TB burden suffered by indigenous communities

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TB burden suffered by indigenous communities
Global Indigenous STOP TB Initiative 23 April
2008, United Nations Headquarters
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Objectives of the session

• During this session we will
• Present the situation starting with our
  experience in Canada
• Illustrate the plight of indigenous communities
  with respect to tuberculosis.

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Stop TBGovernment of Canadas role

• We also recognize the importance of a united
  global effort to stop tuberculosis (TB)
• We know that one reason for its continued spread
  is because those living in poverty do not always
  have access to the proper care
• We support the G8 Okinawa Declaration
• We hope to reduce the number of on-reserve First
  Nations individuals living with TB to 3.6 per
  100,000.

http//www.hc-sc.gc.ca/dc-ma/tuberculos/index_e.ht
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Tuberculosis among First NationsThe context

• During the early decades of the 20th century, a
  terrible epidemic of tuberculosis (TB) occurred
  in the Canadian First Nations population
• Death rates were in excess of 700 per 100,000,
  among the highest ever reported in a human
  population
• TB death rates among children in residential
  schools were as high as 8000 per 100,000, during
  the 1930s and 1940s.

http//www.hc-sc.gc.ca/dc-ma/tuberculos/index_e.ht
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HIV among First NationsThe context

• Although incidence (new HIV infections among the
  total population) has gone down in the Canadian
  population, it appears that HIV rates have been
  steadily increasing in First Nations and Inuit
  populations.

http//www.hc-sc.gc.ca/dc-ma/tuberculos/index_e.ht
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Trend in TB in non-aboriginalBorn in the country
Change from 1990 to 2015 Australia 1/7 Canada
1/23
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Trend in TBRate ratio for Indigenous groups
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Other Indigenous groups

• In USA in 2002, American Indian / Alaskan Natives
  had a risk 6 times higher and rising compared to
  non-Hispanic white Americans
• In Kalaallit Nunaat, residents have a risk 45
  times and rising that of Danish-born
• In New Zealand, Pacific Islanders and Maoris have
  a risk of 22.3 and 10.5 times
• In Taiwan, aboriginal children and adults have a
  risk gt10 times and 4-5 times.

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Transitions in TuberculosisWeb of causation
Mycobacterium tuberculosis
Crowding
Exposure
HIV
Infection
Tobacco smoke
Disease
Poverty
Diabetes mellitus
Biomass smoke
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Role of StopTB strategy

• Multi-pronged, comprehensive strategy
• Core of technical quality and simplicity
• Participation of all sectors
• Crucial role of government
• Engagement of the community.

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Summary

• Tuberculosis is unquestionably a substantial
  challenge to the health of indigenous
  populations
• While this problem may be improving in some
  locations, in most it is not
• The disease cannot be addressed by technological
  solutions alone but must entrain political
  commitment and community involvement.