Comparative analysis of tuberculosis management in Indigenous North Canada and Alaska, USA from 1950s to 2019

Abstract

Background

Both Alaska and Indigenous North Canada share similarities in geographic location, population, and a history of colonization. While both regions have seen a significant decline in tuberculosis (TB) prevalence over the last century, Nunavut, Canada, has reported a troubling resurgence of TB cases since the early 2000s.

Objective

To identify analogies and highlight dissimilarities between the two regions using a comparative health systems approach within the historical and sociopolitical contexts. We also aim to provide governments with insights on employing best practices and adopting effective policies for improved TB management to achieve the WHO END-TB target by 2035.

Method

This study applied a modified version of the WHO Health Systems Building Blocks Framework to assess TB programs in both regions through a contextual lens. A scoping review inspired review of academic literature, government reports, and open-source documents (1950–2019) informed the analysis.

Results

In Indigenous Northern Canada, TB control is hindered by limited healthcare investment, reliance on evacuation policies, and workforce shortages. Social determinants, such as overcrowded housing and food insecurity, exacerbate the issue. In contrast, Alaska's early infrastructure development led to the establishment of local healthcare services, workforce training, and community-based programs, resulting in more effective TB management.

Conclusion

The underdeveloped economy, inadequate primary healthcare, weak community health services, dependence on medical travel, and persistent social determinants hinder TB control in Nunavut. The comparison of TB responses in Alaska and Indigenous Northern Canada highlights the necessity for well-resourced local and regional healthcare that actively involves the community.