Collecting racial data in Manitoba hospitals will help 'disrupt and dismantle' racism in health care: doctor

Manitoba is launchinga new system-wide expansion of race-based data collection in hospitals, buildingonefforts to trackhow different racial groups were disproportionately impacted by COVID-19.

Beginning this spring, the province will ask patients to self-declare their racial or ethnic background as part of the hospital admission process, making Manitoba the first Canadian jurisdiction to do so, according to the University of Manitoba.

"Black, Indigenous and racialized folks actually receive significantly unequal care by race, and that is a reflection of how multi-level racisms operate in our health-care system," said Dr. Marcia Anderson, executive director of theOngomiizwinIndigenous Institute of Health and Healing at the U of MRady Faculty of Health Sciences.

"If we are not able to hold up that mirror and use data and evidence, what happens is a failure to act to change."

Anderson said the datawill enable service providers to "disrupt and dismantle systemic racism in health care."

She will lead the program,jointly run by the U of M and Shared Health, the provincial agency that co-ordinates health-care services.TheGeorge and Fay Yee Centre for Healthcare Innovation at the U of M will evaluate the program and help develop training for hospital staff.

Patients will be asked to volunteer information about their identity starting in April, choosing from categories such asFirst Nations status, Inuit, Mtis, Black, Filipino, Southeast Asian, African, Chinese, South Asian, LatinAmerican, Middle Eastern or white.

In a statement, Monika Warren, chief operating officer of Shared Health provincial services, said while the disclosure is entirely voluntary, "it is an important element in our efforts to improve patient care, health reporting and planning, and health system performance and services."

A 1st in Canada

While race-based hospital data is collected in othercountries, such as the U.S., Australia and England, Manitoba's isthe first suchprogram in Canada, according to Anderson.

Other Canadian jurisdictions have gathered, or will start gathering,some race data.For example, last fall, Nova Scotia started asking people applying to renew provincial health cardsto declare race and language information.

But none have gone so far as to attempt to collect it from all hospital patients, Anderson said.She suggested the Manitoba approach will provide higher-quality data quickly.

"It's really important, collecting this race-based data, because it sort of sheds a light on the disparities in terms of health outcomes," said Souradet Shaw, an assistant professor at the U of M and a Canada Research Chair in global public health.

Shaw said it will be important to ensure data collection doesn't stigmatize certain populations.

Dr. Alan Katz,a professor in family medicine and community health sciences at the U of M,saida culturally sensitive approach will be needed.

"Ifpeople are self-declaring being of First Nations or other racial groups that are at risk for racism, then they are opening themselves up to that kind of discrimination," said Katz.

"That's a potential significant harm."

Expanding pandemic approach

The initiative follows previous effortsby Shared Health and the Manitoba First Nations COVID-19 Pandemic Response Team, which was also headed by Anderson.

The Cree-Anishinaabe physician helped conductdemographic studiesthat found disparities in infection rates and more severe COVID-19 outcomes in Black, Indigenous and other communities of colour.

Anderson and others attributed those trends in part to social determinants of healthsuch as employment and overcrowded housing, particularly on some First Nations and systemic racism that creates barriers to care.

Anderson said that data led to anapproach thatapplieddifferent age criteria for immunization to different demographics deviatingfrom the initial advice of the National Advisory Committee on Immunization.

For example, when Manitobans who were 80 or older became eligible for COVID-19 vaccines, First Nations people60 and over became eligible.

The data also suggested a vaccination lag insome Black, Indigenous and peopleof colourcommunities.The province then started extending eligibility to people living in certain neighbourhoods with high proportions of BIPOCresidents, said Anderson.

More immunization sites were also opened in these areas.

"Once the vaccine was accessible ... enough diverse, Black, Indigenous and racialized people got vaccinatedto completely change the demographics ofwho was getting COVID-19," Anderson said.

"Theoverrepresentation of BIPOC communities amongst those being infected actually dropped."

In the works for years

Anderson's work on the topic began well before the pandemic. Demographic data wasthe subject of her master's degree in public health research over 15 years ago.

After theTruth and Reconciliation Commission reportin 2015,the Winnipeg Regional Health Authority asked Anderson to start working on the commission'scall to action No. 19, which relates to closing the gaps in health outcomes between Indigenous and non-Indigenous communities.

Shared Health then tapped her to expand her focus to the entire province.

All of that provided a foundation for COVID-19 race-based data collection, she said.

The pandemic also showed there was significant public buy-in for the idea, said Anderson.

She hopes to be able to begin sharing hospital data publiclyin the next year or so, and how it may be used.

"I hope that Manitoba becomes known for providing high quality, culturally safe health care that is free of racism."

Fighting racial and ethnic disparities in health care

2 years ago

Duration 2:33

Beginning this spring, the province will ask patients to self-declare their racial or ethnic background as part of the hospital admission process, making Manitoba the first Canadian jurisdiction to do so, according to the University of Manitoba.