Tuberculosis Is Still a Major Concern for Canada’s Inuit

Most Canadians think of tuberculosis as a disease of the past—something eradicated in the earlier half of the last century. But for Canada's Inuit population, the rate of incidence is currently almost 200 times greater, and it’s getting worse.

Jun 19 2014, 2:23pm

Image via Martha of the North.
While most Canadians think of tuberculosis (TB) as a disease of the past or something that people in the 1950s dealt with and solved, for some of our country’s population it remains a very real danger today. The disease, which kills about 1.8 million people worldwide every year, is pretty much non-existent among non-aboriginal Canadians. For Inuit, however, the rate of incidence is almost 200 times greater—and it’s getting worse.

“Tuberculosis is a serious disease that usually attacks the lungs, but can also affect other parts of the body, including the brain, lymph nodes, and bones,” Judith Gadbois-St-Cyr, a media relations officer with Health Canada, said in an email. The disease develops after someone contracts TB bacteria from an infected person. TB “is second only to HIV-AIDS as the greatest killer worldwide due to a single infectious agent,” according to a World Health Organization (WHO) fact sheet.

WHO’s Global Tuberculosis Report 2013 found that rates of TB are the lowest in high-income countries. Canada was one of the first examples of this type of country listed. Overall, Canada consistently has a TB rate of fewer than 10 people per 100,000. Among Inuit populations though, this rate is as high as 195 per 100,000. That’s even higher than the global average, 122, and comparable to rates in Afghanistan, India, and Bangladesh. It’s a bit better than Democratic Republic of the Congo’s rate.

Worldwide, TB rates are declining. But since 2003, TB rates among Inuit have been steadily climbing.

Terry Audla, president of Inuit Tapiriit Kanatami (ITK), a national Inuit advocacy organization, and a man who has dormant TB himself, attributed this to many factors, first and foremost overcrowding. “The transmittal of the disease is that much easier in cramped homes,” he said.

Inuit, more than any other group of Canadians, are most likely to live in over-crowded homes—despite the fact that, collectively, they are the largest private landowners on the planet. (Inuit land claims cover a whopping 40 percent of Canada’s landmass, according to the federal government’s Inuit Relations Secretariat.) And yet, “as a result of an ongoing housing crisis… Inuit are nearly eight times more likely than non-Aboriginal Canadians to live in crowded (more than one person per room) homes,” according to a strategy ITK released on TB among Inuit last year. The strategy also said that 3,300 homes are needed to deal with the immediate housing need in the most populous Inuit region, Nunavut.

This is partly because of the rapid pace at which Inuit families transitioned from semi-nomadic living to settling in permanent homes and cities. Just a generation ago, most Inuit families lived off the land, moving around based on animal migration patterns, said Audla. This, along with the effect of forced relocation programs, has created an ideal climate for TB to spread. The WHO says that TB rates are directly tied to an area’s wealth, resources, and power, and the social and economic conditions people are born into. The rapid “modernization” of Inuit society has resulted in massive problems of malnutrition, food insecurity, poor access to health care, and mental health and addiction issues, on top of the completely lacklustre housing situation.

Once someone has TB bacteria, they are more likely to develop TB disease if they don’t have regular access to nutritious foods. Malnutrition is one of the other major factors contributing to Inuit’s disproportionate TB rates, the ITK strategy says. Both traditional and so-called “market” foods are out of reach for many Inuit families. Climate change is melting the ice used to travel for hunting and killing off the hunted species themselves.  And a weekly basket of food that costs $224 in Ottawa costs $382 in Iqaluit, $422 in Resolute, and $457 in Coral Harbour. Couple that with the fact that the average Inuit salary is $10,000 less than the Canadian average and you get this bleak reality: for many Inuit families, a year’s worth of groceries costs almost an entire year’s salary.

That kind of economic divide is nothing short of a crisis.

It’s likely that TB has killed more Inuit than all the other diseases white people brought to Canada combined, according to the ITK strategy. When TB became a mass epidemic in the 1930s and decades following, Canadian Inuit had the highest TB rates in the world. “Formal requests and proposals for the construction of health-care facilities that specialized in TB care (TB sanatoriums) at various locations throughout the Arctic followed, although none were ever built,” the report says.

Instead, the government shipped a seventh of the Inuit population south for treatment, keeping no records of who came from where or what happened to them. Relatives are still searching for answers about what happened to their loved ones to this day. All of these factors have made it hard for Inuit to trust the health-care system, which in turn makes it even harder for those infected with TB to get the treatment they need, Audla said.

An action plan to tackle TB is in the works, he said. The strategy released last year provided the research necessary to move forward. “Renewed and enduring political, financial, and community commitment will be critical” to fix the problem, the report said. “Expanding partnerships, reducing tobacco addiction, and incorporating new and evolving tools for TB detection, treatment, and prevention might also be part of the solution. The path forward is clear.”

Audla said TB was recognized as a federal priority in Inuit health two years ago, but he “wouldn’t say we have the necessary funding.”

In her email to VICE, Gadbois-St-Cyr said, “the Government of Canada recognizes that Aboriginal communities are disproportionately affected by tuberculosis. We are committed to working with our provincial and territorial health partners, and with Aboriginal communities to address this problem.”

For his part, Audla is optimistic that change can happen. “All we’re trying to do is get at par with other Canadians,” he said. “We have nowhere to go but up. You need to have a good attitude to make progress.”