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TB rates for aboriginals soar

Chiefs contend provincial report fails to capture extent of problem

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Tuberculosis is a common, and in many cases fatal, infectious disease that attacks the lungs. It is spread when people who have an active TB infection cough or sneeze, transmitting  respiratory fluids in the air.

KARIN SCHERMBRUCKER / THE ASSOCIATED PRESS FILES Enlarge Image

Tuberculosis is a common, and in many cases fatal, infectious disease that attacks the lungs. It is spread when people who have an active TB infection cough or sneeze, transmitting respiratory fluids in the air.

The first provincial report on tuberculosis in decades has found remarkably high rates among Manitoba aboriginals, but First Nations leaders say the report is flawed and they want it retracted.

Health Minister Erin Selby ordered the report removed from the province's website.

The short report, released in late March and posted online, found TB is on the wane across Canada but is on the rise in Manitoba. The provincewide TB rate was typically twice the national average.

"Manitoba's experience with TB is in contrast with the declining global and national rates," said the report.

The numbers from the north are even worse. In northern Manitoba's regional health authority, which includes more than two dozen reserves, the rate was often seven times the provincial average. Nearly two-thirds of all TB cases involved First Nations patients.

But aboriginal leaders and local health experts say the report is poorly done. The Assembly of Manitoba Chiefs says the statistics under-count the number of First Nations people by roughly 50,000, which skews the data and minimizes the disease rate. And the report glosses over research showing the effect of poor housing, lack of modern sanitation, poverty and unemployment on TB rates.

Last month, Grand Chief Derek Nepinak wrote to Selby asking her to retract the report and work with the AMC on more accurate statistics and a more complete picture of recent research showing the significant effect poverty and poor housing have on tuberculosis transmission.

"While the minister appreciates the work that officials have done in preparing this report, the minister also recognizes and understands Grand Chief Nepinak's concern regarding the report's omission of the role of housing, poverty, nutrition in the spread of TB," said Selby's spokeswoman.

"The minister has directed the department to take down the report effective immediately."

The report, which crunched surveillance data from 2000 to 2012, says the reasons behind the high rate of TB on reserves are not clear. Housing and access to health care have been "proposed" as reasons.

But two public health experts say the research on what's called the social determinants of health is overwhelming. Study after study has linked high TB rates with the quality of life on reserve -- a lack of sanitation, overcrowded and poorly ventilated houses, poor nutrition, poverty, joblessness and social isolation.

"They kind of mention them as, ho hum, sometimes people look at these things, but they don't say much more," said Anne Fanning, one of the country's leading TB experts and a professor emeritus at the University of Alberta's medical school.

"A lot of us were surprised to see that there," added Brenda Elias, a community health researcher with the University of Manitoba's medical school. "We already know what the determinants are. You don't need more research to tell you you need better housing."

Elias echoed the AMC, saying there are also problems with the way Manitoba Health counts population, especially aboriginals. It's a challenge throughout the country's health-reporting system, made particularly acute when small, high-risk populations are at play.

Tim Hilderman, Manitoba Health's medical lead for communicable diseases, said the report was meant to be a snapshot of the stats and trends during the last dozen years, helping policy-makers identify high-risk populations. It was not meant to offer a detailed discussion of why rates are high in Manitoba, especially among indigenous people.

"We know that the social determinants of health play a major role in driving the tuberculosis rates in all populations where we see higher rates," said Hilderman. "What this shows is we need to continue to evolve our approach to tuberculosis."

Hilderman said the report will be used by the province's TB steering committee to help it tweak programs and work better with communities.

Fanning said tackling the social determinants of TB is essential but not sufficient. Even more important, and also largely missing from the report, is a sense of how Manitoba's treatment and prevention programs are working.

A good TB health program quickly identifies cases, treats them completely and gets to friends and family who might have been exposed. A targeted health program with those elements matters even more than general improvements to housing, income and education, said Fanning.

"You don't get TB without the bug. If the bug is there and you're poor and malnourished, then you're going to have the disease," said Fanning.

"You could fix the food and housing and the education and not treat the bug, but you'd still have the disease."

Fanning said the province should be saluted for having a baseline from which they can start working.

"But now what?" she asked.

maryagnes.welch@freepress.mb.ca

Republished from the Winnipeg Free Press print edition May 31, 2014 A3

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