There is no innovation without social accountability

Opinion

“Can a country call itself innovative if its founding wounds remain open?” That’s a question I’ve been sitting with for a while.

It came up again during wildfire season, as I watched health systems scramble to meet the needs of evacuated communities, many of them Indigenous, across Northern Manitoba. The co-ordination was messy. Elders were separated from families. People with diabetes or kidney failure were moved hours away from their homes, often without proper followup care. The burnout was visible. And the gaps were predictable.

It didn’t feel like a health system ready for the future. It felt like one stuck in the past.

Canada wants to lead in health innovation. We talk about telehealth, AI diagnostics, precision medicine. But how can we claim innovation when access to basic care is still shaped by race, geography, and colonial legacy?

Innovation isn’t just about shiny tools. It’s about what those tools are built on. And who gets to use them.

A recent report from Shared Health — REI Data Public Report: Emergency Department Visits & Care, June 2025 — reinforces this reality. Indigenous and Black patients in Winnipeg’s ERs wait significantly longer than white patients, despite receiving similar triage scores. According to the report’s findings, Indigenous and white patients are assigned comparable urgency levels, a fact that disproves the long-standing myth that Indigenous people “overuse” emergency services.

In fact, Figure 10 of the report clearly shows how closely matched the triage scores are between racial groups, yet Figure 13 reveals that Indigenous and Black patients still face the longest average wait times.

Many leave before ever seeing a doctor. This isn’t due to differences in the severity of illness. They’re triaged the same. It’s systemic. It’s avoidable. And it’s unjust.

The data speak volumes: more than half of the patients who leave without being seen are Indigenous. Figure 24 and Figure 27 show that Indigenous people make up nearly two-thirds of all patients who leave against medical advice. These numbers aren’t about non-compliance. They reflect broken trust, racial bias, and a system still failing those it was never designed to serve.

We can’t design our way out of a crisis we’re not willing to name.

The past isn’t behind us. It’s stitched into the present. Canada’s health systems were not built for Indigenous Peoples; in many cases, they were built against them. From segregated hospitals to forced removals, from medical experimentation to current-day underfunding of on-reserve services. The mistrust isn’t imagined. It’s earned.

And yet, Indigenous communities continue to rise. During COVID-19, many led some of the most co-ordinated, effective pandemic responses in the country. Land-based healing, traditional knowledge, and community governance offer powerful blueprints. But rarely are these seen as the future of health. They’re treated as alternatives. Add-ons. Afterthoughts.

That’s a mistake.

Because the future of health care in Canada, especially in a climate-constrained world, requires a different kind of leadership. It requires deep listening, long-term investment, and shared power. It requires systems that are trauma-informed, culturally grounded, and locally governed.

It requires the kind of accountability that doesn’t just apologize, but reallocates.

The wildfires will return. So will floods, smoke and displacement. In just a matter of weeks, Manitoba has faced two separate states of emergency.

Climate change is not on the horizon: it’s already here. And its impacts won’t be felt equally. Indigenous communities are on the frontlines. They’ve also been leading the responses. But without structural support, they’re being asked to do more with less … again.

And still, many remain hopeful. That’s what humbles me the most.

I’ve spoken with young Indigenous health leaders who are designing mobile clinics rooted in ceremony. Elders who offer counselling and comfort to those evacuated from their territories. Nurses who drive for hours to deliver care where the system doesn’t reach. These are not acts of charity. They are acts of sovereignty.

The question is whether Canada is willing to follow their lead.

To me, equity isn’t just a goal. It’s a precondition for innovation. If your health system leaves people behind, it’s not innovative.

There’s a lot of talk these days about reimagining systems. But reimagining requires reckoning. And reckoning means giving up the illusion that progress is linear or automatic.

If we want health innovation in Canada, we need social accountability first. We need to invest in relationships, repair harm, and co-create solutions that reflect the wisdom and rights of Indigenous Peoples.

Because until Indigenous Peoples are free to define, deliver, and govern their own models of care, on their own lands, then we are not truly advancing. We’re just decorating the same old systems.

And no amount of technology can cover that up.

Marwa Suraj is a naturalized Canadian, a proud Manitoban, and a physician by training. She is Black, Muslim, and a woman: identities that shape her passion for equity, innovation, and social accountability.