Thank you.
As Rosemary Brown has said, “Until all of us have made it, none of us have made it,” and clearly we haven't made it here in Canada yet.
What is stunning, as Dr. Hershfield said, is that the root causes haven't changed. If Dr. Hershfield had déjà vu, I'm sure that Dr. Osler, who in 1900 said that TB is a social disease with a medical aspect and we need to look at housing and nutrition, would clearly be appalled.
The global picture of TB reflects the same inequities we see in first nations in Canada in low-income countries, where poverty and the distribution of poverty is massively inequitable, especially in Africa and South Asia. As well, the expenditure on health care is reflective and inequitable. It has an impact as one of the determinants of health, and thus is one of the determinants of tuberculosis.
There are 370 million indigenous people worldwide. No one knows the prevalence of tuberculosis, because most national tuberculosis programs don't count indigenous people, and there are very significant barriers in access to care.
Canada has made commitments to the world in reducing tuberculosis through a number of initiatives. The millennium development goals include tuberculosis as one of the goals, and there is a call for global partnership to address these issues. We are committed to those millennium development goals, yet here in Canada we have seen an increase in tuberculosis amongst our first nations communities. So while we should be concerned about reaching millennium development goals globally, we should be concerned about our inability to address progress amongst first nations communities. We have committed over $124 million worldwide to tuberculosis, and we will be called upon to reinvest in the global fund next year.
What is needed is a health systems approach, not a health care approach. We've heard this today. We put a little diagram together for you to pull those ideas together. It integrates social determinants and health in all policies; establishes processes for measuring the quality, reach, outcomes, health information systems, surveillance systems, human resources, and evidence-based approaches that are culturally sensitive. It engages communities to allow them to be empowered and accountable, with an ability to interact with governments, researchers, private sector, and other civil society players.
At a global indigenous TB meeting last year, a framework on opportunities for leadership for Canada, in Canada and abroad, brought forward a number of recommendations that we put in our report. They can be considered by this committee.
In closing, it's clear that we need policy coherence. We need to bring together the different policy demands. I suggest an interdepartmental committee be struck to address this issue.
Thank you.