INFECTIOUS DISEASES Dr. Margo Greenwood, Academic Leader, National Collaborating Centre for Indigenous Health, Vice President of Indigenous Health, Northern Health, Professor First Nations Studies, UNBC; Donna Atkinson, M.A., Manager, National Collaborating Centre for Indigenous Health
First Nations, Inuit, and Métis (FNIM) peoples and communities have endured “waves of infectious diseases since the arrival of Europeans more than 500 years ago,” including smallpox, influenza A (Spanish Flu, H1N1), tuberculosis, and the current severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic (Richardson & Crawford, 2020, pg. E1098). Indigenous experiences of past and present infectious disease outbreaks are unique within the broader Canadian context, bringing issues of historic and ongoing colonialization, inequity, sovereignty, and relationality to the forefront of Indigenous public health responses (Mashford-Pringle et al., 2021; Richmond et al., 2020). Below, we briefly examine some of the most troublesome infectious diseases that continue to affect the health and wellness of FNIM peoples.2 In doing so, we highlight the inadequacies of existing data and surveillance systems—including a lack of disaggregated data on FNIM peoples—and the failure 2
of public health policies and programs to fully understand and respond to Indigenous peoples’ lived experiences and realities. We close with a consideration of how to strengthen infectious disease prevention, control, and management efforts.
Current Reality A range of personal risk factors and determinants of health come into play in an individual’s exposure and resistance to infection, disease progression, treatment, and management of illness after diagnosis (CPHO, 2013, 2018). For FNIM peoples, the determinants of infectious diseases, such as inadequate and overcrowded housing, poverty, food and water insecurity, limited access to quality health care, and an existing burden of chronic ill health, are exacerbated by historic and ongoing experiences of colonial violence, stigma, systemic racism, and discrimination within and outside of the health care system (CPHO, 2013, 2018; Ward & MacDonald, 2021). As a result, Indigenous populations
have higher prevalence rates for some infectious diseases than non-Indigenous Canadians, despite only constituting 4.9% of Canada’s total population. Given the enduring issues in health surveillance information in Canada, particularly race/ ethnicity-based data, the burden of many infectious diseases on FNIM populations is likely underestimated (House of Commons, 2021; MashfordPringle et al. 2021; Office of the Auditor General of Canada, 2021b).
Tuberculosis (TB) Tuberculosis is the “epitome of inequity in public health” (CPHO, 2018). Often referred to as a social disease with medical consequences, TB is a preventable and curable disease that disproportionately affects populations living in poor social and economic conditions (CPHO, 2018; PHAC, 2018a). Chronic conditions (e.g., diabetes, HIV), living conditions (e.g., crowding, poor air quality), and personal behaviours (e.g., smoking,
Many more could be listed, such as measles, mumps, chickenpox (varicella), and invasive meningococcal disease (Indigenous Services Canada, 2020). 28
