Multiplying and Dividing - The University of Auckland

communities. Other studies focused on: incidence and prevalence rates; compliance rates;treatment plans; clinical trials of TB medication; tuberculin skin tests; the clinicalmanifestations of certain types of TB; and TB control efforts. Although the majority of researchcontinues to concentrate on biomedical studies, we note an overall increase in the number ofpublications focusing on TB in Aboriginal peoples over the past 15 years.The database searches revealed a much lower number of articles with a focus on the socialdeterminants of TB. Comparatively, little attempt has been made to conduct studies thatendeavour to explore and address the social mechanisms responsible for TB in the Aboriginalpopulation. Those articles identified as contributing to a more social understanding of TBconcentrated on issues such as: the association between housing density, isolation and TB; thesocio-cultural factors influencing prevention and treatment efforts; the importance of enlistingcommunity members’ and health care workers’ support in TB control strategies; factorsaffecting compliance with preventative treatment; and the social, political and historicalfactors that shape Aboriginal perspectives on TB. Some articles had a primarily historicalfocus. A few papers highlighted the role of colonial practices and the resulting ecological,economic and political changes that created conditions that facilitated the transmission of TBin Aboriginal populations/communities. Another examined how Aboriginal children of theQu’Appelle reserves in southern Saskatchewan became the subjects of a trial of the BCGvaccine in 1933. Finally, one paper looked specifically at Inuit explanatory models of healthand TB in the 20 th century.Integrated approaches to studying TB in Canadian Aboriginal communitiesWhile we are aware that biomedical studies on TB are necessary, given our long-standingknowledge of the social mechanisms of TB epidemics it is surprising to find that thepredominance of research continues to occur within the biomedical realm. Despite theexistence of therapies to prevent and treat TB, this disease remains a significant public healthproblem for Aboriginal peoples. In Canada, medical strategies have been successful insubstantially reducing morbidity and mortality from TB in the general Canadian population.However, these efforts have proven less successful in the Aboriginal population whereinfection rates are five times higher than the national average. Clearly biomedicalinterventions alone are not the answer to a disease that is deeply rooted in the socialcircumstances of communities. Nevertheless, this review of the literature shows few attemptsin recent years to understand the underlying societal mechanisms responsible for maintainingTB at such high rates in this population.Since medical risks exist for TB in Aboriginal peoples (e.g., diabetes, HIV/AIDS, cancer), aswell as social risks and vulnerabilities (e.g., crowding, poor nutrition, substance abuse),integrated research strategies and intervention models are necessary. As Dubos and Dubos(1992) state:Tuberculosis is a social disease, and presents problems that transcend the conventionalmedical approach…its understanding demands that the impact of social and economicfactors on the individual be considered as much as the mechanisms by which tuberclebacilli cause damage to the human body (cited in Farmer 1997:348).Yet, although the importance of the social and economic environment in the transmission andpersistence of TB has been noted (CDC 1995, Farmer 1997, 1996), the emphasis is still onclinical and epidemiological research. FitzGerald et al. (2000:351) believe that “A reduction92