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Rethinking Immigrant Tuberculosis Control in Canada: From Medical Surveillance to Tackling Social Determinants of Health

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Abstract

Current tuberculosis control strategies in Canada rely exclusively on screening and surveillance of immigrants. This is consistent with current public health discourse that attributes the high burden of immigrant tuberculosis to the exposure of immigrants to infection in their country of origin. The effectiveness of control strategies is questionable given the evidence that many immigrants are at higher risk of tuberculosis reactivation because of risk factors such as poverty, malnutrition and overcrowded housing. This paper argues that the absence of policies that address poverty-related disadvantages among immigrants makes these populations more vulnerable to the reactivation of their tuberculosis long after they have been exposed in their countries of birth. Policies for tuberculosis prevention in the Aboriginal population attend to their poverty and other social determinants of health. Effective health prevention policy for tuberculosis within the immigrant population must take similar direction.

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Notes

  1. For humanitarian reasons, these rules do not apply to refugees whose poor health condition (if present) might otherwise prevent them from being granted asylum in Canada. Refugees are required to be properly examined within 60 days (5 days in Quebec) of their arrival.

  2. PHAC follows the classification of world’s regions set out by WHO [11]. For instance, for the purpose of TB data collection, the Western Pacific includes the following countries: American Samoa, Cambodia, China, Cook Islands, Fiji, Kiribati, Lao People's Democratic Republic, Malaysia, Marshall Islands, Micronesia, Mongolia, Nauru, Niue, Northern Mariana Islands, Palau, Papua New Guinea, Philippines, Samoa, Solomon Islands, Tokelau, Tonga, Vanuatu, Viet Nam, Wallis and Futuna.

  3. For interested readers, we exposed the roots of the racialized assumptions about immigrants which were central to the development of TB control in Canada at the beginning of twentieth century in other publication outlets [4446].

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Acknowledgments

This work emerged from a larger study which examined the prevalent discourses of immigrant health through the coverage of immigrant tuberculosis in the Canadian press. The original study was financially supported by Social Sciences and Humanities Research Council (SSHRC) in Canada.

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Correspondence to Sylvia Reitmanova.

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Reitmanova, S., Gustafson, D. Rethinking Immigrant Tuberculosis Control in Canada: From Medical Surveillance to Tackling Social Determinants of Health. J Immigrant Minority Health 14, 6–13 (2012). https://doi.org/10.1007/s10903-011-9506-1

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