Good morning.
Current data reveal that the rate of TB for Inuit Nunaat is 185 times that of Canadian-born non-aboriginals. The significance of this cannot be ignored or dismissed. Social research has provided ample evidence that TB is a disease of poverty and social inequality. The same poverty marginalizes communities and threatens health through inadequate housing, food insecurity, and poor access to health care.
Inuit homes are the most crowded in Canada. It is estimated that 53% are overcrowded, a legacy of poverty and the government promise of housing to those who resettled, resulting in a high dependence on social housing, creating true hardship among all four regions, with impacts on psychosocial and physical health. It is estimated that Nunavut alone needs 3,300 housing units to address immediate need.
Inuit have the highest birth rate in Canada, a demographic reality that creates even greater housing need and results in multi-generational overcrowding that can present the perfect milieu for the transmission of reactivated TB from the elderly to the vulnerable young.
Inuit families are seven times more food insecure than other Canadian families. Food security is a complex issue in the north. Rising fuel costs impact immediately on the cost of produce brought in from the south and on the ability to hunt and fish for the country food so essential to optimal health. Weather variations due to climate change have a profound impact on food security, as witnessed this past year with mild temperatures and a lack of sea ice. Ice is essential to transportation and hunting.
The impacts of colonization and resettlement have led to communities in crisis, where coping mechanisms are challenged and addictions and underlying mental health issues are prevalent. These have an impact on wellness and healthy immunity that can make people more vulnerable to TB and can create challenges during treatment with adherence and drug toxicities.
The counselling supports needed for a holistic approach to TB are seriously lacking in many Inuit communities.
In regions with high rates of both latent and active TB, late diagnosis can further increase risk of spread. In many Inuit communities, there is no access to chest X-ray, and people have to fly out for service.
Why are the technologies for TB diagnosis not available where they are needed most? Tuberculosis is a simple medical diagnosis in a complex social situation. It cannot be mentioned without reference to the biological, historical, cultural, political, social, and economic conditions that have contributed, and continue to contribute, to this public health concern.
For Inuit, there appears to be a disconnect between what we know at the community level and what is known at the varying levels of governance and policy about what needs to be put in place to change health outcomes. Is the problem jurisdictional? Is it the lack of clarity around fiscal responsibility for Inuit? Is it the lack of capacity that forces a reliance on southern expertise, who may not have the cultural awareness for the appropriate fit?
Dr. Ellis, manager of TB prevention and control for the Public Health Agency of Canada, describes what is happening with TB among the Inuit as the perfect storm, where the combination of elements, each of which can cause concern, come together to create a serious situation.
Without the right type of intervention, the situation will continue to worsen. To treat TB without addressing the root causes is like using painkillers without looking for the source of pain: it will not go away. There must be a whole-of-government approach to Inuit health, with concrete goals set for immediate and long-term actions to address the social determinants that most impact TB among Inuit: housing, food security, income, and access to health care.
There is a call to consciousness that requires a strong commitment, both human and fiscal, and Inuit must be engaged at every step.
Nakurmiik. Thank you.