Healthy

Communities:
A Role for
Everyone

2022
Health Status
of Manitobans
Report
from the Chief Provincial
Public Health Officer
THE HONOURABLE AUDREY GORDON
Minister of Health
Room 302, Legislative Building
Winnipeg, Manitoba R3C 0V8

Dear Minister Gordon:

Fulfilling the requirements of The Public Health Act,

I have the honour and privilege of presenting you
the Chief Provincial Public Health Officer’s Report
on the Health Status of Manitobans 2022: Healthy
Communities: A Role for Everyone.

Respectfully submitted,

Dr. Brent Roussin

Chief Provincial Public Health Officer
Table of Contents
Message from the
Chief Provincial Public Health Officer. . . . . . . . . . . . . . . . . . 2

Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Executive Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Truth and Reconciliation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

CHAPTER 1:
Public Health:
Beyond Treatment of Disease. . . . . . . . . . . . . . . . . . . . . . . . 9

CHAPTER 2:
Health Status Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

CHAPTER 3:
Measuring Population Health
in Manitoba. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

CHAPTER 4:
COVID-19 in Manitoba. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

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Message from the
Chief Provincial Public Health Officer
COVID-19 has brought upheaval to all of our lives, and has made many of us reconsider what
it means to be healthy. Although health has different meanings for different people, we can
generally agree it includes physical, mental, social, emotional and spiritual components.

Most Manitobans enjoy very good health, but unfortunately, this is not evenly distributed across
our province. We know that racialized people in Manitoba, and those living with lower incomes,
have poorer health outcomes compared with other people in Manitoba.

Consider SARS CoV-2, the virus that causes COVID-19. This novel (new) virus was introduced into
a world where essentially no one was immune, meaning that everyone was at risk of infection.
Even though the entire population was equally susceptible, we still saw that certain groups were
unequally affected across many jurisdictions, including our own.

We can also look at the widespread transmission of sexually transmitted and blood-borne
infections (STBBIs) and high rates of substance use in our province, which, once again,
disproportionally impact marginalized populations.

To address these inequitable health outcomes, we must continue to measure and report on
these disparities and strive to address the root causes, especially inequitable structural issues
that adversely affect health, such as poverty, racism, stigma, historical trauma and access to care.

During the COVID-19 pandemic, public health played a supporting role with First Nations and
Inuit partners that developed a more autonomous and Indigenous-informed and led public
health response. This community-led approach, provides a framework for future work on other
health issues that can lead to improved health outcomes and long-lasting change.

This report highlights the gaps in health status that impact different populations across our
province. My hope is that shining a light on these health inequities and the structural factors
that underpin them, will inspire Manitobans to consider their own roles in making Manitoba a
healthier place for everyone.

“As COVID-19 has once again shown us,

we are all truly in this together.”

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Land Acknowedgement
I would like to acknowledge the land on and about well-being of racialized and Indigenous Peoples,
which this report was developed. Manitoba borders and I am dedicated to moving forward collaboratively
include the treaty territories and ancestral lands with community and Indigenous leadership towards
of the Anisihinaabeg, Anishiniewuk, Dakota Oyate, healing and true reconciliation.
Densuline and Nehethowuk peoples. Manitoba lands
cover seven numbered Treaties between Canada and This report describes the health gaps that exist
First Nations (1, 2, 3, 4, 5, 6, 10), although five Manitoba between different groups of people in Manitoba and
First Nations are not signatory to any Treaty (Birdtail discusses the inequitable practices and conditions
Sioux, Sioux Valley, Canupawakpa, Dakota Tipi and that have led to them. It is my hope that a greater
Dakota Plains).[1] I also acknowledge that Manitoba understanding of the determinants of health,
is located on the homeland of the Red River Métis including the legacy of colonialism in Canada,
and that the northern region includes ancestral lands will support greater health equity in our province.
of the Inuit. Manitoba continues to be the home of
diverse Indigenous cultures and we are committed DATA
to working in partnership with First Nations people, The nearly two-year delay of this report, due to the
Inuit and Red River Métis citizens in the spirit of truth, COVID-19 pandemic, has created many challenges,
reconciliation and collaboration. including, in some cases, the reporting of older
data. Data has been updated to the extent possible.
OTHER ACKNOWLEDGEMENTS However, timing constraints, the timing of data cycles
As Manitoba’s Chief Provincial Public Health Officer, for certain reports, such as the census, and
I acknowledge that racist and colonial practices, past reporting delays as a result of resources being
and current, have negatively affected the health and directed to reporting on COVID-19, have meant
that some data presented is older.

Identifying and measuring health inequities in

Manitoba sets the foundation for creating goals and
taking action to close the gaps in health outcomes
experienced by different populations. For many
indicators presented, data is not available by race,
ethnicity and Indigeneity as this information is not
regularly collected. To describe the health gap
between First Nations and non-First Nations people
in Manitoba, this report relies heavily on data from
The Health Status of and Access to Healthcare by
Registered First Nation Peoples in Manitoba report
produced in partnership between the First Nations
Health and Social Secretariat and the Manitoba
Centre for Health Policy.

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 This report would not have been possible
without contributions from many individuals and
organizations. A sincere thank you to the numerous
people who have provided their time, expertise
and perspectives in order to support this effort to
describe and improve the health of Manitobans.

Data and feedback were provided by many

individuals, government departments and
organizations across Manitoba. While not all
contributors can be included, the input received
was crucial in the development of this final report.

In particular, the Chief Provincial Public Health Office

would like to acknowledge (alphabetically):
• Assembly Manitoba Chiefs
• First Nations Health and
Social Secretariat of Manitoba
• Pandemic Response Coordination Team
• First Nations and Intuit Health – Manitoba Branch
• Manitoba Finance
• Communications and Engagement Division
• Manitoba Health
• Population and Public Health Branch
During the COVID-19 pandemic, Manitoba began • Epidemiology and Surveillance Unit
collecting information on race, ethnicity and • Information Management and Analytics Unit
Indigenous self-identity which supported further • Manitoba Keewatinowi Okimakanak/Keewatinohk
analysis of how COVID-19 impacted different groups. Inniniw Minoayawin
In addition, an information sharing agreement • Mental Health and Community Wellness
between the First Nations Health and Social • Health Promotion and Wellness Branch
Secretariat of Manitoba and the Province of Manitoba • Mental Health and Addictions Branch
was signed on April 28, 2020. This unprecedented
agreement sets the standard for future agreements Finally, this report was made possible through
that respects the First Nations principles of the leadership of the writing team who overcame
Ownership, Control, Access and Possession (OCAP®) many obstacles, including a global pandemic,
and First Nations data sovereignty. during its development.

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Executive Summary
The COVID-19 pandemic delayed the release of this When it comes to improving the health of our
report by almost two years. During this time, we had population, every Manitoban has a role a play.
an opportunity to see, first-hand, the impact of health However, those with the power and privilege to
inequities in our province. When SARS CoV-2, the virus make decisions and set policy direction have a
that causes COVID-19, was first identified in humans particular responsibility to disrupt and transform
we were all equally susceptible, but not all groups public policy, institutional practices and cultural
were affected to the same degree. This report will views that further entrench these disparities. As
outline how this pattern can be seen in many other public health practitioners, we recognize that to
health outcomes. advance health equity, we need to continue to
measure and expand our understanding of health
It is important to reflect upon the idea that health disparities, set measurable and achievable targets
disparities are not due to chance, poor life choices, and collaborate with community leadership. We must
genetics or some other inherent predisposition to also incorporate evidence-informed remedies, such
poor health outcomes. One of the goals of this report as cultural safety, decolonization and anti-racism into
is to emphasize the role that the social determinants our work.
of health (such as income, racism and colonialism)
have on the health of Manitobans. After providing a general health status update, this
report provides a description of COVID-19 in Manitoba
Measuring the gaps in health status in our province is between March 2020 and March 2022, and concludes
necessary to guide actions to improve the health of with a closer look at the inequitable impact by race,
all Manitobans. Having a more equitable society and ethnicity and Indigeneity.
improving access to education, justice, employment,
housing, wealth and other social and structural
determinants of health benefits us all.

"It is important to reflect upon the idea that

health disparities are not due to chance,
poor life choices, genetics or some
other inherent predisposition to
poor health outcomes."

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Truth and Reconciliation
Governments have been called upon by the Truth
and Reconciliation Commission of Canada’s Call to
Action #18

“to acknowledge that the current state of

Aboriginal health in Canada is a direct
result of previous Canadian government
policies, including residential schools, and
to recognize and implement the health-care
rights of Aboriginal people as identified in
international law, constitutional law, and
under the Treaties.[2]”

The Truth and Reconciliation Commission (TRC) was

established in 2008 to bear witness to the impacts
of residential schools and to facilitate reconciliation Reconciliation can mean different things to different
among former students and their families, their people. Chief Joseph has suggested that “what is
communities, governments and all Canadians. important is that we are thinking about it now and
Residential schools are a part of Canada’s shared we build from the place that we are at to create the
history, which was not widely acknowledged by non- reconciliation that has outcomes that we desire as
Indigenous people before the TRC’s work. Canada’s human beings - a loving, caring, just society”.[4]
relationship with Indigenous people suffered due to
the profound effects of residential schools.[3] The TRC defines reconciliation as “establishing and
maintaining a mutually respectful relationship
Everyone has a role in reconciliation. Chief Robert between Aboriginal and non-Aboriginal peoples
Joseph, who was an honorary witness to the TRC, in this country. In order for that to happen, there
suggests that “the most important definition has to be awareness of the past, acknowledgement
of reconciliation is the one that applies to an of the harm that has been inflicted, atonement
individual’s own life experience” by asking for the causes, and action to change behaviour.”[5]
Reconciliation is not a destination, or something
“What is it in your life that that is achieved and checked off of a to-do list.
needs to be reconciled?” It will require continual effort and action over time.

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The journey of reconciliation that Canadians are TERMINOLOGY
embarking on involves fundamental change that Throughout this report we will primarily use the terms
is incorporated into every aspect of our society, racialized people to describe historically marginalized
including in our churches, educational institutions, races and ethnicities and Indigenous to describe
all levels of governments and all sectors. With this First Nations people, Inuit and Métis Nation citizens.
change, attitudes of mutual respect are being However, it is important to recognize that these terms
cultivated throughout the nation. refer to distinct peoples that have unique cultures
between them as well as within them, such as
There are many ways for people of all ages diverse histories, geography, customs, traditions and
to engage in reconciliation including: languages. Where information presented relates to
• participating in local community events on the a specific group, we will be as specific as possible in
National Day for Truth and Reconciliation (Sept. 30) recognition and respect of the diversity throughout
and local Indigenous cultural events open to the our province and country.
public throughout the year.
• reading Indigenous books and watching
movies by Indigenous filmmakers.
• learning more about Indigenous arts and artists.

RESOURCES FOR FURTHER LEARNING:

• Reconciliation: What does it mean?
A short video of a panel discussion with
Indigenous leaders and experts hosted by
Health Canada in 2018. https://www.canada.ca/en/
health-canada/services/video/reconciliation.html
• Truth and Reconciliation
Commission of Canada: Calls to Action
The 94 Calls to Action of the Truth and Reconciliation
Commission. https://publications.gc.ca/collections/
collection_2015/trc/IR4-8-2015-eng.pdf
• Honoring the Truth, Reconciling for the Future
Summary of the Final Report of the Truth and
Reconciliation Commission of Canada.
https://publications.gc.ca/collections/collection_2015/
trc/IR4-7-2015-eng.pdf
• What We Have Learned
Principles of Truth and Reconciliation
https://publications.gc.ca/collections/
collection_2015/trc/IR4-6-2015-eng.pdf
• Where are the Children Buried?
This report addressed the question about where
deceased Indian Residential School students
are buried. Figures and illustrations to accompany
the report are available at https://nctr.ca/wp-content/
uploads/2021/05/AAA-Hamilton-cemetery-FInal.pdf.

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 7

 1
CHAPTER

PUBLIC HEALTH:
Beyond Treatment
of Disease
C h a p t e r 1: P u b l i c H e a l t h: B e y o n d Tr e a t m e n t o f D i s e a s e

What Is Public Health?

Public health is defined as the organized
efforts to keep people healthy and prevent
injury, illness and early death. It is a
combination of programs, services and
policies that promote and protect the health
of people and the communities where we
live, learn, work and play.[6]

Supporting the Health of Population

Since the early 1900s, the average lifespan of Canadians
The main roles of
has increased by more than 30 years.[7] Twenty-five public health are:
of those years are attributable to advances in public
health.[7] Various public health achievements have
HEALTH
led to this increase, including the control of infectious
PROMOTION
disease, the decline in deaths from heart disease
and stroke, improved maternal and child health,
workplace safety, vaccination, motor vehicle safety, DISEASE AND
the recognition of tobacco as a health hazard, and
INJURY PREVENTION
food safety.[7]

Public health takes a population health approach to EMERGENCY PREPAREDNESS

improving the health of an entire population, group
or community. The population health approach
looks at why some communities are healthier than POPULATION HEALTH
others and uses that information to take action. This ASSESSMENT AND
action includes developing programs and policies SURVEILLANCE
to improve the health and well-being of those
populations.[8] To support the health of populations,
some public health work provides direct support to PROTECTION OF THE HEALTH OF
people in their communities, such as free flu shot THE POPULATION AS A WHOLE
clinics, breast feeding support for parents, client-
centred advocacy (e.g., financial benefits or housing),
smoking and vaping education for youth in schools
and injury prevention programs for seniors. At a
broader level, some examples of public health work
include supporting access to safe drinking water,
analyzing the epidemiology of various diseases
and conditions, and managing disease outbreaks.

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Public health is a branch of medicine that EPIDEMIOLOGY
aims to prevent people from getting sick or Epidemiology is a foundational science of public
injured in the first place. It also addresses the health. It is the study of disease introduction and
spread through a population. Epidemiology is
health of populations or groups.[9]
key to understanding how healthy our province
When we think about health care, we might think is and the differences in health between different
of doctors and nurses treating people who are populations.[11] Epidemiologists interpret analysis to
sick. Public health includes a wide range of health contribute an evidence base for public health policy,
professionals, including doctors with specialty health promotion and interventions.
training in community health, nurses, public health
inspectors, epidemiologists, environmental health
officers, laboratory scientists, policy analysts,
dietitians, health promoters, tobacco control officers
and mental health and addictions specialists.

EVERYONE HAS A ROLE IN PUBLIC HEALTH

It is not just health care professionals who are
involved in public health. Community leaders,
teachers, principals, families, employers, social,
cultural and health organizations and sports and
recreation clubs all contribute to public health in
Canada.[10] The actions of all Manitobans contribute
to the overall health of our communities. This
became very clear during the COVID-19 pandemic.
Manitobans acted together to reduce the spread
of COVID-19 by staying home as much as possible
(especially when sick), wearing a mask in public,
and practicing physical distancing and
good hand hygiene.

Teachers and Sports and

Principals Employers Recreation
Social, Clubs
Cultural
Community
Families and Health
Leaders Organizations

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 PUBLIC HEALTH IN CANADA
In Canada, the term “public health” is sometimes
confused with our publicly-funded health care
system. Publicly-funded health care means that
our overall health care system (i.e. hospitals, clinics)
is funded by taxpayers’ dollars.[8] Public health is
one important part of our publicly-funded system,
working to prevent illness and keep people out
of hospitals.

The Public Health Agency of Canada, which was

created in 2004, is part of the federal health portfolio.
Its activities focus on preventing chronic disease
and injuries, responding to public health threats,
promoting good physical and mental health, and
providing information to support informed decision-
making.[12] The federal, provincial and territorial levels
of government are responsible for different aspects
of public health. They work collaboratively through
the Pan-Canadian Public Health Network to improve
public health in Canada and meet regularly to share
knowledge and information on best practices
and develop and implement efficient and
collaborative approaches.[10]

The Chief Medical Officers of Health across

Canada are responsible for the protection
and promotion of the health of the public
and prevention of disease and injury within
their provinces or territories.

They collaborate on the Council of Chief Medical

Officers of Health. This pan-Canadian forum promotes
excellence in population and public health practice
through communication, collaboration and the
exchange of ideas, knowledge, experience and best
practices. This collaboration enables Chief Medical
Officers of Health to advance public health practice
across Canada, while respecting each government’s
jurisdiction. The council may provide direction,
guidance and recommendations on technical issues
relating to the Public Health Network's work, as
appropriate.[13]

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PUBLIC HEALTH IN MANITOBA The roles of the chief and deputy chief
The Population and Public Health Branch of Manitoba provincial public health officers are to:
Health provides clinical public health leadership,
monitor and report on the health status
as well as policy, planning, funding, oversight and
of Manitobans;
coordination for an integrated approach to public
health programs and services across Manitoba.
support government departments and other
The branch works closely with other areas within
partners to improve the overall health of
the ministry and other provincial government
departments, as well as the seven service delivery
Manitobans and reduce health inequities;
organizations within the health sector, including the
take appropriate action consistent with the
five regional health authorities, the cancer authority
(Cancer Care Manitoba) and the provincial authority powers and responsibilities described for the
(Shared Health) to align and integrate initiatives CPPHO in the Public Health Act; and
across government.
advance public health knowledge and
Manitoba has had a Public Health Act since 1965. capacity.[15]
However, Manitoba’s current Public Health Act came
into effect on April 1, 2009.

The act provides a legislative framework that helps

the province anticipate and respond to public health
emergencies and creates a framework for the other
provincial public health functions, such as health
surveillance, disease and injury prevention, and
population health assessments.[14]

In accordance with the Public Health Act, the

Minister of Health must appoint a physician as
chief provincial public health officer (CPPHO).
The CPPHO plays a key leadership role in the
Population and Public Health Branch.

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 13

In addition to the chief and deputy chief provincial MANITOBA’S CLINICAL AND
public health officers, Manitoba has a team of PREVENTIVE SERVICES PLAN
medical officers of health (MOHs) reporting through Improving the overall health status of Manitobans
the deputy CPPHO. cannot be achieved by public health working in
isolation. Manitoba’s health care system also plays an
The MOHs important role. Collaboration between public health
contribute to policy, strategy and program and the acute care system is necessary to ensure the
development; clinical planning of health services is based on the
health needs of the population. Manitoba’s clinical
provide expert public health consultation and preventive services plan will guide improvements
and leadership; to access, coordination and integration of health
services in the province.
advocate for, and communicate about, the
public’s health and perform their legislated "Better coordination will lead to
requirements for investigating and mitigating better access and better quality of
health hazards. Medical officers of health care for Manitobans across the province."
are specialists that also act as consultants to
Updated annually, this rolling five-year plan will
primary care providers for the management of
identify improved, innovative ways of delivering care,
certain diseases and programs, such as sexually
clear provider roles and responsibilities and easy to
transmitted and blood-borne infections and
understand pathways for patients to ensure they are
vaccinations. able to access appropriate care as close to home as
possible, with the certainty that specialized resources
are available to them if they are required. Better
coordination will lead to better access and better
Regional health authorities (RHAs) deliver many public
quality of care for Manitobans across the province.
health programs and services throughout Manitoba.
Public health nurses, community dietitians and
To learn more about the plan, visit
health promoters are the front line of public health
https://sharedhealthmb.ca/about/clinical-planning/
professionals, providing services such as influenza
immunization clinics; prenatal, maternal and child
health programs; and injury prevention programs for
seniors. They work with families, communities and
community organizations to understand and address
their needs to achieve good health.

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 2
CHAPTER

HEALTH STATUS
Overview
Chapter 2: Health Status Over view

To find out what makes Manitobans healthy, we have Only 25 per cent of overall health outcomes
to look beyond the treatment of disease and the are influenced by the health care system
health care system and need to direct our focus to
and its services. The social determinants
our environments, the conditions of our daily lives
and the systems and structures that create these.
of health contribute up to 60 per cent to a
population’s health status.[18]
Health is more than simply not being sick. The World
Health Organization defines health as “a state of These conditions have a large impact on our health
complete physical, mental and social well-being”.[16] and include experiences of racism and colonialism,
gender, Indigenous identity, social status and access
Health and well-being are determined to income, employment, housing and education.
Other factors, such as cultural and family connections,
outside of the health care system.
language retention, and strong community networks
and identity, also have important impacts on health
DETERMINANTS OF HEALTH
and well-being.
A population health approach examines what makes
and keeps people healthy. Health is created by the
Not all groups of people have the same access to
structures and circumstances of our everyday life.
the social determinants of health, access which is
We often talk of the social determinants of health,
driven by underlying factors including political,
defined as “the conditions in which people are born,
social, cultural and economic structures; natural
grow, live, work and age – conditions that together
environment, land and climate change; and the
provide the freedom people need to live lives
history and legacy, of ongoing colonialism and
they value”.[17]
systemic racism.[19] The health status of racialized
people and 2SLGBTQQIA1 people, for instance, is
negatively affected by discrimination, racism and
historical trauma.[20]

Income and social status Healthy behaviours

Employment and Access to health
working conditions services
Education and literacy Biology and genetic
endowment
Childhood experiences
Gender
Physical environments
Culture
Social supports and
coping skills Race / Racism

1
Two-spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex and asexual and those who self-define outside
of this inexhaustive list

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Source: Robert Wood Johnson Foundation[22]

We all have the ability to create the Health inequity refers to “differences in health
conditions in which everyone has associated with structural and social disadvantage
that are systemic, modifiable, avoidable and unfair.”[21]
access to opportunities for the
Health inequalities are preventable and are often due
highest standard of health. to how people or groups are treated.
Achieving good health isn’t as simple as making
Health disparity is “a measurable difference in
the right choices. It depends on whether we have
health outcomes between groups, communities
options and what those options might be. Power,
and populations who experience relative advantage
privilege and resources are unequally distributed in
or disadvantage due to structural and social
our society. This factor impacts our opportunities for
determinants of health.”[21]
good health.
The equality image shows what happens when each
Health equity means “that all people (individuals,
person has the same or equal access to resources.
groups and communities) have fair access to, and
Not everyone is able to ride the bike. The outcome for
can act on, opportunities to reach their full health
providing everyone the same bike is clearly unequal.
potential and are not disadvantaged by social,
The equity image shows what happens when people
economic and environmental conditions, including
have equitable access to resources based on their
socially constructed factors such as race, gender,
needs. With equitable access, everyone is able to ride,
sexuality, religion and social status.”[21]
as the bike reflects their needs. This image shows that
taking the same approach to promoting health does
not work for everyone.[22]

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RACISM In recent years, people of all races and backgrounds
Racism is “the race-based allocation of value, are learning more about the effects of racism, and
resources, opportunities and status in cultural, coming together to speak out on social injustice. This
political, institutional, economic and social forms” movement is resulting in increased recognition that
and “is reinforced by dominant white culture and racism is a public health issue affecting the health
practices.” [21] Current systems are designed to status of racialized and Indigenous peoples. Racism
structure opportunity along racial lines. Racism results in inequities in social inclusion, economic
influences these systems that limits racialized outcomes, personal health and access to, and quality
populations’ access to goods and services necessary of, health and social services.[23]
for health.[23] Racism benefits those with power
and privilege, while disadvantaging those without. Racism is embedded in our social, economic,
As with other European and Westernized cultures, ecological and political world and negatively affects
racism in Canada tends to favour light-skinned or the health of people belonging to racialized and
white Canadians. Indigenous communities in Manitoba.[24] It silences
their voices and knowledge and creates barriers to
meaningful engagement with those who experience
structural disadvantage. Racism is a public health
issue and remains a driving factor of health
inequities in Manitoba.

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 health problems, substance use disorders, and HIV infection.107,Stigma affects health and safety by
STIGMA 140, 141

Stigma
These ispractices
an attitude,
include belief or behaviour
refusing thatcare to people who
mental health contributing to factors including:
use drugs or against
discriminates restricting treatment
people. [25] for recurrent drug use, and denying
Canada’s Chief Public
accessOfficer’s
to treatment a reduction in access to and/or mistrust of
Health 2019 because
Report on of particular
the State sexual practices or gender
of Public
nonconformity. 107, 134, 138, 141–143
protective resources, such as health care and
Health “Addressing Stigma: Towards a More Inclusive
StigmaSystem”
in organizational cultures may also haveaffects
an impact on the economic resources;
Health focuses on this issue. Stigma
health and well-being of staff. Healthcare providers may be reluctant
people’s education, employment, housing options
to acknowledge or disclose their own stigmatized conditions, such an increase in chronic stress; and
and opportunities,
as mental illness, inwhich
workplacescan, inwhere
turn,stigma
greatlyisaffect
persistent. This may
their health
result status.
in self-treatment and a lack of peer support.108
a higher risk of injury or assault
How Stigma
Although Leads
many groups toexperience
that Adverseracism Health Outcomes
have
The to deal with
following more stigma, stigmahow
fully unpacks is notthelimited
experience of stigma All
leads
three of these can affect an individual’s
totorace. People
poorer may face
outcomes stigma due
and impacts to health.
overall their Emerging research
mental and physical health outcomes.[26]
indicates
sexual that stigma
orientation, affectsage,
religion, health in threephysical
income, key ways:xiii
or 1cognitive abilities,
It reduces accessweight or health
to and qualityconditions
of protective
such as mental illness,
resources substance
and health use disorder
services
or 2HIVItinfection. [26]
increases the risk of chronic stress and poor
coping responses

3 It puts stigmatized people at higher risk of assault

and injury

FIGURE 8: How Stigma Affects an Individual’s Health

Mental health
Poorer living conditions
and socioeconomic status
outcomes
1 Reduced access
to protective Anxiety
Decreased access to and
resources Depression
quality of health services
Suicide and self-harm

Individual
experience Physical health
Psychological symptoms outcomes
of stigma
(enacted, 2 Chronic stress Negative coping behaviours Cardiovascular disease
internalized,
Physiological stress responses Decreased birth weights
anticipated)
Increased blood pressure
Physical injury
Sexually transmitted and
blood-borne infections

3 Violence and assault

Source: Public Health Agency of Canada

While this is not a comprehensive list of all possible outcomes or mechanisms, it does summarize many of
the proposed associations.144
Source: Adapted from Paradies et al. 2013155

xiii These data generally comes from self-reported experiences of stigma in relation to health outcomes. Additionally, many of
these studies were conducted in the US. Caution should be taken regarding the generalizability of the findings.

The Chief Public Health Officer’s Report on the State of Public Health in Canada 2019 33
MANI TOBA | 2022 HE ALT H S TAT US REPOR T 19
COLONIALISM
European settlers arrived in Canada with the incorrect
assumption that European culture and Christian
religions were superior to Indigenous cultures, lives
and ways of knowing. Colonialism involved the
imposition of laws, policies and systems to occupy
Indigenous lands and to dominate Indigenous
Peoples.[27] Colonization by European settlers caused
the forced disconnection and removal of Indigenous
Peoples from land, culture and community.[28]

There is a direct link between colonialism

Children were not allowed to speak their
in Canada and health inequities
languages, wear traditional clothing or, in many
between Indigenous Peoples cases, communicate with their families. Many
and non-Indigenous people. students experienced physical, emotional, spiritual
and/or sexual abuse at residential schools.[5] They
RESIDENTIAL SCHOOLS were also subjected to highly unethical nutritional
Residential schools were a colonial project designed experiments.
in the mid-1800’s to assimilate Indigenous Peoples
through forced removal of children from their families Research has found that:
and communities. The Truth and Reconciliation
Between 1942 and 1952, some of Canada’s
Commission describes residential schools as cultural
leading nutrition experts, in cooperation with
genocide due to the major disruptions of family,
forced removal from supportive family networks and various federal departments, conducted an
role models, and disconnection from culture. Cultural unprecedented series of nutritional studies of
genocide is the destruction of those structures and Aboriginal communities and residential schools.[29]
practices that allow the group to continue to grow
as a group.[5] Schools were underfunded by design, with
poor nutrition and living conditions, which
led to illness and death.[5]

20 2022 HE ALT H S TAT US REPOR T | MANI TOBA

In May 2021, the heartbreaking The last federally-run residential school in
tragedy and tragic legacy of Canada did not close until 1996.[5]
residential schools was brought
Residential schools were devastating to
to the forefront across Canada
Indigenous cultures, languages, family ties and
with the finding of 200 (possibly
community networks, and created ongoing
underestimated) potential intergenerational harm and trauma. As a result,
unmarked graves at the former Indigenous Peoples have poorer general, and self-
Kamloops Indian Residential rated, health and increased rates of chronic and
School.[30] Canadians were infectious diseases. In terms of overall well-being, the
forced to reflect on the fact that trauma of the residential school system manifests
children died at these schools as increased rates of mental distress, depression,
problematic substance use, stress and suicidal
and were buried nearby without
behaviours.[31] The effects of residential schools
their families knowing where are collective, affecting the health and well-being
they were. In the wake of these of not only individual survivors, but also their
reports, First Nations across families and communities.
the country are carrying out
the sobering task of finding Understanding the historical and present context
missing children who died while outlined here is necessary to make progress
on reducing health disparities in Manitoba.
attending residential schools,
Improvements in the ability to measure health
with the hope of returning outcomes by race, ethnicity and Indigeneity
them home. From surviving across systems are required to better understand
and accessible death records, health inequalities in Manitoba to assess and make
the Truth and Reconciliation progress on closing health gaps. Improving the health
Commission estimates that of all Manitobans will take individuals, organizations,
over 6,000 children died while public health practitioners and systems working
together to disrupt and transform the public policy,
in the residential school system.
institutional practices and cultural views that maintain
However, the increasing number the underlying conditions that lead to inequitable
of potential unmarked graves health outcomes.
being identified across the
country corresponds with the
commission’s caution that
estimates are much higher than
originally reported.

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 21

 3
CHAPTER

MEASURING
POPULATION HEALTH
in Manitoba
Chapte r 3: Me asu r i ng Po p u latio n He alth i n Mani to b a

Understanding the disparities in

health status between different regions
and populations is important for
the planning and delivery of
health services across Manitoba.

To describe the health of a population, we use health

indicators. These measures allow us to monitor and
compare different aspects of health across regions,
populations and times.[32] Indicators of ill health are
often used when reporting on population health,
as they are more readily available than measures of
overall health.[33]

When we look at the overall health status of people

in Manitoba, we see gradual improvements, with
a longer life expectancy. However, the health of
people in Manitoba is not equal, and the gap in
health between First Nations and all other people
in Manitoba is, in fact, widening.[33] The root causes
of these health gaps have been discussed in the
previous chapter. The following sections provides
specific information, where available, on the
health of First Nations people living in Manitoba.
As of June 1, 2020
MANITOBA’S POPULATION Manitoba had a population of

1,386,938
Overall, Manitoba’s population is growing, but it is
also aging. From 1997 to 2016, there has been a clear
residents[34]
shift, with children making up a steadily decreasing
percentage of the population (28.5 per cent to
25.2 per cent), while the percentage of older adults
increased (13.6 per cent to 15 per cent).[35] Manitoba is In 2019-20, there were

16,274
also unique in that 18 per cent of the population self-
reported an Aboriginal identity in 2016, the highest
percentage of any province in Canada.[36] Of this
babies born to Manitoba residents, for an average
group, 58.4 per cent were First Nations people,
birth rate of 11.9 newborns per 1,000 residents.[38]
40 per cent were Metis and 0.3 per cent were Inuit.[37]

24 2022 HE ALT H S TAT US REPOR T | MANI TOBA

 Close to 75 per cent of international newcomers who
land in Manitoba are of working age and contribute
In 2016, the average age of significantly to Manitoba’s labour force growth.[39]
the Aboriginal population Immigration is shaping the future of Manitoba as
in Manitoba was 29.3 years, a significant driver of economic and population
compared with 40.7 years for the growth.[39]
non-Aboriginal population. The
POPULATION STRUCTURE
average age was 26.8 years for
The age and sex of a population influence both the
First Nations people; 33 years for
health status and health care use of that population.
Métis; and 27 years for Inuit.[37] Population pyramids show the percentage of people
by age and sex of a population over a one-year
period and can help with planning for future needs.
IMMIGRATION In general, the Aboriginal population is younger than
In 2019, Manitoba welcomed 18,905 new Immigrants, the non-Aboriginal population.
the highest number in the province’s 150-year
history.[39] Notably, the percentage of immigrants
Chapter 4: Population Description
increased from 1.8 per cent (2001) to 5.2 per cent
(2016).[40]

Age and Sex Distribution for Manitoba

AGE PROFILE
First Nations: OF MANITOBA, 2016
141,965
All Other
First Manitobans:
Nations: 141,9651,209,214
All Other Manitobans: 1,209,214

Source: University of Manitoba[37]

First Nations On-Reserve: 89,769

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 25

SENSE OF BELONGING TO COMMUNITY According to the Regional Health Survey, in
A strong sense of community belonging is associated 2015-16 78.5 per cent of First Nations people in
with positive health outcomes. Without a strong Manitoba described their sense of belonging to
sense of belonging, social isolation, which is local community as being very or somewhat
harmful to health, can occur. strong. Elders, community health programs,
awareness of First Nations culture, family values/
In 2020, 71.2 per cent of connections and use of First Nations language were
Manitobans aged 12 years and the most commonly reported strengths in First
older reported their sense Nations communities.[43]
of belonging to their local 71.2%
community as being very
strong or somewhat strong.[42]

26 2022 HE ALT H S TAT US REPOR T | MANI TOBA

 The Material and Social Deprivation indices are two
parts of a story of the wellness of a community, and
both have major impacts on health. In 2019,
the Manitoba Centre for Health Policy assessed
both measures across Manitoban regional
health authorities.

SOCIAL DEPRIVATION INDEX[44]

Chapter 2: Demographics
The social deprivation index measures the status
2.4 Social Deprivationamong
of relationships Index individuals • Overall, social deprivation got slightly worse
inThe
over time. the family,
values for Southern and Northern
improved, whereas Prairie Mountain and Interlake-
workplace and community. It measures
The social deprivation index includes the
percent of the population age 15 and older who are
Eastern got worse.the
Social deprivation in Winnipeg
did not change over time.
separated, divorced, or widowed, the percent of the
populationpercentage
that lives alone, and theofpercent
theofpopulation
the aged 15 years and
population that has moved at least once in the past 20-Year Time Trend Analysis
older who are separated, divorced • or widowed,
Social deprivation the
was stable over time for Manitoba
Lower scores (e.g., below zero) indicate better status (less
proportion
deprivation), while scores higher ofthanthe population
zero indicate worse that
overall (see online supplement).
lives alone, and the MATERIAL DEPRIVATION INDEX
Chapter
[44]
2: Demographics
status [10]. Population-weighted scores were calculated for • Values got worse in Southern and Prairie

proportion of the population that has Winnipeg

moved at least 2.3Another
Materialmeasure often used alongside the social
2011 and 2016.
in Northern. and Interlake-Eastern Deprivation Index •
provincial average in both time periods.
showed no clear pattern.
Key Findings
once in the past five years. deprivation index is the
The material deprivation index includes material • deprivation index.
Overall, material deprivation got better over time.
• average household income, the unemployment rate The values for Southern, Winnipeg, and Interlake-
provincial average in both time periods. of theIt assesses
population education,
age 15 and employment
older, and the percent of and
Eastern RHAsincome status
improved, whereas Northern got
the population age 15 and older without a high school worse. Prairie Mountain did not change over time.
•
The
Prairie lower
Mountain the score,
and Winnipeg, which werethe both stronger the of people over the age of 15. Interestingly, despite
diploma. Lower scores (e.g., below zero) indicate better
status (less deprivation), while scores higher than zero 20-Year Time Trend Analysis
relationships and the less socially-deprived scoring well on the social index,• the
indicate worse status [10]. Population-weighted scores were
calculated for 2011 and 2016.
Northern
Material deprivation wasHealth
relatively stable over time,

Figure 2.17:a person/persons is considered. . Region scores the worst (highest) on this material
[45]
Social Deprivation by RHA, Canadian Census 2011 and 2016 Manitoba overall (see online supplement). Values
Average score on MCHP’s Social Deprivation Index. Lower values indicate better status Key Findings
got worse in Winnipeg and Northern, though only
• deprivation.
provincial average in both time periods. Prairie Mountain and Interlake-Eastern showed no
clear pattern over time.
•
than the Manitoba average.
Lower scores indicate better status, while
Figurehigher scoresbyindicate worse2011 andstatus.
[45]
2.15: Material Deprivation RHA, Canadian Census 2016
Average score on MCHP’s Material Deprivation Index. Lower values indicate better status

The Northern Health Region has the lowest (best)

social deprivation score of all health regions, which
suggests people living in the north have stronger
relationships with their families, workplaces and
communities.[46] The lower score, combined with a
www.mchp.ca 31 Overall, the material deprivation index in Manitoba
strong sense of community belonging, highlights the has improved from 2011. All health regions, except
strength and resiliency of people and communities in the Winnipeg Health Region, had worse (higher)
the Northern Health Region. index scores than the provincial average in both
time periods.[45]
www.mchp.ca 29

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 27

SELF-RATED MENTAL HEALTH PERCEIVED LIFE STRESS
Similar to our physical health, our mental health is Lengthy exposure to high levels of stress can have
not constant. Anyone can experience a mental health negative impacts on health, including increased risk
issue, including emotional health problems, such of illness and chronic disease. Stress is associated
as anxiety and depression, at any time in their life. with social practices that can cause harm, such
Changing roles and responsibilities, such as starting as substance use.[45] This indicator measures the
at a new school, getting a new job or retiring from population, aged 12 and over, who reported
the workforce, having a baby or ending a long-term perceiving that most days in their life were
relationship can often trigger changes in mental quite a bit, or extremely, stressful.[48]
health status. This indicator measures how residents
aged 12 and older perceive their mental health.
In 2020, 21.4 per cent of Manitoba
In 2020…
respondents aged 12 or older
63.1 per cent of Manitoba respondents aged
12 and older perceived they had ‘very good’ or
reported most days in their life were
‘excellent’ mental health.[47] quite a bit, or extremely, stressful.[48]

9.1 per cent of Manitoba respondents aged

12 and older perceived they had fair or poor
mental health.[47]

PERCEIVED MENTAL HEALTH OF MANITOBANS

AGED 12 YEARS AND Mental
OLDER. Health

720,000 100,000

705,000 90,000

690,000 80,000

675,000 70,000

660,000 60,000
2015 2016 2017 2018 2019 2020
Perceived mental health, Perceived mental health,
very good or excellent fair or poor

Source: Statistics Canada

28 2022 HE ALT H S TAT US REPOR T | MANI TOBA

 Renters have significantly higher levels
of core housing need than owners.

In Manitoba…

5.5% of owners are in core housing

5.5%
need compared to 6.5% nationally

CORE HOUSING NEED

Housing that is affordable, good quality and stable is
26% of renters are in core housing
essential for promoting health and preventing illness 26%
need compared to 23% nationally[49]
and injuries. Living in poor housing conditions can
have negative impacts on health and can lead to
respiratory conditions, lead poisoning, injuries and When examining the rates at which households
decreased mental health.[45] Having a stable address fail housing standards (adequacy, suitability and
allows individuals to participate in the basics of civil affordability), failure of the affordability standard is
society, such as securing identification, accessing predominant across Manitoba and Canada. Manitoba
benefits and services, gaining employment, as well as is above the Canadian average for the percentage of
allowing healthier engagement in community. houses that fail either the suitability or
adequacy standard.
A household is said to be in “core housing need”
if it meets two criteria: Percentage of households below…
A household is below one or more of the
adequacy, suitability and affordability
standards. Affordability standard
only 75% Canada, 70% Manitoba
The household would have to spend
30 per cent or more of its total before-tax Suitability standard
income to pay the median rent of alternative only 3.8% Canada, 4.3% Manitoba
local housing that is acceptable (meets all three
housing standards).[49] Adequacy standard
only 6.6 Canada, 10.2% Manitoba.[50]

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 29

HOUSEHOLD FOOD INSECURITY In 2020…
Food insecurity is the inability to acquire or consume
an adequate quality diet or enough food in socially
acceptable ways, or the uncertainty that one will be Twelve per cent of Manitobans
able to do so.[51] Having access to, and being able to reported moderate or severe food
buy, enough high quality and culturally acceptable insecurity compared to 11.2 per
food is important for achieving and maintaining
cent for all Canadians.[52]
good health. Household food insecurity is important
to help us understand health disparities because it is
Manitobans under 18 years of age,
often related to a household’s ability to buy food.[45]
and those aged 35 to 44, reported
the highest rate of food insecurity
at 14.2 per cent, while those aged
65 years and older reported the
lowest at 5.9 per cent.[52]

This data does not include data for the

territories or for persons living on reserve.

Results from the 2015-16 First Nations Regional

Health Survey indicate that 43.8 per cent of adults
lived in moderately food insecure households,
and 16.5 per cent were experiencing severe food
insecurity.[43] A significantly higher proportion of
children faced severe food insecurity, compared
to adults. Of adults who had one or more children
or youth in the household, 12.4 per cent were
moderately food insecure, and 37.5 per cent
were experiencing severe good insecurity.

30 2022 HE ALT H S TAT US REPOR T | MANI TOBA

PROPORTION OF CHILDREN
LIVING IN LOW INCOME FAMILIES
Family income affects children’s access to
basic needs, such as adequate housing in safe
environments, nutritious food and clothing. Living
on a low income poses many challenges for child
growth and development, including access to early
learning and care programs, recreational/sports and
art programs.[45] The proportion of children living
in low income families measures the percentage of
Children
people aged 17 living
years andin low-income
younger, households
who live in low
income families (according to the low income
measure – after tax).[45]

Low-income rates for children, by province, 2015

per cent
25

20

15

10

0
British Alberta Saskatchewan Manitoba Ontario Quebec New Nova Prince Newfoundland
Columbia Brunswick Scotia Edward and
Island Labrador
Province

Source: Statistics Canada, Census of Population, 2016

In 2015, 22 per cent of

There are notable differences across Manitoba Manitoba children were living
when it comes to children living in low income
Taux deBoth
faible revenu chez les enfants et les
22% in low income families,[45]
adultes, selon la province, 2015 which is higher than the
families. Winnipeg and Northern health regions
pourcentage
have rates higher than the Manitoba average at national average of
25
23 per cent and 27 per cent respectively. In
[45] [46] 17 per cent.[53]
some community areas within these regions, the
20
percentage of children living in low income families is
as high as 60 to 80 per cent.[45]
15

10

5
MANI TOBA | 2022 HE ALT H S TAT US REPOR T 31
CHILDREN AND CHILD WELFARE SERVICES IMMUNIZATION (VACCINATION)
The continued impact of colonization, the legacy Vaccines are a safe and effective way of preventing
of the residential school system and the Sixties many diseases and have saved more lives in Canada
Scoop, and the ongoing diminished access to the in the last 50 years than any other medical practice.
determinants of health have all contributed to Vaccines help the body’s immune system recognize
Indigenous children being vastly over-represented in and fight bacteria and viruses that cause disease.[57]
the child welfare system today. Being involved in the Common infectious diseases that were once a major
child welfare system makes children and youth more cause of sickness and death in Canada, mainly among
likely to become involved in the youth criminal justice children, are now preventable with vaccines.[58]
system, and less likely to graduate from high school As the number of people who get immunized
by age 21. These outcomes can contribute to poorer increases, the chance of infectious disease spreading
long-term health status.[54] decreases. Community-level resistance to the disease
(i.e. herd immunity) becomes stronger in a way that
As of March 31, 2021 there were provides a protective barrier for those individuals

9,8501
who cannot be immunized for health reasons, such as
illness, age or allergy.

children in welfare services Immunization is the single most important

91 per cent of these children
public health achievement in the past
are Indigenous.[55] 91% century, as infectious diseases have dropped
from the leading cause of death to less than
Days in care represents the five per cent of all deaths in Canada.[46]
total number of days for which
payments were made to support children in care, For additional information on vaccine eligibility and
and young adults, whose care needs are financially timing, see the Routine Immunization Schedules
supported by government. In the reporting period, for Manitoba at: https://www.gov.mb.ca/health/
paid days care decreased by 8.3 per cent in 2020 publichealth/cdc/div/schedules.html
when compared to 2019 in the table below.
The following data on immunization is from 2017,
DAYS IN CARE the most recent information available at the time
2014/15 – 2019/20 [56] of writing. More recent immunization data will be
days in care
available by fall 2022.
7.1%
3,300,000
4.8% 3,191,131
3,200,000 3,167,454
2.9% 2.6%
3,100,000
3,000,000 2,979,061
2,903,358 2,903,727
2,900,000
2,800,000 2,770,876 -0.7%
2,700,000
2,600,000
-8.3%
2,500,000
2014/15 2015/16 2016/17 2017/18 2018/19 2019/20
total days in care Growth Rate
from Prior Fiscal

32 2022 HE ALT H S TAT US REPOR T | MANI TOBA

ROUTINE IMMUNIZATION SCHEDULES

RHA RHA

Provincial
Age Vaccine target Goal Highest coverage Lowest coverage
coverage

diphtheria, pertussis Northern Health

7 5 doses 65% Winnipeg RHA (61%)
and tetanus (DPT) Region (76%)

Northern Health Southern Health-

7 Measles, mumps 2 doses 75%
Region (85%) Santé Sud (71%)

Northern Health Southern Health-

7 Rubella 2 doses 90%
Region (95%) Santé Sud (86%)

As a direct result of successful universal vaccination programs, measles was eliminated in Canada in 1998.[59]
However, since then, vaccination rates have declined and there have been a number of outbreaks in Canada,
including an outbreak of 678 cases in Quebec in 2011.[60] Measles is a very contagious disease that resulted in
110,000 deaths globally in 2017.[46]

RHA RHA
Provincial
Age Vaccine target Goal Highest coverage Lowest coverage
coverage
human papillomavirus Prairie Mountain Southern Health-
17* 2 doses 63%
(HPV) Health (74%) Santé Sud (51%)

*Females only. Due to males becoming eligible for HPV vaccination later than females, information on the first
cohort of males was not available at the time this report was produced.

HPV is estimated to be one of the most common sexually transmitted infections and can cause cells within the
body to change and lead to cancer if left untreated. Many cancers that are caused by HPV, such as cervical cancer,
do not have symptoms until they are quite advanced. When the HPV vaccine is given before exposure to the
virus, it provides protection against nine types of HPV that cause 90 per cent of all cervical and anal cancers and
90 per cent of all genital warts.[46]

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 33

 INFLUENZA IN MANITOBA
Between Sept. 1, 2021 and March 12, 2022
402,817 Manitobans received at least one dose
of influenza vaccine, corresponding to an overall
uptake rate of 28.4 per cent.[62]

Seasonal influenza can cause significant disease

and death.

Between Sept. 2020 and

March 2021, Manitobans had
1,856 lab-confirmed cases of
influenza.[63]

Between Sept. 2020 and March 2021,

as a result of influenza, there were:

403 Hospitalizations

40 ICU Admissions*

29 deaths

*ICU admissions are included in hospitalization counts.

34 2022 HE ALT H S TAT US REPOR T | MANI TOBA

LIFE EXPECTANCY
Life expectancy is the expected length of life, based
For the five years from 2012-2016,
on patterns of death in the population for the past
five years. It is one of the most widely used indicators
there was a seven-year gap in
of a population’s health status.[45]
life expectancy between health
regions.[35]
Overall, life expectancy has been increasing for males
and females in all health regions. However, the life
expectancy for First Nations people is 11 years lower
than average and this gap is growing.

MALE LIFE EXPECTANCY AT BIRTH

by RHA, based on mortality in 2012-2016

H/L Significantly higher (H) or lower (L) than the MB average for that time period
+/- A significant increase (+) or decrease (-) since the first time period

FEMALE LIFE EXPECTANCY AT BIRTH

by RHA, based on mortality in 2012-2016

In 2016, life expectancy Across

H/L Significantly higher (H) or lower (L) than the Manitoba,
MB average lifetime
for that expectancy
period continues to be
for First Nations people +/-
[64] A significant increase (+) or decreaseshorter
(-) since the
for first
both time period
males and females from lower
income areas across urban and rural settings.[35]
Female - 72 years
Within health regions, the gap between those living
the shortest and those living the longest can be as
Male - 68 years
high as 18 years.[45]

For all other Manitobans

Female - 82.8 years

Male - 78.5 years

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 35

 PREMATURE MORTALITY RATE (PMR)
Premature mortality is death before the age of
75 years. The rate is calculated per 1,000 population,
aged 0 to 74 years, for a five-year period. Populations
3x PMR for all First Nations in
Manitoba is three times higher than
with higher PMR tend to have poorer health overall,
for other Manitobans.[64] Premature
and use more health services.[45] PMR is often
considered to be the best single measure to show
deaths account for 81 per cent of all
the health status of a population.[63] In the 20 years deaths among First Nations (80 per
from 1997 to 2016, the PMR declined significantly in cent on-reserve and 82 per cent
all health regions, except the Northern Health Region, off-reserve) and 35 per cent for
which has not had a clear time trend.[35] among all other Manitobans”.[64]
The most frequent causes of premature death
were cancer (32.7 per cent) and circulatory diseases There is a strong relationship between income and
(19.9 per cent), followed by injury and poisoning PMR. For the period of 2012 to 2016, in urban settings,
(11.5 per cent).[38] residents of the lowest income areas were 2.9 times
more likely to die before age 75, compared to the
20,012 Manitobans died prematurely in highest income areas. In rural settings, the
2016-2020.[38] difference is 2.2 times.[45]

The 2019 RHA Indicators Atlas

PREMATURE MORTALITY RATE BY RHA, 1997-2016[44]
Figure
Age-3.4:
andPremature Mortality
sex-adjusted, Rate by
per 1,000 RHA, 1997-2016
residents age 0-74
Age- and sex-adjusted, per 1,000 residents age 0-74

* This areas rate has a statistically significant change over time.

see page 38 http://mchp-appserv.cpe.umanitoba.ca/reference/RHA_Report_web.pdf

36 2022 HE ALT H S TAT US REPOR T | MANI TOBA

INFANT MORTALITY POTENTIAL YEARS OF LIFE LOST (PYLL)
Infant mortality is the number of deaths among Potential years of life lost adds the number of years
infants, under one year of age, per 1,000 live births, “lost” when a person dies before the age of 75. For
over a five-year period. Many health experts see this example, a person dying at age 50 has lost 25 years of
rate as a key indicator of child health and the well- life. PYLL is higher if there is a high death rate among
Infant
being of a society over time.Deaths
[45]
young and middle-aged people.[64] Overall, the PYLL
for Manitoba has decreased over time, however the
10
9.2 gap between First Nations and all other Manitobans
8 is growing.

6 5.4
4.6 4.4 5.0

4
4x – The First Nations PYLL is
2 almost four times higher than for
all other Manitobans.[64]
10 years – The increase
0
Southern/ Winnipeg Prairie Interlake- Northern
Sud Mountain Eastern
Manitoba average 5.1 (per 1,000 live births) in gap of PYLL between First Nations
The rates in the Northern Health Region were and all other Manitobans since
significantly higher than the Manitoba average. 2002.[64]

Manitoba's infant mortality rate

was 5.4/1,000 between 2015/16 –
2019/20 (total of 420 infant
deaths).[38] This is higher than
the national average of 4.5/1,000
in 2020.[65]

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 37

POTENTIALLY AVOIDABLE DEATHS Over the five years
This indicator measures deaths in people younger from 2012-2016, there were…
than 75 from both preventable (e.g., some cancers)
and treatable (e.g., asthma) causes. Preventable deaths
can be avoided through efforts such as addressing
2,774
income inequality, vaccinations, or injury prevention. unintentional injury deaths in Manitoba.
Treatable deaths can be avoided with effective
screening and treatment for disease. This indicator Deaths from unintentional injuries among males were
tells us about the effectiveness of population health 35 per cent higher than among females.
approaches, such as healthy public policies, health
promotion and access to health care.[66] Almost half of all unintentional injury deaths were
among adults aged 65 and older.[45]

13,699 In the Northern Health Region, the rates of

unintentional injury deaths are significantly higher
Manitobans had potentially avoidable deaths than the Manitoba average, but rates have been
in the five years from 2012-2016.[45] declining across all regions over time.[45]

SUICIDE
High rates of suicide are an important indication of

2.3 2.1 the mental health of communities and underlying

trauma. These deaths may be prevented with safe
2007-2011 2012-2016 and appropriate mental health supports for people
from all different walks of life.
the rate of potentially avoidable
deaths significantly decreased
between time periods. 1,075
Manitobans aged 10 and older died by suicide
in the five-year period from 2015/16 to 2019/20.[38]
UNINTENTIONAL INJURY
Unintentional injuries are one of the leading causes Similar to other indicators, there were strong
of death in Canada and worldwide. Most accidental relationships between income and suicide rate in
injuries and deaths are preventable. This indicator both urban and rural areas. From 2012 to 2016, the
measures the accidental causes of death, such as road rates of suicide between those from the lowest
traffic injuries, drowning, falls, burns and poisonings, income areas versus the highest income areas were…
per 1,000 population, over a five-year time period.[45]

Evaluation of causes for unintentional injuries and

deaths helps in the development of safety programs
and technologies, safety laws and promotion of safe
3.6x 2.3x
behaviours at home and in the workplace. Urban settings Rural settings

38 2022 HE ALT H S TAT US REPOR T | MANI TOBA

Suicide rates are significantly higher among all First
Nations compared to other Manitobans, with the
gap being the most pronounced in the rural part of In the five years from 2016/2017
the province. According to the 2015-16 First Nations to 2020/2021, there were 314,631
Regional Survey, 24 per cent of First Nations Manitoba residents treated for
living on-reserve identified suicide as a mood and anxiety disorders,
community challenge.[33] representing 25.4 per cent of
MOOD AND ANXIETY DISORDERS
Manitoba residents aged 10 and
In 2017, 14.5 per cent of Manitobans aged 12 and
older.[38]
older reported having a diagnosed mood and/or
anxiety disorder, compared to a national average of
Across the lifespan, the prevalence of mood and
13.4 per cent.[68]
anxiety disorders is higher in females than in males.[41]
People with mood and anxiety disorders often also These statistics only account for people who are
have other chronic diseases and/or conditions. For treated for mood and anxiety disorders and do not
example, the early onset of depressive and anxiety fully describe the prevalence of mood and anxiety
disorders is associated with an increased risk of disorders in Manitoba. People with undiagnosed
developing heart disease, asthma, arthritis, chronic conditions, those with diagnosed conditions who
back pain and chronic headaches in adults.[68] do not seek treatment and those who do not have
access to treatment are not included in this data.

MOOD AND ANXIETY DISORDERS BY AGE AND SEX [41]

Crude per cent of residents, 2014/2015 to 2018/2019

40
33.4 34.1 33.3 32.8 32.9 32.1
31.3 32.1 31.6 31.3 31.9
29.1
27.4
30 27.2 27.1 25.5

19.6
Per cent

23.1
20 21.4 22.5
19.9 19.6 19.1 20.3 20.4
18.2 19.0 19.2 18.8
15.8 16.8
14.4 15.1
10
9.5

0
10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Age
Male Female

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 39

HYPERTENSION In 2020/21
Hypertension, or high blood pressure, is a risk factor
for a number of cardiovascular conditions, such as
heart disease and stroke. It is possible to have high
2,083
blood pressure and have no signs and symptoms Manitoba residents suffered a heart attack.
for many years. Accurate assessment of high blood
pressure can guide prevention efforts and treatment 3.2/1,000 people[38]
choices, which may lead to a reduction in heart-
related disease and death.[45] Over the last 10 years, the rate of heart attacks has
been decreasing for both males and females.[41]
In 2018/19
The rate of heart attacks in the Northern Health

309,177 Region is almost two times more than the

Manitoba average.
Manitobans aged 20 and over had hypertension

Northern
This represents 30.3 per cent of MB total
30.3% the total population aged 20
Health Region
3.2/1,000
and over.[38] 5.4/1,000[38]

The percentage of people

In 2017/18, the age standardized rate for newly
living with hypertension was
34.1% diagnosed heart attacks in those aged 20 and
significantly higher in Northern
over was 207.7/100,000 in Manitoba, compared
Health Region when compared
to 204.1/100,000 nationally.[67]
to Manitoba overall.[38]

HEART ATTACK
This indicator measures the annual rate of death or
hospitalization due to acute myocardial infarction
(AMI or heart attack) per 1,000 population, aged 40
and older, for a five-year time period. This rate, used
together with stroke and ischemic heart disease data,
describes the level of heart health in the population.
This measure is important for the development and
maintenance of health care strategies in primary
and secondary prevention, health care planning
and allocation of resources.[45]

40 2022 HE ALT H S TAT US REPOR T | MANI TOBA

DIABETES
This indicator measures the per cent of residents aged
19 or older, diagnosed with diabetes (Type I and II), In 2017/18 9.5 per cent of
for a three-year time period. Diabetes can lead to Manitobans age of one
serious complications (e.g., cardiovascular disease, and older have diabetes[41]
vision loss, kidney failure, nerve damage and
compared to 8.1 per cent of all
amputation) and premature death. However, it is
possible to remain healthy with diabetes through
Canadians.[67]
appropriate management and health care.[45]

RESIDENTS WITH DIABETES

Per cent age of one and older by fiscal year and sex 10.0
9.8
10 9.5
9.2
8.9
8.6
8.3
7.8 8.0 9.0
7.5 8.7 8.9
8 8.4
per cent

8.2
7.9
7.5 7.6
7.1 7.3
6

0
2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Year

Male Female

131,300
In Canada, the prevalence of diabetes among South
Asian and Black adults is 8.1 times and 6.6 times
higher, respectively, then the prevalence among
Manitobans were living with diabetes in 2018/19.[38]
White adults.[69]
Diabetes
Over the last 10 years, there has been a slow, steady
20.0%
and significant increase over time. Males have had a 20
higher prevalence of diabetes than females. This gap
has been increasing over the last few years.[68] 15

8.9% 10.3% 10.3%

There is significant regional disparity in the 10
prevalence of diabetes in Manitoba.[41] Manitoba 7.2%
residents from the Northern Health Region are almost 5
two times as likely to be diagnosed with diabetes.[41]
0
There are certain populations at higher risk of Southern/ Winnipeg Prairie Interlake- Northern
Sud Mountain Eastern
developing type two diabetes.
Manitoba average (9.5%)

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 41

END STAGE KIDNEY DISEASE (ESKD) CANCER
Manitoba has the highest rate of kidney disease in Lung and bronchus, breast, colorectal and prostate
Canada.[45] In 2020, Manitoba’s incidence per million are the most diagnosed cancer sites in Manitoba.[45]
population was 250.9, compared to the Canadian Understanding the rates of cancer diagnosis by
average of 208.1 (excluding Quebec).[70] specific site is important for health care planning
of screening programs, access to treatment and
Manitoba’s rate of ESKD is 24 per cent higher than the understanding cancer risk factors.[45] This indicator
Canadian average.[71] measures the number of new cases of cancer for the
top four diagnosed cancers per 100,000 population,
Although relatively rare, ESKD is an important for all ages, for a two-year time period.
health problem because of the high cost of kidney
replacement therapy, the related high death rate and Cancer diagnoses in Manitoba in 2014-16[45]
the effect on patients’ quality of life and life-long
2,504 – colorectal
dependence on dialysis.[72] Diabetes is the most
common cause of ESKD in Manitoba. Forty-three per
2,530 – breast
cent of all patients with ESKD have diabetes as their
primary diagnosis.[45] ESKD is based on a patient’s
2,778 – lung and bronchus
use of renal replacement therapies (dialysis or kidney
transplant). 2,145 – prostate

More than 1,700 Manitobans

complete dialysis treatments TEEN PREGNANCY
annually.[71] The teen pregnancy rate in Manitoba has decreased
across all health regions.[35] Pregnant teens are less
likely to receive early prenatal care and more likely
There is a strong relationship between hypertension,
to experience anemia, eclampsia (seizures) and
diabetes, heart attack and kidney disease. People with
depressive disorders. Teenage pregnancy is often
diabetes are twice as likely to have hypertension as
associated with social practices that may cause harm,
those who do not have diabetes.[73] People who have
such as problematic substance use. Teenage mothers
hypertension are more likely to develop diabetes.
tend to have lower socioeconomic status, as well as
[73]
Hypertension is also a key risk factor for the
reduced educational opportunities, which negatively
development of kidney disease.[74] Hypertension and
affect their access to social supports [45].
diabetes are key risk factors for both heart attack and
kidney disease. It is known that people with kidney
The provincial teen pregnancy
disease are at higher risk of heart attacks than those
rate decreased
without kidney disease.[74]

33%
between T1 (2007/08-2011/12) and
T2 (2012/13-2016/17)[45]

42 2022 HE ALT H S TAT US REPOR T | MANI TOBA

Substance Use
ALCOHOL The majority of Manitobans use substances
Alcohol is a mind-altering, depressant substance that in some form, ranging from unregulated
can affect thinking, behaviour and heart rate.[76] drugs (e.g.,caffeine), controlled substances
The effects of using alcohol can range from mild
(e.g.,alcohol, nicotine, prescription drugs) or
relaxation to coma and death.[77] While many people
drink alcohol in moderation and do not experience
illegal substances (e.g.,cocaine, heroin, or
associated harms, the health and social impacts of diverted prescriptions).
alcohol overuse are nevertheless higher than for any
All of these substances have effects on the human
other substance.[78]
body, and not all substance use leads to harm.
However, substance use can cause significant
Alcohol is the most widely used controlled
harm for individuals and communities.
substance by Manitobans. In 2019, with
75.5 per cent of Manitobans reporting CANNABIS
alcohol use in the past 12 months.[75]
Cannabis is the second most commonly used
substance in Canada, after alcohol.[81] Cannabis is
Alcohol is also the most widely used substance
a psychoactive drug that people use for medical and
by Manitoba students. In 2018-19, 40.9 per cent
recreational purposes. The sale and use of cannabis
of students in grades 7 to 12 reported has been legal in Canada since 2018.
alcohol use.[79]

Alcohol use is also responsible for more

admissions to hospital than other substances.
In 2021, 25 per cent of
In 2017, the rate of hospitalizations entirely caused
Manitobans the age 16 used
by alcohol was 13 times higher than
for opioids.[80]
cannabis for non-medical
purposes in the past 12 months,
while 17 per cent reported use in
the past 30 days.[82]

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 43

 2018: 76 of 147 deaths (52%)
2019: 62 of 151 deaths (41%)
2020: (January – September):*
147 of 229 deaths (64%)[85]
* Data from October – December is still
under review.

There is evidence that drug-related deaths,

including those involving opioids, increased during
OPIOIDS the COVID-19 pandemic. The number of opioid-
Opioids are depressant drugs that are available over related deaths in Manitoba increased 137 per cent
the counter, by prescription or from the illegal market. from 2019 to 2020, even without the last three
Some examples of opioid drugs or chemicals include months of data for 2020.
codeine, oxycodone, morphine, fentanyl and heroin.
These substances have an important role in medical
care, but can sometimes lead to dependency and
addiction. For example, in Canada, around 10 per cent In 2020, the age-adjusted rate
of those who used any opioid pain medication in the per 100,000 population of total
past year reported problematic use.[83] apparent opioid toxicity deaths
in Manitoba was 13.3, compared
In 2018, Canada was the second to the Canadian average of 17.3.
highest consumer of prescription
opioids worldwide.[84]

Misuse of opioids can have significant health Even with only nine months of data included,
consequences. Opioids have been a primary or compared to 12 months for the other provinces,
contributing cause of death in approximately Manitoba’s rate of increase between 2019 and 2020
half of all drug-related deaths each year prior to 2020. was the highest at 289 per cent. This rate will only
This proportion has significantly increased in 2020, increase when data from the last three months of
which appears to be the driving increase in overall 2020 is reported. Saskatchewan had the second
substance-related deaths. highest rate of increase at 223 per cent.[86]

44 2022 HE ALT H S TAT US REPOR T | MANI TOBA

Stimulants
Stimulants are a broad category of drugs that act to
increase the level of activity of the central nervous
system (brain and spinal cord). Caffeine, nicotine,
cocaine/crack and methamphetamine are all
examples of stimulant drugs.

NICOTINE
Excluding caffeine, nicotine is likely the most
common stimulant used by Manitobans. Found
naturally in tobacco leaves, it is commonly found
in cigarettes, chewing tobacco and sometimes
e-cigarettes. Cigarette smoking remains a large
contributor to illness and death.

2,100 Manitobans die each year

as a result of smoking.[87]

Over the past 20 years, smoking rates have

declined significantly in Manitoba. In 2019, the
overall smoking rate for Manitobans aged 15 In 2019, Manitoba had the highest rate of past
and over was 14.5 per cent.[88] 30 day vaping. MB – 8.8% Can – 4.7%.[88]
Youth vaping rates appear to be increasing more
rapidly than vaping rates among other age groups.
E-cigarettes have become
increasingly popular in Manitoba Youth Vaping in Manitoba
over the last few years. In 2019, (past 30-day use)
24.3 per cent of Manitobans had 50% increase from 2014/15 – 2016/17
ever tried vaping, compared with 10% - 15% overall
16.2 per cent of Canadians.[88]

Grade 7-9 Grade 10-12[89]

7% 22%

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 45

COCAINE AND METHAMPHETAMINE Average monthly meth-related emergency
Both cocaine and methamphetamine are powerful departments visits in Winnipeg Regional Health
stimulant drugs that are illegal to sell or possess Authority:
in Canada. Cocaine is made from the leaves of the
coca plant grown mainly in South America, while
methamphetamine is a man-made drug, sometimes
15 207
in 2013 in 2018[94]
produced using a combination of household
chemicals and pseudoephedrine. Both substances
can be snorted through the nose, smoked or
injected.[90]
Manitoba has been experiencing a syndemic of
substance use and sexually transmitted and blood-
In Manitoba, the use of both cocaine and
borne infections (STBBI's) prior to the COVID-19
methamphetamine has been increasing.
pandemic. Research shows that “people who have
LIFETIME USE OF COCAINE IN MANITOBA been systemically marginalized (e.g., people who are
insecurely housed, people who have experienced
trauma and/or abuse, people with low income,
6% 10% and racialized groups) are disproportionately more
likely to use methamphetamine, compared with
others who have not experienced any of these
6% in 2013 10% in 2017[91] circumstances.[93]” Substance use and STBBI’s share
these common root causes that make it necessary
IN CANADA
to address these issues together.

3.7% of Canadians reported lifetime use

of methamphetamine in 2017.[92]

The potential health and social consequences of

methamphetamine use are substantial. According
to a Manitoba Centre for Health Policy study, in 2019,
methamphetamine was the most common reason
(aside from alcohol) why Manitobans were seeking
support for addictions and drug use.[93] From 2013-2018,
there was a seven-fold increase in the number of
Manitobans who used meth and then, had contact
with the health care system. During each year of
the study, more Manitobans used meth than
in the previous year.[93]

46 2022 HE ALT H S TAT US REPOR T | MANI TOBA

Sexually Transmitted and
Blood-Borne Infections (STBBIs)
STBBIs are the most common infectious for HIV. These numbers are subject to change
diseases of public health importance in as case investigations are completed and staging
North America. They are spread mainly is updated.
through person-to-person sexual contact.
Chlamydia
Some STBBIs are also spread by blood- CHLAMYDIA
to-blood contact, which can occur when 9000 8250
8000
people who inject drugs share needles. They 6455 6445 6773 6561
7000
can also be passed from mother to child 6000
during pregnancy and childbirth.[95] 5000
4000
3000
If untreated, STBBIs can cause serious health
2000
problems, including infertility and death. Chlamydia, 1000
gonorrhea and syphilis are the most common 0
2017 2018 2019 2020 2021
STBBIs. Chlamydia and gonorrhea may not cause any
symptoms so people may not know they are infected. 6,561 cases in 2021
People who are sexually active, or who share drug The rate of chlamydia in northern Manitoba
paraphernalia, should be routinely tested, even if not (1,783.1 per 100, 0000) was four times greater than
showing symptoms. the Manitoba overall rate (473.1 per 100,000) in 2021.

It is particularly important to note that the COVID-19

pandemic resulted in reduced STBBI testing levels,
GONORRHEA Gonorrhea
and a decrease in the number of people tested for all
STBBIs, in Manitoba. This decrease is due to reduced 4000 3744
3088 3298 3393
access to care during months with the highest 3500
COVID-19 restrictions and fear of attending health 2520
3000
care settings due to COVID-19. Any decrease in STBBI 2500
cases reported from 2019 to 2020 may simply be due 2000
to decreased testing and therefore, decreased case 1500
identification, rather than a true decrease in incident 1000
cases.[116] The testing levels for most STBBIs, with the 500
exception of gonorrhea and chlamydia, returned to 0
2017 2018 2019 2020 2021
pre-pandemic levels in 2021.
2,520 cases in 2021
The data reported within this section include The rate of gonorrhea in northern Manitoba
cases diagnosed up to Dec. 31, 2021 for chlamydia, (753.1 per 100, 0000) was more than four times
gonorrhea, infectious syphilis, hepatitis B, and greater than the Manitoba overall rate
hepatitis C, and cases diagnosed up to Dec. 31, 2020 (181.7 per 100,000) in 2021.

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 47

 Infectious Syphilis
INFECTIOUS SYPHILIS CONGENITAL SYPHILIS
Congenital Syphilis
2500 60
1945 48
2000
1695 45 42
1368
1500
876 30 25
1000
11
15
500
257
1
0 0
2017 2018 2019 2020 2021 2017 2018 2019 2020 2021

1,368 cases in 2021 48 cases in 2021

While the diagnosis of infectious syphilis cases has In 2015, for the first time in decades, Manitoba
been decreasing since 2019, the amount of syphilis recorded a case of congenital syphilis.
in Manitoba is still concerning. The number of
infectious syphilis cases diagnosed in 2021 was five Congenital syphilis occurs when a pregnant female
times higher than the number of infectious syphilis is infected with syphilis and passes the infection to
cases diagnosed in 2017. The recent decrease in the fetus. If the mother goes untreated, the child may
diagnosed infectious syphilis cases may be partially be born with an active syphilis infection. Congenital
due to the decrease in testing levels discussed above, syphilis can cause numerous and sometimes severe
as well as a change in how the infectious vs. non- medical complications to the child, including bone
infectious syphilis definition is being applied. As case lesions, hearing loss and even death.[96]
investigations are completed and syphilis cases are
staged, some cases may move from non-infectious to Since mid 2018, there has been a surge in congenital
infectious status. syphilis cases, with 13 confirmed and eight probable
cases occurring between June 2018 and June 2019
The rate of infectious syphilis in northern Manitoba alone.[96] Manitoba recorded 42 congenital syphilis
(179.9 per 100, 0000) was greater than the Manitoba cases in 2020 and 48 congenital syphilis cases in 2021.
overall rate (100.1 per 100,000) for 2021. The rate in the Lack of prenatal care and substance use are known
north decreased almost three-fold from 2020 to 2021 risk factors for congenital syphilis infections.[97]
(504.6 per 100,000 to 179.9 per 100,000).
It is strongly suspected that methamphetamine
use is linked to the dramatic increase in cases of
congenital syphilis in Manitoba.[93]

48 2022 HE ALT H S TAT US REPOR T | MANI TOBA

HUMAN IMMUNODEFICIENCY VIRUS (HIV)

150 12.5

118 119 117

Crude rate per 100,000 population

10.0
109 107
Number of Cases

104
9.2
100 90 8.7
87 8.1 8.4
7.9 7.9 7.5
78
70 6.7 6.6
6.2
5.5 5.0
50

2.5

0 0.0
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Year

Cases Crude rate

Figure 3. from 2020 ANNUAL SURVEILLANCE UPDATE: HIV IN MANITOBA (gov.mb.ca) [98]

As the figure above shows, there has been some

fluctuation of HIV cases in Manitoba.
In 2020, 58.1 per cent of cases
Regionally, rates of HIV started to climb in Prairie were male and 41.9 per cent were
Mountain Health in 2018, and in the Northern Health
female.[98] In recent years, the
Region in 2019. However, due to small numbers in
these regions, a slight increase of cases can create
proportion of HIV cases among
large fluctuations in rates. females has increased, but the
proportion decreased slightly in
Prairie Mountain Health went from a rate of 1.2 per 2020.[98]
100,000 in 2017, to 7 per 100,000 in 2018 and then, up
to 8.7 per 100,000 in 2019.[98] 2017 – 31.1%
2018 – 40.2%
Northern Health Region’s rate was stable over time 2019 – 44.5%
until 2019, when it went to 16.8 per 100,000, from 5.2 2020 – 41.9%
per 100,000 in 2018. This is an increase of over 200 per
cent in one year.[98]

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 49

HEPATITIS B
Hepatitis B HEPATITIS C
Hepatitis C
300 283 800 757 746
239 244 627
223 700 596
250 614
188 600
200
500
150 400
300
100
200
50
100
0 0
2017 2018 2019 2020 2021 2017 2018 2019 2020 2021

223 cases in 2021 596 cases in 2021

The rate of Hepatitis B in the Winnipeg Regional The rate of Hepatitis C in northern Manitoba
Health Authority (23 per 100, 0000) was one-and-a- (94.5 per 100, 0000) was more than two times
half times greater than the Manitoba overall rate greater than the Manitoba overall rate
(16.1 per 100,000) in 2021. (43 per 100,000) in 2021.

TUBERCULOSIS (TB)
Tuberculosis (TB) is a communicable disease that
primarily affects the lungs and can cause significant
illness and death. A person can have active or latent
(sleeping) TB. People with active TB have signs and
symptoms, and those with latent TB do not. Both
are an important public health concern, because
someone with latent TB can progress to active
TB if they do not receive and follow treatment.
In Canada, Manitoba has one of the highest rates
of active TB.[99]

In Manitoba, the average rate of respiratory TB cases

over the last five years is 138.6 cases per year.[100]

In 2019, this translated into 13.2 cases per 100,000

Manitobans. However, the impact is disproportionate
by regional health authority, and significantly higher
than the national average of approximately 4.9 cases
per 100,000.[100]

50 2022 HE ALT H S TAT US REPOR T | MANI TOBA

 4
CHAPTER

COVID-19
in Manitoba
C h a p t e r 4 : C O V I D -1 9 i n M a n i t o b a

As discussed in Chapter 1, part of the role of public novel coronavirus disease COVID-19 (formerly 2019-
health is to respond to public health emergencies, nCoV).[101] Despite initial control efforts, this new virus
including outbreaks of disease. In early 2020, public spread across Eastern Asia and eventually, across
health systems around the world were thrust into the the globe. On Jan. 30 2020, it was declared a Public
spotlight following the detection of a cluster of cases Health Emergency of International Concern and
of pneumonia with unknown etiology in Wuhan, on March 11, 2020, the WHO declared COVID-19 a
China. Investigations revealed that the outbreak was pandemic.[102, 103] Public health systems around the
caused by a novel (new) coronavirus. The World world jumped into action to slow and prevent the
Health Organization (WHO) officially named this spread of COVID-19, bringing with it a new global
awareness of the work of public health.

WHAT IS A PANDEMIC?
For a disease to be considered a pandemic, it must
spread across a large region, or cross international
boundaries, and affect many people.

52 2022 HE ALT H S TAT US REPOR T | MANI TOBA

Key dates early in the COVID-19 Pandemic [103] NAMING OF COVID-19 VARIANTS OF CONCERN
• January 4, 2020 – WHO reported on social media
that there was a cluster of pneumonia cases – with Pango Lineage WHO Label
no deaths – in Wuhan, Hubei province.
B.1.1.7 Alpha
• January 9, 2020 – WHO reported that Chinese
authorities determined the outbreak was caused by
B.1.351 Beta
a novel (new) coronavirus.
• January 13, 2020 – Officials confirmed a case of P.1 Gamma
COVID-19 in Thailand, the first recorded case
outside of China. B.1.617.2 Delta
• January 30, 2020 - The WHO Director-General
declared the novel coronavirus outbreak
B.1.1.529
(2019-nCoV) a Public Health Emergency of
International Concern. WHO’s situation report BA.1 Omicron
reported 7,818 total confirmed cases worldwide,
with the majority of these in China, and 82 cases BA.2
reported in 18 countries outside China.
• March 11, 2020 – WHO declared the novel
coronavirus (COVID-19) outbreak a global pandemic.

COVID-19 VARIANTS OF CONCERN

Genetic variants of viruses are common and
expected. Variants of a virus become concerning
when they spread more easily, cause more severe
disease or when vaccines and treatments are less
effective against them.[104] Such strains are termed
variants of concern (VOC). A number of COVID-19
variants of concern have been identified that
continue to spread globally.[54] The emergence of
the Alpha variant significantly affected COVID-19
transmission in the fall of 2020, which will be
examined later in this chapter.

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 53

COVID-19 Public Health Activities
PREPAREDNESS AND RESPONSE
Emergency preparedness activities such as planning,
training and organizing to respond to harmful events
and situations, are all part of the work of public health
in non-pandemic times.[92] The provincial response
to COVID-19 began long before the identification of
the first case in Manitoba. In Jan. 2020, a leadership
committee was established to coordinate the
provincial response to COVID-19. As the situation with
COVID-19 developed, this committee transformed
into a joint Incident Command System on
Feb. 3, 2020.

Following notification of the novel

coronavirus outbreak in China from the
Public Health Agency of Canada, Manitoba’s
chief provincial public health officer issued
a health alert to health care providers
on Jan. 17, 2020. FIRST NATIONS LEADERSHIP DURING COVID-19
The Manitoba First Nations COVID-19 Pandemic
The primary objectives of the response to COVID-19
Response Coordination Team (PRCT) is a partnership
were to minimize serious health outcomes and
between the First Nations Health and Social
overall deaths, while minimizing societal disruption.
Secretariat of Manitoba, Manitoba Keewatinowi
Achieving these goals meant that managing the
Okimakanak, and the Assembly of Manitoba Chiefs.
pandemic involved using the least restrictive means
This group was empowered to make decisions to
necessary to balance the risk of COVID-19 versus the
assist in responding to First Nations’ needs and
risk of negative health impacts from public health
worked with all levels of government, service delivery
restrictions. In the context of a global pandemic with
organizations, tribal councils, Southern Chiefs
a highly transmissible virus, the degree of public
Organization and Ongomiizwin (Rady Faculty of
health restrictions enacted and the challenges in
Health Sciences). One of the roles of the coordination
attaining a balanced approach were unprecedented.
team was providing First Nations with updates
on cases of COVID-19. The Manitoba First Nations
Over 100 public health orders were issued in
COVID-19 PRCT published daily and weekly bulletins,
Manitoba between March 2020 and March 2022.
vaccination reports and tribal council reports to
provide First Nations specific data.

54 2022 HE ALT H S TAT US REPOR T | MANI TOBA

PUBLIC HEALTH MEASURES AND ORDERS Throughout the COVID-19 pandemic, public health
Under the Public Health Act, the chief provincial orders were issued that placed restrictions on
public health officer has the authority to issue public numerous aspects of daily life including:
health orders when they determine there is a serious
and immediate threat to public health that exists Use of masks
because of an epidemic, or threatened epidemic, of a
communicable disease, and that the threat to public Travel restrictions/isolation requirements
health cannot be prevented, reduced or eliminated
without taking special measures. These orders can be Group gatherings
issued at any time and may be in place for a specified
period, or until revoked by the chief provincial public Business capacity limits and closures
health officer. Orders must be approved by the
Minister of Health. Recreation/sports

Public health measures changed rapidly in response Schools

to the burden of COVID-19 in the province, emerging/
changing evidence and the availability of key Proof of vaccination requirements
interventions, such as vaccination.

Key dates and public health measures in Manitoba’s

initial pandemic response (March –May 2020):

Public Health Measures

Jan. 17 March 23 March 31
CPPHO makes Suspended classes Suspended classes April 17
novel coronavirus March 20 at Manitoba at Manitoba K-12 Extended public health orders until May 1,
a reportable disease Public health orders K-12 schools for schools indefinitely added requirements under The Public Health
issued to limit three weeks Act for all travellers to self-isolate for 14 days
gatherings, hospitality April 1 after returning to Manitoba
Late Jan. premises and closing Expanded public
Testing for the gyms and gaming sites
novel coronavirus March 26 health orders to
April 20
Expanded testing further limit
begins Suspended child-care gatherings, close Extended state of
services criteria
non-essential emergency until
businesses until May 18
April 14
March 12 March 20 March 27 April 21
First case Province declares First death Issuing guidelines for
identified in state of emergency identified the use of protective
Manitoba in Manitoba personal equipment

Feb. 3 March 12 March 19 April 1

Established a First testing Suspended visits
health system sites opened to hospitals Initiating screening
incident command procedures for staff
structure March 16 at hospitals and
Limited visitor personal care homes
access to hospitals
April 6
March 17 Hotel based
Suspended visits Case Isolation
to long-term
care patients

Health System Operational Measures

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 55

 The provincial response was based on key
The Fundamentals indicators being monitored by public health
officials, including:
Key public health recommendations,
often termed “the fundamentals”, Test positivity rates
included physical distancing of two
Case numbers and growth rates
meters (six feet), staying home and
getting tested when sick, washing The speed of disease spread, called doubling
hands frequently and wearing time (the time it takes for cases to double)
a mask.
Contact tracing and the degree in which to
cases are contained in clusters and outbreaks

Health system capacity regarding

hospitalization or intensive care unit admissions

COVID-19 vaccination rates

56 2022 HE ALT H S TAT US REPOR T | MANI TOBA

Unintended Impacts of
Public Health Measures
While public health measures may have A 2021 study by Sick Kids in Ontario found that
been necessary to protect Manitobans between April and June 2020:
from the spread of COVID-19, a balanced
approach was needed to limit any
unintended harms.

Many of the negative unintended consequences of

the pandemic were the result of existing inequities.
2⁄3
Job loss and loss of income, social isolation, mental More than two thirds of children and adolescents
health impacts, increases in substance use and experienced deterioration in mental health, strongly
domestic and family violence, reduced access associated with stress related to social isolation.[105]
to in-person learning and supports and delayed
surgical and diagnostic procedures and routine
immunizations are just a few examples of
potential harms. 70.2% of children 6–18 years old
and 66.1% of children 2–5 years old
It should be noted that many of these experienced a decline in at least
unintended consequences were not due one domain of mental health
to public health measures alone.
(e.g., depression, anxiety,
COVID-19 infections themselves also played a role due irritability, attention, hyperactivity,
to staff redeployments in health care and increased and obsessions/compulsions).[105]
absenteeism due to illness across sectors. People who
have been re-infected or who are experiencing long
COVID-19 symptoms, continue to be impacted even
though public health measures were removed in
spring 2022.

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 57

SUBSTANCE USE AND HARM
Substance-related deaths in Manitoba increased
from 191 in 2019 to 372 in 2020, representing an
almost 95 per cent increase.[106]

This sharp rise was believed to be due to:

stress caused by the COVID-19 pandemic, which
has resulted in increased mental health issues,
including feelings of anxiety, depression and
suicidal thoughts;

an increase in solitary substance use

because of COVID-19 public health orders
limiting gatherings

barriers to treatment

Between January and July 2021

alone, 236 substance toxicity
deaths were reported by the Office
of the Chief Medical Examiner
(OCME).[107]

ROUTINE IMMUNIZATIONS
Routine immunization programs, including school-
The response to COVID-19 has impacted
based programs, were postponed to prioritize
Manitobans physically, mentally, socially, emotionally
COVID-19 vaccination.
and spiritually, and through reduced access to the
adequate social, economic and developmental
The number of monthly diphtheria, tetanus, pertussis,
supports, such as loss of employment or housing
polio, haemophilus influenza type b (DTaP-IPV-Hib)
and access to education. The full impact of COVID-19
and measles, mumps, rubella, varicella (MMRV)
from the societal level to the individual level, will take
vaccine dose provision in Manitoba decreased in
years to fully understand. However, health and social
April 2020 compared with February 2020, by 18 per
inequities have widened because of the pandemic
cent and 38 per cent, respectively.[108]
and related measures, and it will take significant effort
and collaboration across all sectors to close these gaps.

58 2022 HE ALT H S TAT US REPOR T | MANI TOBA

COVID-19 Vaccination
As discussed in Chapter 2, vaccination is the single There are some regional differences in vaccination
most important public health achievement in the coverage. As of April 13, 2022…
past century, as infectious diseases have dropped
from the leading cause of death to less than
in the Winnipeg Regional
five per cent of all deaths in Canada. COVID-19 88%
Health Authority
has shown us the devastating effects an emerging
infectious disease can have on a population when
general immunity is low and a vaccine is not available.
in Prairie Mountain Health
80%
and Interlake Eastern
The COVID-19 vaccination campaign is
the largest vaccination campaign ever
undertaken in Manitoba. in Northern Regional
82%
Health Authorities, and
As of April 13, 2022…

2,871,481 66%
in Southern Health have received
two doses of COVID-19 vaccine.
doses of vaccine have been administered.

82.9% For First Nations as of April 7, 2022

of Manitobans aged five and
older have received two doses
307,800
45.0% doses of vaccine have been administered
have received three doses [109]
89.4% 70.4%
On-reserve Off-reserve
of people aged five and older have received
two doses

29% 21.5%
On-reserve Off-reserve
of people have received three doses [110]

On Dec. 16, 2020, the first COVID-19 vaccine

was given in Manitoba.

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 59

COVID-19 vaccines are highly effective at preventing
severe COVID-19 disease, including the need for 17.3%
supplemental oxygen, hospital admission and of the Manitoba population is not vaccinated
intensive care unit (ICU) admission. No vaccine is against COVID-19, yet from March 1 – 31, 2022,
100 per cent effective in preventing infection, and, they account for:
as a result, we expect to see breakthrough infection
in fully vaccinated Manitobans. Manitobans that have
received no dose of COVID-19 vaccine are more likely
to be hospitalized, admitted to the ICU or die 22.6 per cent of hospital admission
if infected with COVID-19.

27.1 per cent of ICU admissions

30.2 per cent of deaths [111]

60 2022 HE ALT H S TAT US REPOR T | MANI TOBA

Epidemiology of COVID-19 in Manitoba
Epidemiological analysis answers key questions about Manitoba’s COVID-19 experience follows the pattern
the movement of COVID-19 through the population. of other jurisdictions, with cases rising and falling in
Interpretation of data on severe outcomes (e.g., waves, but remains unique in terms of the timing,
hospitalization, ICU, death, vaccine status) helps clusters and populations that were impacted. Each
explain how the virus spreads in different settings, wave of COVID-19 was different from the next, and
and informs public health interventions and the context of COVID-19 infection dynamics changed
decision-making. rapidly. Manitoba’s first wave of COVID-19 was
significantly smaller than the waves that followed.
For this reason, the data in this report focuses on
As of April 27, 2022 there were
the impact of COVID-19 from August 2020 to March

141,377 2 2022. While small in magnitude, wave one was not

insignificant. It happened at a time where the entire
world knew very little about SARS CoV-2, the virus
cases of COVID-19 identified in Manitoba
that causes what is now known as COVID-19, and
Of these, 37,428 were identified amongst the identification of the first case of COVID-19 in
First Nations people with Manitoba that triggered a series of significant actions,
as already noted earlier in this chapter. A combination
22,053 on-reserve of timing and quick action prevented a large first
15,375 off-reserve wave in Manitoba.

First Nations people have been disproportionately

impacted by COVID-19 representing 26.5 per cent of
all COVID-19 cases in Manitoba.[112]

2
It should be noted that the number of cases reported is an undercount of the total number of Manitobans infected
with COVID-19. There are many factors that contribute to the undercounting of cases, including people who do not have
symptoms and do not know they are infected, changes to testing criteria and people with mild illness not seeking testing,
even if they were eligible.

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 61

 16000 1600

14000 1400

12000 1200

Death Rate
10000 1000
Cases

8000 800

6000 600

4000 400

2000 200

0 0
2021-02-07–

2021-03-07–

2021-04-04–

2021-05-02–

2021-05-30–

2021-06-27–

2021-07-25–

2021-08-22–

2022-01-09–

2022-02-06–

2022-03-06–

2022-04-03–

2022-05-01–
2020-08-23–

2020-09-20–

2021-09-19–

2021-12-12–
2021-01-10–

2021-10-17–

2021-11-14–
2020-12-13–
2020-10-18–

2020-11-15–

Starting Date of Epidemiological Week

Cases Deaths

Cases of COVID-19 by Week of Public Health Report Date, The peak daily case count in Wave Two
Manitoba, August 23, 2020 – April 23, 2022 [111]
was 593, on Nov. 22, 2020.
Wave Two, which began in early fall 2020, was when
Between Waves Two and Three, two significant
Manitoba experienced widespread community
factors changed the COVID-19 landscape: vaccines
transmission of COVID-19 for the first time, with
became available and the alpha variant of concern
case counts reaching 300 to 500 new diagnoses per
(VOC) emerged, which was more transmissible and
day. At this time, Manitoba’s population was largely
more severe than the original wild type of the virus.
susceptible to COVID-19, with no vaccine and very
little protection from previous infections. Despite While early supply of vaccine was limited, some
having significant public health measures and people most at risk for severe outcomes from
precautions in place across the province, personal COVID-19 (e.g., elder residents of personal care
care homes were hit particularly hard, a pattern that homes) were able to be vaccinated in early 2021.
was seen in other provinces across Canada. As shown in the epi curve above, while cases
increased notably in Wave Three, the overall
number of COVID-19-related fatalities was
lower than Wave Two.

62 2022 HE ALT H S TAT US REPOR T | MANI TOBA

The peak daily case count in Wave The peak daily case count when Omicron
Three (Alpha) was 601 on May 19, 2021. overtook the Delta variant was 2,091 on
Jan. 5, 2022.
After the Alpha VOC emerged, new variants
continued to be identified, and it was the Delta It is estimated that each Omicron case infects
variant, with its increased transmissibility and severity 4.5 times more people than a case of Delta.[114]
compared to Alpha, that was becoming the dominant
circulating variant by summer and into fall 2021.[113] DEMOGRAPHICS OF COVID-19 CASES IN
MANITOBA[111]
The following figure shows the breakdown of cases
The Delta VOC was up to 79 per
by age and sex. We can see that the case counts are
cent more transmissible than generally balanced between males and females, but
Alpha.[113] not by age group, where people aged 20 to 29 had a
higher burden of infection. This is similar to what was
Manitoba’s fourth wave began in the fall of 2021, seen across Canada.
driven by the Delta variant. Manitoba had sufficient
vaccination and restrictions in place to keep
cases lower than previous waves, that changed
in December when the Omicron variant quickly
overtook Delta as the dominant variant in Canada.
The Omicron variant was more transmissible
than Delta, and two doses of COVID-19 were less
effective at preventing omicron infection, though
they continued to offer protection against severe
outcomes.[114] This combination of factors led to a
steep incline in cases in the beginning of late Dec.
2021. People vaccinated with a third dose of vaccine
appear to have been more protected than people
with two doses only.

Sex and Age Distribution of COVID-19 Cases,

Manitoba, March 1, 2020 – April 23, 2022

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 63

Severe Outcomes: Hospital and Intensive
Care Unit (ICU) Admissions, and Deaths

Throughout the pandemic, there was concern that

health systems would become overwhelmed due to
high numbers of COVID-19 positive patients needing
care, combined with reduced capacity due to staff
having COVID-19 themselves, or having to isolate due
to exposure. In addition to significant public health
measures, the hospital system also had to reduce
volumes of elective surgeries and redeploy staff to
ensure there was sufficient staff to care for COVID-19
positive patients. These measures, while necessary,
have had unintended negative consequences that
have been previously discussed.

As of April 21, 2022, related to COVID-19 infection

THE PROVINCE SAW A TOTAL OF FIRST NATIONS SEVERE OUTCOMES [115]

2,860
9,163 Hospitalizations
31.2 per cent of hospital admission

583
1,407 ICU Admissions
41.4 per cent of ICU admissions

350
1,789 deaths
19.6 per cent of deaths

A disproportionate number of severe outcomes

were experienced by First Nations people in each
wave, except for the first wave in spring 2020.

64 2022 HE ALT H S TAT US REPOR T | MANI TOBA

Severe Outcomes of COVID-19 by Week of Outcome Date,
Manitoba, August 23, 2020 – April 23, 2022

As you can see in the figure above, the severe Longstanding structural factors including
outcomes in Wave Three (Alpha), are lower than in overcrowded housing, and income and food
Wave Two, despite the volume of cases being higher. insecurity, have contributed to this disproportionate
This decline in severe outcomes is attributed to the disease burden. Higher severity of disease is also
efficacy of vaccines for those most at risk of likely the result of higher rates of underlying chronic
severe outcomes from COVID-19. illnesses, which are also caused by structural gaps.

On April 28, 2021, during Wave Three (Alpha), The arrival of the Omicron variant in Dec. 2021 had
First Nations people made up 19 per cent of new a significant impact on the acute care system in
cases, 36 per cent of active cases, 38 per cent of Manitoba. Despite early data suggesting Omicron
hospitalizations and 52 per cent of ICU patients. [115] caused more mild disease than previous variants,
This means that First Nations people made up about the spread of Omicron was so quick that there were
half of all critically ill patients admitted to the ICU. This record numbers of COVID-19 positive hospitalizations
is a striking overrepresentation of severe COVID-19 in Manitoba.[114]
disease in this population.

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 65

PEOPLE WHO EXPERIENCED DISPROPORTIONATE Three reports and one public brief on the collection
IMPACTS OF COVID-19 IN MANITOBA of REI information and impacts of COVID-19 on
A description of how case counts, vaccination rates racialized communities in Manitoba have been
and acute care usage changed over time provides released to the public and can be found on Manitoba
an overview of the COVID-19 pandemic. However, Health’s Epidemiology and Surveillance website
tracking the spread of a virus is more than just at https://www.gov.mb.ca/health/publichealth/
looking at cases. There is more to be learned by surveillance/reports.html
taking a closer look at the people who are affected.
The collection of REI identifiers to allow for
Historically, race, ethnicity and Indigenous (REI) disaggregation of data is a complex balancing act
self-identity data has not been consistently captured of potential harms and potential benefits. Benefits
in Manitoba, nor across Canada. As COVID-19 arrived are most likely to occur when diverse communities
in Manitoba, a group of representative experts have representation in all aspects of the data
supported the development of a data collection cycle, including collection, analysis, reporting,
process, including the creation of scripts and recommendations and shared decision-making.
training videos, and a REI question for use during
case investigations. COVID-19 became the first Expert analysis and recommendations requires
instance of the safe and regular collection of people who are members of, and connected to,
race-based data in Manitoba. diverse communities, who hold knowledge in critical
race and gender studies, public health, health care
Data about race, ethnicity and Indigenous systems, human rights, and epidemiology. The data
is useful when expertise, advocacy and participating
self-identity of persons testing positive for
in planning, policy and decision-making can occur,
COVID-19 and undergoing public health
as well as when it is provided to support informed-
follow-up began being collected on decision making by the members of diverse
May 1, 2020.[116] communities that it describes.

The provision of health data and analysis to

communities experiencing higher burden gives the
community leadership an opportunity to provide
and create pathways of care and interventions that
will make real impacts for their own people. This is
one example of how appropriate governance and
participatory planning results in improved outcomes
that can be recreated to address other health issues.

Equity in public health does not start at the

intervention, but rather at the interpretation of a
community’s health needs through the analysis
of data. Equitable practices around health
data-sharing, governance and evidence-informed
decision-making are fundamental requirements
for achieving equitable outcomes.

66 2022 HE ALT H S TAT US REPOR T | MANI TOBA

REI AND COVID-19 DISEASE when we look at the differences between diverse
Between May and Dec. 2020, 54 per cent of COVID-19 racialized communities, compared to what would be
cases identified were in people who self-identified as expected based on population size.[118] Using cases
members of a racialized community despite racialized among white people in Manitoba as a reference, age
communities making up only 36 per cent of the standardized COVID-19 infection rates were up to
Manitoban population.[117] 21.7 times greater for the South-East Asian
community.[118]
This finding is 1.6 times higher than
Figure 1 shows the number of cases by REI identifiers.
expected.[116]
The data shows that there is an unequal distribution
WAVE THREE (ALPHA) FINDINGS of cases in Manitoba, with members of diverse
racialized communities having much higher numbers
Between March 31, 2021 and June 7, 2021,
of COVID-19 infections, taking into consideration their
76.6 per cent (14,408) of Manitoba’s 18,808 cases
much smaller population sizes. It is not race, ethnicity
of COVID-19 had REI data recorded, including those
of Indigeneity that may increase the risk of COVID-19
who declined to answer.[118] The data showed an
infection, but rather the structures of society that
over-representation of COVID-19 infection in all
place people at advantage or disadvantage.[116]
racialized groups, except for the Chinese community,
ranging from 1.8 to more than 11 times higher
These numbers suggest that there is an
overrepresentation of COVID-19 infections in
racialized community members. (External Report,
Figure 1).[116]

Figure 1 from COVID-19 Infections in Manitoba: Race, Ethnicity, and Indigeneity Public Brief
(https://www.gov.mb.ca/health/publichealth/surveillance/docs/rei_brief.pdf) [117]

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 67

Beyond examining the disproportionate burden
of COVID-19 cases in Manitoba, it is also important
to look at the data on severe outcomes, including
Between March 31 and June 7,
hospitalizations, ICU admissions and deaths. 2021, when age was accounted
for, racialized people in Manitoba
Between March 31, and June 7, 2021… were at:
For racialized people in Manitoba, the
hospitalization rate was 3.5 times that of
3 - 10 times higher risk for
white people in Manitoba. infection;
2 - 7 times higher risk for
The average age of hospitalized cases was
hospitalization; and
14 years younger for racialized people in
Manitoba.[118] 2 - 6 times higher risk for
ICU admission than white
In terms of ICU admissions, the rate was
Manitobans.
4.2 times greater among racialized people in
Manitoba, compared to white Manitobans and
the average patient age was 10 years younger.[118]. Occupations requiring continued front-line work
appear to have led to more exposure to COVID-19
among racialized people in Manitoba.[118] COVID-19
transmission risk is highest in settings where
congregation and prolonged close contact
between individuals occurs at a higher frequency.
Lower income and racialized Manitobans are also
more likely to live in overcrowded housing where
more transmission may occur.[118] A higher burden
of underlying chronic diseases and reduced access
to health care may have also contributed to these
disproportionate impacts.[118]

The data also showed a relationship between

income level, race and severe COVID-19 disease.
ICU admissions were higher among Manitobans in
lower income quintiles (levels), with the effect being
inversely proportionate to income level.[118]

A particularly striking finding is that

ICU admissions were the highest among
racialized community members in the lowest
income quintile at just over one in every
three hospitalizations.[118]

68 2022 HE ALT H S TAT US REPOR T | MANI TOBA

In Manitoba, all public health measures
were lifted on March 15, 2022.

Between March 2020 and March 2022, the COVID-19

pandemic required unprecedented actions by
government, public health officials and all citizens to
address a new and immediate threat to the health
of Manitobans. Since then, much has changed,
including the virus itself. The Omicron variant,
This pandemic has predictably affected Manitobans
while more transmissible, causes less severe disease
inequitably. The spread of COVID-19 in Manitoba
than other variants of concern. A safe and effective
has provided a real-time look at how certain groups
vaccine is now widely available and the majority of
and populations experience inequitable health
Manitobans over the age of five are fully vaccinated.
outcomes. Older people, and those with underlying
Finally, there are effective treatments available. All of
chronic conditions were at a higher risk of severe
these factors played an important role in transitioning
disease. Diverse racialized communities have also
from pandemic management, to managing COVID-19
been more significantly impacted due to underlying
with more routine practices and recommendations,
inequitable social and structural health determinants,
similar to those used to manage influenza and other
which itself is due to structural racism. While we
respiratory illnesses, in early spring 2022.
can gather data about illness from COVID-19 in
real time, the full physical, social and economic
impact of this pandemic, including the unintended
consequences of public health measures, will not be
well understood for years to come.

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 69

Final Thoughts
For many Manitobans, the time of the pandemic has
been a time of much reflection. We hope that this
report provides an opportunity for Manitobans to
reflect further. Why is it that despite the majority of
Manitobans being able to enjoy good health, certain
groups persistently have poorer health outcomes?
Why is it that certain groups of Manitobans
experienced more negative impacts of COVID-19
infection and disease, compared to others?

For many Manitobans, these questions are not

new and much great work continues to be done
on further understanding the underpinnings of
health disparities across the province. There is also a
tremendous amount of work being undertaken by
many organizations to attempt to improve gaps in
care and services. For some Manitobans, this may be
their first opportunity to reflect on this topic.
By approaching our review from this baseline
For those that wish to delve deeper into these issues, understanding, we can see that health inequities
I suggest starting your endeavour from a common are due to, and perpetuated by, social and systemic
baseline of three very basic premises: factors, including employment opportunities,
housing conditions, poverty and racism. In order to
1. These disparities are not due to chance. address these disparities in health outcomes, we must
first address these systemic factors. Improving these
2. These disparities are not due to genetics or long-standing factors is complex and will require
some other inherent predisposition to community engagement and significant time and
poor health outcomes. resources to implement.

3. These disparities are not due to

poor life choices.

70 2022 HE ALT H S TAT US REPOR T | MANI TOBA

To move toward a reduction of health inequities,
and seek to improve the overall health of
Manitobans, it is necessary to:

Continue to measure and expand our

understanding of health disparities;

Set measurable and achievable short-, medium-

and long-term targets for improving the health
of all Manitobans, including targets to reducing
the gaps outlined in this report;

Use this and other data to inform Manitoba’s

clinical preventive services plan;

Engage and work along side community

leadership in tackling health disparities that
various groups face;

Publically report on these indicators at

regular intervals.

Continue to support Indigenous-led responses

to health issues

MANI TOBA | 2022 HE ALT H S TAT US REPOR T 71

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