Thank you.
I'm presenting today on the root causes of the elevated rates of tuberculosis infection in first nations communities. According to information recently released by the Public Health Agency of Canada, in 2008 rates of tuberculosis among members of first nations were 31 times higher than among others born in Canada. It is worth noting that this figure represents a rise in the rate of TB among first nations from only a few years before. It's unconscionable that rates of tuberculosis continue to increase among first nations in a country that otherwise boasts one of the lowest TB rates in the world.
Behind these rising rates are significant disparities between health services available to first nations and those available to other Canadians, as well as disparities in the social determinants of health. If we are to arrest the high rates of TB among first nations, we need to pursue two courses of action.
First, we need to improve the quality of TB control programming within the first nations and Inuit health branch so that it matches standards and resources applied elsewhere in Canada.
Second, we need to address the social determinants of health that contribute to the spread of TB in first nations communities.
Let me expand on the first point, improving the quality of TB control programming within the first nations and Inuit health branch. There is an urgent need to develop consistent program standards that will be followed in all of the first nations and Inuit health regions. These programming standards should be comparable to those that serve other Canadians and may even need to include additional measures to address issues such as latent TB, which, evidence would suggest, continues to persist at higher rates among first nations citizens.
In terms of programming standards, first nations and Inuit health in Ottawa funds its regional branches for TB control. When we examine what is happening in each region, we find there is no consistency in how regions program or monitor for TB in first nations communities. For example, there is no consistency across the region in how to define a TB outbreak. In the absence of an outbreak being declared, there are insufficient resources to control the treatment and spread of the disease. For example, regional health authorities and services are not brought in to assist and chief and council are not notified that persons have TB within their community.
Another example of this inconsistency is in the researching of case contacts, or, in other words, determining who may have come into contact with the disease and who may be at risk. It is left to the first nations and Inuit health regions to determine how many case contacts they will search and when they have searched sufficiently. Again we would suggest there should be national standards.
I also stated earlier that programming within the first nations and Inuit health branch should match standards and resources applied elsewhere in Canada. We looked at the health systems in the provinces and territories. Each sets annual targets related to TB cases, and they report to the Public Health Agency of Canada on the progress they make against these targets. For example, they may look at trying to reduce the number of cases by a certain amount on an annual basis or set a target for expanding their search for contacts.
Within the first nations and Inuit health branch, there are no annual targets for reduction of TB that would enable regions or the federal government to monitor the progress made in addressing TB or reducing rates. In fact, in a recent evaluation of the first nations and Inuit health branch communicable disease cluster, there were tables containing multiple gaps and blanks where there should have been information on a number of cases. This is an important gap that calls for immediate action. Programming and monitoring standards for first nations should be comparable to those that serve other Canadians.
If there is any doubt that programming and monitoring for tuberculosis in first nations falls below the levels serving other Canadians, I would point to data collected by the World Health Organization, which shows that Canada invests on average $47,000 in each case of tuberculosis for non-native patients. However, a report commissioned by the Public Health Agency of Canada reported that the first nations and Inuit health branch invests less than half--only $16,700 per case--in treating first nations citizens, including those in remote communities.
This table is shown as part of the package. Clearly, new investments are critical to closing the gap on standards of care between first nations and other Canadians.
I've also said that additional measures are needed to address issues such as latent TB.