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NCCs collaborate on a national forum, focus on eliminating TB in northern Indigenous communities

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Photo L-R: Dianne Oickle (NCCDH), Val Morrison (NCCHPP), Shivoan Balakumar (NCCID), Roberta Stout (NCCAH), Donna Atkinson (NCCAH), Margaret Haworth-Brockman (NCCID)

Canada’s northern Indigenous peoples are disproportionately affected by TB

Tuberculosis (TB) is an infectious disease that has created a significant burden of loss and hardship for Indigenous communities. It is a disease fueled by socioenvironmental factors such as poverty, food insecurity, and overcrowded housing. TB thrives in the presence of other health conditions such as HIV/AIDS and diabetes, diseases whose root causes similarly intersect with multiple social determinants of health, and also disproportionately affect Indigenous people. Finally, TB in Indigenous communities cannot be considered without also noting the context of colonization and inter-generational trauma. This long history includes the removal of Indigenous children and adults from their communities for treatment in non-Indigenous run institutions, creating generations of family hardship, isolation, and disruption.

While the overall incidence of TB among Indigenous communities has decreased over the past few decades, rates remain disproportionately high compared to the rest of Canada. A recent report[1] reveals these statistics: In 2015, the incidence rates among the Métis was almost four times higher than in the Canadian-born non-Indigenous population (2.2 per 100,000 population), among First Nations the incidence rate was 25 times higher (15.1 per 100,000 population), and among the Inuit, a staggering 270 times higher (166.2 per 100,000 population). What’s more, in recent years, progress in combating the disease has slowed.

NCCs hold national forum to explore partnerships and approaches toward TB elimination

Consultations and plans in northern health regions revealed a clear need to bring together community representatives, clinicians and public health planners. In response, the NCC for Infectious Diseases (NCCID), with support from the NCCs for Aboriginal Health (NCCAH)Determinants of Health (NCCDH), and Healthy Public Policy (NCCHPP), planned an in-person event to learn about the historical context and lived experience of those infected and affected by TB, and explore collaborative opportunities to end TB in the north.

Towards TB elimination in northern Indigenous communities was held on January 31 – February 1, 2018 on Treaty 1 territory, the traditional territory of Anishinaabeg, Cree, Oji-Cree, Dakota, and Dene Peoples, and the homeland of the Métis Nation (Winnipeg, Manitoba). This national forum convened Indigenous and non-Indigenous stakeholders working on TB from the Northwest Territories, Nunavut, northern British Columbia, Saskatchewan, Manitoba, northern Quebec, and Newfoundland-Labrador.

Lead organizer Shivoan Balakumar, Senior Project Manager at NCCID, reflected on the event’s significance:

“This event provided an opportunity to centre the voices and experiences of Indigenous community members and health organizations within a gathering of practitioners, decision-makers and researchers… especially necessary as the systemic inequities experienced by Indigenous people are intimately linked with the rates and outcomes of TB in northern communities.”  

Solutions lie in addressing root causes and engaging in true partnerships with northern Indigenous communities

The event was opened with prayers offered by three elders from Keeseekoowenin First NationManitoba Inuit Association, and the Metis Nation of Manitoba.

Throughout the two-day event, the agenda was designed so that participants could learn about innovative community-based TB strategies from each other. Knowledge exchange among participants was framed by stories graciously shared by Ron Gerard (BC), Boas Mitsuk (Nunavik), and William Tagoona (QC), who have personally experienced TB and its impact on northern Indigenous communities. Participants heard difficult stories of how Indigenous children were separated from their families - sometimes for years - a result of the colonizing policies of both residential schools and “Indian hospitals”, institutions which isolated Indigenous patients from their families and the rest of society. Through further presentations and sharing, participants also heard from public health programmers and nurses from Sioux Lookout First Nations Health AuthorityBC First Nations Health AuthorityNorthern Inter-tribal Health Authority (Saskatchewan)Inuit Tapirit Kanatami (ITK) as well as other Inuit regions. 

Throughout their discussions, participants considered systemic inequities experienced by Indigenous people and their role in perpetuating TB. Alongside equity issues such as poverty, inadequate housing, food insecurity, and lack of access to health services, Indigenous self-determination was a cross-cutting discussion theme. Isa Wolf, Communicable Disease Coordinator at First Nations Health Authority, described self-determination as a “determinant of TB”, and shared stories from her work with TB programs that focus on holistic concepts of wellness in addition to medical models of TB treatment and infection control. Isa went on to note that current TB approaches are designed with a “western colonial lens that needs to be undone. We can't heal TB until we heal the hurts of the residential schools."

Following the forum, TB elimination will continue to be a specific area of focus for the NCCID, and the NCCs will continue to engage with various partners committed to ending TB in Canada. These partners include the Canadian Tuberculosis Elimination Network (CTBEN), the Inuit TB Elimination Task Force, the Public Health Agency of Canada, and provincial and territorial TB elimination programs.

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[1]Gallant V, Duvvuri V, McGuire M. Tuberculosis in Canada - Summary 2015. Can Commun Dis Rep. 2017;43(3):77-82.