The Conservative Government and the Re-Emergence of Tuberculosis in First Nations and Inuit Communities

By Thomas, Ginette | Canadian Review of Social Policy, January 1, 2015 | Go to article overview

The Conservative Government and the Re-Emergence of Tuberculosis in First Nations and Inuit Communities


Thomas, Ginette, Canadian Review of Social Policy


Introduction

Tuberculosis is an infections disease that started a dramatic and steady decline in Canada from the 1950s to the 1980s when the rates dropped significantly in the general population, and it appeared to have been beaten. It re-emerged as a public health issue in the 1990s, as the rates of tuberculosis started to rise again. However, when it returned, the rates of tuberculosis remained at much higher levels in First Nations and Inuit communities,1 while in the general population the rates declined to a level that is now approaching zero. The elevated rates of tuberculosis infection in First Nations and Inuit communities continue to be a public health concern and in 2010 it was the subject of a study by the House of Commons Standing Committee on Health. The Committee tabled its Final Report, entitled The Way Forward: Addressing The Elevated Rates of Tuberculosis Infection In On-Reserve First Nations and Inuit Communities (the Final Report), in the House of Commons on June 8, 2010. The Conservative government tabled its response to this Final Report on October 6, 2010.

This paper examines the government's response to addressing the issues that were raised in the Committee's Final Report. The Background section will provide a general overview of tuberculosis and the disparities in the prevalence of tuberculosis in First Nations and Inuit communities. The section on the House of Commons Standing Committee on Health (the Committee) will review the players involved in, and the major issues raised by the Committee's study of the elevated rates of tuberculosis in First Nations and Inuit communities. The section entitled Government Response will explore the government's interpretation of their responsibilities for the health of Aboriginal peoples and their commitment to addressing the tuberculosis problems in First Nations and Inuit communities.

Background

According to the Public Health Agency of Canada (PHAC), tuberculosis is a highly infectious disease that is spread from person to person, primarily through the air when a person with active tuberculosis exhales by coughing, sneezing or even just talking. Among the list of known risk factors for this disease, PHAC includes: living in communities with high rates of tuberculosis; living in a low-income household, in crowded and inadequately ventilated housing; or being homeless (PHAC, 2014,p. 55).

Tuberculosis is a disease with a long history in Canada, and during the first half of the twentieth century, it was a major cause of morbidity and mortality (PHAC, CLA & CTS, 2014,p. 8). Historical data on the reported number of cases of tuberculosis and the number of deaths attributed to tuberculosis are available from 1924 onwards, although these reports may not have captured all cases of tuberculosis. The reason for this discrepancy is that the data included only hospitalized cases of the disease, whereas the number of deaths captured all terminal cases of tuberculosis whether they were hospitalized or not. More accurate data started in 1933 when the systematic reporting of tuberculosis cases was introduced across Canada (PHAC, CLA & CYS, 2014, p. 8).

As Figure 1 below demonstrates, the historical rates of tuberculosis cases remain high until the 1940s, at which time the rates start to first level off, and then decline. This decline is attributed to improved living conditions, to the introduction of sanatoria across the country that served to isolate infectious patients, and to the discovery and introduction of streptomycin in 1944 as an effective antibiotic treatment against the tuberculosis bacillus (PHAC, CLA & CYS, 2014, p. 8) (Gandy & Zumla, 2003, p. 18) (Waldram, Herring & Young, 1997, p. 75) (Wherrett, 1977, p.17).

The prescriptive cure throughout much of the first half of the twentieth century involved rest, fresh air and segregation. Governments in most western nations undertook massive public health campaigns in order to diagnose, treat and prevent the spread of this highly infectious disease with the establishment of medical dispensaries, the construction and management of a network of tuberculosis sanatoria, and after the introduction of antibiotic treatments, providing support for patients in order to ensure that they receive drug therapy (Smith, 1988, pp. …

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