We Must Do Better: Ending Tuberculosis in Indigenous Communities in Canada

By Alexandre Grant

This post is part of a series of opinion pieces in diverse mediums focusing on the theme “What makes you mad about global health?” These submissions are by McGill students who were part of the course PPHS 511 Fundamentals of Global Health in Fall 2021.

On November 25th, 2021, Nunavut’s Department of Health declared an outbreak of a dangerous infectious disease in Pangnirtung that is transmitted by inhaling infectious droplets, sometimes leading to a persistent cough, fatigue, loss of appetite, and fever. The infection I am referring to is not COVID-19, but another deadly disease: tuberculosis (TB). Unlike COVID-19, TB does not take up much room in the collective mind of most Canadian communities, as this disease is often viewed as having been almost completely eradicated for decades in Canada. After all, the rate of TB in Canada—4.9 per 100,000 in 2017—is one of the lowest in the world. However, this figure is not representative of the disparities that exist in TB in Canada today.

In 2016, the rate of TB in Canadian-born, non-Indigenous people was 0.6 per 100,000. While for Métis people, First Nations people, and Inuit, that rate rose to 2.1, 23.8, and 170.1 per 100,000, respectively. That’s nearly 4, 40, and 300 times the rate of Canadian-born, non-Indigenous people. And if, like me, these figures outrage you, it’s because they are indeed outrageous.

So why does TB continue to pose such a significant problem in Indigenous communities in Canada? The answer lies partly in the fact that TB is highly associated with the conditions of poverty, including overcrowding, malnutrition, and challenges in accessing health care.

For instance, First Nations people are almost 5 times more likely to report living in crowded households than non-Indigenous Canadians. In Nunavut, 52% of the largely Inuit population lives in social housing, 38% of which live in overcrowded conditions. Finding that a 4-bedroom house is occupied by more than 20 people, sometimes forcing household members to sleep in shifts, is not uncommon. Overcrowding is especially detrimental to interrupting the transmission of TB because it creates ideal conditions for the spread of TB within households.

In addition to this severe housing crisis that persists, food insecurity and malnutrition remains a significant barrier to health in Nunavut communities, with some households experiencing 7-fold higher rates of food insecurity than those in the rest of Canada. And this food insecurity is only expected to be worsened by climate change, namely by jeopardizing access to traditional foods derived from hunting and harvesting. Diet westernization has also introduced foods of poorer nutritional value and, for Arctic communities in particular, these foods are significantly more costly—at least twice the price—than in the rest of Canada.

Many Indigenous communities also face important challenges in accessing health care, especially in rural and remote areas. For First Nations people living on reserve, a difficulty in recruiting and retaining health care providers has led to long waitlists to receive care. This is detrimental to all aspects of health; however, in TB, this may translate to significant delays in the diagnosis and treatment of the disease, allowing for infected individuals to continue spreading the disease within their communities.

Accessible care can also be seen to mean care that is culturally competent. Indeed, TB care is a source of ongoing trauma, including as it relates to residential schools where TB ran rampant because of deliberate abuse and neglect. In the 1950s and 1960s, a time when at least one-third of all Inuit were infected with TB, many were taken against their will, put on boats, and brought South for treatment in hospitals and sanitoria, some never to be seen or heard from again by their families.

In Canada, significant socioeconomic disparities persist between non-Indigenous and Indigenous people. Combined with an enduring legacy of colonialism, mistrust, and cultural deafness, it is no surprise that First Nations people, Inuit, and Métis people continue to suffer from preventable and resolvable issues, including high rates of TB. This reality is completely unacceptable, particularly in Canada, a country with the means to rightfully fix these issues. We must simply do better.

References:

  1. Association, C. P. H. (2021). TB and Aboriginal people. Retrieved from https://www.cpha.ca/tb-and-aboriginal-people 

  2. Beaumier, M. C., & Ford, J. D. (2010). Food insecurity among Inuit women exacerbated by socioeconomic stresses and climate change. Can J Public Health, 101(3), 196-201. doi:10.1007/bf03404373 

  3. Canada, G. o. (2014). Tuberculosis in First Nations in Canada. Retrieved from https://www.sac-isc.gc.ca/eng/1570717311129/1570717353306 

  4. Canada, G. o. (2020). Tuberculosis in Indigenous communities. Retrieved from https://www.sac-isc.gc.ca/eng/1570132922208/1570132959826 

  5. Canada, G. o. (2021). Tuberculosis: Monitoring. Retrieved from https://www.canada.ca/en/public-health/services/diseases/tuberculosis/surveillance.html#a1 

  6. Heffernan, L. F. a. C. (2021). Residential school deaths from tuberculosis weren’t unavoidable – they were caused by deliberate neglect, Opinion. The Globe and Mail. Retrieved from https://www.theglobeandmail.com/opinion/article-residential-school-deaths-from-tuberculosis-werent-unavoidable-they/ 

  7. Hick, S. (2019). The Enduring Plague: How Tuberculosis in Canadian Indigenous Communities is Emblematic of a Greater Failure in Healthcare Equality. J Epidemiol Glob Health, 9(2), 89-92. doi:10.2991/jegh.k.190314.002 

  8. Huet, C., Rosol, R., & Egeland, G. M. (2012). The prevalence of food insecurity is high and the diet quality poor in Inuit communities. J Nutr, 142(3), 541-547. doi:10.3945/jn.111.149278 

  9. Jetty, R. (2020). Tuberculosis among First Nations, Inuit and Métis children and youth in Canada: Beyond medical management. Paediatrics & Child Health, 26(2), e78-e81. doi:10.1093/pch/pxz183 

  10. Nunavut, G. o. (2021). Public Health Advisory Tuberculosis Outbreak in Pangnirtung. Online Retrieved from https://www.gov.nu.ca/sites/default/files/2021-11_pha_hea_tuberculosis_outbreak_in_pangnirtung_-_eng_0.pdf 

  11. Patterson, M., Flinn, S., & Barker, K. (2018). Addressing tuberculosis among Inuit in Canada. Can Commun Dis Rep, 44(3-4), 82-85. doi:10.14745/ccdr.v44i34a02 

  12. Peoples, N. H. C. s. A. b. t. S. S. C. o. A. (2016). Nunavut is facing a severe housing crisis. Retrieved from https://assembly.nu.ca/sites/default/files/TD%20158-4(3)%20EN%20Nunavut%20is%20Facing%20a%20Severe%20Housing%20Crisis.pdf 

Acknowledgments:

We would like to thank Professor Madhukar Pai for setting and sharing this assignment results with us and the teaching assistants Alexandra Jaye Zimmer, Lavanya Huria and Angie Sassi for their support in coordinating the results.

Indigenous HealthMcGill Perspectives on Global HealthInfectious Disease, Indigenous Health, McGill, Ethics & Equity, Opinion