LANG Committee Report

The issue of health and social services in the language of the minority has become increasingly prominent in the past five years. The official language minority communities have made it a priority and the focal point of their political demands.

On the Francophone side, the decision by the Health Services Restructuring Commission of Ontario to close Montfort Hospital in February 1997, and the ensuing legal battle, have shed light on the problem of health care in French for minority Francophones in Canada. However, that issue had already been a concern for Francophone and Acadian communities for some time. In June 2001, the FCFAC coordinated the preparation of an exhaustive study entitled Pour un meilleur accès à des services de santé en français²⁷ [Toward Better Access to Health Services in French], which showed that between 50% and 55% of minority Francophones have little or no access to health services in French (see Table 1).

TABLE 1
FRANCOPHONES WITH ACCESS TO HEALTH SERVICES IN FRENCH
BY POINT OF SERVICE
(AS A PERCENTAGE OF THE TOTAL NUMBER OF MINORITY FRANCOPHONES)

In the Quebec Anglophone community, access to health and social services offered in English varies with a number of factors such as demographic weight, economic restrictions and changing government priorities. In the spring of 2000, the Missisquoi Institute conducted a survey of Quebec Anglophones’ perceptions of the health and social services obtained in their language. While access to services in the Montreal administrative region was quite high, it was a problem in the regional Anglophone communities. When it appeared before our committee, the Quebec Community Group Network presented a table revealing that, in the regions where Anglophone communities represent less than 2.5% of the regional population, the percentage of health and social services accessible in English is quite low: Lower St. Lawrence (17.9%), Saguenay-Lac-Saint-Jean (16.3%), Quebec City (31.7%), Mauricie (22.8%), Chaudière-Appalaches (43.3%) and Lanaudière (41.1%). (See Table 2.)

The Association representing the Anglophone population of the Gaspé peninsula — the Committee for Anglophone Social Action — numbering some 10,000 or 10% of the population, commented on the results of the Missisquoi Institute Survey before the Committee.  Whether prenatal care, palliative care or preventive medicine is involved, “[…] the [Gaspesian] English-speaking community is in crisis in terms of access to health services.”²⁸

It should be pointed out here that the right to health care and social services in English is recognized in Quebec as the result of amendments in 1986 to the Act respecting health services and social services.  Article 15 of this legislation provides that “English-speaking persons are entitled to receive health services and social services in the English language.”²⁹

In 1999, the federal Health Minister, the Honourable Allan Rock, established a consultative committee for french-speaking minority communities (CCFSMC). A year later, a similar committee was organized for English-speaking minority communities (CCESMC). The two committees had the same mandate, to advise the federal Minister of Health on ways to support and assist each of the linguistic minorities in the field of health, in accordance with section 41 of the Official Languages Act. Each Committee was composed of individuals working in the field of health with expertise in the area.

In its final report,³⁰ the CCFSMC recommended to the federal Minister of Health that five levers of intervention be implemented to improve the accessibility of French-language health care services.

One year later, the CCESMC came to the same conclusions as the CCFSMC in its report to the federal Minister of Health, the Honourable Anne McLellan. The means of intervention that the Anglophone Committee proposed in its report to improve the accessibility of health care in English are similar in all respects to those put forward by the CCFSMC: networking and cooperation, training and human resources development, service delivery models, technology and strategic information.³²

In their respective reports, the two consultative committees agreed to give priority to three of the recommendations: networking, training and primary health care. In the following pages, the reader will be able to see what progress has been made in those areas. Initiatives could also eventually be taken in information (research), although much work remains to be done. The persons responsible for implementing certain levers of intervention appeared before the Committee to discuss progress made, but also the challenges that remain to be met. Their comments are summarized below.

Networking

In their testimony of 27 May 2003, the officials of Société Santé en français presented a complete picture of the situation regarding health care in the minority language. The newly incorporated agency is a major stakeholder on the issue of health care in French outside Quebec. Société Santé en français is composed of delegates representing the five main partners in the health world: health institutions, community organizations devoted to health services, health professionals, training institutions and federal and provincial government representatives. The 17 networks representing all the provinces and territories where Francophones live in the minority are represented in Société Santé en français, which, in a way, constitutes a “national network”. Those provincial and territorial networks are organizations of individuals who represent the aforementioned five main partners. Organizational structures vary from region to region, reflecting varied resources and needs of the various communities. In a number of provinces, the networks were established in conjunction with measures confirming the will of the respective provincial governments to take part in that mechanism for joint action and to more fully recognize the health services needs of its Francophone minority.³³

In 2002-2003, Health Canada³⁴ paid out $1.9 million to the Société Santé en français, which was used to introduce the networking initiative, to maintain existing networks and conduct feasibility studies to lay the ground work for the networks’ introduction and to create the national network to support the various priority initiatives. The Canadian government’s Action Plan for Official Languages has consolidated this action by providing funding in the amount of $10 million for Francophone networks and $4 million for Anglophone networks over the next five years.

Primary Care

Primary care is the first level of contact with the health system. It includes visits to the doctor, a call to a health line, promotional, prevention and rehabilitation services often called upon by health service users.

The CCFSMC made primary care a priority from the start of its work. In the health component of the Action Plan for Official Languages, $30 million has been allocated for 2003-2006 to support this lever of intervention. The funds come from Health Canada’s Primary Health Care Transition Fund (PHCTF), a program introduced in 2000. Of PHCTF’s total $800 million budget over five years, $20 million has been made available to Francophone minorities and $10 million to Quebec Anglophones, also over five years. We note here that that amount is less than the $25 million per year that the CCFSMC considered necessary in its September 2001 report to introduce infrastructures in which Francophones would be able to obtain first-line care.

Société Santé en français has already allocated the $20 million among the provinces and territories to show their members what kind of funding will be available at the provincial and territorial level. It will be up to the networks to establish the kind of projects they want to introduce, in accordance with PHCTF criteria.

However, Société Santé en français is concerned that the PHCTF will expire on 31 March 2006. While the Consortium national de formation en santé will receive funding until 2008 under the Action Plan for Official Languages, the projects put forward by the networks in the area of primary care may not have the necessary financial resources to remain in place if the PHCTF disappears.  Access to permanent funding is perhaps the greatest challenge facing the networks in the coming years.

RECOMMENDATION 3

The Committee recommends the Government of Canada ensure that the funds it allocates to the linguistic minorities for primary care by the PHCTF are guaranteed at least until 2008 and permanently thereafter.

RECOMMENDATION 4

The Committee recommends to Health Canada that it submit an annual report on funds granted to minority language communities under the PHCTF so that Parliament and the players concerned may know precisely the level of performance and the amounts spent. The report should also provide a breakdown of the funds accorded by Health Canada for other levers of intervention proposed by the CCFSMC and the CCASMC.

Training

Access to services in the language of the patient is possible only where there is a sufficient number of professionals in the field to provide those services. Prior to 1999, health training programs in French were virtually non-existent. The creation of the National Health Training Centre in 1999 laid the ground work for continuing training in those disciplines outside Quebec. The second phase of that project is called the Consortium national de formation en santé (CNFS). That agency’s mission is to implement a network of post-secondary institutions³⁵ in French to support both the training institutions that offer or could offer training in the health field and researchers who can reinforce health research relating in particular to the Francophone minority communities.

Under the Action Plan for Official Languages announced by the Government of Canada last March, CNFS obtained $63 million for the next five years (2003-2008) and the Quebec Anglophone community $12 million. The 10 participating institutions of the CNFS have set as their objective to admit approximately 2,500 students in 15 training disciplines where there is a linguistic interaction between patient and professional. A number of challenges lie in the way of achieving that objective: recruiting young Francophones, offering training programs in the regions and keeping new graduates at home. In addition, new graduates entering the labour market will ensure higher quality services in French, but will not meet needs, which according to CNFS officials, are for “three or even four times more professionals in the health field”.³⁶ It will be important for CNFS officials to adequately assess results, in order to have an idea of the progress made on training at the end of this second phase. For example, it will be useful for the CNFS and decision-makers to have a fairly accurate idea of the costs involved in training a Francophone professional for various health professions along with indicators of the successful retention of professionals in their home community.

RECOMMENDATION 5

The Committee calls on the CNFS to develop performance indicators on the retention of health professionals in home community and to inform the Committee of those indicators.

Research

Mr. Christian Sylvain, Director, Corporate Policy and Planning, Social Sciences and Humanities Research Council of Canada (SSHRC), admitted that there was a lack of research on official languages.³⁷ Grants awarded for projects concerning official languages and linguistic minorities represent a small percentage of SSHRC’s total budget, for a number of reasons. It is often more difficult for the smallest Francophone universities and colleges to get involved in major research trends. The teachers of those academic institutions must often devote most of their time to teaching, to the detriment of research. Furthermore, as Professor Anne Gilbert of the University of Ottawa’s Centre interdisciplinaire de recherche sur la citoyenneté et les minorités francophones said, researchers who work on linguistic issues produce good research, but do not get the same recognition. Their work focuses more on understanding and solving social problems in the field, a form of action research which is very useful for the immediate community, but does not get the same recognition from funding organizations. To correct the situation, the SSHRC introduced the Community-University Research Alliances program (CURA) in 1999. According to Christian Sylvain of the SSHRC, the small Francophone colleges and universities are quite well-positioned in the first funding rounds of the CURA program.³⁸

In addition, the Canadian government’s Action Plan for Official Languages provides for the creation of a new strategic research field on the theme of “citizenship, culture and identity,” which will offer funding for studies on linguistic duality and linguistic minorities. We hope that, in the next few years, these various measures will increase the amount of research conducted on linguistic minorities in general and on health related issues in particular.

RECOMMENDATION 6

The Committee recommends that the SSHRC pay particular attention, especially over the next five years, to research projects on health issues specific to the official language minority communities.

RECOMMENDATION 7

The Committee calls on the SSHRC to conduct renewed promotion of its programs to researchers in the official language minority communities.

The Canadian Institutes of Health Research (CIHR) are the main subsidizing body for research in the health field. The CIHR comprise 13 institutes, each operating in a specific field. When they testified before the Committee, the CIHR admitted that they had only just recently begun to take an interest in health care for official language minorities. Contact with the Anglophone and Francophone consultative committees (CCESMC and CCFSMC) is still in the early stages. It should be noted that the CIHR are considering supporting one of the 10 members of the Consortium national de formation en santé (CNFS)³⁹ in the coming months.

The Committee doubts the CIHR’s seriousness in implementing the Canadian government’s official languages programs and its involvement in research on the health of the official language minority communities. The 2002-2003 annual report on official languages submitted to the Treasury Board Secretariat reveals major deficiencies in various areas. For example, at the time this report is written, the position of “Official Languages Champion” has been vacant for six months and has not yet been staffed. And yet this is a strategic position in the federal public service. The champion is responsible for increasing the visibility of the official language program within the federal institutions and for acting as a high-level interlocutor for the official language minority communities.

For all these reasons, we believe that the CIHR must do more. The 13 institutes of the CIHR focus on the specific health priorities for a number of particular Canadian groups, and, based on the testimony before us, the health issues related to the linguistic minorities are simply absent from their strategic planning. An exhaustive study prepared for Health Canada in 2001 states that “specific Canadian research is needed in this area.”⁴⁰

The Committee believes that the CIHR should be added to the 29 institutions designated to ensure the implementation of sections 41 and 42 of the Official Languages Act. If necessary, it will be called upon to prepare an annual action plan, after first consulting the official language minority communities regarding their needs. In his appearance before our committee, Marc Bisby, Vice-President for research at CIHR, gave his approval to that proposal.⁴¹ Now that health and social services are a priority for the official language minority communities, the Committee is firmly convinced that the CIHR has a preponderant role to play in the field. The dialogue that the Institutes have opened with the linguistic minorities is a good start, but we must ensure that those consultations are held at regular intervals and on an annual basis. The action plans that are developed will enable parliamentarians to ensure the necessary follow-up.

RECOMMENDATION 8

The Committee calls on the CIHR to appoint a new official languages champion as soon as possible and to inform the Appointments Committee.

RECOMMENDATION 9

The Committee recommends that the Government of Canada add the CIHR to the list of federal institutions designated within the accountability framework adopted in August 1994 to ensure the implementation of sections 41 and 42 of Part VII of the Official Languages Act.

RECOMMENDATION 10

The Committee recommends that a fourteenth institute be created at the CIHR to explore all issues of health care related to official language minority communities.

New technologies (InfoHealth)

The use of new information and communications technologies (ICT) in the field of health care is often called telehealth or infohealth.  The intent of telehealth is to share information among the various health care providers and facilities and to provide health services over short and long distances.⁴²  We have not considered this lever of intervention in depth in the context of our work, but recent developments permit us to view its future implementation optimistically.  When he testified, the National Coordinator with Intergovernmental Francophone Affairs, Mr. Edmond LaBossière, noted the commitment by ministers of Francophone Affairs to make telehealth a priority.  At the recent Ministerial Conference on Francophone Affairs held in Winnipeg in September 2003, the participating ministers adopted an intergovernmental action plan on Francophone affairs in connection with “opportunities for intergovernmental cooperation with respect to regional French-language health lines or a national French-language health line.”⁴³

To conclude this section, the Committee enthusiastically reviewed the various initiatives that have been taken in the past five years. For example, we note networking and the development of the CNFS, which may be cited as genuine models of joint action and team work. Despite the gains made to date, however, it is now necessary to think of the future. The levers of intervention cited above (networking, primary care, training, research and telehealth) will sooner or later have to face the challenges raised by the recurrent funding of these initiatives. The Canadian government’s Action Plan for Official Languages has of course provided a promising start toward achieving the recommendations of both consultative committees. However, it should be borne in mind that the investments under the plan, which are spread over a five-year period, are relatively modest in proportion to Health Canada’s overall budget. That is why the Committee believes it is more than ever necessary to make linguistic minority health care one of the issues addressed within the intergovernmental cooperation mechanisms existing between the federal and provincial governments in this sector. We address this question in the next chapter.