Coloring the white plague: a syndemic approach to immigrant tuberculosis in Canada

Abstract

Objective. In this article, we adopt a syndemic approach to immigrant tuberculosis (TB) in Canada as a way of challenging contemporary epidemiological models of infectious diseases that tend to racialize and medicalize the risk of infections in socio-economically disadvantage populations and obscure the role of social conditions in sustaining the unequal distribution of diseases in these populations.

Design. A syndemic approach unravels social and biological connections which shape the distribution of infections over space and time and is useful in de-racializing and de-medicalizing these epidemiologic models. The socio-historic framework allows us to examine social factors which, refracted through medical science, were central to the development of TB control in Canada at the beginning of twentieth century.

Results. We expose the ideological assumptions about race, immigration, and social status which underpin current policies designed to control TB within the immigrant population. We argue that TB control policies which divert the attention from structural health determinants perpetuate health and social inequities of racialized populations in Canada. Medical screening and surveillance is an ineffective control policy because the proportion of TB cases attributed to immigrants increased from 18 to 66% between 1970 and 2007.

Conclusion. More effective TB control policies require shifting the focus from the individual disease carriers toward social inequities which underlie the problem of immigrant TB in Canada. In addition, de-racialization and de-medicalization of the contemporary epidemiological models of infectious diseases entail an in-depth exploration of how the categories of ethnicity, culture, and immigration status are played out in everyday health-related experiences of racialized groups.

Keywords:

• immigrants
• tuberculosis
• syndemics
• racialization
• medicalization
• policy
• Canada

Acknowledgements

This article is based on the results of a larger study on discourses about immigrant tuberculosis in the Canadian press which was financially supported by the Social Sciences and Humanities Research Council of Canada. We are grateful to the comments of anonymous reviewers.

Notes

1. Visible minority are defined in the Canadian Employment Equity Act as persons who are nonCaucasian in origin or nonwhite in color (except Aboriginals). Statistics Canada uses this definition provided by the Employment Equity Act. According to the Statistics Canada (2007), about 16% of the population (n=5,068,090) self-identified as visible minorities in Canada. About 30% of these persons (n=1,528,350) were born in Canada while 70% (n=3,539,740) came to the country as immigrants. This number represents 57% of all immigrants (n=6,186,950) residing in Canada in 2006 and 11% of the total Canadian population (n=31,241,030).

2. Historically many distinct groups of immigrants to Canada such as Italians, Greeks, Irish, or Jews were subjected to racialization and medical profiling. Now widely considered white Europeans, these same groups have been de-racialized illustrating that the social constructs of race change in time and space (Avery 1995, Miles and Brown 2003).

3. There are no publicly available data on the distribution of TB by the birthplace and by metropolitan areas.

4. The name of this association was changed to the Canadian Tuberculosis Association in 1922 and then to the Canadian Lung Association in 1977 to reflect the changes in the scope of its work.

5. In the early 1900s, the prevalent discourse attributed the problem of TB to the physical characteristics of an imagined Jewish body which was presumably prone to this disease. More importantly, the so-called ‘racial tuberculosis’ of Jews was one of the reasons that Adolf Hitler used in his (wrongful) justification of the extermination of the Jewish people (Lavin 2011).