Diseases such as smallpox, measles, and influenza wreaked havoc on Alaska and its neighboring Arctic communities for nearly one hundred years throughout the nineteenth and twentieth centuries. They journeyed to the Arctic from their foreign origins over land and sea, devastating Alaskan towns and villages by the thousands, leaving little, if anything, in their path. Often hidden in the barracks of fur traders and explorers, these devious murderers sought infestation where conditions where cramped, and the breathing room was scarce. This era of disease in the Arctic began as the word of Alaska’s unrivaled beauty and abundant resources spread throughout the globe. Foreigners flocked to the unclaimed territory, carrying cocktails of new bacteria and viruses along with them. Prior to the 19th century, Alaska Natives remained relatively unexposed to many of the world’s illnesses, leaving their immune systems vulnerable to attack when outsiders arrived. While the rates of many of these ailments have declined to a rarity, one disease has remained particularly tenacious: Tuberculosis (TB).
Once known as “consumption” for its devastating ability to “consume” the human body, Tuberculosis has plagued the planet for thousands of years. The genetic analysis of hundreds of TB strains from around the world suggests that the infectious bacteria originated as early as 70,000 years ago with Homo sapiens in Africa. Yet, despite centuries of research and significant advances in clinical care and detection methods, TB remains one of the top 10 causes of death worldwide. The World Health Organization (WHO) reports that 10.4 million people fell ill with TB in 2015, 1.8 million of which died from the disease. The WHO predicts that this year’s TB death toll will reach 2-3 million people; an astonishing number for a disease that is both preventable and curable. Nonetheless, it is the not the disease itself that elicits such deadly consequences, but rather the conditions in which it thrives.
Spreading like wildfire, TB is a communicable disease that travels from person-to-person through a gesture as simple as a cough or a sneeze. Those at the highest risk for contracting the disease are individuals living with HIV, malnutrition, diabetes, and tobacco users, a huge portion of which live in low-middle income countries. Furthermore, those living in lower income communities tend to experience overcrowded living conditions, poor sanitation, and a lack of running water, all of which boost TB’s ability to spread. Unfortunately, Alaska’s rural and homeless populations boast a significant number of these characteristics, lending to the state’s substantial lead as the highest rate of Tuberculosis in the country.
During the first half of the twentieth century, Tuberculosis was the deadliest disease in Alaska. In 1932, the death rate from tuberculosis was nearly 20 times greater than the continental United States, killing an estimated 1,300 people per every 100,000. Moreover, the Alaskan populations most severely impacted by the disease were those only accessible by boat or plane, rendering access to treatment nearly impossible. Prior to the development of a successful treatment, sanatoriums were used to isolate those with the disease, tearing communities apart as those with the TB were forced into solitary confinement. Alaska’s first sanatorium was built in Skagway, located in Southeast Alaska. By the 1940’s, approximately 4,000 active cases of Tuberculosis had been identified in the Southeast, with only 70 hospital beds available.
It wasn’t until the mid-19th century that scientists discovered that Tuberculosis was in-fact, curable. A combination of chemotherapy and drugs finally proved successful in treating the disease, and by the mid 1950’s, Alaska’s largest city of Anchorage had dedicated 400 beds to Tuberculosis patients in its Alaska Native Hospital. Alaska’s battle with Tuberculosis continued at nearly full throttle until the 1970s, when the state finally experienced a decline in death rates.
Nonetheless, here we are nearly 50 years later, and Alaska’s rate of Tuberculosis remains 16 times that of the United States’ national average. With preventative and curative treatments well established in today’s society, the root of TB’s winning streak can no longer be blamed on foreign fur traders and explorers introducing the disease to ill-equipped immune systems. Now, the disease has rooted itself into an intricate web of societal factors that must also be addressed in order to reduce the incidence of infection.
A community’s level of vulnerability towards TB outbreaks or high infection rates is directly related to a wide range of socio-economic, environmental, and cultural characteristics that influence the risks of contracting and/or spreading TB. These societal characteristics are otherwise known as social determinants. In my next blog post, I will provide an overview of the relevant social determinants of TB in Alaska, and discuss their relation to the tenacity of Alaska’s long and arduous battle with disease.