Multiplying and Dividing - The University of Auckland

IntroductionThis volume, Multiplying and Dividing: Tuberculosis in Canada and Aotearoa New Zealand,grew out of a transdisciplinary workshop of academics, graduate students, and health careprofessionals from Canada and New Zealand, held at McMaster University in June 2006.Earlier, we had become aware that there were two research projects in our respectivecountries whose focus was on tuberculosis from a social perspective. Our rich and fruitfuldialogue – which led to the workshop and to this volume – began in Aotearoa New Zealandin February 2005 when the “Political Economy of Tuberculosis” 1 team brought to Aucklandmembers of the “Three Centuries of Tuberculosis among Western Canada’s First Nations” 2to discuss our projects and exchange ideas. 3We discovered that our projects had much in common. Tuberculosis is a major global healthproblem, but both Aotearoa New Zealand and Canada are fortunate to experience relativelylow national TB rates (11/100,000 and 5/100,000, respectively) compared to global standards.Although both nations have been successful in lowering the incidence of TB, the disease hasyet to be eradicated from either of these wealthy nations. In fact, the very success incontrolling tuberculosis may actually make both nations vulnerable to a certain level ofcomplacency and neglect (Paluzzi 2004). When diseases like TB are allowed to ‘hide’ amongthe more vulnerable and disenfranchised members of society, the importance of the problemfades (Farmer 1999:200-1). In fact, while rates may be very low for the general populations,this masks the reality that TB is rooted in pockets of marginalised communities in bothnations. Individuals and communities suffering from it often bear overlapping burdens ofother diseases, coupled with adverse social conditions, rendering them multiply burdened(Singer and Clair 2003).Our two projects also shared the view that tuberculosis is a sign of social and politicalinequality and that disproportionately high rates of tuberculosis in particular communities arethe surface expression of underlying inequalities. Both projects were asking questions aboutthe impact of colonialism, government policy, medical practice and authoritative writing onmarginalised groups suffering from tuberculosis in our respective countries. Canada and NewZealand share a history as former British colonies and as members of the Commonwealth ofNations. Both are characterised by cultural, economic and political diversity fuelled byimmigration. Some of the immigration streams are from similar parts of the world, such asthe Horn of Africa and parts of Asia. Both nations have indigenous populations – Maori,indigenous people from other Pacific Islands now resident in New Zealand, and First Nations,Inuit and Métis in Canada – that suffer an excess burden of tuberculosis, as do immigrant andrefugee communities in both nations. At the same time, the two research groups wereworking within a variety of methodologies and theoretical paradigms, including politicalecology and syndemics, and within historical and contemporary frameworks. In addition, theworkshop provided a place for frank exchanges about research methodologies and forparticipants to share research experiences. We discovered how multiple methods ofethnographic, ethnohistorical, discourse, archival, epidemiological and spatial analysis areenriching social research on tuberculosis in both nations. There was much to be learned fromthis prism of perspectives.3