IQ11: The Social Determinants of TB in Indigenous Communities (TB Talk, Pt 3)


The third in our ‘TB Talk’ series, we hear from Dr. Malcolm King, a professor in the Faculty of Health Sciences at Simon Fraser University. He discusses the importance of social determinants of health to the rate of new TB infections and better TB outcomes in remote, northern and Indigenous communities.

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Rick Harp: Welcome to Infectious Questions, a public health podcast from the National Collaborating Centre for Infectious Diseases. I’m Rick Harp. This episode, we continue our look at tuberculosis with NCCID’s Shivoan Balakumar. Hey, Shivoan.

Shivoan Balakumar:   Hello again, Rick.

Harp: Now, like last episode, you’re going to share a conversation from End TB 2017, a meeting of the North American Region of the International Union Against Tuberculosis. Who will we hear from this time?

Balakumar: Dr. Malcolm King is a professor in the Faculty of Health Sciences at Simon Fraser University. He recently stepped down as the scientific director of the CIHR Institute for Aboriginal Peoples Health.

Now, he presented at the event on social determinants of health in remote, northern and Indigenous communities. I asked him about their importance to the rate of new TB infections and better TB outcomes.

Dr. Malcolm King: So, determinants of health are important because it’s not just even income, poverty, lack of employment, under-education, but many other things, access to health services, housing and so on. And when we think of the TB issues in Canada, Indigenous peoples, even though they make up only four or five per cent of the overall population, make up at least 30 per cent of the tuberculosis new cases diagnosed every year. So that’s a huge disparity. And it’s mostly in northern and remote communities.

So there are many important issues there. Certainly, the geographical distance, the lack of access, but also the lack of health services that we come to take for granted in the major cities. There’s housing: that’s an important determinant of health. We know that housing quality is very poor both in First Nations and Inuit communities in the north. There are more people in smaller houses. That means overcrowding. Ventilation, especially through the long winter, is very poor; people are trying to conserve heat. A lot of smoking, particularly by adults but even adolescents… and so, children are growing up in smoking environments without the adequate ventilation. It’s just ripe conditions for transmission of disease.

And when you add onto it the stigma associated with tuberculosis that still exists now… and, also, fear of tuberculosis. Remember that it’s not even a hundred years since people were brought in off the land and into small communities. So it’s changed in a matter of two generations, from the grandparents to the children of today.

And tuberculosis was a killer: it stills remains a serious problem. We’re fortunate that not too many people actually die from it, but we’re still living in a situation where TB is being transmitted from one person to the next in these crowded environments.

Balakumar: Again, that’s Dr. Malcolm King, a Health Sciences professor at Simon Fraser, speaking about remote, northern and Indigenous communities. I asked Dr. King about how members of those communities can be more involved and included in health research about them.

King: Community empowerment, I think, is really key to us making the inroads that we need to in tuberculosis transmission, and getting people into care that will lead to the cure of their tuberculosis. If it’s just external agencies, whether it’s doctors, whether it’s governments and so on, and local people aren’t involved in their own healthcare… not that they have to all become health professionals, but that they need to be active participants.

And we need to look for community leadership to help the health professionals and the health system actually make the kind of connections that are needed to get people into treatment, to get people diagnosed. And to work within the community to reduce that stigma associated with tuberculosis. It’s not going to happen unless we have active involvement of people in the community.

Balakumar: That’s Dr. Malcolm King, in conversation with me this February at End TB 2017. Learn more about his work at Simon Fraser University at

Harp: Thank you, Shivoan.

Balakumar: My pleasure, Rick.

Harp: And thank you for listening to Infectious Questions, a production of the National Collaborating Centre for Infectious Diseases. Production of this podcast has been made possible through a financial contribution from the Public Health Agency of Canada. Note that the views expressed here do not necessarily represent those of the Agency. The host organization of the NCCID is the University of Manitoba. Learn more at

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