A recent outbreak of tuberculosis in Nunavut, with a population infection rate 62 times the Canadian average, points to a need to rebuild trust in public health to combat the disease, states an editorial published in CMAJ (Canadian Medical Association Journal) (pre-embargo link only) http://www.
Nunavut is Canada's third territory in the eastern Arctic, created in 1999. Its population is about 30,000 people, and almost 80% are Inuit, spread over an area of more than 2 million square kilometers.
At least 100 new active cases of tuberculosis were reported in 2010 involving adolescents and young adults as well as older people
Public health measures are in place in the territory with screening programs for school children and people in high-risk facilities such as homeless shelters and prisons but screening for the rest of the population is much less consistent and under resourced. The historical legacy of previous approaches to tuberculosis in which people were sent south, often without consent or notice to families, may be a barrier for control efforts.
"The ensuing mistrust of physicians and public health, combined with the stigma of tuberculosis, may still be hampering control efforts," write Drs. Noni MacDonald, Paul Hébert and Matthew Stanbrook.
The isolation and wide geographic distribution of communities in Nunavut, high rates of poverty and smoking and overcrowded housing with poor ventilation are other factors affecting the ability to control tuberculosis.
"Eradication of tuberculosis will require not only the implementation of immediate coordinated public health measures, but also long-term economic investments and growth to tackle poverty and poor housing," state the authors.
They conclude "this is not just Nunavut's problem -- it is Canada's problem. It's long past time that the people of Nunavut were freed from the "white plague."