodies of water, including rivers and lakes, influences the climate and ecosystems of Nunavut. 

Figure 1 Example of Inuit Place Names Map developed by Inuit Heritage Trust which shows Inuktitut language names for places in Tasiujarjuaq (Frobisher Bay) (reproduced with permission) 2017

Nunavut is home to a predominantly Inuit population, with Inuit culture and practices deeply rooted in the land and waters of the region. The territory is divided into three regions, the Kitikmeot, Kivalliq, and Qikiqtaaluk (Baffin) regions, each with its own distinct geography and communities. Despite its vast size, Nunavut’s population is relatively small and dispersed across remote settlements and hamlets, many of which are accessible only by air or sea. Every inlet, lake and river in Nunavut has an Inuit name that is part of the oral history of the region (see Figure 1). Before European contact, small groups of families travelled together to different camps and hunting grounds. In the Qikiqtaaluk2 region alone, for example, Inuit lived in small, kin-based groups in over 100 locations throughout the region3  where families still visit and camp to this day.ii Of the approximately 150,000 Inuit living in the circumpolar region today, more than 45,000 live in Canada’s North. Nunavut is one of the four Canadian Inuit Nunangat,4 the others being: Nunavik (Northern Quebec); Inuvialuit (northern Northwest Territories; and Nunatsiavut (northern Labrador). Nunavut occupies the largest geographical area of all the Inuit Nunangat, and became Canada’s third Territory in 1999 under the Nunavut Act.iii  

Nunavut’s geography also offers opportunities for innovative approaches to healthcare delivery and community development. The close connection between the land, culture, and wellbeing of Inuit provides a foundation for culturally relevant health initiatives and holistic wellness programs. By leveraging Inuit knowledge, community resources, and partnerships, organizations like the Qaujigiartiit Health Research Centre can develop tailored solutions to address the unique healthcare needs of Nunavut’s population. 

The geography of Nunavut shapes the context in which initiatives like the creation of community wellness hubs take place, influencing access to healthcare services, cultural dynamics, and the overall wellbeing of the Inuit community. Understanding and navigating these geographical factors are essential for the success and sustainability of healthcare initiatives in the territory. 

Colonialism 

For most Indigenous5 populations globally, cultural changes have been imposed or produced invariably though legislation, colonization, war, disease, and industrialization.iv,v Cultural changes among colonized peoples have largely occurred as a result of force rather than choice, for example, to relocate to another geographic area. Kirmayer et al. argued that over the past century, Canadian and American government policies have sustained the initial processes of colonization which have continued to destroy Indigenous cultures and ways of life.vi These colonial impositions include forced settlement, the creation of reserves, relocation to remote regions, residential schools, chronic underfunding and poor resourcing of essential services such as health care and education, and bureaucratic control.vii,viii,ix,x,xi  

Nearly three centuries ago, the arrival of European whalers and explorers to the Canadian Arctic marked a significant turning point in the health of Inuit. Interaction with European visitors through trade and gift exchange resulted in the introduction of infectious diseases, which quickly took their toll among the Inuit population. Traffic in the Arctic continued to increase over time with the creation of trading posts, the arrival of explorers, cartographers, and missionaries, and the efforts of the government to build schools.1,xii,xiii,xiv,xv  

Settlement 

Before the arrival of other peoples, Inuit lived a nomadic lifestyle in ilagiit nunagivaktangat6 or camps. Although the process of relocation to communities began as a response by Inuit to the presence of traders, explorers, and missionaries, it took a new form with the systematic efforts of the government in the 1950s to ‘resettle’ Canada’s North. At that time, the Canadian government implemented resettlement programs in the eastern Canadian Arctic in an effort to: 1) protect Canada’s sovereignty post-World War II; 2) facilitate the opening of trading posts by the Hudson’s Bay Company; and 3) police, educate, and provide health care for remote populations.8,12  As a result, Inuit were relocated to southern Canada to cut relief costs or to remote High Arctic regions to maintain sovereignty and support the on-going economic initiatives of the Hudson’s Bay Company. They were also moved off the land and into settlements to facilitate the provision of supplies, education, and medical care. In the Qikiqtaaluk region, many hunters lost their dogs to an outbreak of encephalitis and to a vicious slaughter of sled dogs.2 This left them without a means of transportation, which inevitably impacted hunting and food sovereignty,12 further complicating the settlement experience for Inuit.  

Ilagiit nunagivaktangat were chosen by Inuit for the access they gave, seasonally or year-round, to favourable sites for hunting and harvesting. By 1981, four times as many people lived in just 13 permanent settlements. A few settlements had originated as trading posts, so they remained close to good hunting and harvesting areas. For the remaining posts, the single most important criterion for government was that they were accessible by sea or would fit into planned air routes as part of a military defence initiative,xvi therefore many of the settlements were not located near good harvesting areas.2,11 For example, the community of Arviat7, NU was built on a coastal swamp, far from the inland caribou herds that Inuit had followed for centuries.  

Although life on the land was never easy, much of the autonomy and self-sufficiency that were part of life on the land were lost when families moved into settlements.2 Elders speak passionately and eloquently about the ties of kinship that united members of each ilagiit nunagivaktangat. Each person within a kinship group was (and is) valued for his or her contribution to the group’s wellbeing and success.xvii,xviii,xix Excellence was highly respected, whether it was in hunting, problem solving, leadership, or sewing. At the same time, a tradition of humility dictated that gifted individuals should not boast or otherwise demonstrate pride, but use their gifts in service to others.2,xx Although conflicts were inevitable, they were minimized or resolved as quickly as possible, because they had the potential to put the group survival at risk.1,2,14,18,xxi Inuit families were close, and guided by a set of beliefs that valued family, kinship, and the bonding relationships that supported the thriving of the group.2,17,20,xxii,xxiii  

Contemporary Context 

Nunavut officially became a territory and a land claim settlement area in 199 by an act of Parliament.3 Today, there are 25 communities in Nunavut ranging in size from a population of 150 to 8,300.xxiv All of the communities are geographically isolated from each other and are only accessible by air, water, or snowmobile in winter. The population of Nunavut in 2020 was over39,000, of whom approximately 75% are Inuit.xxv Fifty-two percent of Nunavummiut8 speak the Inuit languages of Inuktitut or Inuinnaqtun at home.xxvi Nunavut has a very young population compared to Canada as a whole. In 2020 48.5% of the Nunavut population was comprised of those 24 years of age and younger compared to 28% in the whole of Canada.xxvii  

Nunavut has one hospital in Iqaluit, and two larger health centres in regional centres in Rankin Inlet and Cambridge Bay, which are staffed by physicians. Health centres staffed by community health nurses service the rest of the communities, and physicians make visits throughout the year. This dearth of services means that patients are often sent to tertiary care facilities in as far away as Ottawa if more advanced or complex care is required.  

Case Study 

Background for the Inuusirvik Community Wellness Hub 

The Inuit community in Canada’s northern territories has long struggled with inadequate access to healthcare and wellness services as demonstrated by the contextual information shared in the previous section. Despite the significance of Inuit approaches to health and wellbeing, programs that incorporate these practices often face challenges such as underfunding and lack of dedicated spaces. Many programs are forced to operate in makeshift locations like church halls or school gyms, hindering their effectiveness and sustainability. 

The project is based on multiple sources of advice on capturing the opportunities of the social enterprise model and 10 years of work by our collective. This has included the compilation of narratives from community members about trauma, mental health, family health, youth wellness, and the spaces that are needed to support community-centred programming.19,xxviii,xxix,xxx,xxxi,xxxii  

Early childhood education, counseling, family support, education, and research are all handled by different institutions, agencies and departments, and a family must navigate a complicated system to access a single service from any given agency. As a result of this fragmented model, non-profit community organizations, like Tasiuqtigiit Hand-in-Hand Society, and Qaujigiartiit Health Research Centre have formed independently to provide family- and community-centric programs and services that are designed by and for Inuit communities to support wellness and economic growth. Our organizations are important assets and make a positive contribution to our stretched-out system.  

In response to these challenges, the Qaujigiartiit Health Research Centre spearheaded an initiative to establish social enterprise businesses and community development corporations. The primary objective was to create dedicated spaces for community wellness hubs that would house various health and wellness programs, early childhood education initiatives, and Inuit pedagogical practices. By elevating Inuit pathways to wellbeing and integrating them into community healthcare systems, the initiative aimed to address the unique needs of the Inuit population. 

The Project 

The Inuusirvik Community Wellness Hub is a new commercial building in downtown Iqaluit, that is an innovative, self-sustaining, holistic, community-driven economic development with the intent that it can be replicated in other northern communities and across the Arctic. This is a need identified by all our communities in Nunavut, and by other communities across the North.xxxiii This project is about actualizing Inuit self-determination in achieving health and wellbeing.xxxiv  

The concept behind the hubs is to provide an economical and sustainable home to community-serving non-profit organizations, which houses services in a family-centred, evidence-based social enterprise model. This would provide wellness programming and services that will lead to increased health outcomes and community economic development. This innovative, self-sustaining, holistic, community-driven space that provides programs and services through a non-profit Inuit community-led model. Numerous studies have shown that where health improves, economic output and development also improves.xxxv,xxxvi,xxxvii,xxxviii,xxxix  

Inuit-focused Vision, Mission and Values  

Figure 2. Vision, Mission, Values for the Inuusirvik Community Wellness Hub 

Design and Development 

Working closely with architects, designers, and community members, the Qaujigiartiit Health Research Centre developed plans for the construction and renovation of facilities to serve as community wellness hubs. The design process prioritized Inuit science and architecture concepts, cultural sensitivity, accessibility, and functionality to ensure the spaces both reflected and catered to the diverse needs of the community. 

Program Implementation and Impact 

Upon the completion of the facilities, the focus shifted to the implementation of health and wellness programs, early childhood education initiatives, and Inuit pedagogical practices. These programs were designed to promote holistic wellbeing, cultural preservation, and community engagement. 

The establishment of community wellness hubs had a profound impact on the Inuit community, including: 

  1. Improved access to services. By providing dedicated spaces for health and wellness programs, community members gained easier access to essential services tailored to their needs. 
  1. Cultural revitalization. The integration of Inuit pedagogical practices and traditional approaches to health and wellbeing helped revitalize cultural identity and strengthen community connections. 
  1. Enhanced community wraparound services. The hubs served as focal points for community gatherings, workshops, and events, fostering social cohesion and collective empowerment. 
  1. Sustainable healthcare solutions. By incorporating Inuit pathways to wellbeing into community healthcare systems, the initiative contributed to the development of sustainable and culturally relevant healthcare solutions. The existence of this project and social enterprise business will ensure the regular sustained delivery of a multitude of programs based on Inuit holistic wellbeing including early childhood language and cultural programs, land-based programs for youth, Inuit counselling services, embedded literacy programs (e.g. cooking, skin prep, sewing, tool-making), drop-in public health and health promotion activities, and post-secondary and community-led lifelong learning/education initiatives in a variety of subject areas. 
  1. Sustainable commercial space for non-profit organizations. The Hub model provides rent-free space to a daycare and low-cost meeting and training space that suits the needs of non-profit service providers providing drop-in family programs.  
  1. Education and Training. Learning opportunities to Inuit in a variety of subject areas including but not limited to: trades, early childhood development, Inuit counselling, parenting and childrearing, nutrition and cooking, Inuit traditional skills (skin preparation and tool-making), visual and performance arts, youth training, and more. 
  1. More collaborative projects across non-profits. Co-location and collaboration will enhance tenant goal achievement; organizations can achieve more by working together. It will encourage greater efficiency, productivity, and economical outcomes for non-profit organizations and create rental and social shared spaces to enhance organizational cooperation and collaboration. The increase in amount and efficacy of the services non-profit organizations provide will increase the social and economic wellbeing of our community.   

Looking to the Future 

The Inuusirvik Community Wellness Hub, led by the Qaujigiartiit Health Research Centre, established a social enterprise business and community development corporation focused on systemic change and building an infrastructure to support Inuit worldviews on health and wellbeing. This initiative has significantly contributed to addressing the needs of the community. 

Supporting long-term sustainability and well-being in northern and remote areas requires a multifaceted approach, considering the unique challenges and opportunities faced in these regions. There are key lessons to be learned and put into practice through policy and evidence-based decision-making.  

Looking to the future, there are five key take-aways that we take with us in our work: 1) Community engagement and empowerment is a central theme in our work, and we take that focus with us into any new initiative without compromise; 2) Economic diversification and innovation is important, particularly in rural areas that see conflict between traditional market economies or extractive industries and sustainable industries that are more mindful of environmental impacts, climate change, relationships with lands and waters, and food security; 3) Infrastructure development can have a tremendous impact on the health of a community, in terms of water access, transportation, and communications, as well as health and wellbeing spaces; 4) Communities in the Canadian Arctic and, indeed, all across the country, are looking to environmental stewardship frameworks to enhance multi-level governance and meaningfully address conservation priorities and adaptations to climate change; 5) Future planning and visioning is essential to prepare for emergencies and population growth in rural areas that are already underserved because reactive approaches to emerging issues tend to be less thought-out and/or poorly executed and can have consequences for communities. Research and evidence is required to support decision-making at all levels.  

Figure 3 Lessons learned that form the foundation for future planning 

Implementing these policies and practices requires a holistic and integrated approach, ensuring that development is sustainable, inclusive, and respects the cultural and environmental contexts of northern and remote regions. As we look to the future, we are confident that health and wellbeing can be elevated by innovations that are grounded in the values and practices of our northern communities.  

Appendix A: About the Organizations 

Qaujigiartiit Health Research Centre 

The Qaujigiartiit Health Research Centre is an independent non-profit community research centre that has been operating in Iqaluit since 2006. It is the only independent, Inuit-governed fully functioning health research centre in Canada. The goal of Qaujigiartiit is to enable health research to be conducted locally, by northerners, and with communities in a supportive, safe, culturally-sensitive and ethical environment. They also promote the inclusion of both Inuit and Western epistemologies and methodologies (ways of knowing and doing) to address health concerns, create healthy environments, and improve the health of Nunavummiut. Qaujigiartiit works collaboratively with community members to develop evidence-based training workshops, curriculum resources, and innovative solutions to community concerns, and evaluates the projects and programs to provide a rich evidence-base for Nunavut decision-makers and innovators. Qaujigiartiit is well-known in Nunavut and in the Circumpolar world for the integrity of its research and for the use of Inuit conceptual frameworks for research and evaluation. Qaujigiartiit is the primary lead for this project, has gathered the evidence to support the implementation of the Hub model, and is evaluating the implementation of the model for adaptation/replication in other northern communities.  

Tasiuqtigiit Hand-in-Hand Society 

The Tasiuqtigiit Hand-in-Hand Society has been operating as a non-profit community agency in Iqaluit for more than 20 years. It started and continues to run the first and only Inuktitut preschool program in Iqaluit, as well as provides a variety of drop-in and after school programs for mothers and children. They also lease and manage apartments for childcare workers to help daycares in Iqaluit provide housing for long-term staff. Tasiuqtigiit Hand-in-Hand Society is implementing the early childhood education and parenting support programs identified for the Inuusirvik Community Wellness Hub.   

References 

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