Quick – what’s the first place you think of when you think ‘tuberculosis’?
I’m going to guess that you thought of peasants in the Middle Ages. Or a developing country. Or the movie Moulin Rouge and the tragic demise of Sadine (or whatever Nicole Kidman’s character’s name is).
Well…I’m sure you know where this is going. A couple of weeks ago, there was a media buzz about Nunavut’s tuberculosis rates which are something like 38.4 times the national average. (Nunatsiaq News wrote an article with more information here).
As I learned more about tuberculosis, its perfectly clear to me that tuberculosis is a disease that relates more to social determinants of health than it does to health behaviours – although they are a factor too. Thinking back to my first question – what do all three things (peasants in the Middle Ages, developing countries and Moulin Rouge) all have in common? At the risk of oversimplification, I would go with: poverty, overcrowded housing, limited access to medical care and/or limited medical knowledge and poor nutrition (is there any food or drink in Moulin Rouge that is non-alcoholic?)
Yes, Nunavut’s TB rates are higher than other places in Canada. Significantly higher in fact. But there is also more poverty, overcrowded housing, and restrained access to healthy, nutritious food – even in spite of subsidized shipping on healthy foods, its still more expensive and often of poorer quality and lesser selection than down south. Addressing these social determinants of health is crucial to see a decrease in tuberculosis here.
Luckily, the Government of Nunavut has a great treatment program that meets or exceeds Canadian standards. We track the illness and have tuberculosis-specific staff throughout the territory to make sure TB remains under control. But…like what needs to happen elsewhere in the world, TB is going to be here to stay until we address the social contributors – not just the medical ones.
Again – no need to reinvent the wheel. Check out these links for more information than I can fit in here: