Disease incidence may by 90 times higher than in rest of Canada

Canada a world leader in Inuit tuberculosis”

By JOHN BIRD

Tuberculosis rates among Inuit in Canada may be 90 times higher than in Canada overall, Dr. David Butler-Jones, head of the Public Health Agency of Canada, told delegates to an international gathering in Toronto last week on tuberculosis and indigenous peoples.

Those rates are among the highest in the world in places where reliable statistics are available. Butler-Jones said poverty and overcrowded housing are mainly to blame.

"We have a tragic history when it comes to tuberculosis, and unfortunately for many Inuit communities, it continues to be today's reality," national Inuit leader Mary Simon said on the eve of the international forum.

The Toronto meeting, sponsored by Inuit Tapiriit Kanatami and the Assembly of First Nations, brought together representatives of indigenous organizations from over 60 countries.

Around the world, indigenous people suffer from much higher rates of tuberculosis than other populations, Gail Turner, director of health services for Nunatsiavut in Labrador, said after attending the global gathering.

It may be even higher among the Masai of Africa, or in indigenous groups in the Himalayas than among the Inuit, Turner said, but accurate statistics are not available for those areas.

"It's totally because of social determinants of health," she explained.

While proper health care is essential to treating the immediate problem, the real and lasting solution lies in improved housing, education, employment and diet, Turner said.

Turner, who stood in for ITK president Mary Simon at the meeting after Simon bowed out due to the death of her father, said indigenous peoples decided to come together to address the issue because nobody else understands the extreme social and economic contexts indigenous peoples face.

"But we understand each other," she said.

Tuberculosis, or TB, is an infectious disease that can remain dormant (or latent) for a lifetime. It may become active when the immune system is weakened, and most often affects the lungs.

Other organs may be affected, but TB can only be spread when active in the lungs, mostly by coughing as the bacteria must be "aerosolized" before they can be transmitted, Elaine Randell, a communicable disease consultant with the Government of Nunavut, said in an interview.

If active and untreated, the disease can kill. Persons with active tuberculosis may transmit it to as many as 15 other people, Randell added.

Latent tuberculosis produces no symptoms, cannot be transmitted, and can only be detected by a positive skin test.

It has been estimated that up to a third of the Inuit population of Nunavut may be infected with latent TB, Randell said.

There is about a five per cent risk of latent cases becoming active, she said, although it is higher for children.

Randell said Nunavut has an aggressive treatment program for people with either latent or active tuberculosis. Both types are treated with antibiotics, four different kinds for active TB, just one for the latent form.

Treating latent tuberculosis is a preventive measure, intended to stop the development of active tuberculosis.

The drug is administered in the presence of a health-care professional, to make sure that the full prescribed course of antibiotics is taken.

This prevents the development of drug-resistant forms of TB, Randell explained.

The health worker will also try to trace all the people the person with tuberculosis has interacted with while ill, as they may also have contracted the disease.

Health workers try, with parental consent, to do kindergarten or pre-school assessments to identify and treat children with either latent or active forms of TB.

Earlier this summer Randell told an Iqaluit meeting of northern public health directors there were 48 cases of active tuberculosis in Nunavut for 2006.

That produces a 2006 rate of 156 per 100,000 people, or 31 times the Canadian average of five cases per 100,000.

Gail Turner said the underlying issues that contribute to the spread of tuberculosis include:

  • overcrowded housing and poor air quality in houses;
  • food insecurity, when people are not able to eat properly to maintain their immune systems;
  • reduced access to medical services, including public health staffing at the community level, because of remoteness and the difficulty to keeping medical staff;
  • drug and alcohol abuse, because of its impact on personal and family health, and because abusers are often more difficult to hold to treatment;
  • smoking, because it compromises lung health.
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