LANG Committee Report

In this chapter, we use the term “intergovernmental cooperation” to mean the sum of all relations instituted between the various levels of government of a federation to achieve common objectives.

Intergovernmental cooperation in official languages is generally recognized as being well-established. In education, since 1970, the federal government has signed bilateral agreements with each of the provincial and territorial governments (departments of education) and provides financial support to cover a portion of the additional costs incurred to provide instruction in the primary language. The Official Languages in Education Program was one of the Laurendeau-Dunton Commission’s main recommendations. In addition, through the Department of Canadian Heritage, the Government of Canada also signs federal-provincial agreements on services in the minority language on a multi-year basis with the provincial and territorial governments in key areas for the development and vitality of the official language minority communities: the economy, justice, social services and recreation to name a few.

On September 23, Hilaire Lemoine, Director General, Official Languages Support Programs, at the Department of Canadian Heritage, provided some historical background on the Official Languages in Education Program (OLEP). In the past 30 years, the Program has evolved in accordance with the principles of mutual respect and partnership with the participating governments. Since 1998, the action plan approach including performance indicators has resulted in increased transparency and accountability in the Program’s management. Mr. Lemoine closed his presentation by emphasizing that the Program had previously been cited “as a model of federal-provincial cooperation”.⁴⁴

In the course of the work by the Commission on the Future of Health Care in Canada (Romanow Commission), a number of Francophone associations⁴⁵ asked that an intergovernmental health cooperation program be created, similar to what currently exists in the education field. That request was reiterated by Anglophone and Francophone associations that appeared before us. Mr. Gilles Beaulieu, Vice-President of the Régie régionale de Beauséjour, N.B., supported such a proposal:

This idea (creating an OLEP) goes in the same direction as our proposal to dedicate a special fund. Better still, your proposal ensures a framework and a commitment of the various levels of government to develop health care services in a minority community. For minority language communities, an intergovernmental forum could certainly develop programs in the area of health promotion, disease prevention and training for Francophones in the health sciences. It would also allow for increased use of new technologies such as telemedicine and information technologies, and thus facilitate greater access to health care services for the Francophone population in a minority setting. Such an agreement would also allow health care institutions to maintain their assets and ensure their development.⁴⁶

The Committee believes that OLEP is a practical model which could be drawn on in whole or in part to improve access to health care for linguistic minorities. We believe this proposal deserves careful study by the Government of Canada.

It is important, however, that the fundamental principles of such a program be based on those that have made OLEP a success. First the program will have to be introduced in a manner that respects the provinces’ areas of jurisdiction, in accordance with the principles of mutual respect and equal partnership between governments. We would point out that the National Coordinator of Francophone Affairs, Edmond LaBossière, reminded the Committee that the provinces, territories and communities have achieved very different degrees of advancement with regard to health care in the language of the patient; a program of this kind would therefore have to afford all the necessary flexibility to accommodate differences in the field. The second principle that must be respected is constant participation by the official language minority communities at all stages of the process. The networks could play this role by identifying priorities in the field and adding value to program management. Third, the system’s transparency and financial accountability will have to be ensured. The idea here is for taxpaying citizens to have an idea of the costs associated with offering health services in the minority language. Fourth, we believe that this kind of program should be administered by Health Canada given its natural expertise in the field. The decision to assign responsibility to that federal institution is consistent with the spirit and letter of section 41 of the Official Languages Act. We suggest that a memorandum of understanding be ratified between Health Canada and Canadian Heritage (PHC) along the lines of what already exists between the Treasury Board and PHC. We are referring here to the memorandum of understanding signed in 1997 between the Treasury Board and Heritage Canada for the implementation of section 41. That agreement serves to encourage federal institutions to take the government’s commitment to promoting the vitality and development of the official language communities into account in their overall strategic planning and evaluation process.

Thus, as a result of the importance of health for the development and vitality of the linguistic minorities, the Committee on Official Languages believes that the entire issue of access to health care for the official language minorities, including the creation of the intergovernmental cooperation program, will have to be raised within two years in the context of future federal-provincial-territorial conferences of health ministers. Those talks will have to take place before the expiry date of the federal-provincial-territorial agreements on health in 2005-2006. It is time that this fundamental issue was addressed in the fora where the future of the health system is discussed.

RECOMMENDATION 11

The Committee calls on the Government of Canada to have one of the future federal-provincial-territorial conferences of health ministers focus primarily on the question of health care for linguistic minorities.

RECOMMENDATION 12

The Committee recommends that the Government of Canada create an intergovernmental cooperation program in the health field, a program to be managed by Health Canada which will provide financial support to the provincial and territorial governments in providing health care for the linguistic minorities. That program should be based on the following principles: respect for the provinces’ areas of jurisdiction, equal partnership, participation of the community health networks and accountability.

Finance Canada, the CHST and the Official Languages Act

The Canadian Health and Social Transfer (CHST) is the largest transfer the federal government makes to the provinces and territories. It contributes to the funding of health care, post-secondary education, social assistance and social services in the form of cash payments and transfers of tax points. At the federal-provincial conference held in Toronto in January of this year for the renewal and long-term viability of health care, the prime ministers agreed to create the new Canada Health Transfer (CHT) in April 2004. The CHT, which will replace the CHST, will improve the transparency and accountability of federal aid to the provinces and territories. In all, $34.8 billion will be flowing into provincial health and social programs over the next five years.⁴⁷

The CHST currently affords the provinces and territories a degree of independence in allocating payments among social programs based on their priorities, while complying with the principles of the Canada Health Act: public administration, comprehensiveness, universality, portability and accessibility. Neither the present CHST nor the future CHT entails conditions respecting linguistic duality or the number of Anglophones or Francophones. Instead, the transfer is made in accordance with a complex formula based in part on the number of inhabitants per province, without regard to demo-linguistic statistics.

In addition, Finance Canada explained, when it appeared before our committee, that the CHST is governed by the Federal-Provincial Fiscal Arrangements Act and by certain federal accounting regulations. When they appeared, the officials from Finance Canada were unable to confirm that the Official Languages Act applied to the CHST (apart from the obligation to make their documents available to the public in English and French). We remind the reader that the commitments stated in section 41 of Part VII of the Official Languages Act apply to all federal departments, agencies and Crown corporations.

The Committee believes that the prime ministers’ 2003 Health Care Renewal Accord represented a fine opportunity for the Government of Canada to express the health care needs of the official language minority communities to its stakeholders.  The Canadian government should give more attention to this issue in its future discussions with the provincial and territorial governments.  Future agreements must not remain silent on this matter.  For example, the needs of the official language minority communities should have been identified a priority sector in the new Health Reform Fund.⁴⁸  The same applies to the future Health Council, which will be created in the next few months to facilitate co-operation among governments We recommend that members of the official languages minority communities be represented on it.

RECOMMENDATION 13

In the light of the prime ministers’ 2003 Health Care Renewal Accord, in which a fund of $16 billion was set up to support reform to health care and in which front-line health care, home care and the skyrocketing costs of prescription drugs were targeted specifically, the Committee recommends that the Government of Canada target as well health care in minority language communities in the current agreement and in future ones.

RECOMMENDATION 14

The Committee recommends the Government of Canada ensure the official language minority communities are represented on the Health Council.

Conclusion

A number of initiatives have been put forward in recent years to improve health care for the linguistic minorities. The communities themselves have adopted the issue as their own. In every province, the networks are in place or are being established. The Consortium national de formation en santé is functional and has been turning out graduates in the health science professions for a number of years now. It is also important to refute the myth that it necessarily costs more to provide health care in the language of the patient. We quote here the testimony of the President and CEO of the Montfort Hospital, Mr. Gérald Savoie, who is quite eloquent in this regard.

I can tell you that Montfort hospital is the most efficient hospital in Ontario. We are being compared with the other 138 hospitals. We provide services in both languages, namely, in the language chosen by the client. […] We were able to demonstrate that we are capable of providing all of that at a very affordable price.⁴⁹

However, although considerable progress has been achieved, the situation remains fragile and vulnerable to political change. The Standing Committee on Official Languages wishes to reiterate the importance of stable, long-term commitment by governments to ensure that the initiatives currently in place are sustained. Ideally, access to health care for the linguistic minorities should be protected or reinforced by firm and clear statutory provisions.