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The determinants of tuberculosis transmission in Indigenous people in Canada and New Zealand



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The disparity in tuberculosis rates between Indigenous and non-Indigenous people persists in Canada and New Zealand. The most common form of tuberculosis in humans is pulmonary tuberculosis so eliminating tuberculosis transmission is an important obstacle to decreasing the overall rates of the disease. In both Canada and New Zealand, social determinants of health such as housing conditions, access to health care and historical influences (including similar experiences with colonization) have been implicated in the high rates of tuberculosis. This thesis examines and compares the social determinants of tuberculosis transmission among Aboriginal people in the Canadian province of Alberta and Maori and Pacific people in New Zealand. In Alberta, ten Aboriginal individuals with smear-positive pulmonary tuberculosis participating in a larger prairie wide study were divided into two groups (transmitter and non-transmitter) based on transmission events identified through contact tracing and DNA fingerprinting. Interviews with the ten participants were analyzed and compared using an interpretive phenomenological perspective and informed by an Aboriginal framework of health. Survey data from the same individuals provided complementary descriptive statistics. In New Zealand, interviews with Maori and Pacific pulmonary TB participants that had been conducted as part of other studies were accessed and analyzed using an interpretive phenomenological perspective. Like in Canada, Indigenous frameworks of health specific to Maori and Pacific people informed the analysis. The Canadian analysis identified three factors of greater relevance within the transmission group: substance use, patient-delay-in-seeking-treatment, and number of contacts. These factors were also relevant for the Maori and Pacific experience of tuberculosis. The results of this cross-cultural comparative study highlight the complexity of the experience of tuberculosis for Indigenous people in both Canada and New Zealand. Future research and education and intervention programs must not only consider the proximal social determinants of health, such as poverty, unemployment, etc, but also the more distal social determinants of health and the “causes of causes” such as colonization and its multi-generational effects.



New Zealand, Canada, Indigenous, Social determinants of health, Tuberculosis transmission



Master of Science (M.Sc.)


Community Health and Epidemiology


Community Health and Epidemiology


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