Persistently high rates of TB among Canadian Indigenous Peoples are a symptom of health disparities rooted in colonization. Colonization is systemic dominance of one group over another, often resulting in racial and cultural inequities.81–83 Colonial approaches to healthcare continue to endure in Canada, preventing Indigenous Peoples from making decisions about their own health and the health of their communities. The effects of colonization continue to plague how Canadian Indigenous populations experience TB care.84 Health workers are not immune to the propagation of the effects of colonization,85 which are often driven by unperceived and unintended racism and privilege that continue to permeate healthcare delivery in Canada. Racism in this context is defined as an organized system that distributes power, resources and opportunities unequally and inequitably across racial or ethnic groups; historically, racism has gone hand-in-hand with colonization.81 This may be seen in inequity in access to, or quality of, healthcare, dominance of colonial language and culture in healthcare systems and a lack of opportunities to improve social determinants of health.81 As part of the decolonization movement, the Truth and Reconciliation Commission of Canada outlined several key Calls to Action that pertain to health, including the education of health workers working with Indigenous populations (Call to Action #24).21 Achieving health equity in TB care can come from understanding and redressing the power dynamics between health workers and Indigenous patients.85 The foundation of effective TB care is positive partnerships between health care workers, public health professionals, patients and governments.
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