Before Covid-19 became one of the most transmissible diseases known to human-kind, Tuberculosis (TB) was a significant concern for public health providers, like Genevieve Armstrong, because of its ability to cause outbreaks of disease and death from what is largely a treatable illness.
TB is an airborne disease like COVID-19 though not as infectious, and was endemic in Canada prior to the development of anti-TB medication in the 1950’s. It still currently affects many Indigenous populations and migrants.
“A significant contributing factor to ongoing TB spread are social determinants of health, including immigration status, overcrowded housing, or lack of proper housing and sanitation,” says Armstrong, who is also a PhD candidate in the Lawrence Bloomberg Faculty of Nursing.
Armstrong was also a public health nurse for over 10 years with Toronto Public Health’s TB program and throughout her practice, she saw the highest rates of TB among migrants including those with a precarious immigration status such as temporary workers, international students, undocumented migrants, and refugee claimants. Some of the countries they come from, like the Philippines, India, China and sub-Saharan Africa, also have high rates of TB, and when they arrive in Canada, they are often faced with some unique barriers to accessing TB care.
“For many of these patients, they might not have the financial means, or they might be afraid to access care, even fear deportation if they are undocumented,” says Armstrong. “For those requiring in-patient hospital care, they may end up owing thousands of dollars for being hospitalized. Though we think of Canada as having a universal health care system, situations like this expose some gaps and in what we think of as “free” health care.”
As part of her doctoral work, Armstrong is looking to focus specifically on policies that will help to create truly equitable access to TB care for everyone but particularly migrants with a precarious immigration status. This will involve collaborating with not only hospitals but multiple levels of government who oversee TB care policies.
Throughout her doctoral work, donor funded awards have helped Armstrong pursue her PhD without worrying about financial constraints and have allowed her to focus on her passion for social justice and health equity. Her advocacy stems from her own personal experiences, growing up as a person of colour and as part of a migrant family.
“I’ve witnessed the challenges of migration and the influence it can have on a person’s health,” says Armstrong. “That has spurred my passion to shed light on TB as not only a medical disease but as a social disease, one that requires a shift in policy.”
Currently, migrants are tested with an exam and chest x-ray in their home country to determine if they have any active signs of TB and are treated before being allowed entry into Canada. However, Armstrong points out that there is also the possibility of a latent TB infection, where the disease lies dormant and the stress of migration and integrating into Canadian society, can lead to a resurfacing of the infection.
“If an individual develops TB upon arrival, diagnostic testing and medication is free in Canada, but that is where we start to see barriers to access appear preventing them from seeking treatment all together,” says Armstrong.
The physical and social impacts of delayed TB treatment are also significant. While the disease typically affects the lungs, it can also spread to other parts of the body. There is also a stigma associated with the disease because the individual is required to be in isolation, and because in many cultures, TB is viewed as a disease of the poor.
Armstrong’s research to disrupt the social and healthcare inequity faced by those needing TB care is well-timed because in 2018, Canada became a signatory to the United Nations political declaration on the fight against TB to eradicate the disease by 2030. She is hopeful that her research will support this broader national and global focus on disease eradication and will spur policy makers and governments to attribute more funding to TB and public health in general.
“TB has long been a neglected disease though it is treatable and preventable,” says Armstrong. “There is no reason that we cannot eradicate it by 2030 with sound and equitable policy that promotes the health of all.”
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