Troubling new evidence of systemic racism in Manitoba’s emergency departments (ERs) was released this summer. Overall, the new Race, Ethnicity and Indigenous Identity (REI) data shows that African/Black and Indigenous patients wait longer in emergency rooms and leave more often without being seen and against medical advice. On average, white patients waited for the shortest amount of time, at 4.1 hours, while African/Black patients waited the longest to be seen at 5.5 hours. Indigenous patients in the data set waited 5.3 hours on average. 

We have this information, backing up what advocates and academics have long signalled about systemic racism in health care, because of a decision made by the Manitoba government to start collecting disaggregated race, Indigenous identity, and ethnicity data in 2023. Thus far, Manitoba is the first province to do so. 

The 2023 change, however, comes nearly ten years after the Truth and Reconciliation Commission released its final report in 2015, including 94 Calls to Action for Canadian governments, care workers, newcomers, and all Canadians. Call to Action no. 19 relates to the need to identify and close gaps in health outcomes between Indigenous and non-Indigenous communities.

While it is positive that Manitoba is the first province to collect such data, it should not have taken until 2023 for provinces in Canada to take up this important call. The realities of systemic racism are felt in the daily lives of Indigenous, Black, and other racially marginalized people in Canada, and Manitoba is sadly no different. Academics and community advocates have known about this problem and have regularly sounded the alarm about systemic racism in health care systems across Canada. But now we have new data to help prove it. 

It’s a start, but the data presented in the June report came with little substantive analysis and has yet to prompt any significant change at the government level or from Shared Health.  

Thus far, the Manitoba government has acknowledged the report, suggesting there is hard work to be done, but offering few details on how that work should proceed. Over three months after its release, the report’s conclusion that ER staff should be first in line for cultural safety and anti-racism training has been left at the level of a recommendation, not a requirement, on the government side. 

The government must move from acknowledgement into action. They must stand up for health equity and put funding behind their commitment to anti-racism within all public systems, including health care. It cannot be left up to individual health care workers – or a single employer or health authority – to address this system-wide issue. We need coordinated, sustained actions to address structural racism, applied to all areas of public health care – not just anti-racism training for staff working in Winnipeg ERs, and not just targeting nurses.

Racism is not just a nursing problem or a problem contained in Winnipeg ERs due to short staffing or lack of primary care facilities, although these are also systemic issues that play a role. Racism is structural. It impacts all aspects of life in Manitoba, and it can be deadly. 

Making real change on systemic inequalities like racism in Manitoba will take political will and both cultural and economic transformation. Social determinants of health, like access to housing, must also be addressed alongside efforts to combat racism directly in health care delivery and across Manitoba. Patients and workers do not exist in a vacuum. Workplaces are not sealed off from the communities and cultures that surround them, and changes made only within a given industry or worksite alone are not enough. 

Improving health outcomes for Indigenous patients is part of the material work of reconciliation, and everyone who lives on these territories should be motivated to do that work. Combatting anti-Black racism is a matter of justice that all Manitobans should care about. But already overworked, burnt out, and short-staffed health care workers can unfortunately not be expected to undergo additional training without time off and financial support simply because it is the right thing to do.

The government and Shared Health must show leadership and work with nurses and other members of the health care team to develop a clear action plan with annual progress reports and assessments of long-term trends. Anti-racism and cultural safety training must be paid and mandatory, not just for current staff, but as part of the educational requirements to work in health care and as part of health professionals’ continuous educational improvement. 

Urgent and substantive action is needed. Societal and structural change takes time, but patients can be better protected today through government and community-based action. Alongside anti-racism and cultural safety education, additional supports can be added to the system, like patient buddies and advocates – something the research shows helps reduce the number of racially marginalized patients who leave without being seen at ERs. 

While the system also desperately needs more health care workers on shift, building diverse teams of patient advocates is an evidence-based approach that can help provide culturally safe and anti-oppressive care for all patients who use Manitoba’s health care system. These roles should be paid and incorporated into the health care team and workflow within emergency rooms to help all patients feel safe, heard, and willing to stay long enough to be seen by medical professionals. This is just one way that structural racism and discriminatory gaps in health outcomes can be meaningfully addressed in Manitoba. If done right, such a program could save lives and help rebuild trust in the public health care system. 

Ultimately, the ongoing effects of colonialism and white supremacy are structural, collective problems that need structural, collective solutions. Employers and the government must work together to address systemic racism in health care, not put the blame on individual health care workers or pass responsibility back and forth between levels of power without making any real changes. It is our collective responsibility as Manitobans to learn about how we can dismantle colonial and racialized hierarchies and work together to build a more equitable and healthy society for current and future generations.