HomeIn Canada, there were 1.67 million Indigenous Peoples, comprising 4.9% of the Canadian population, according to the 2016 Census.1 The term Indigenous Peoples refers to the original inhabitants of the land, predating the arrival of Europeans. The Canadian constitution recognizes three groups of Indigenous Peoples: First Nations, with a population of 977,230 people; Inuit, with 65,021 people; and Métis with 587,545 people.2 In 2017, the incidence rate of TB among Canadian-born Indigenous Peoples was 21.5 cases/100,000 population,3 a rate that has not changed substantially in the past decade. Despite Indigenous Canadians representing only 4.9% of the Canadian population, they represent 19% of all TB cases, with the foreign-born population accounting for the majority of cases in Canada, at 71.8% of all cases in absolute numbers (see Chapter 1: Epidemiology of Tuberculosis in Canada, Figure 5).3
The impacts of historical traumas and systematic inattention paid to the upstream social determinants of health and comorbidities among Indigenous populations of Canada have shaped the TB epidemics seen over the past century. Available evidence suggests that TB did occur sporadically among Canadian Indigenous populations,4,5 as well as other Indigenous populations in the Americas, prior to European contact.6–8 However, genomic evidence suggests that TB was further dispersed into Canadian Indigenous populations as a result of contact between European fur traders with First Nations Peoples during the 18th century.9 Large-scale TB epidemics would unfortunately follow in the 19th and 20th centuries, propagated by ecologic, political and economic factors. The epidemic spread of TB in Indigenous populations was accelerated by the forced relocation of individuals who were separated from their families and sent to reserves, hamlets and residential schools.10 Forced relocation disrupted the relationship of Indigenous Peoples with their lands, the ancestral place where the totality of life occurred.11,12 These forced relocations caused malnutrition, as hunters and fisherman did not know the new territories where they were moved, making subsistence difficult or impossible.13–15 Once relocated, families lived in crowded conditions, which favored transmission of TB, while malnutrition fostered the progression of infection to disease.16–20 The death rate among Indigenous children in residential schools in Canada was exceedingly high at the turn of the last century and TB was a significant cause of death.21 All three Canadian Indigenous groups experienced significant disruption in their families and communities as those with TB were sent to sanatoria in southern Canada for treatment throughout the 1930s-1960s for long periods of time, sometimes never to return. The magnitude of the impact of evacuations to southern sanatoria, relocations and residential schools cannot be overstated. Survival was often accompanied by a legacy of emotional, psychological and physical scars. The history of TB in First Nations, Inuit and Métis communities speaks of transgenerational loss and suffering.16–20 Those who work in TB prevention and care in the 21st century must be aware of the existence of a collective memory of the suffering of individuals, families and communities associated with prior TB epidemics.
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