I would first like to thank the committee for the opportunity to speak.
Tuberculosis control programming in Canada is a provincial-territorial responsibility, with the exception of tuberculosis control in first nations communities and selected Inuit communities, largely those in Atlantic Canada and south of the 60th parallel, where tuberculosis control is a shared federal and provincial-territorial responsibility.
One must be careful with respect to tuberculosis incidence rates in aboriginal peoples, as the only two aboriginal groups in which there is reasonably reliable denominator data are status Indians and the Inuit. However, if we put aside denominator data for the moment and include all aboriginal groups, the gravity of the tuberculosis situation in aboriginal peoples is evident in a single observation. The absolute number of tuberculosis cases in aboriginal peoples in Canada has not changed for 15 years or more, while it has been steadily falling in non-aboriginal peoples.
From 2003, the absolute number of cases of tuberculosis in the aboriginal peoples of Canada, who comprise only 4.7% of the Canadian-born population of Canada, has exceeded the number of cases in the remainder of the Canadian-born population. The ignominy of persistent, seemingly intractable tuberculosis in the aboriginal peoples of Canada while rates of tuberculosis in the Canadian-born, non-aboriginal peoples continue to fall and ratios between the two groups continue to rise is not to be borne by people of conscience in a developed country.
I would encourage the federal government to adopt a broader perspective. First, more than ever, aboriginal peoples need to be at the table federally, provincially, and territorially. Historically they have not had a seat at the table. If they are not given a seat, we, the dominant society, will only continue to promote our legacy to aboriginal peoples, a legacy of learned helplessness, which if we are to move forward we must recognize as untenable. Education of both societies with a view to a deeper understanding of our history and commonality are in order.
Second, the bacterium that causes tuberculosis is uniquely well adapted to exploit weakness in the social development of its host. The disease thrives wherever conditions of poverty exist. The unrelenting success of this pathogen inculpates each new generation of its host in its failure to address the basic social needs of all. Attention to the upstream determinants of health, which impact the proximate risk factors for tuberculosis, is urgent. Aboriginal peoples have on average more frequent contact with people with active TB, a higher likelihood of crowded and poorly ventilated living conditions, limited access to safe cooking facilities, more food insecurity, lower levels of awareness and/or less power to act on existing knowledge concerning health behaviour, and limited access to high-quality health care.
Addressing the social determinants of health is a tuberculosis prevention paradigm that is complimentary to the traditional biomedical prevention paradigm of providing preventive therapy to someone who has latent infection. There is a historical and moral imperative for all Canadians to address this socio-economic disparity. This imperative goes far beyond tuberculosis, but tuberculosis as a social disease is like a barometer in measuring the success of our efforts.
With respect to all of the above, government must recognize that public health achievements may well depend on actions outside the health care sector. They must be prepared to work across ministries and in a non-partisan spirit that goes beyond election cycles and pursues social policies aimed to promote equity in health.
I'll stop there.