Unhealthy Policies: The Role of Citizenship in the Government Response to Tuberculosis in Indigenous Populations 1945-2015

At a time when the overall national rates of tuberculosis in Canada are among the lowest in the world, the rates of tuberculosis among the Canadian Indigenous population are ten to twenty times higher than among the Canadian non-Indigenous population. In light of factors such as Canada’s universal health care system and advancements in public health and medical interventions over the past century, the question remains as to why this disparity continues to exist. Finding the answer to that question lies at the core of this research project. It involves the analysis of a complex array of factors that lie at the intersection of public policy, politics, and the place in society that the Canadian federal government continues to attribute to Indigenous peoples.The relationship between federal policies and health and social inequalities in Indigenous communities is examined through the lens of state power and citizenship. It’s the federal government who exercises the power to define the scope of its responsibility for ‘Indians, and lands reserved for Indians’ under Section 91 (24) of the Constitution Act. It is also the federal government, not Indigenous peoples, who decides who is an ‘Indian’ under the Indian Act for the purposes of determining who is eligible for federal services.This research project studies the impact of the federal government’s position that it does not recognize a treaty or legal obligation for Indigenous health, and that it provides health services as a matter of policy only. Citizenship theories provide the analytical lens with which to review how the federal government chooses to include and exclude certain sub-groups of Indigenous peoples based on their Indian Status, whether they live on or off reserve, and based on which provincial or territorial jurisdiction they reside. The result is an ad-hoc network of service delivery across Canada. The research demonstrates that the federal government’s own Indigenous health policies play a central role in perpetuating the health and social inequalities that are contributing factors to the elevated rates of tuberculosis that persist in Indigenous communities.