Issue 32: Inuit in Canada and the 'problem behind the problem'

For Inuit in Canada, the COVID-19 problem is a reminder that tuberculosis continues to affect them at a rate 300 times that of the non-Indigenous population

May 05, 2020

Today’s briefing is written by Matthew Zammit-Maempel (MZM), a Nunatsiavut beneficiary and graduate student at the Max Bell School of Public Policy. He is currently riding out the pandemic in Ottawa.

The Unknown Future of a Known Disease

It is released in the air and spreads through the inhalation of bacteria.

It is difficult to detect without proper testing.

Canada’s chief medical officer Dr. Theresa Tam has stated that some people are nearly 300 times more likely to contract it.

This disease is not COVID-19, but tuberculosis (TB).

As of 2016, the incidence of TB in Inuit Nunangat (the homeland of Inuit in Canada) was nearly 300 times higher than in the Canadian-born, non-Indigenous population. While public health officials work to eliminate COVID-19, Canadians must not forget the federal government’s promise to eliminate TB from Inuit Nunangat by 2030. This also includes their commitment with the national Inuit organization in Canada, Inuit Tapiriit Kanatami (ITK) to reduce active TB cases by at least 50% by 2025.

In the past few weeks, COVID-19 news has gone from coverage of its development into a global pandemic to plans on how things will “get back to normal.” But there was a brief period in between where the focus was on examining the social determinants of health. One may ask why some populations are more susceptible to catching infectious diseases. The answer lies in the fact that health outcomes are determined in large part by social and economic conditions. The very same determinants of Inuit health are found in the cases of both TB and COVID-19.

What are Social Determinants of Health?

Overcrowded and inadequate housing: 52% of Inuit in Inuit Nunangat live in crowded homes making self-isolation difficult, if not impossible. Housing is inadequate because of poor ventilation and air quality, and the need for major repairs. In Nunavut, housing construction costs are about three times more than the rest of Canada.

Poor access to healthcare: Nunavut has roughly 30 physicians per 100,000 people, compared to 119 physicians per 100,000 in urban health authorities. Separate from the geographic hurdle, urban Inuit experience substantive barriers in accessing culturally relevant health services.

Food insecurity: 70% of Inuit households in Nunavut are food insecure, meaning lack of access to reliable, affordable, and healthy food to fulfill basic nutritional needs. Numbers in Nunatsiavut, the Inuvialuit Settlement Region, and Nunavik are also very high.

These issues are not new and remain inextricably linked to Canada’s settler colonial policies: the forced relocation of Inuit to new settlement areas, residential schools, the Sixties Scoop, TB evacuations to the south, and much more. In the 1950s, it is estimated that 1 in 7 Inuit was living in a southern sanatorium, where many Inuit were separated from their families to be treated and tested without consent. Many never returned home. Prime Minister Justin Trudeau apologized for the federal government’s role in managing TB evacuations to the south from the 1940s to the 1960s, but the shadow of this time still looms large.

COVID-19 has brought social determinants of health back into the spotlight. Cases of the disease have already been confirmed in Nunavik (20), and while Nunavut’s first presumed case turned out to be a false positive, if the need to address the ‘problem behind the problem’ wasn’t clear before, it should be now. The response to COVID-19 in Inuit Nunangat must address TB and the history of underfunding and colonial violence that led to Inuit being more vulnerable to this disease.

Policy Responses So Far

Inuit-led initiatives are key to renewing the Inuit-Crown relationship. In February 2017, the Inuit-Crown Partnership Committee was established to monitor progress on social development, the implementation of Inuit land claims agreements, and reconciliation.

In March 2018, the federal government published The Time is Now which outlines their strategy for targeting TB with foreign-born populations and Indigenous people. Also in March 2018, ITK released the Inuit Tuberculosis Elimination Framework, an Inuit-led strategy in partnership with the Government of Canada. Ottawa committed $27.5 million over 5 years for TB elimination, and $400 million over 10 years to support the Inuit-led housing plans for the regions of Nunavik, Nunatsiavut, and the Inuvialuit Settlement Region, with Nunavut set to receive $240 million over the same period. As of 2019, leaders and communities from the four regions of Inuit Nunangat have each been designing their own regional action plans for the implementation of this framework.

Progress on TB elimination in Nunavut stalled in January 2020 when community screening clinics stopped due to lack of funding. Former federal health minister Jane Philpott reiterated that fulfilling the 2030 promise requires tremendous (and continuous) political will. This support is needed now more than ever.

In the meantime, $45 million has been committed to beneficiaries of Inuit land claims organizations through the Government of Canada’s COVID-19 Emergency Response Plan.

Moving Forward

Regardless of the political party in power, the Government of Canada must continue to support Inuit-led initiatives: self-government, financial support, and making issues affecting Indigenous people known to the rest of Canada. Wavering support for TB initiatives violates that commitment. Ottawa should not be given a pass because of the pandemic.

The future of public health planning requires breaking down colonial structures and starting anew. Community consultation can no longer be a last-minute addition. This reimagining must include research and policy design by Inuit, for Inuit.

Canadians everywhere are anxious for life to get back to normal. But that “normal” is characterized by the ongoing exclusion of the challenges facing Indigenous people from mainstream discourse. Discussions about the social determinants of Inuit, and more broadly, Indigenous health belong in the public square: the workplace and classroom. The student. The professor. The future policy leader.

This effort starts with you. TB remains prevalent, not because Inuit leaders haven’t taken up the charge, but because these discussions need to be amplified to a status greater than the ill-fitting title “Issues of the North.” COVID-19 has exposed systemic vulnerabilities that remain, and Canada’s response to TB must target the social determinants of health. (MZM)

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