World TB Day Part VI – TB in Canada

March 30, 2016 Maria Wilson Leave a Comment

Source: Government of Ontario Archives.

The World Health Organization (WHO) has declared March 24, 2016 as World Tuberculosis (TB) Day [1]. Over the month of March, the Global Health Office will be publishing a series of blog posts about TB in hopes of raising awareness of its worldwide impact. WHO’s “End TB Strategy” has a goal of ending the TB epidemic by 2030, by targeting poverty, improving testing and treatment, ending stigma and discrimination, and driving research and innovation. Put simply, TB is not yet a disease of the past, but if we unite and focus our efforts, we can make TB history.

We have finally reached our final post in the March TB blog series: TB in Canada. Let’s start with a little history lesson.

The modern global TB epidemic began in Western Europe in the 17^th century. European settlers brought their TB infection with them to Canada (called “Consumption” back in the good old days), thus beginning the Canadian TB epidemic of the last several centuries. In 1897, the first Canadian sanatorium, the Muskoka Cottage Sanatorium, was opened to treat TB patients. These facilities isolated infected patients, while providing rest, nutritious food, fresh air, education and rehabilitation. Other initiatives to treat and control TB in Canada in the pre-antibiotic era included free treatment hospitals, home visits from TB health nurses, and TB dispensaries providing food, clothing, free medicines and sputum boxes to those affected. By 1953, Canada had 101 sanatoria, which along with TB units in general hospitals, totalled 19,000 beds nationwide. Antibiotic treatment became widely available in 1948 with the introduction of streptomycin, and improved in effectiveness in 1952 with the introduction of isoniazid. These treatment advances greatly reduced the burden of TB in Canada, allowing most sanatoria to close by the end of the 1970s [2]. However, TB is still present in Canada today, disproportionately affecting certain populations.

Nowadays, there are about 1600 new cases of active TB reported in Canada annually, a number that has remained relatively stable since the 1980s. This translates to one of the lowest rates of active TB worldwide. Cases of active TB must (legally) be reported to provincial or territorial departments of health. Provinces and territories may then voluntarily submit their surveillance data to the federal government for national surveillance reports. Approximately 90% of cases reported in Canada affect 2 main populations: foreign-born individuals (70%) and Canadian-born Indigenous Peoples (20%) [3]. Compared to the Canadian-born non-Aboriginal population, the incidence rate of active TB disease for Inuit was almost 400 times higher in 2012. Higher rates of TB in these populations are linked to the social determinants of health. Certain Indigenous populations are subject to overcrowding and poorly ventilated housing conditions, as well as higher rates of co-morbidities such as HIV infection and diabetes, which increase the risk of TB infection. Poverty, recent travel to or residence in high-risk foreign countries, and the stresses associated with integration into Canadian society are all factors that may increase the risk of latent TB infection or profession to active TB disease in foreign-born populations [4].

The federal government participates in several initiatives to prevent, control and provide education around TB. One is the TAIMA TB project, funded by the Public Health Agency of Canada. This project was designed to increase awareness about TB in Iqaluit, while providing door-to-door latent TB testing in high-risk areas [4]. Canada has also been active in both the STOP TB and the END TB strategies developed by the World Health Organization [5].

We hope you have learned more about TB through our series of blog posts! If you have any suggestions for feature topics on the GHO blog, please let us know by sending an e-mail to gho@dal.ca.

When One Door Closes, Another Door Opens: From the MDGs to the SDGs Part 2

December 20, 2015 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

SDGs-GlobalGoalsForSustainableDevelopment-05

As a follow-up to the MDGs, the UN has developed 17 Sustainable Development Goals (SDGs), which will come into effect on January 1 2016. As with the MDGs, each SDG has specific targets, which can be found on the UN website, and a set of indicators to measure progress, which will be finalized by March 2016. This ambitious agenda has been proposed to shape the policies and actions of UN member states through to 2030:

End poverty in all its forms everywhere
End hunger, achieve food security and improved nutrition and promote sustainable agriculture
Ensure healthy lives and promote well-being for all
Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
Achieve gender equality and empower all women and girls
Ensure access to water and sanitation for all
Ensure access to affordable, reliable, sustainable and modern energy for all
Promote inclusive and sustainable economic growth, employment and decent work for all
Build resilient infrastructure, promote sustainable industrialization and foster innovation
Reduce inequality within and among countries
Make cities inclusive, safe, resilient and sustainable
Ensure sustainable consumption and production patterns
Take urgent action to combat climate change and its impacts
Conserve and sustainably use the oceans, seas and marine resources
Sustainably manage forests, combat desertification, halt and reverse land degradation, halt biodiversity loss
Promote just, peaceful and inclusive societies
Revitalize the global partnership for sustainable development

What makes the SDGs different from the MDGs? The most obvious answer is that there are more than double the number of SDGs than there are MDGs, but there are more differences than just that! More SDGs translates to the UN being able to tackle a more broad range of issues related to development. The MDGs were grounded in anti-poverty, however, they often failed to address the root causes of poverty, opting instead to treat the symptoms. The SDGs aim to address the systemic issues that allow poverty to persist, including human rights, governance, peace and stability. The SDG targets also move beyond poverty, examining issues such as climate change and sustainable consumption, which will impact everyone, regardless of their socioeconomic status.

The MDGs were primarily developed by member countries of the Organization for Economic Co-operation and Development and donor agencies focusing their efforts on low and middle-income countries. The process for determining the MDGs barely involved those who were most affected by their targets. The SDGs, however, have come out of international negotiations where low and middle-income countries were granted input. Furthermore, the SDGs are regarded as universal, applying to all countries and actors, rather than creating a divide between “rich donors” and “poor recipients.”

More opportunities for partnership will (hopefully) be a product of, and a driver of, the SDGs. These include public-private partnerships, trade partnerships, global partnerships, local partnerships, and most importantly equitable partnerships. In order to meet the ambitious targets set out in the SDGs, a multidisciplinary and multi-stakeholder approach will be vital.

The MDGs are about to expire, and though there has been considerable progress made on many of the targets, there is still much work to be done. About 1 billion people still live on less than $1.25 per day worldwide, gender inequality persists as women worldwide continue to face discrimination in their everyday lives and over 800 million people still suffer from hunger. The SDGs hope to finish the job of the MDGs, and ensure that this time around, no one is left behind. Over the next 15 years, we are excited to see how the SDGs will impact global health, as health is a key outcome of development.

When One Door Closes, Another Door Opens: From the MDGs to the SDGs (Part 1)

December 15, 2015 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

The United Nations (UN) established a set of eight Millennium Development Goals (MDGs) in 2000. The goals are as follows:

To eradicate extreme poverty and hunger
To achieve universal primary education
To promote gender equality
To reduce child mortality
To improve maternal health
To combat HIV/AIDS malaria and other diseases
To ensure environmental sustainability
To develop a global partnership for development

Each goal has a specific set of targets and technical indicators to measure progress, which can be found here if you are interested. While some targets had earlier end dates, the goals were part of a 15-year plan, set to end in 2015. Despite a commitment from all UN member states at the time, as well as multiple international organizations, the targets have not all met.

However, significant progress was made on the MDGs, and that progress should be celebrated! Below, we have highlighted one achievement under each goal contained in The 2015 Millennium Development Goals Report. The full report can be accessed here.

Goal 1: The proportion of the population in the developing world living on less than $1.25 a day has dropped from 50% in 1990 to 14% in 2015.

Goal 2: Literacy rates among youth aged 15 to 24 have increased globally from 83% in 1990 to 91% in 2015. Furthermore, the literacy gap between women and men has narrowed.

Goal 3: In Southern Asia, there are now 103 girls enrolled in primary school for every 100 boys. This is compared to 74 girls enrolled for every 100 boys in 1990.

Goal 4: The worldwide under-five mortality rate has declined by over half, from 90 deaths per 1,000 births in 1990, to 43 deaths per 1,000 births in 2015.

Goal 5: Over 71% of births globally were assisted by skilled health personnel in 2014, an increase from 59% in 1990.

Goal 6: Over 6.2 million malaria deaths were averted between 2000 and 2015, primarily in children under the age of five living in sub-Saharan Africa. Globally, the incidence rate of malaria has fallen by approximately 37%, and the mortality rate by 58%.

Goal 7: 2.6 billion people have gained access to improved drinking water since 1990. In 2015, this equated to 91% of the global population have access to an improved drinking water source.

Goal 8: Official development assistance from developed countries increased from $81 billion to $135 billion between 2000 and 2014. In real terms, this represents a 66% increase.

There is still much progress to be made on these goals, as well as in other areas. Gender inequality still persists, large gaps in health outcomes still exist between the poorest and the richest, conflict continues to threaten human development, and the health and environmental effects of climate change still need to be addressed. More importantly, we need long-term and universal solutions.

As a follow-up to the MDGs, the UN has developed 17 new Sustainable Development Goals (SDGs), which will come into effect on January 1 2016. Part 2 of this post, coming next week, will review the SDGs, and the ambitious targets they aim to meet by 2030.

Category: Current Topics