People at risk

Why swine flu is sweeping through our native population

People at riskRumour has it swine flu came to St. Theresa Point, in northern Manitoba, with a Catholic priest who visited Mexico in March. He flew directly into the tiny First Nations community, locals say, leaving one week later because he was so sick. Whether that’s how the H1N1 virus landed at the reserve or not, one thing’s certain: by early May, many residents there were very sick. The virus spread like wildfire to neighbouring First Nations communities.

In the global H1N1 pandemic, Canada has been disproportionately hit. Our national infection rate is now 24 per 100,000 people, significantly higher than Mexico’s, which is nine per 100,000, or that of the United States, which is 11. Even so, “the raw numbers alone aren’t helpful,” says Alan Davidson, associate professor of health studies at the University of British Columbia, Okanagan. To address the problem, he says, “we have to have an understanding of who’s being affected.”

By now, the answer seems to be clear enough: it’s Canada’s native population. According to the Assembly of Manitoba Chiefs, First Nations people in that province have an infection rate of about 130 per 100,000. The rate in Nunavut, home to half of Canada’s Inuit, is a staggering 1,070 per 100,000. This pandemic may have caught almost everyone off guard; but its impact on Canada’s native population, which has been swift and brutal, should come as no surprise.

In fact, our First Nations and Inuit have some of the highest rates of lower respiratory tract infections (or LRTIs) in the world, says Toronto-based infectious disease pediatrician Dr. Anna Banerji, who recently published a study on risk factors associated with LRTI hospitalization among Inuit children. Of the people who do contract H1N1, many will see their symptoms resolve “after a typical flu-like illness,” she says. “We only worry when they get severe lower respiratory tract infections,” like pneumonia or bronchiolitis, to which Inuit children are especially prone.

When it comes to swine flu, it’s the young who are at risk: in Canada, the average age of people infected is 22, and the median age is 17. There are several risk factors that up an Inuit child’s risk of being hospitalized with an LRTI, according to Banerji’s work, including smoking during pregnancy (59 per cent of First Nations adults on reserves are smokers, compared to 24 per cent of the general population) and lack of breastfeeding (60 per cent of First Nations children on reserves are breastfed, versus 80 per cent in the general population). Smoking during pregnancy seems to harm a baby’s lung development, Banerji says; in her study, babies of women who did smoke while pregnant were four times more likely to be hospitalized. “These same risk factors could make H1N1 devastating to the Aboriginal population,” she says.

Overcrowded housing, which helps the virus spread, was another risk factor in Banerji’s study. Sanitation is also an issue: in Garden Hill First Nations, not far from St. Theresa Point, just half of all homes are hooked up to the sewage system, Chief David Harper says. Homes are often poorly ventilated, too, and so contaminants like cigarette smoke and mould—which ups the risk for infection, asthma and allergies—linger. Around Iqaluit, roughly 80 per cent of Inuit homes had ventilation rates below the recommended Canadian standard, one 2007 study found; what’s more, 94 per cent of Inuit babies were exposed to tobacco smoke at home, compared to 25 per cent in southern Canada.

And then there’s overall health to consider. When it comes to swine flu, people with some underlying conditions seem to be at greater risk, says the University of Alberta’s Dr. Malcolm King, scientific director of the Institute of Aboriginal Peoples’ Health at the Canadian Institutes of Health Research: “When they get the flu, it will be serious, and could lead to complications, or even death.”

Among Canada’s native population, many of the health problems that might up the risk posed by H1N1—including obesity, which seems to stress the lungs, and diabetes—are widespread. Among a U.S. sample of 268 people hospitalized with H1N1 infection, 15 per cent had diabetes. Meanwhile, the prevalence of diabetes among Canada’s First Nations adults is four times higher than the general population. And the obesity rate of First Nations adults living on reserves is more than double that of the general population.
Based on their high infection rates, some experts wonder if First Nations and Inuit people may be more genetically susceptible. Banerji’s work identified Inuit race as an independent risk factor for hospitalization with a lower respiratory tract infection: although up to 20 per cent of the general population are non-Inuit on Baffin Island, where her study was conducted, all the hospitalized children were Inuit. “It suggests to me there is a genetic component,” she says, although this still hasn’t been proven.

Besides genetics, other risk factors—from poor nutrition and smoking to overcrowded housing—are markers of poverty, Banerji says. With the H1N1 epidemic expected to grow worse in the fall, huge sections of the Aboriginal population will be at risk. A vaccine is expected to be available by October; people living on reserves should be a priority. “If we don’t start addressing some of these issues, and soon, the impact of H1N1 will be due to our neglect, and our failure,” Banerji says. “If people die, we are all responsible.”
As the virus spreads across Canada’s Aboriginal communities, it’s not just the native population we need to worry about—it’s the young, or those with diabetes, asthma, and other health problems. In other words, millions of Canadians are vulnerable.

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