Milligan Crystal, Greenland Sharla, Storr Lorna, Pascal Agnes, Irlbacher-Fox Stephanie, Dobrow Mark J
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Gwich'in Tribal Council, Inuvik, NT, Canada.
Int J Circumpolar Health. 2025 Dec;84(1):2438430. doi: 10.1080/22423982.2024.2438430. Epub 2024 Dec 15.
In northern Canada, medical travel - the movement of patients to a larger centre to access healthcare services outside their home community - is a dominant feature of the healthcare system. This qualitative study explored the medical travel experiences of Gwich'in living above the Arctic Circle in the Gwich'in Settlement Area in Northwest Territories (NT). Data collection in 2020 comprised storytelling sessions with 10 Gwich'in medical travellers (6 female, 4 male). Using inductive and deductive methods with continual critical reflexivity, and guided by Gwich'in values, concerns about access to healthcare were found to be at the heart of each story. A broad conceptualisation of access was applied to understand and interpret the results according to six dimensions: accessibility, availability, affordability, adequacy, acceptability, and awareness. Situated within a context of colonialism, structural inequities and other factors relevant across the Circumpolar North, the results suggest that the NT medical travel policy framework provides only partial access to care. This article illustrates a need for healthcare and other government systems to think about policy and programmes in a more wholistic, equitable and relationship-centred way, which would help not only to bridge distances across geography, but also between peoples.
在加拿大北部，医疗旅行——患者前往更大的中心以获取其家乡社区以外的医疗服务——是医疗保健系统的一个主要特征。这项定性研究探讨了居住在西北地区（NT）北极圈以北的格威琴人（Gwich'in）的医疗旅行经历。2020年的数据收集包括与10名格威琴医疗旅行者（6名女性，4名男性）进行的故事讲述环节。运用归纳法和演绎法，并持续进行批判性反思，在格威琴价值观的指导下，人们发现对医疗保健可及性的担忧是每个故事的核心。根据可及性、可得性、可承受性、充分性、可接受性和知晓度这六个维度，采用了对可及性的广义概念化来理解和解释研究结果。鉴于殖民主义、结构性不平等以及环北极地区普遍存在的其他相关因素，研究结果表明，NT的医疗旅行政策框架仅提供了部分医疗服务可及性。本文表明，医疗保健及其他政府系统需要以更全面、公平且以关系为中心的方式来思考政策和项目，这不仅有助于跨越地理距离，也有助于弥合不同人群之间的距离。
