| Summary: | Pharmaceuticals are an essential component of modern health care as their therapeutic properties are often required to achieve optimal health outcomes. The pharmaceutical market is also a significant contributor to health care expenditures, with global sales exceeding US$300 billion and expenditures predicted to increase. These global factors necessitate the development of pharmaceutical policies that are adaptive to local contexts and address the complexities of purchasing, distribution, prescribing and administration practices that best suit the needs of local populations. Through multi-method research, my doctoral thesis explores three areas of pharmacy health care in Nunavut, Canada: policy and practice, discordance in health models, and language translation. First, this research examines the pharmacy policy currently serving remote communities in Nunavut, a territory affected by weather-related access issues, scarce human resources and complex financial allocations. Current policies are often in conflict with patient-centred care and result in significant pharmaceutical waste. Revised policies may better support health providers, and address distribution issues to optimize financial expenditures. Second, pharmaceutical health care is part of biomedicine, which offers sharp contrast to the more holistic Inuit wellness model. In Nunavut, although the majority of inhabitants are Inuit, biomedical health care is delivered primarily by Qallunaat (non-Inuit) health providers. This research uses a comparative framework to contrast these two health models to explain how multiple levels of cultural discordance layered with postcolonial inequalities may influence patient-provider relationships and patient adherence to pharmacotherapy. Third, this research considers language discordance in pharmacy health care in Nunavut, where pharmacy services are delivered in English to predominantly Inuit language speaking patients. Pharmacy language discordance can result in adverse drug events and serious patient harm. This situation is currently in transition as language legislation in Nunavut will soon require pharmacy services to be available in Inuit languages and efforts are underway to standardize Inuit-language pharmaceutical terminology. Together, these three issues influence the quality of pharmacy health care in Nunavut and this thesis contributes to a greater understanding of issues which hold the potential to direct future endeavours towards the optimization of pharmacy health care in Nunavut. Ph.D.
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