Take action before emergency declarations

Manitoba is living through several emergencies at once.

An HIV public-health emergency. A toxic drug crisis. Rising hepatitis C. Severe housing pressures. Communities asking for help before more people are lost.

In July, leaders from four Island Lake First Nations declared a regional public-health emergency. They described addiction, infection, homelessness and overcrowding converging in communities that do not have enough prevention, treatment or locally led care to meet the need.

These may look like separate problems.

They are not.

They are different expressions of the same pattern: we often wait until suffering becomes impossible to ignore before prevention is treated as urgent.

To be fair, not every crisis can be prevented. Novel infectious threats can emerge. Drugs can become more toxic. Climate events can intensify. Human behaviour is complex, and no government can anticipate every threat.

But prevention is not about promising that nothing bad will ever happen.

It is about reducing how often harm occurs, how far it spreads and how many people are left to carry its consequences.

It is the difference between one infection and a full-blown outbreak.

Between a community having local support and being forced to declare an emergency simply to be heard.

Prevention is rarely dramatic.

It looks like stable housing. Reliable primary care. Testing. Harm reduction. Community outreach. Clean water. Food security. Mental-health support. Public-health surveillance. Culturally safe services designed and led by the people who use them.

None of this produces the urgency of an emergency-room hallway or a public declaration.

That may be part of the problem.

We reward visible rescue. Prevention is harder to see.

When prevention works, the headline never happens.

The infection does not spread. The overdose is reversed or avoided. The person does not lose their housing. The patient does not arrive at the hospital in the final stage of a problem that began months or years earlier.

That absence can make prevention look optional. It is not.

It is also not simply compassionate policy. It is sound economic policy.

Waiting is expensive.

We pay for ambulances, hospital beds, emergency shelters, outbreak control, evacuations and prolonged treatment. We pay through missed work, family disruption, exhausted health workers and communities repeatedly asked to recover from preventable harm.

The costs may appear in different budgets, but they are still public costs.

This is one reason prevention is so easily neglected. The department that pays today may not be the department that saves tomorrow. A housing investment may reduce future emergency visits. Harm reduction may prevent infections that would otherwise require years of treatment. Community-led care may improve trust and bring people into the system earlier.

The return may be real even when it does not appear neatly on the same balance sheet.

Manitoba has not stood still. Declaring the HIV emergency matters. Recent investments in responses to the toxic drug supply matter. Public acknowledgment matters because it can unlock resources, co-ordination and attention.

But declarations of emergency should not become our main prevention strategy.

Island Lake leaders are not asking only for a stronger emergency response. They are asking for the conditions that make emergencies less likely: housing, prevention, treatment, harm reduction and sustained Anisininew-led care.

That distinction matters.

Communities should not have to reach a breaking point before long-known needs become actionable.

We have become very good at naming emergencies.

We remain far less willing to fund the conditions that might prevent them.

The real test of foresight is not whether we can respond once a crisis is visible.

It is whether we are willing to invest while the warning signs are still quiet, the solutions are less costly and the suffering can still be reduced.

Emergency declarations have a purpose.

But a healthy province should not measure itself only by how forcefully it responds after harm becomes undeniable.

It should also ask how much harm it had the courage to prevent.

Marwa Suraj is a Manitoba-based health leader whose work centres equity and social accountability.