1. Global Indigenous STOP TB Initiative Dr Kim Barker, Public Health Advisor, Assembly of First Nations, Canada

2. Overview Who are the indigenous? What makes them vulnerable? Case in point examples Why focus on Tuberculosis? Options going forward

3. Who are the Indigenous Peoples? 370 million people identify as indigenous in over 70 countries 5% of the world’s population 15% of the world’s poor 30% of the world’s extreme poor in rural people

4. Historical Context

5. Current Day Realities: Global Examples Bolivia – infant mortality rate among the indigenous populations is close to 75 of 1,000, compared to 50 of 1,000 for the non-indigenous populations Guatemala – 53.5% of indigenous youth have not completed primary school compared to 32.2% of non- indigenous Guatemalans Canada – rates of TB in Aboriginal communities are 20-30 times higher than non-aboriginal born Canadians

6. Case in Point: Oral Children’s Health 95%of FN Children in the Sioux Lookout Zone require general anaesthetic intervention for Early Childhood Caries DMFT Index Toronto—1.1 DMFT Index non-First Nations—2.5-2.8 DMFT Index First Nations Southern Ontario— 3.5-4.8 DMFT Index First Nations SLZ Ontario—10-13.7

7. Case in Point: Food Security Food insecurity driven by highly inflated food prices with no subsidies Milk is $12 for 4L, alcohol is regulated Loss of traditional ways and access to the land Environmental contaminants and climate change are additional threats

8. Why focus on TB? At the turn of the century extensive public health systems were created to improve living conditions and hygiene When effective medication became available the number of tuberculosis cases dropped dramatically. As the numbers dropped, officials and the public became complacent. Despite high rates of tuberculosis that persisted in the poorest communities and countries, there was a belief that modern medicine had defeated this ancient enemy. Funding was slashed and tuberculosis control declined. Clinics were disbanded and hospital beds for tuberculosis patients were eliminated. After decades of decline, tuberculosis rates have sky rocketed due to increasing homelessness, greater poverty, over-crowding and the emergence of HIV-AIDS

9. How invisible can 370 million people be?

10. UNPFII – potential role The United Nations Permanent Forum on Indigenous Issues was created by the United Nations Economic and Social Council (ECOSOC) in July 2000), through resolution 2000/22 with the mandate to provide expertise and recommendations on indigenous issues to the United Nations through ECOSOC. The forum’s role includes promotion and coordination of activities, as well as, the preparation and dissemination of information specific to indigenous issues. Across all hemispheres and latitudes there is one common health issue facing all Indigenous groups globally – higher rather of TB than the non- indigenous citizens UNPFII requests countries to report back on targets annually – why not TB?

11. WHO-STOP TB Initiative in Partnership with the AFN and ITK As a result of tabling a resolution at the most recent UNPFII, the Canadian Government, together with PHAC and WHO sponsored a meeting of global TB experts and Indigenous leaders November 13- 14 in Toronto.

12. Purpose of the Meeting to develop a strategic plan that will aim to include indigenous groups globally in National TB programs, encourage the collection of disaggregated data and promote the implementation of culturally appropriate best practises.

13. Potential Next Steps Creation of a Secretariat? Assurance of the Global community commitment to including Indigenous groups in their policy and program development as it relates to TB? Other?

14. Thanks! kbarker@afn.ca