There has been significant progress towards United Nations Sustainable Development Goal (SDG) 3, ensuring healthy lives and promoting well-being for all. However, SDG 3.3, which aims to end communicable diseases by 2030, remains off-track, especially for tuberculosis (TB).
In 2020, Statistics Canada reported that the rate of TB was over 300 times higher in Inuit Nunangat, the Arctic homeland of the Inuit (spanning the Northwest Territories, Nunavut, northern Quebec and northern Labrador) than among Canadian-born, non-Indigenous populations.
TB is an infectious illness that affects the lungs. It was the world’s leading cause of infectious death in 2022 after COVID-19. The goal of the World Health Organization’s (WHO) End TB Strategy is to reduce TB incidence by 80 per cent by 2030. Unfortunately, TB rates are instead steadily increasing.
Statistics Canada developed the Canadian Indicator Framework (CIF) as part of Canada’s commitment to achieving the SDGs. One of its targets is to reduce the incidence of active TB by 50 per cent by 2025 and eliminate it across Inuit Nunangat by 2030.
TB among non-indigenous Canadian populations had an incidence rate of 0.3 per 100,000 in 2021. The corresponding figure for the Inuit population was 135 per 100,000. These alarming statistics raise the question of why such stark disparities exist between two populations in the same country.
The mismanagement of TB in Canada among Indigenous populations had catastrophic repercussions for communities in Inuit Nunangat.
Scholars found that from the 1940s to the 1960s, the Canadian government addressed the epidemic by forcibly removing sick people from their homes and moving them to sanitoriums—medical facilities designed to treat specific diseases in southern Canada.
Many Indigenous patients lived in sanatoriums for an average of two-and-a-half years with little or no contact with their families. They were generally unaware of where they were going and the medical treatment they would receive. Healthcare workers did not even speak the patients’ language. Perhaps worst of all, information about deceased patients was not reported to their families.
The systemic mishandling of TB cases and treatment set the stage for distrust between Indigenous communities and the Canadian healthcare system. Many Inuit are reluctant to undergo TB screening, causing delayed diagnoses and treatment and contributing to ongoing transmission. To top it all off, the lack of adequate healthcare resources and infrastructure in Inuit Nunangat increases the incidence of TB.
In an attempt to resolve this problem, the Canadian government finances medical transportation for Canadian Inuit living in the north to receive medical treatment in southern Canada. However, when receiving care from healthcare workers in the south, patients are left to deal with the language barrier and cultural differences that often hinder the effectiveness of their care.
“There is some fear and estrangement from the healthcare system which contributes to reluctance or opposition to seeking treatment”, says Richard Budgell, a Labrador Inuk who has worked on First Nations and Inuit health as a public servant in the federal government for over 30 years. He now develops and teaches Inuit-specific health courses in his capacity as Assistant Professor in the Department of Family Medicine at McGill University.
Budgell says Iqaluit, the capital of Nunavut, has a large hospital serving the populations of the Baffin region and Iqaluit, but there is still significant reliance on hospitals outside Nunavut.
“We have become so reliant on medical transportation that minds become closed to other options”, Budgell says, as the federal government focuses more on funding medical transportation to hospitals in Ottawa, Winnipeg and Montréal than on healthcare in Iqaluit.
Additionally, various social and economic inequities, such as poverty and inadequate healthcare systems, contribute to the prevalence of TB.
Poverty, which presents as overcrowding and poor housing quality, can increase exposure to indoor mould and the transmission of airborne TB bacteria. Malnutrition caused by chronic food insecurity in the northern regions also increases the risk of developing TB.
Eliminating TB throughout Inuit Nunangat will require a comprehensive strategy that includes collaboration with various stakeholders to deliver culturally competent healthcare.
The first step is having healthcare providers who understand the historical and current context of TB and work alongside indigenous communities to create a TB plan.
Moreover, such a care plan would need to address barriers like language, consider Inuit patients’ life priorities and their social and economic challenges, address the stigma associated with the healthcare system, and increase the uptake of screening and treatment.
Academics say increasing investments in contact tracing programmes and residential infrastructure to reduce overcrowding will help decrease the rate of TB.
As for whether Canada will be able to achieve a 50 per cent reduction in TB rates by 2025 remains questionable.
Research in 2022 used disease simulations to model various scenarios under current plans and found that such a goal would not be achievable by 2025 for the Inuit Nunangat region.
“Every dollar spent on medical transportation is a dollar not devoted to work to incorporate Inuit health knowledge into medical practice”, Budgell says.
The persistent challenge of TB within Indigenous communities demands a multifaceted and urgent approach that acknowledges historical injustices, systemic barriers and the social determinants of health. Only when this is realized can Canada hope to achieve the goals set out in SDG 3.3 and help ensure healthier lives and well-being for all.
Edited by Angel Xing and Ali Shahrukh Pracha