Tuberculosis Canada (Keystone, 2013). In addition, theTuberculosis Canada (Keystone, 2013). In addition, the

incidence all over the world is on the rise, in spite of the intensified global
efforts. It is estimated that a quarter of the world’s total population is
infected with tuberculosis (Keystone, 2013). In addition, 8.4 million people
are infected by the disease annually all over the world (Wallace, 2017).

Similarly, in Canada, the rates at which tuberculosis spreads particularly
among immigrants is very high (Sharma, 2017). Foreigners residing in Canada are
at a very high risk of contracting TB as compared to native Canadians (Lange &
Migliori, 2012). Immigrants constitute 18% of the country’s total population,
whereas they account for 65% of all reported TB cases (Sharma, 2017). This
basically explains how they risk being infected by the disease. For that
reason, it is necessary for a health promotion strategy addressing the
increased risk of tuberculosis in Canada to be designed. This paper will,
therefore, describe tuberculosis disparity in Canada, and the health promotion
strategy, before discussing the effectiveness and barriers of the health
promotion strategy, and finally, provide the evidence on how effective the
given strategy is through the provision of examples of how the strategy is
being used.

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Description of the Health Disparity

rates of tuberculosis cases in Canada have drastically dropped over the years,
due to the new methods of screening introduced by the immigration department
(Illingworth & Parmet, 2017). These methods have helped in preventing the
entry of immigrants suffering from tuberculosis into the country. As of the
year 2004, the country experienced 1,612 both new and retreatment cases
(Wallace, 2017). Nevertheless, in the year 2014, this number had dropped to
1,568, which was both the number of new or retreatment cases in the country (Lange
& Migliori, 2012). On the other hand, Immigrants and the Inuit are at a
very high risk of contracting tuberculosis, a factor which has been majorly
attributed to poverty (Sharma, 2017). As of the year 2014, aboriginal
populations constituted 4% of the total Canadian population, nonetheless, they
accounted for 21% of the total number of reported cases of TB in Canada
(Keystone, 2013). In addition, the rate of tuberculosis among the Inuit was
also higher as compared to that of other Canadians, making them be 50 times
likely to contract the disease (Sharma, 2017).

as much as the Inuit seem to be most likely to be affected by TB, immigrants
constitute the largest percentage of people suffering from TB in Canada
(Keystone, 2013). Immigrants from different parts of the world, constitute 18%
of Canada’s total population, however, they account for 65% of all reported TB
cases (Sharma, 2017). This basically explains who is at risk of contracting TB
in Canada (Wallace, 2017). Immigrants are majorly at a high risk of contracting
TB, due to changes in lifestyle once they move to Canada, and due to the new
climatic conditions which they experience in the country, hence affecting their
health (Lange & Migliori, 2012). Most immigrants arrive in the country from
developing countries, which are at high levels of contracting TB (Illingworth
& Parmet, 2017). Upon their arrival, immigrants tend to have good health
conditions and records, nonetheless, this changes after a certain period of
time. For instance, 10% of the cases tend to develop after the first year, 17%
after the second year, and 35% after spending 5 years in the country (Keystone,
2013). Furthermore, among the immigrants who developed tuberculosis while in
Canada, were also found to be most likely to be drug-resistant, with some of
them being six times more likely to being multi-drug resistant, than the actual
Canadian-born persons (Illingworth & Parmet, 2017).

Description of the Promotion Strategy      

to the prevalence of TB among immigrants in Canada, it has become necessary for
the government to come up with different strategies to address this pandemic
(Sharma, 2017). Canada has, therefore, come up with an immigration medical
screening program which aims at reducing and preventing the spread of TB among
the immigrants who arrive into the country (Wallace, 2017). This strategy is
effective through the Citizenship and Immigration Canada’s (CIC), which helps
in reducing the admission of affected persons into Canada (Keystone, 2013). The
medical screening program helps in denying entry to Canada for those found to
have vigorous pulmonary TB. Once a person is screened, the health of the person
becomes known to the relevant authorities, where they can be able to evaluate
and understand the condition of the given applicant (Lange & Migliori, 2012).

Likewise, those applying while living in Canada who are scanned and found to
have an active pulmonary TB are usually treated and must also be able to
complete their treatment before the finalization of their treatment, whereas
those who are found to have a past history of TB and are in a good condition,
are treated and allowed into the country (Sharma, 2017). Conversely, these
individuals are supposed to report to the territorial or the provincial public
health TB control programs immediately after their arrival into the country,
for a broader follow-up. In so doing, the immigration department is able to
regulate the entry of persons who suffer from TB into the country and to also
understand ways through which it can drastically reduce the spread of TB which
seems to emanate from immigrants (Wallace, 2017). This strategy does not only
aim at eliminating those suffering from TB, but it also seeks to help in
reducing the prevalence of TB among immigrants, particularly after moving into
the country.  

How the Promotion Strategy meets the requirements of Health
Promotion Strategy

strategy meets health promotion requirements in that it seeks to prevent the
spread of TB among the immigrants, hence preventing the transmission of the
disease to the native Canadians too (Sharma, 2017). In as much as the strategy
does not seem to inform people on what they could do to stay healthy, it
actually does so, through enabling those who have a past history of TB to live
peacefully, and through admitting them into the country and having a follow up
on their condition (Lange & Migliori, 2012). This helps in preventing them
from spreading the disease, and also preventing the general Canadian population
from being infected by TB (Wallace, 2017). Secondly, it addresses the areas in
the community which influence health and the wellbeing of the Canadians, so the
rates of TB among foreign-born Canadians can drop. Among the areas which
influence the spread of TB among the immigrants is movement from high risk
countries into Canada, which puts most Canadians at the risk of contracting TB,
because some of them may be carriers of the disease, whereas others may have
taken wrong drug doses, which makes them become drug-resistant (Sharma, 2017).

In addition, through screening the applicants before they are admitted into the
country, it makes it easier for the government to prevent its citizens from
contracting tuberculosis, thus taking care of the general population of Canada.

In the same way, the country is able to deal with health risk factors, a move
which is necessary for the prevention of the spread of tuberculosis (Keystone,

it enables and also allows the Canadian immigrants to have total control over
their lives and to also improve their health. Screening the immigrants enables
the immigrant communities in Canada to be less likely to contract TB (Sharma,
2017). In so doing, the immigrants are able to carry on with their activities
at ease. As a matter of fact, the strategy aims at protecting the immigrants
once they migrate into the country, hence enabling them to be able to carry on
with their lives (Sharma, 2017). For instance, most immigrants who migrate into
Canada usually end up doing simple jobs, which may not earn them a lot of
money, thus if they are infected with TB, then it might be hard for them to be
able to carry on with their lives, since they may end up being poor due to the
burden of dealing with TB. TB is highly related to poverty, a factor which
makes most of the poor people to end up contracting the disease (Lange &
Migliori, 2012). Understanding the situation in which most immigrants live
under, the strategy aims at cushioning them from contracting the disease
through screening the applicants, thus making sure they are free from TB before
being allowed into the country (Wallace, 2017).  

Barriers to Access

as much as the screening process seems to be successful, in some cases, some
immigrants may be found to be free from TB, or some of them may not have any
past history of TB (Sharma, 2017). Nonetheless, after moving into Canada, they
contract the disease, and in most cases, they end up being drug resistant
(Keystone, 2013). The effects of drug resistance are severe since the victim is
likely to die or his or her condition is also likely to worsen if care is not
taken. In addition, the victim is also likely to spread the disease,
particularly if the person lives in a crowded place (Lange & Migliori,
2012). This is a factor which basically limits the effectiveness of the
strategy, making it hard for the government to be able to deal with the issue
of TB amongst immigrants in the country. On the contrary, most of those who end
passing the screening tests without past TB history, end up contracting the
disease once in Canada, and in most cases, they become drug resistant, making
them to negatively impact the greater Canadian population (Wallace, 2017).

cost of screening the applicants is very high, making it hard for Canada to be
able to manage the strategy (Lange & Migliori, 2012). This is basically
because all applicants are usually screened, making the process costly, thus
making it hard for the country to cater for it (Keystone, 2013).

Correspondingly, immigrants arriving from all parts of the world are screened,
without considering if they are from low incidence countries (Sharma, 2017).

Canada is therefore forced to incur huge costs or screening all the applicants,
hence financing the program becomes a barrier because of the amount of money
which is spent on the program. The strategy in most cases may be faced with a
lot of challenges, because of poor resources required to make the surveillance successful
(Wallace, 2017).          

Evidence of Effectiveness 

strategy has been effective in dissimilar ways, in the sense that screening has
proven to be effective, through the way the process has aided in reducing the
rates at which the immigrants are affected by the disease (Sharma, 2017). This
strategy is consequently effective in the following ways, according to a
research conducted in Ontario between the periods of 2000-2011 (Lange &
Migliori, 2012). Immigrants scanned from 6 different countries accounted for
87.3% of active TB cases which were spotted through the pre-immigration
screening, and 10 other countries also accounted for 80.4% of the cases which
were identified through the post-immigration reconnaissance (Sharma, 2017).

Immigrants who came from countries with low TB prevalence rates resulted in
both pre- and post-immigration detection of 2.4 and 0.9 cases out of every
100,000 immigrants, correspondingly (Lange & Migliori, 2012). Post-immigration
surveillance was responsible for the detection of 2.6% of active TB cases in
Ontario residents who were foreign-born, and TB was majorly detected a median
of 18 days prior to those who were undergoing the surveillance than in those
who were not undergoing the surveillance, or those who did not conform (Sharma,
2017). The forecasters of active TB post-immigration comprised radiographic
indicators of old TB, country of birth, immigration group, place of application
for residency, immune status, and age (Keystone, 2013).

from the above results from Ontario, it is clearly evident that the number of
immigrants who were screened particularly those from high-risk countries
represented active TB cases (Wallace, 2017). Similarly, it was also evident
through the post-immigration surveillance that 2.6% of active TB cases in
Ontario were actually from foreign-born residents (Sharma, 2017). This
basically explains how the surveillance was effective, simply because of both
pre- and post-immigrant screening which pointed out the areas and the persons
who are responsible for the spread of the disease, hence being able to come up
with ways through which the disease could be contained in Canada (Lange &
Migliori, 2012). Due to that reason, the strategy has been effective, since it
has been able to control the rates of TB in Canada, through screening all the
applicants before they were allowed into the country (Keystone, 2013).

Examples of Strategy in Use     

strategy is used in different fields, which entails different states in the
country, and also across all races in Canada (Wallace, 2017). For example, the
Inuit, who are at a very high risk of contracting TB as compared to any other
race in Canada are usually screened and monitored, to make sure they are taken
good care of and are also prevented from contracting the disease (Lange &
Migliori, 2012). The strategy targets those who are more vulnerable to TB, thus
coming up with ways through which their lives can be taken care of through
preventing them from contracting the disease. For instance, refugees who are
also immigrants in Canada are usually screened before being allowed into the
country (Sharma, 2017). This is usually done to prevent the transmission of the
disease to other people, who may be living in crowded areas, a factor which may
increase the levels of TB in Canada. Secondly, the strategy relies on the
radiographic indicators of old TB, in both applicants and post-immigrants. This
enables the country to tackle the issue of redevelopment of TB, once a person
is in Canada, after a period of 2 – 5 years (Sharma, 2017). The strategy has
consequently seen immigrants with active TB cases being treated, whereas
applicants with active TB cases being denied the chance to move into Canada.

Finally, the strategy has been effective ever since it was first used in the
year 1995, where all immigrants were screened, to make sure they do not end up
spreading the disease while in Canada (Keystone, 2013).


to my point of view, the effectiveness of the strategy is good, this is
basically because of the evidence provided (Illingworth & Parmet, 2017).

The strategy has not only enabled Canada to curb the issue of TB, but it has
also provided the country with ways through which it can be able to protect its
citizens and to make sure they are safe from tuberculosis. The first step which
the strategy took was to look at the causes of TB among immigrants in Canada,
and the factors which make them vulnerable to the disease. In so doing, the
country has been able to protect and also treat immigrants with active TB cases
(Keystone, 2013). Furthermore, applicants with any cases of TB were not allowed
into the country, hence protecting them from transmitting the disease to other
Canadian citizens once in Canada. 

  The strategy has also helped in supporting
immigrants with TB living in Canada, which is a factor which makes the strategy
to meet the requirements of health promotion strategy (Illingworth &
Parmet, 2017). The strategy aims at eradicating TB, through treating the
immigrants, and also through screening them, because they are at the risk of
contracting the disease. For that reason, the strategy has helped in improving
the well-being of the immigrants in Canada, through protecting them from the
risk of contracting TB (Keystone, 2013). Finally, I would recommend CIC to only
scan successful applicants, so as to reduce the cost of the surveillance


in Canada is a disease which majorly affects immigrants, who in most cases fall
victims of the disease. In order to deal with this issue, the government in
collaboration with the immigration department came up with a health promotion
strategy known as CIC, which screens all immigration applicants and immigrants
residing in Canada, so as to reduce the effects of TB amongst the Canadians.

The strategy has proven to be successful, since most immigrants have been
screened, and the country has also been able to reduce the rates of TB amongst
the immigrants.