As part of a new province-wide quality improvement initiative, a new report helps shed light on the specific ways systemic racism and discrimination affect our province’s patients, providers, and health care system overall. The study of more than 600,000 emergency room visits in Manitoba between May 2023 and September 2024, led by Dr. Marcia Anderson, zeroed in on the ways racism and discrimination affect emergency room wait times, triage scores and other factors like whether or not a patient will leave without being seen or leave against medical advice. 

Why it matters: 

The report uncovers details of concerning disparities in access and wait times for many Manitobans based on the analysis of race, ethnicity and Indigenous identity. Key findings include: 

• Indigenous patients present with similar triage scores to white patients, which dispels the common stereotype of Indigenous people using the emergency departments inappropriately. 

• African and/​or Black patients wait the longest to be seen even though they are less likely to present in the lowest acuity triage scores. 

• The data presented shows that in the WRHA and at HSC, Indigenous and African and/​or Black patients wait the longest to be seen. 

• Even though there are more visits by Indigenous people compared to their population size in the province, this doesn’t mean that ED use is inappropriate. This can reflect higher needs because of factors like underlying health gaps and lower access to other forms of care, such as primary care, that would help decrease the need for care in an ED. 

More context:

The report also delved into racism and discrimination in the workplace, noting in a review of one local study, 86 per cent of Black, Indigenous and racially marginalized emergency department providers experienced racism in the workplace and 63 per cent of white emergency department providers experienced discrimination. 

The report serves as an initial analysis, and will be used as a benchmark for future initiatives in this space. Manitoba is the first province to collect and share data in this way. 

Manitoba’s Health Minister Uzoma Asagwara joined the release, signaling the importance of the work. They noted that ​“we cannot fix what we do not measure and that’s why this work is so important,” and that ​“whether you’re receiving care or delivering it, systemic racism is making that harder for you.” 

Worth noting:

This continues Dr. Anderson’s groundbreaking work during the pandemic implementing identity indicators and using them to influence provincial policy about vaccine access and outreach that helped reduce the disproportionate impact COVID-19 was having on Indigenous and racially diverse populations. Her work was celebrated with the Physician of the Year award in 2022 from Doctors Manitoba. 

Doctors Manitoba supports this continued work to better understand how race affects access to health services, because that analysis is essential to improving equity in access and outcomes for all patients. Indeed, the report notes that ​“one of the important ways that we can use race-based data is to challenge harmful narratives that can compromise the healthcare different populations receive.” 

Based on physician feedback, Doctors Manitoba has been advocating for more resources to support care in ERs and Urgent Care and beyond, recognizing that Manitoba has among the longest wait times in Canada. This report reinforces the need for more resources to reduce waits and improve care, with particular attention to ensuring these investments lead to improved access to care for patients. This was part of our recommendations back in 2023, based on physician feedback, shared in our Prescription for Improving Health Care.

What’s next:

The team recommended immediate action on cultural safety and anti-Indigenous racism training at all levels of the health care system. Dr. Anderson notes that ​“educational interventions are really important, particularly when teams do education as a whole. This helps increase their capacity to have conversations about different forms of racism including racial micro-aggressions since they’re all learning the same content around the same time. It helps create an expectation that the team will talk about and apply what they are learning.” 

Dr. Anderson emphasizes that racism and discrimination stem not just from patients, but colleagues and health care leaders, and encourages physicians across the province to take part in this work. 

“If we consider micro-aggressions that people might not be aware of like eye-rolling or making invalidating statements like ​‘You’re just being too sensitive,’ or if someone uses a stereotype about an Indigenous person and substance use, if there’s a culture of safety any member of the team is more able to intervene and say, ​‘I noticed some of our team members are rolling their eyes whenever this person contributes an idea,’ or ​‘hey, what did you mean when you just said that?” 

There are several education options included in the report, which notably overlap with four pre-approved options identified by the College of Physicians and Surgeons of Manitoba to comply with its required education in this area, which you can learn more about here from CPSM. We also anticipate an update very soon from the College of Physicians and Surgeons about cultural safety and anti-Indigenous racism education. 

More resources on how to drive systemic change and improved outcomes are available from this resource from Ongomiizwin, the Indigenous Institute of Health and Healing. 

Doctors Manitoba has made anti-Indigenous racism training compulsory for all Board members and staff since 2022, and we will continue on our journey to improve our education and reflection as we go forward.