TB Manual

The Métis are a distinct group of Indigenous Peoples, with their own unique culture, traditions, language (Michif), way of life and nationhood.⁷³ The Métis Nation emerged in the historic Northwest during the 18th century, when European fur traders established relationships with local Indigenous women.⁷⁴ The offspring of these relations form the Métis Nation.⁷⁴ According to the 2016 population census, 587,545 people identified as single-identity Métis in Canada, accounting for 1.7% of the total population.¹ The majority of the Métis population lives in Ontario and the western provinces.¹ Alberta is the only province to have land-based Métis settlements. That said, there are many communities across the western provinces containing ≥25% Métis residents, based on Statistics Canada census data.³²

Citizens of the Métis Nation are not homogenous. Métis health outcomes and experiences with the healthcare system writ large, and specifically TB treatment, differ across the country and according to age, gender and socioeconomic status. There are significant social and economic differences, for instance, between remote northern Métis communities and Métis living in urban areas. As of 2016, Métis are a predominately urban population; 62.6% of Métis people live in an area of at least 30,000 people.¹ Métis residing in rural areas tend to face more challenges accessing consistent and high-quality healthcare.

According to the most recent statistics, there were 313 cases of TB reported among Canadian-born Indigenous persons in 2017. Of these Indigenous cases, 5.4% (n = 17) were Métis.³ Among Métis, the incidence rate of TB was 3.5 cases per 100,000 population, which is lower than the overall Canadian rate (4.9 per 100,000) but higher than the Canadian-born, non-Indigenous rate (0.5 per 100,000).³ Métis in the prairie provinces are disproportionately affected by TB, with cases largely concentrated (excluding Winnipeg) in a relatively small number of Métis settlements/communities in the northern portion of each province.³² The higher prevalence of TB relative to the Canadian-born, non-Indigenous population is mainly due to social determinants of health, which cannot be understood in isolation from the historical processes of colonization, forced assimilation and social exclusion.

The Métis Nation’s history, especially in the context of TB, is often left out of the mainstream narrative of Canadian history. Like other Indigenous Peoples, the Métis Nation was devastated by the smallpox epidemic and later, TB infection.³⁵ Many Métis children also attended residential schools designed to remove children from their families and to assimilate them into European culture.⁷⁵ Often, Métis children suffered physical, emotional and sexual abuse in these schools.⁷⁵ Conditions in residential schools were considered “breeding grounds” for TB.⁷¹ In 1907, Dr. Peter Bryce, the first Chief Medical Officer of the Department of the Interior, released a report stating that roughly one-quarter of all Indigenous children attending residential schools at that time had died from TB.³⁹ From the 1940s through to the 1960s, doctors confined infected Métis Nation members in TB sanatoria, cutting patients off from their family and communities.⁷¹ After long periods of confinement in the sanatoria, those who survived found it challenging to re-integrate into their home communities.⁴² The stigma of a TB diagnosis only compounded the feelings of isolation by patients. Contemporary physicians reinforced the stigma of TB by arguing that it was Métis morality, personality and social behaviors that were responsible for the elevated rates of TB among the Métis population.⁷⁶ Many adults and Elders of the Métis Nation today lived through the sanatorium age. These experiences continue to affect how the Métis perceive the consequences of a TB diagnosis.⁷¹ Across the Métis Nation population, there remains a profound mistrust of medical institutions, due to colonial medical policies and continued racial discrimination in the healthcare system.⁷¹ Medical staff working with Métis should complete cultural safety training so that they understand the historical and current context of TB.⁷¹

Today, many Métis are at a higher risk of TB due to poverty and health inequity rooted in colonialism and the marginalization of the Métis population. Crowded, poor-quality housing, food insecurity, barriers to healthcare access, coinfections with HIV and diabetes and malnutrition are all risk factors for TB in Métis communities. Métis youth are more likely to live in low-income households; in 2016, 21.5% of Métis under 18 years were living in low-income households, compared to 16% of non-Indigenous youth.⁷⁷ Métis individuals are also more likely to live in houses that are in disrepair; in 2016, 14% of Métis homes needed major repairs, compared to 7% nationally.⁷⁷ Métis are more likely to live in a food-insecure household, particularly within the urban population.⁷⁸

In terms of accessing healthcare, jurisdictional disputes exclude the Métis Nation population to a certain degree from both mainstream and Indigenous-specific health systems. First Nations and Inuit people access some of their programming through the First Nations and Inuit Health Branch (FNIHB) of Health Canada, which does not have a mandate to work with the Métis.⁷⁹ While the Métis must access mainstream provincial services as a result, these services often do not meet the specific cultural or geographical needs of Métis communities.⁷⁹ To date, there is no agreed strategy for addressing TB among the Métis Nation with the federal government. Métis living in rural areas have more severe challenges in accessing healthcare. Métis individuals often have to find the money to pay for their transportation to see specialists and to get directly observed therapy (DOT) for TB in larger urban centers.⁷¹ For example, a Métis individual living in Northern Saskatchewan who is diagnosed with TB has to travel to Saskatoon for specialized treatment.⁸⁰

There is an urgent need for Métis-specific information and complete TB surveillance among the Métis population. Relative to other Indigenous groups and the non-Indigenous population, there is limited Métis-focused research on TB, which means there is an incomplete picture of TB in Métis communities. The current identification of Métis TB incidence is likely to be underreported. For example, Saskatchewan has particularly high rates of TB; the province is also distinct in that the majority of cases are in First Nations, Métis, and northern populations, rather than foreign-born populations.⁸⁰ However, TB reporting often conflates Métis TB cases with First Nations TB cases, due to mixed family ancestry or intermarriage, similar geographic location and the same disparities in social determinants of health.⁷¹ With improved TB reporting and research, the Métis Nation and health workers can develop a Métis-specific TB strategy designed by and for Métis people to meet their unique needs and realities.

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