Although a link between housing and tuberculosis (TB) is discussed in the medical literature, it is rarely considered from a community perspective. This paper looks at the link between social environment, housing, and TB transmission from the perspective of a First Nations reserve community. Using a community-based participatory research framework we conducted semi-structured interviews (n=15) in a First Nations reserve community with persistent TB. Data collection and analysis were iterative, using qualitative content analysis. A community advisory board, comprising Elders, community members, and two community co-investigators, was instrumental to ensuring cultural sensitivity. Participants discussed their experiences with a lack of control, and described the effect of inadequate housing and overcrowding on TB transmission. Participants linked overcrowding and addictions to high TB incidence rates, and also discussed the effects moving to the city had on culture and wellbeing. The findings of this study demonstrate that onreserve housing cannot be considered as simply four walls and a roof; rather the underlying conditions, such as inadequate housing, overcrowding, addictions, and policies such as the Indian Act, create an environment which contains many pathways to the promotion of infectious disease.
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