Tuberculosis and Colonialism: Current Tales about Tuberculosis and Colonialism in Nunavut

Abstract

The objective of this study was to examine Inuit experience and make meaning of tuberculosis (TB) and how this may relate to the prevalence of TB in Nunavut. The study was conducted through seven months of fieldwork in two Nunavut communities using ethnographic methods for data collection including interviews, observation, participant observation, and document review. The study found that Inuit participants made meaning of TB through a combination of biomedical and traditionally Inuit holistic explanations. The theme of colonialism recurred as an influence shaping the Inuit experience of TB, through socio-political effects of colonization, such as poverty and substance abuse, and through continuing colonialism, including offering public health education in culturally incongruent ways. Examples of discrimination within and outside the healthcare system were also described as effecting the Inuit experience of TB. In order to decrease the incidence of TB in Nunavut, decolonizing measures are necessary. Decolonizing measures include embracing Inuit ways and values in educational, health and political matters. In order for this to be possible and to reduce poverty, an infusion of funds from the federal government is needed. Euro Canadians working in the Nunavut healthcare system must also examine the assumptions, motivations and values that inform their work.

Addressing the persistence of Tuberculosis Among the Canadian Inuit Population: The need for a social determinants of health framework

“…In addition to having lower levels of health, the Inuit also experience significantly lower standards of living than other Aboriginal populations as well as the nonAboriginal Canadian population (Adelson, 2005;Møller, 2010). See Tables 2, 3 and 4 for social indicators including, income, unemployment, and incidence of crowded housing (Statistics Canada, 2006a, 2006c, 2006d.…”

“…Entrance into the wage economy was necessary, and the low availability of employment left many families struggling on social assistance (Indian and Northern Affairs Canada, 1996;Pretty & Samson, 2006). This created poor living conditions in many Inuit communities, which are still prevalent today (Møller, 2010). For example, 31% of Inuit live in crowded homes ("more than one person per room"), and many homes are in poor condition (28% "in need of major repairs"), without running water (Møller, 2010;Loppie Reading & Wien, 2009, p. 9).…”

“…For example, 31% of Inuit live in crowded homes ("more than one person per room"), and many homes are in poor condition (28% "in need of major repairs"), without running water (Møller, 2010;Loppie Reading & Wien, 2009, p. 9). Compared with the general Canadian population, Inuit experience lower levels of education attainment, higher infant mortality, shorter life expectancy, significantly higher rates of suicide, higher morbidity, and higher levels of unemployment (Hicks, 2007;Møller, 2010;StatsCan, 2001 a, b;Nunavut Department of Health and Social Services, 2002). Many communities also suffer from high rates (higher than the average for Canada) of sexual, physical, and substance abuse (Møller, 2010;StatsCan, 2001 a, b).…”

“…The poor living conditions of the Inuit are well documented, as is the high prevalence of TB (Bjerregaard, Young, Dewailly, & Ebbesson, 2004;Grzybowski & Allen, 1999;Hotez, 2010;Kunimoto, Chedore, Allen, & Kasatiya, 2001;Loppie Reading & Wien, 2009;Møller, 2010;Nguyen et al, 2003;Richmond, 2009). Indeed, evidence from around the globe suggests that the determinants of TB are not purely biomedical (Barr, Diez-Roux, Knirsch, & Pablos-Méndez, 2001;Clark, Riben, & Nowgesic, 2002;Dubos & Dubos, 1952, 1987Elender, Bentham, & Langford, 1998;Farmer, 1999;FitzGerald, Wang, & Elwood, 2000;Gibson, Cave, Doering, Ortiz, & Harms, 2005;Mangtani, Jolley, Watson, & Rodrigues, 1995;Møller, 2010;Rubel & Garro, 1992;Spence, Hotchkiss, Williams, & Davies, 1993;Wanyeki et al, 2006). Rather, there is a growing base of evidence to substantiate the strong pathways between TB incidence and various social and economic determinants (Cantwell, McKenna, McCray, & Onorato, 1998;Clark et al, 2002;Elender et al, 1998;Farmer, 1996;Farmer, 2000;Spence et al, 1993).…”

“…Rather, there is a growing base of evidence to substantiate the strong pathways between TB incidence and various social and economic determinants (Cantwell, McKenna, McCray, & Onorato, 1998;Clark et al, 2002;Elender et al, 1998;Farmer, 1996;Farmer, 2000;Spence et al, 1993). In the Canadian literature around Aboriginal TB however, only a handful of studies (Clark et al, 2002;Møller, 2010) have incorporated a social determinants of health (SDOH) framework for understanding and describing patterns of TB. Because of the strong policy reliance on biologically and genetically based scientific evidence in Canada (Kiefer, Frank, Di Ruggerio, Dobbins & Manuel et al, 2005), the lack of evidence detailing the links between social circumstance and TB incidence means that initiatives designed to combat TB in Canada's North have not focused on social, economic, or environmental factors.…”