Canada's efforts to fight tuberculosis in Nunavut, where infection rates hit a record high last year, has been called a "century of failure" by a leading medical journal.
In an editorial released Monday, the Canadian Medical Journal Association says last year's tuberculosis outbreak in Nunavut — the worst since the territory was created in 1999 — is a problem for all of Canada.
"We are a rich, developed nation that has the resources to solve the problem in Nunavut if we choose to employ them," said Dr. Matthew Stanbrook, a respirologist at Toronto Western Hospital.
"The fact that we have failed to do so, not just once but over a century, should be an embarrassment to every Canadian."
The editorial reports that Nunavut had 100 new and active cases of TB in 2010. That's the highest number in the territory's history and represents an infection rate 62 times the Canadian average.
Meanwhile, 14 new tuberculosis cases have emerged so far in 2011. Nunavut health officials told CBC News they could use more help to screen and track new infections.
Similar to developing world
Stanbrook and the editorial's other authors say most of the new TB cases in 2010 occurred in younger patients, suggesting the disease is being actively spread.
"This is happening at rates we see in the developing world," Stanbrook told CBC News on Monday.
"As the people of Nunavut are Canadians too, they deserve the same degree of effort that we have successfully exerted in the rest of Canada."
Tuberculosis is a germ-borne infection that most commonly attacks the lungs. It can cause shortness of breath, coughing, fever and death.
It has been largely eliminated in the south — although it is present in some aboriginal communities — but it has never left the North since it arrived with whaling crews in the 19th century.
Sociologists say the disease took firm root among the Inuit after the Second World War, when they were moved from hunting camps on the land into communities.
Government-provided, one-room houses with no bathrooms, or cramped shacks cobbled together from construction debris, provided ideal conditions for the disease to spread.
TB legacy remains
Records show that between 1953 and 1961, a total of 5,240 Inuit were sent south to be treated. The entire population of the Eastern Arctic at the time was about 11,500.
Many of those never returned or lost contact with their families, a memory that makes treating the current outbreak even harder, Stanbrook said.
"That legacy persists in the minds of the community in Nunavut today, especially among the elder generation who are the people who are most likely to reactivate the tuberculosis disease…. If you don't trust the public health officials, you're not going to disclose symptoms that seem like TB," he said.
"That really has frustrated efforts to address this epidemic."
The editorial notes that Nunavummiut add to the problem with unhealthy behaviours. More than half of them smoke at least once a day.
But the editorial says governments should do what they can to alleviate the problem. It calls for more emphasis on early diagnosis, testing and screening as well as for education programs to rebuild public trust. Overcrowded, substandard homes must go, it adds.
Aglukkaq defends Ottawa's response
But federal Health Minister Leona Aglukkaq insisted that her government is dealing with Nunavut's TB problem, having spent money to fight the outbreak itself and build more houses in Canada's North.
"I would say we have reacted, we have responded. We have invested in Nunavut alone, $100 million to construct 1,000 units. We know TB is a direct result of overcrowding," Aglukkaq told CBC News.
Last month, Aglukkaq announced $800,000 for Taima TB, a new program in which teams will go door-to-door in Nunavut communities to test people for signs of latent tuberculosis infection.
Stanbrook said Ottawa needs to do even better if it wants to lead the fight against tuberculosis, no matter what it costs.
"When we have the wealth that this country has, there's no excuse for not using all our resources to cure a curable epidemic disease," he said.
Stanbrook added that it's not good enough to accept poorer health in the North simply because the region is far away and thinly populated.