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PROJECT – 3INUIT HEALTH ISSUE PROJECT –TUBERCULOSISSADAF PATHAN-A00205643INTRODUCTIONIn Canada Tuberculosis in presents condition affects the aboriginals and the global immigrants from different regions (Douglas, 2013). The forced reserves with the inactive and passive lifestyle factors made more infectious as a disease. (Pepperell, 2011).It is affected to both people on reserve and off reserve but majorly to on reserve people. It is one of the most chronic disease to affect the Canadian indigenous (Douglas, 2013) .It is known as disease of social consequences and outcomes as a result of determinants of health and is commonly spread among people who live in non-ventilated area and poverty and it gets settled where various community don’t have health care facilities and screening options. Tuberculosis (TB) is the catalyst and product of inequity of health care (Tam, 2018).Past and the health Issue1. It has been considered a chronic disease because infection didn’t decrease instead increase within community and there was no development and research of antibiotics to control. Many Europeans came in the past to settle and brought many disease with them to the land and majority of people suffered with the infectious disease named as tuberculosis along with other chronic disease (AAAS, 2019).2. In the past people affected by TB were send to sanatoriums isolating them from family and community and they were left without any spiritual healing loosing connection from land. Many of those didn’t returned back to community hence in past there was lot of injustice faced by the community and sacrifices given by the community members to fight against the disease (CPHA, 2019).3. Stigma to BCG vaccination was developed as it was giving positive false results and lead to trust issues for western medicine and had disadvantage to many patients (Picard.2018).History of colonization is one of the root causes in the past to affect the people because of trauma affected by the people this disease were at peak in residential schools. The forced reserve system, followed by the forced residential schools, created a pool for TB leading to overflowed and non-ventilated areas with poor nutrition food (Abonyi, Mayan, Boffa, 2017)Present and the health issue1. Currently northern communities are more prone to the spread of disease. Inuit communities have undertaken leadership quality to flourish the community (Tam, 2018) The Health Department along with funding from the government has taken appropriate step to bring up the mobile clinic in a community and is screening patients. The mobilization project is introduced to north increase TB awareness among community for teaching prevention steps for eradication of disease and developing high level of trust and respect between community member and health care practitioner (Dorset, 2019).2. Currently efforts are made for access to tuberculosis screening and treatment and prevention steps and helping people who are scared to go to hospital for receiving treatment. Social determinants of health like poverty which make tuberculosis elevated along with inadequate food requirements and non-ventilated housing is been to addressed for the population (Hargreaves, Boccia,Evans,2011).In present situation intergenerational trauma due to colonization affects the disease hence policies for funding is developed to address unemployment. TB control programs such as contact tracing and latent TB infection treatment were introduced to deal with the disease along with DOT therapy know as direct observed therapy by local community members (Karumbi, Garner,2015). Doctors have partnered with the government to conduct program called Taima TB (Taima means “stop” in Inuktitut) to spread awareness. TAIMA TB is a joint project supported by the Government and other research institute. It relies on foundations of education, collaboration, and awareness is required in joint relationship with health providers for program eradication (Tam, 2018). Community TB experts are offered to community members as help to give screening, treatments and medication assistance to aboriginals. Focus on Housing is needed to address the root cause. Various provincial organizations developed programs to address TB through modern equipped screening and door to door screening supported to deal with the disease (Alvarez, Vandyk, Aron, 2014)3. Currently medical universities to have Indigenous health as part of their studies is been incorporated as first level approach. Doctors and nurses have been given training to be more culturally safe with patient receiving treatment. But some of them haven’t had a lot of education on Indigenous health hence more education is been imparted to reduce the impact of disease. Various universities of Toronto and Ottawa and Manitoba have made Indigenous health issues as part of the student’s medical school learning program to learn the importance of the culture and traditions of the communities (Baba,2013) .North Food Price Survey analyzed that price for basic food grocery was double than south hence it made difficult for the locals to purchase basic food hence insecurity for food which is root cause of TB is analyzed currently and efforts are made to address and reduce it (Skura,2016).Recent introduction of the automatic equipment test has reduced the time required between diagnosis and treatment of TB hence it has made an ease for need to carry the samples far away for testing (CBC,2015).Future and the heath issueIn Future there is likely to get control over tuberculosis as government is planning to release some funding models mentioned below and various protocols to collaborate with indigenous health leaders to reduce its impact.1. The social determinants of health and health inequities can be explored by government to finds various solutions for the communities and it can be done by awareness, education, research advancements in technology, in different region according to the different languages. There is more need to find solutions for global TB termination efforts as the community reflect its contributions at global level as they are or protectors of land and safeguard them should be first priority. Health awareness message for all partners in health and wellness for indigenous will have a more solid impact than individual efforts because they always flourish together and they believe in unity rather than doing independently. Leaders and champions are the key successors to accomplish the goals. TB can be eliminated by including respect to culture understands the language and the past hence decisions must be made keeping they key points in priority.2. Specific planning related to geographic region need to be explored as high risk groups need more attention and effects could be declined gradually. Protocols can be scheduled for tools which are running out to treat with various medicines Innovative approaches such as investment in the necessary research and development laboratories or vaccines or drugs will be much beneficial to reduce the impact of disease for a long term. The hidden social, cultural, and incidences of past that lead to stigma a need to be challenged through health awareness program. Indigenous and global immigrant deserve the support to seek the medical jargons of tuberculosis (Douglas, 2013).3. Efforts like Ottawa took oath to terminate tuberculosis by 2030 for future eradication. Government plan to eradicate by 2025 as long term goal (Raviglione, Sulis, 2016). Decision of funding of around $300 million for housing is proposed as a step to sort the social determinants of TB as the root cause of TB is housing with no proper ventilation. The government plans in spending money to deal with the spread by buying rapid diagnosis and antibiotic kits. Underlying inequalities linked to tuberculosis including housing, food security and nutrition, health services and mental wellness is planned to address. The Inuit Committee announced a tuberculosis task force and finding cause .One step toward eradicating TB in the North would be with an education awareness campaign (Berger, 2019).ConclusionInvolvement of community is the most important tool when you are planning to eradicate disease from that particular community hence government should involve the community members as much as possible instead of neglecting them when taking any decision. Government should ask people what are the barriers they face and research should be done on social determinants of health and protocols should be developed to address the determinants. Government should work in collaboration with Aboriginal health leaders to eradicate the spread of TB. Understanding people behavior is a key to identify the causes. More indigenous populations should be included in the awareness programs as language is more related to culture and they can understand patients need. Root cause of TB is overcrowded housing and food insecurity should be focus by government at macro level. Sufficient funds with appropriate targets should be overcome within given time. The most important of all is the ultimate eradication of the disease can be accomplished only if medicine wheel teachings is involved with the community, their physical, spiritual, mental and emotional health should be balanced while eradication of disease as whole because a change in any one category will create imbalance and wholistic approach is better than in parts.ReferencesRichardson K, Sander B, Guo H, Greer A, Heffernan J. Tuberculosis in Canada: Detection, Intervention and Compliance. AIMS Public Health. 2014; 1(4):241– 255. Published 2014 Nov 25. doi:10.3934/publichealth.2014.4.241Karumbi, Jamlick, and Paul Garner. “Directly observed therapy for treating tuberculosis.” The Cochrane database of systematic reviews vol. 2015, 5 CD003343. 29 May. 2015, doi:10.1002/14651858.CD003343.pub4Hargreaves JR, Boccia D, Evans CA, Adato M, Petticrew M, Porter JD. The social determinants of tuberculosis: from evidence to action. Am J Public Health. 2011; 101(4):654–662. doi:10.2105/AJPH.2010.199505Douglas, V. (2013). Introduction to Aboriginal health and health care in Canada: Bridging health and healing. New York, NY: Springer Publishing CompanyWorld Health Organization (2017). Global tuberculosis report 2017. Retrieved from (2016, June 24)Food in Nunavut still costs up to 3 time’s national average. Retrieved from survey-2016-1.3650637 (AAAS,Science) How Europeans brought sickness to the New World Heather PringleJun. 4, 2015 Retrieved from Department of Health (2019, January 8). Health announces next tuberculosis prevention screening clinic in Cape Dorse. Retrieved from prevention-screening-clinic-cape-dorset Vachon, J., Gallant, V., Siu, W. (2018). Tuberculosis in Canada, 2016. Canada Communicable Disease Report, 44(3/4), 75-81.Public Health Agency of Canada. (2013). The Chief Public Health Officer’s Report on the State of Public Health in Canada, 2013: Infectious Disease – The Never-ending Threat. Ottawa ON: Public Health Agency of Canada.CPHO SPOTLIGHT ON ELIMINATING TUBERCULOSIS IN CANADA MARCH 201Ronald, L. A., Campbell, J. R., Balshaw, R. F., Romanowski, K., Roth, D. Z., Marra, F., Cook, V. J., Johnston, J. C. (2018). Demographic predictors of active tuberculosis in people migrating to British Columbia, Canada: a retrospective cohort study. Canadian Medical Association Journal, 190(8), E209-E216.Canadian Public Health Association. History of Public Health – TB and Aboriginal People. Retrieved from.