Canada has one of the greatest health care systems in the world, and yet some of the country’s population lives in fear of contracting a disease most Canadians know little about — tuberculosis (TB).

Inuit people are almost 300 times more likely to get TB than Canadian-born non-Indigenous people, and the TB rate is more than 50 times higher for First Nations people living on reserve.

TB is highly infectious, which means that it thrives in close-knit communities as it spreads from person to person through the air.

Overcrowding, poor nutrition, food insecurity, and poor health overall increase one’s risk of contracting TB.

In Nunavut, 44.8% of homes are overcrowded and more than 2,000 citizens are on a public housing waiting list, according to data from the Nunavut Housing Corporation.

Food insecurity continues to be an issue in the northern territory, too, where costs of basic items are more than double the price when compared to other parts of Canada. Statistics Canada revealed that at least 55% of Inuit adults (25 and older) had experienced food insecurity, according to data from 2012.

Kilikvak Karen Kabloona, an Inuit woman from Nunavut, recently posted on Instagram about her TB diagnosis and the treatment she’s had to endure.

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Last April, I found out I had TB. I had just lost a close friend to suicide when I started coughing a deep, painful cough. I got the skin test days before his memorial. Weeks later, a doctor diagnosed me with latent TB (not contagious). The cough was from a cold. The deep pain from grief. My kindergarten skin test has no result. We assume my mom would have taken me for treatment. I decided to wait for treatment. I wasn’t ready to give up alcohol. I was and am still pissed about Direct Observed Therapy or DOT (someone watches me take the pills which is so patriarchal). I travel for work so much that DOT would be impossible for 10 months, the regular treatment. It’s also impossible when I go on the land. In the fall, I decided that I would start 3HP in January. It’s a shorter treatment of 12 doses in 16 weeks. I dread going for the treatments. They make me feel sick to my stomach and sweaty. My third dose, made me violently sick and light headed. A few days after each dose, I get bumps on my face and arms. I still hate DOT. It’s a voluntary treatment but I’m not trusted to take it. Wtf! I skip out on social activities. On days with meds, I know I’ll feel sick. Other days, I avoid going out when I know people will be drinking. I had to create new habits. Instead of a glass of wine, I drink a lot of tea and sparkling water. I go to the gym every morning with two friends who quit drinking with me and we’re training for a marathon. I have worked in many projects. I didn’t drink that much but it has been good for me to reflect on how frequently I did drink, how it contributed to me being tired and how much easier it is to parent sober. In the year that passed, there have been four deaths by suicide that re-opened the wounds. The fact that Inuit live with ancient diseases and lose so many of our loved ones is fucked up. I still wouldn’t live anywhere else. #TB #tuberculosis #inuitnunangat #inuittbelimination #inuusivutanninaqtuq #nunavutsuicideprevention

A post shared by Kilikvak Kabloona (@kilikvakkabloona) on Apr 18, 2019 at 7:27am PDT

“I was and am still pissed about Direct Observed Therapy or DOT (someone watches me take the pills which is so patriarchal). I travel for work so much that DOT would be impossible for 10 months, the regular treatment. It’s also impossible when I go on the land,” she wrote.

DOT is essentially what Kabloona describes — it involves a medical practitioner watching their TB patients take their pills so as to confirm they are taking the treatment as prescribed.

Kabloona did end up going for treatment months after her diagnosis.

“I dread going for the treatments. They make me feel sick to my stomach and sweaty. My third dose made me violently sick and lightheaded. A few days after each dose, I get bumps on my face and arms. I still hate DOT. It’s a voluntary treatment but I’m not trusted to take it. Wtf!” she wrote.

Stephen Lewis, co-founder and co-director of AIDS-Free World, visited Nunavut in 2017 and released a strong statement upon his return. At its core, his point was this: “There is a TB crisis in Nunavut at this very moment.”

Lewis detailed five clear points that he felt needed to be addressed: There was a crisis, a shortage of staff, TB is driven by the social determinants of health, and there is a desperate shortage of housing.

The fifth point, though, was about racial disparity.

“The colonial inheritance … the fevered destruction of language and culture lies at the root of every contemporary Inuit struggle,” he wrote.

And this is a significant point to consider when it comes to Canadian health care.

Anti-Indigenous racism has been highlighted in the Northwest Territories’ health care system before, but it exists across the country.

Racial bias in health care is not unique to Canada or to Indigenous people, or to tuberculosis. For example, a report from ProPublica and NPR found that black mothers in the US are 243% more likely than white mothers to die from pregnancy or complications related to childbirth.

“The fact that Inuit live with ancient diseases and lose so many of our loved ones is fucked up. I still wouldn’t live anywhere else,” Kabloona finished.

The Canadian government has pledged to eliminate TB from Inuit communities by 2030. TB is the leading infectious cause of death around the world. In 2017 alone, 10 million people were infected by TB and 1.6 million died.

With proper treatment and support, TB is curable. An estimated 54 million lives were saved globally due to TB diagnosis and treatment between 2000 and 2017, according to the World Health Organization.

If Canada managed to eliminate it from its most vulnerable populations, the effects on Inuit health could be incredible. But this requires more than reform and resources in health care alone.

Because social determinants, such as income and status, education, and access to health care, greatly impact the likelihood of a population being prone to TB transmission, it is likely that the TB crisis in Nunavut cannot be tackling without these issues being addressed, too.