Nunavik's tuberculosis outbreaks are a result of decades of colonial neglect, professor says
There have been 56 cases so far this year of tuberculosis reported in the region, according to Quebec's health department.
On Monday, the region's 14 mayors released a letter, calling on the Quebec government to declare a public health emergency over the rates of tuberculosis. The Nunavik Regional Board of Health and Social Services has said the incidence of tuberculosis in the region is 1,000 times higher than among non-Indigenous people born in Canada.
Health Minister Christian Dubé told CBC News he "will continue to follow the recommendations of public health experts on the subject," though he stopped short of committing to a declaration.
Natasha MacDonald, a McGill University professor from Kuujjuaraapik who researches culturally responsive care for tuberculosis in Nunavik, said she doesn't believe Quebec is treating the tuberculosis situation in Nunavik with the same urgency as elsewhere in the province.
This interview has been edited for length and clarity.
What do you make of this call from the mayors to declare a public health emergency over the tuberculosis situation?
It's unfortunate that we are in a time and place where we have to make such calls to action. Under a number of international, national and provincial jurisdictions, including the Viens Commission, the Quebec government has a responsibility to ensure that health care in our communities is adequate and is on par with those of non-Indigenous populations.
Because of the urgent situation that Nunavik is in right now, the mayors have had no choice but to unite together as one voice to demand that the government do its job.
Why do you think we're seeing this upward trajectory in cases of tuberculosis, in 2025?
What's unbelievable is that we are a first world nation in Canada, and we have a third world disease within Canada. It exists in Nunavik in our Inuit communities, and it's the same strain that has been in Nunavik since 1928.
Quebec made efforts with the City of Montreal, not that long ago, to stop the spread of tuberculosis. Cases were found, contact tracing was done, people were isolated and medicated.
In Nunavik, it has been left to grow and we have outbreaks in six of our 14 communities. This is unacceptable, and it should not happen. We are part of Quebec, we are part of Canada.
You've alluded to the damage that tuberculosis has wreaked on families historically, with Inuit being sent south for care. Given that history, what do you believe we, as a society, still don't understand treating tuberculosis in Nunavik?
What's happening in Nunavik is a result of decades of systemic colonial neglect. Inuit are expected to adapt to those systems, rather than the government adapting those systems to meet the needs of Inuit. The way the regional health board has been implanted by the provincial government makes it a very program-centred health-care system and not a person-centred health-care program.
One of the infectious disease nurses said at one point, in all of Nunavik, they ran out of sputum testing kits. So she had to beg and plead from the province of Manitoba to send over 40,000 sputum testing kits. Quebec didn't have any and it wouldn't procure more.
There aren't even X-rays in most of our communities, much less X-ray technicians in those communities. And Inuit feel uncomfortable going to the clinic or hospital because of decades of mistrust in medical care and the systemic and individual racism that exists.
One of the calls to action in the mayors' letter is about Inuit health sovereignty. What does that look like?
For things to change in our communities, Inuit need to be the ones who determine how our programs and systems run, so that they are tailored to the way we think and work. Inuit are being expected to move around the calendars and schedules of health-care workers, and they are workers are told they should not be going house to house for testing. If it were Inuit leading our organizations, we would have a better understanding on how to do more screening.
It's not somebody from Quebec City who should be dictating how much money should be going toward basic equipment, We should be. We're the ones in our communities. We're the ones that know that the X-ray machine is broken in this one town, or that we have a new graduate who's just finished their radiography course who could be hired into a position within their community.
What we are talking about here is structural change. Can you compare what the system looks like now with Nunavik's health organizations, to that ideal vision you've just talked about?
Systemic change would come when Inuit are able to create a new system altogether, through self-determination or self-government. Or if we can appropriate the system and have an Inuk lead who can hire resources, because we know best on how to allocate our resources and where the needs are.
The midwifery program in Nunavik is a perfect example of that. This is a system where Inuit have designed how our mothers want to give birth in a community with support, in an Inuit way, and it is unbelievably successful. This is not rocket science.
We also understand that translators are as key as any doctor or nurse. Right now, you have French-speaking nurses and doctors that come into our community, and English is often the lingua franca because most Inuit in Nunavik still speak Inuktitut. When you're translating, for example, with a term like tuberculosis, you have to be very careful to make the difference between tuberculosis, which is a disease that can kill you, and something like bronchitis. You can't just say it's a lung problem.
I understand that we have to collaborate with the Ministry of Health in Quebec, but at the same time, they have to understand we are not just another region within Quebec. We are distinct and we have needs that have not been met for decades.
It's also an example of systemic racism because Inuit in Nunavik have been ignored, have been left behind, have been left to die for decades, and this is unacceptable. It was unacceptable after the first TB case. It was unacceptable after the first death. It's unacceptable now when our numbers are record high. We have nurses who are burnt out. And if this were anywhere else in Quebec, there would be an outcry and the government would be immediately addressing this, so we are expecting the same.
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