The federal government has pledged to eliminate the scourge of tuberculosis in Canada’s North – and hard-hit Inuit communities specifically – by 2030.
“Not only can Canada eliminate TB in Inuit communities, we have a moral imperative to do so,” said Jane Philpott, the Minister of Indigenous Services.
Those are welcome, long-overdue words.
Even more welcome is Dr. Philpott’s acknowledgment that this is not strictly a medical issue.
TB is a disease caused by the pathogen Mycobacterium tuberculosis, but it is really a social disease, one that spreads and flourishes where there is poor housing, food insecurity and poverty, which describes to a T the conditions in which many of the 65,000 Inuit live.
The rate of tuberculosis among the Inuit is 300 times higher than among Canadian-born non-Indigenous Canadians not because they are more susceptible to illness, but because they lack adequate housing, malnutrition is commonplace due to a lack of affordable food and scant employment opportunities mean too many families have trouble making ends meet.
Going forward, we cannot underestimate the size of the challenge. But the way to tackle public-health problems is with precise goals and concrete plans and, to its credit, Ottawa is taking that approach.
Dr. Philpott set a specific timetable – reduce active TB cases by half by 2025 and eliminate the disease by 2030. Ottawa has also backed up its talk with money, $27.5-million over five years for prevention, screening and treatment. Specific plans for each of the four regions of Inuit Nunangat (traditional Inuit territory) are also being developed in conjunction with the Inuit Tapiriit Kanatami, the organization that represents the Inuit in Canada.
A new report by Dr. Theresa Tam, the Chief Public Health Officer of Canada, titled The Time Is Now, outlines the basics of the TB problem well.
Tuberculosis is one of the world’s oldest and most common infectious diseases, affecting about two billion of the eight billion people in the world. In 2016 alone, TB infected 10.4 million people, killing 1.7 million.
On a global scale, Canada’s TB problem is minuscule, with 1,700 cases annually – almost all of them in refugees and immigrants from countries where TB is endemic, and in First Nations and Inuit people − and a handful of deaths.
Screening and treatment of refugees for TB is standard procedure. But testing in Inuit communities is only now beginning in earnest, prompted largely by the death of 15-year-old Ileen Kooneeliusie of the tiny hamlet of Qikiqtarjuaq in January, 2017.
That someone should die of a treatable disease such as TB in a wealthy country such as Canada is unconscionable. Yet, last week, another Inuit teen, 14-year-old Gussie Bennett, also died of TB.
These deaths are, in many ways, a perpetuation of Canada’s shameful history of neglect of Indigenous peoples.
Tuberculosis was the leading cause of death in residential schools – where the TB mortality rate was 8,000 per 100,000 population, one of the highest rates ever recorded in the world.
Until the 1950s, TB rates in First Nations and Inuit communities were as bad as in the developing world, and the solutions imposed were often cruel.
“Hospital ships” travelled to the Arctic, doing rudimentary screening; suspected sufferers had “TB” printed on their hands, and were forcibly removed for treatment in sanatoriums in the south. Many were children. For the Inuit, this dislocation and destruction of families ranks with the horrors of residential schools for First Nations people.
Given this backdrop, one can understand why there might be reluctance about screening and treatment, and even vaccination. (Nunavut is the only territory in Canada that routinely vaccinates children with Bacillus Calmette-Guérin, or BCG, a moderately effective vaccine.)
That stigma, however, can be overcome, especially if the TB program leads to improved health care and if governments live up to their broader commitments to improve the social conditions that allow TB to flourish.
Dealing with chronic housing problems, punishingly high food prices and financial challenges in the part of Canada with the fastest-growing population is going to require much more money and visionary plans that extend well beyond tackling one disease by 2030.
TB is a symptom of social inequity. It is also an opportunity to demonstrate what reconciliation means in practical terms.
The litmus test for success will not be if the bacterium stops spreading, but whether the conditions that have allowed it to spread for so long disappear.