Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 66 - Evidence - September 10 (Morning)
OTTAWA, Tuesday September 10, 2002
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 10:07 a.m. to study the document entitled ``Santé en français — Pour un meilleur accès à des services de santé en français'' (``Health in French: Towards improved access to health care services in French'').
Senator Yves Morin (Acting Chairman) is in the Chair.
[Translation]
The Chairman: I will not call the meeting to order. I would first like to welcome our witnesses. May I remind senators that the purpose of this meeting is to resume our consideration of the report on health care provided to francophones outside Quebec, pursuant to a Senate resolution. There are, in fact, two reports: one report from the Fédération des communautés francophones et acadienne du Canada on health care for francophones in minority communities, and a second report submitted to Minister Rock which by and large contains the same resolutions as the first report.
You will remember that this is a priority matter for French-speaking communities outside Quebec, a priority which was raised again by Minister Dion in Whitehorse recently, and referred to repeatedly by Minister Rock when the committee was struck.
During a previous meeting, we heard representatives from Health Canada, who outlined the work they have done and updated us on the one-time allocation of funds that have been granted to help resolve the problem.
This morning we shall hear witnesses who will describe the situation of francophones outside Quebec. I would like to welcome Mr. Paul d'Entremont, from the Fédération acadienne de la Nouvelle-Écosse, Ms Yseult Friolet, from the Fédération des francophones de la Colombie-Britannique, Mr. Alcide Gour, from the Association canadienne- française de l'Ontario, and finally, Mr. Jean-Guy Rioux, representing the Fédération des communautés francophones et acadienne du Canada.
I would remind witnesses that we will listen to their first presentation, which should last from six to seven minutes, and that a question period will follow. A certain number of senators will be joining us a bit later and they will also take part in the debate.
Mr. d'Entremont, it will be our pleasure to listen to you now.
Mr. Paul d'Entremont, Health Sector Coordinator, Fédération acadienne de la Nouvelle-Écosse: It is as Coordinator of the Health Sector of the FAN that I speak to you today. The FAN is an umbrella organization of regional, provincial and institutional organizations and the main voice of the Acadian and francophone community.
Allow me to give you some background about the Acadian community of Nova Scotia. Our origins go back to the 17th century, when about 100 French families settled on the shores of the Bay of Fundy and around Grand-Pré. More recently, and according to the 1996 census, our 36,300 francophones made up 4 per cent of the overall population of the province, which stood at about 900,000 inhabitants at that time. It is a community whose numbers have remained stable over the past 50 years, but one which has decreased in relative terms, as a percentage of the whole. It is also a well-rooted community, since 70 per cent of francophones were born here and very few of them migrate to other provinces.
Our demographic weight is relatively light, but we are concentrated in fairly homogeneous rural regions, which gives us some political clout. For instance, in the Argyle and Clare regions in the south west area of the province, Acadians make up the majority of the population. There are two concentrations of Acadian francophone inhabitants in urban areas, i.e. those of Halifax-Dartmouth and Sydney, Cape Breton. Acadians make up more than 15 per cent of the population, and 4 of the 18 provincial counties.
In Nova Scotia, there exists no provincial law or policy stipulating that services must be offered in French. This explains why access to health care in French is so very limited, and where such services are offered, they are provided thanks to the dogged persistence of individuals and community organizations. Existing French services have often been put in place by chance, randomly, and the community fears losing them. The comments gathered during the recent consultation of the Acadian francophone population in our eight Acadian regions, such as in the recent study carried out by the FCFA, bear witness to the fact that there is very little access to services in French.
Nevertheless, in Chéticamp, Cape Breton, one finds a community health centre that provides just about a full range of primary care services. On Île Madame, also in Cape Breton, there is a centre which offers more limited services. A few medical clinics offer services in French in five regions of the province. In short, overall, French services are by and large non-existent in community or hospital health care settings.
Aside from the language barrier, another stumbling block to the provision of services is the rural nature of our communities, which gives rise to many difficulties. For instance, Acadian women must travel more than three hours from Chéticamp or West Pubnico to have access to specialized services in the capital.
The existence of French institutions in our communities strengthens our presence and contributes to a better sense of belonging. Thus, the presence of francophone community health centres in Acadian regions would strengthen Acadian people's sense of belonging to their community while contributing to cultural, economic and community development. The desire to see such centres was expressed very strongly during the consultations.
The regional ``Capital'' health board located in Halifax-Dartmouth has been designated as the administrative centre for tertiary care and specialized services for all of the province as well as for the other Maritime provinces and Saint- Pierre-et-Miquelon. Unfortunately, it does not offer services in French. This shortcoming is sometimes compensated by the use of interpretation services for patients and users of French-language services and their families which is, as I am sure you will agree, insufficient.
I would now like to discuss a project which was launched recently by our organization, a project known as ``Les services de santé en français'' (Health services in French). Thanks to financial support provided by Health Canada and the Department of Canadian Heritage, the FANE and its partners consulted the Acadian francophone community, health professionals, and leaders and decision-makers in the health care field concerning action strategies with regard to the provision of health care services in French. To this end, public consultations were held in the month of May in eight regions of the province. Participants described the situation as they experienced it in each of the regions, and professionals shared their expertise; thus, the stakes, problems, concerns and existing initiatives were identified, as well as the areas where interventions were needed, as well as action strategies which might improve access to French- language health care services.
A provincial forum was then held in June, where initiatives and action strategies and possible solutions which might impact on policies involving access and the provision of French-language health care services were proposed, in order to determine how political leaders might take action to improve access to French-language health care services at the regional, provincial and national levels.
Proposed initiatives favoured strengthening community skills in devising strategies and policies to provide services in both rural and urban regions, as well as disease prevention, health promotion, specialized care, long-term health care, screening of young children and the elderly, recruitment, training and retention of staff in the health care professions, consciousness-raising among political leaders and authorities with regard to the need for services, a demographics-based funding formula to be used by the federal and provincial governments for the provision of health care services, and finally, the creation of a sectoral committee of the FANE for the purpose of creating and monitoring a plan to provide French health care services. The proposed initiatives attribute a great deal of importance to the determinants of health and suggest that the community be involved in the decision-making structure.
Language has repercussions on the quality and effectiveness of services and is a matter of common sense. Health care services are of better quality and often more effective if they are provided in the language of the patient. The Acadian and francophone community of Nova Scotia is no different from other minority Acadian and francophone communities in Canada in this regard. The provision of quality services is closely related to whether or not health care professionals can care for, help, inform, advise, guide and educate service users. Understanding and being understood is essential if there is to be an effective relation between the health care professional and the user of the service.
Speaking the client's language shows respect for his or her culture. In addition, language is closely linked to improving health conditions, promoting health and population health. It enables communities to establish the procedures and structures they need to access health care services in French, and it enables individuals to live in French until the end of their lives.
Health Canada has already demonstrated its openness to this issue. In September 2001, the Consultative Committee for French-speaking Minority Communities submitted its report to the Health Minister. It described quite specifically the five mechanisms that must be established and used to ensure the development of health care services in French for minority communities. The FANE endorses the action plan recommended for the five areas with a view to facilitating community initiatives and improving the accessibility of health care services in French.
We are prepared to go forward to enable the other members of our communities to live in French until the end of their lives. However, we would like to draw your attention to the importance of training health care professionals in French close to our communities. Easy access to training will further foster recruitment and retention.
Finally, I would like to mention the importance of the federal government's role in the area of health care services in French. As the protector of official language minority communities, the federal government must make a clear contribution to their development. This committee's final report must remind it of that and tell it how to proceed in the area of health care. I would like to make two recommendations that the committee could pass on to the government in this regard.
First, that the federal government establish a joint federal-provincial program comparable to the Official Languages in Education program to support the development of health care services in French in minority communities. Second, that the federal government add a sixth principle to the Canada Health Act on linguistic duality. Since my time has run out, I would just mention that some personal testimonies have been appended to our text.
The Acting Chairman: We will definitely have some questions to ask you a little later. We will now proceed with Mr. Gour, the out-going president of the Association canadienne française de l'Ontario.
Mr. Alcide Gour, Outgoing President, Association canadienne-française de l'Ontario: Mr. Chairman, the objective of the Association canadienne-française de l'Ontario is to promote the development of the approximately half million francophones living in Ontario, who account for 50 per cent of francophones living in minority communities in Canada. The ACFO is the main body that speaks for the Franco-Ontarian population.
The report entitled ``Santé en français: Pour un meilleur accès à des services de santé en français'', (``Health in French: towards improved access to health care services in French''), produced by the Fédération des communautés francophones et acadienne du Canada in June 2001, describes the state of health care services in French for francophone minority communities. I would like to congratulate your committee for doing a thorough study of this report which is very important for francophone minority communities.
The section of the report on francophones in Ontario, as in other parts of Canada, shows some very serious problems regarding access to health care services in French.
The ACFO maintains, as my colleague just mentioned, that access to health care services in French for minority communities in our province is a fundamental matter.
The Romanow commission and your committee will have to consider the issue of access to service in French during your deliberations when you present your final reports. We are talking about access to services to which we should be entitled.
The data show that half the time, francophones living in minority situations have little or no access to health care services in their own language. In other words, a great deal remains to be done before we achieve equality as regards health care services for francophone minority communities.
It must be acknowledged that this is as much an issue of efficiency as of equity. The ability to communicate and be understood is crucial for both the health care professionals and the client. A better relationship between these two individuals makes for greater efficiency, but also avoids putting the client into a dangerous situation. We should be entitled to high quality services. If services are offered in a language other than the client's mother tongue, a foreign language which may be misunderstood in many cases, this can represent a danger for the client. It is certainly not the way to get high quality services.
The brief we submitted to the Romanow commission also shows that being able to train francophone professionals in all health care disciplines is essential if we are to offer high quality services in French in minority communities. Consequently, ACFO supports the recommendation made by the Consultative Committee for French-speaking Minority Communities regarding the establishment of a Canada-wide consortium for training health care professionals in French. Our association fully supports the other eight recommendations put forward by the committee in April 2001 in its report to the Honourable Allan Rock, the Minister of Health at the time.
The purpose of the brief was to make the Romanow commission aware of the urgent need of improving access to health care services in French in minority communities through five mechanisms: networking, French-language intake facilities, human resources training and research. We have very little information about the state of health of francophones living in minority communities, and very little research is being done in this field. We also think that the use of information and communication technologies to reach widely scattered population groups is essential and is an important development mechanism.
In order to support these initiatives and mechanisms, we recommended the creation of a federal-provincial- territorial support program for health care delivery for official language minority communities. There is a program to support official languages in education, which is a provincial jurisdiction, and there should be a similar program in the area of health, an area that is just as important as education. A great deal of money is spent on both health and education in Canada, and this disproportion still exists.
Finally, we recommended that the Canada Health Act be amended to add a sixth principle, on linguistic duality and the protection of minorities. This would ensure that the linguistic minorities in this country would be entitled to health care services in their own language. These two principles have moreover been recognized by the Supreme Court of Canada. They exist, but they have not yet been implemented in a number of areas and intergovernmental memorandums of understanding. Respect for Canada's linguistic duality and a commitment to protect minorities should be an integral part of the work of your committee and that of the Romanow commission in order to maintain and improve Canada's public health care system. Without service in French for francophones, we do not have a high quality health care service. This is a matter of efficiency and equity.
In the Speech from the Throne, the government identified linguistic minority communities as one of its priorities. We are convinced that adopting the following recommendations will ensure sustainable health care services in French in Ontario and elsewhere and will also support the fundamental Canadian values of a universal health care system accessible to all but that also respects our linguistic duality and protects minorities.
The recommendations we ask you to support and that we ask the Romanow commission to support are as follows:
- that the government recognize the responsibility of Health Canada as regards linguistic duality and the protection of minorities in its efforts to maintain and improve Canada's public health care system;
- that Health Canada play a leadership role by adopting the strategies recommended by this francophone committee on health care for minority communities;
- that the federal government establish and implement a federal-provincial-territorial support program for health care services in French similar to the one for education;
- that the federal government amend the Canada Health Act to add a sixth principle similar to the one in our Constitution on linguistic duality and the protection of minorities. This would guarantee the right of official language minority communities in this country to health care services in their own language.
The Acting Chairman: Thank you, Mr. Gour. We will have an opportunity to ask you some questions on your testimony a little later. I will now give the floor to Ms Yseult Friolet, from the Fédération des francophones de la Colombie-Britannique.
Ms Yseult Friolet, Executive Director, Fédération des francophones de la Colombie-Britannique: I would like to start by giving you a brief description of our community. When we think of British Columbia, we often think about mountains and the sea, but we may forget that there are 61,000 francophones living in our beautiful province.
Without going into statistical detail, I have asked that you be given some documentation on our community, that you can look at when you have time. There are 61,000 francophones living in British Columbia, but it is interesting to know that according to the most recent statistics, for 1996, the Department of Health extrapolated that there were 63,000 francophones living in the province.
I would like to draw your attention to the fact that B.C. is the third largest francophone community in Canada, after Ontario and New Brunswick. It is often forgotten that there are more than 61,000 francophones living on the Pacific Coast, according to Statistics Canada. There is also a large community of people who speak French as their second or third language. There are close to 250,000 people in our province who can speak French, which is roughly 7 per cent of the population.
Our federation was founded in 1945. It is the organization that speaks for francophones in our province and is now made up of 35 associate members representing the francophones in various sectors and in all regions of British Columbia.
We are not a widely scattered community, but one that can be found throughout the province.
Luckily or unluckily, over 50 per cent of our population lives in the metropolitan Vancouver area. The fact that we live as a community in a major urban centre means that we are somewhat similar to the francophone community in Toronto. Our rural community is not so large, and that is one of the unique features of the francophone community in our province.
We are more urban than rural. I will not go into our backgrounds; I am sure you are familiar with the history of Canada. The presence of francophones dates back to the arrival of Mackenzie. We have been on the Pacific Coast since 1793. French Canadians built forts in Manley, Victoria and Nanaïmo. In 1860, 60 per cent of the population of European origin was francophone. After 1860 and after the introduction of the Official Languages Act, we lost a great many services. This period may have been the Middle Ages for the francophone community in B.C., but it was a rather gloomy time, not a happy one.
Nevertheless, the community has continued to develop and be present. I would like to talk about the major issues facing us today. We have some projects regarding post-secondary education. British Columbia still does not have a university-level institution in French. We are involved in immigration matters for new arrivals. The issue of interest to us today is health care.
Health care is extremely important for our community. That is why we were given a mandate six years ago to ensure that francophones in B.C. would have access to health care services in French. What a task, you may say, but nevertheless! I would just like to remind you of one historical fact. French Canadians established the first hospitals in British Columbia — namely Mount Saint-Joseph Hospital and Saint-Paul Hospital. The hospitals were run by religious communities from the greater Montreal area. When the Saint-Paul Hospital celebrated its anniversary, all its archives were in French. There was a cost to be paid to have them translated and to inform the anglophone community about this part of our history. There was a reluctance to acknowledge this fact, but it is not so easy to erase words that have been written down. So we have a presence in this province.
Thus the francophone community in British Columbia is not well known. We have started our work and we support totally the work carried out by the francophone and Acadian communities of Canada. Their research has made it possible for us to get on board as far as developing services in French is concerned. We support their initiatives and we are very satisfied with what they have done. You know that if you are sick it is very important to receive care in your own language. I do not have to try to convince you of that. My colleagues have already spoken about this need. Mr. d'Entremont has some examples of this.
I would like to talk to you about the report on providing better access to health services in French. We feel it is very well written and gives a good representation of our own situation. This report deals primarily with the public health network. We have only one public institution in British Columbia, namely the Foyer Maillard, which is a retirement residence.
You all know of the Maillardville community, which dates back to around 1905. The community managed to obtain this residence. It is our only institution which is designated as bilingual and it is funded by our provincial government. We do not have any other health services in French. Otherwise we can obtain health care through the private sector.
We would like to change this situation. We have carried out a study — and I have asked that it be circulated — which identifies francophones' needs. We would like to develop two initiatives. In the first place, health care is often provided by professionals. We have developed a list and we are trying to convince many people that they do have access to services in French, to a dentist, a psychologist, and so on. We need a network of institutions, such as community clinics. This will take a bit more time.
These are the two areas, therefore, where we have to make improvements so that we may eventually have access to health services in French. We have prepared a study which enables us to identify francophones' needs and to take part in the work of the advisory committee. We are ready to move on to the first stage of the recommendations made by the advisory committee, which is to set up a network.
In our case, it would be a sectoral health table where we could bring together the health boards, the provincial government, the federal government and our institutions. As well, we have a list of approximately 120 francophone health professionals and we are circulating it. This is an initiative designed to encourage people to use services in French. These are things which we have done for francophones without any assistance. We need funding to provide a structure for all these initiatives. We put in a request and we thank Mr. Stéphane Dion for the $1.9 million which he has promised us. We will be able to have our sectoral health table and we will be able to start a dialogue with the provincial government and our regional health boards in order to start setting up a public health system.
We realize that $1.9 million and the $8 million announced for francophones in a minority situation will be very quickly used up in the health field. I am in agreement, therefore, with what my colleagues have said. The Government of Canada must help the provincial governments and set up a program in the health sector similar to the Official Languages Education Program. We support this recommendation. We believe that a mechanism of this kind would make it possible for us to have longer term access to health care services.
We have also appeared before the Romanow commission. We asked that a sixth principle be added, one dealing with linguistic duality. We are all in agreement on this, as you can hear. If you are weak or ill, it is important for francophone communities to show solidarity and work together.
The Acting Chairman: Thank you for your presentation, it was akin to a brief history course. I would now like to welcome Mr. Jean-Guy Rioux.
Mr. Jean-Guy Rioux, Vice-President, Fédération des communautés francophones et acadienne du Canada: Thank you for providing me with the opportunity to discuss the study entitled ``Santé en français — Pour un meilleur accès à des services de santé en français.'' In my capacity as vice-president of the Fédération des communautés francophones et acadienne du Canada, I feel, as do the previous witnesses who have come from all over the country, that the work we are currently doing is in line with the approach taken by Minister Dion, who is also responsible for coordinating the official languages file within the federal government. Health care is a priority for Canada's minority francophone and Acadian communities. This study is part of our global development plan and of the plan Minister Dion presented to us at our Whitehorse meeting last June. It is useful to keep in mind these facts in the course of our debate. Minister Dion has a very important responsibility within the federal government, even though it does not directly relate to health care. The issue at hand is official languages, but also access to health care in minority francophone communities in Canada.
I would like to begin by speaking to the main conclusions reached in the study which the Fédération des communautés francophones et acadienne coordinated for the Comité consultatif des communautés francophones en situation minoritaire. Over 300 people working in the field of health care contributed directly or indirectly to this vast consultation. This is unprecedented. Indeed, it was the first time that anyone had tried to paint a national picture of minority francophone communities' access to health care in French.
This study therefore represents a unique contribution to what we know about francophones living in a minority situation. Yet is health care not essential to human well-being? As the Honourable Marcel Massé, President of Treasury Board, said when he appeared before the joint Official Languages Committee: ``There is no doubt in my mind that the most crucial situations in which you need your language are when you are sick and need help and when you are in school.''
Every year, tens of thousands of francophones living in minority communities have the opportunity to confirm Mr. Massé's words when they must grapple with the general lack of French services found outside Quebec. The report paints a worrying picture of the state of French health care services in Canada. Half of francophones living outside Quebec are rarely able to receive health care in French and this proportion varies greatly from one province to the next. For instance, about 25 per cent of francophones living in New Brunswick and Manitoba do not have access to health care services in French in their community care clinics, whereas this figure stands at 59 per cent in Ontario, 80 per cent in Nova Scotia and 93 per cent in Alberta.
The fact that these basic services are only available in English, and that this is also the case in areas where francophones live, is, to say the least, worrying. But the situation is much worse for many other francophones. Specialized, potentially life-saving services are almost non-existent in some places, even in cases where good patient- doctor communication is essential.
For example, 84 per cent of francophone communities do not have access to mental health services in French — but that may be because we do not need any!
Of the 58 regions surveyed in the study, less than 25 per cent had partial or total access to French health care services. Some areas did better than others, but there was no area whose needs were completely met. A francophone is 3 to 7 times more likely not to receive health care services in his language than an anglophone living in the same region. Since the Constitution and the Canadian Charter of Rights and Freedoms guarantees every Canadian the right to be educated in French, and since the Supreme Court has ruled that francophones have the right to face trial in French, it goes without saying that we should also have the right to be born, to be cared for and to die in French. It is a question of basic human dignity. It is also a simple matter of fairness. Quality care necessarily involves good communication between the patient and his doctor or health care professional. When a French Canadian is forced to speak English with a health care provider, the quality of care he receives is lower than that made available to the rest of the population. It is unacceptable that francophones are forced to receive health care in another language when they are at their most vulnerable.
How is it possible to help a young anorexic woman when all you can say is: ``I am sorry, I do not speak French''? How can you possibly help a child who has trouble expressing himself, when all you can say is: ``I am sorry, I do not speak French''? How can you possibly help a 50-year-old man or woman who must choose between various cancer treatments when all you can say is, again: ``I am sorry, I do not speak French''? How can you possibly help a senior citizen needing home care when the only thing you can say to this person is, once more: ``I am sorry, I do not speak French''? You're not doing any good by replying with ``I am sorry...''. Everyone knows that when they hear a sentence beginning with those words, it's because they are not able to obtain something. francophones understand that as well.
For the Fédération des communautés francophones et acadiennes du Canada, health care is of the utmost importance, an essential service which more than half of the minority francophone population is currently deprived of. Even though some francophone minority communities have access to French health care services, which were brought about thanks to the work of various governments, there is still room for improvements in every province and territory. In that regard, we have been pleased to participate in the work of the advisory committee on minority francophone communities, which was created by the Federal Health Department in April 2000. The committee presented the minister with a report in September 2001, that is, one year ago. It was an excellent report which must not be shelved. The report could be an excellent plan of action. It was supported by the ``Santé en français'' forum, which brought together over 250 participants to Moncton in November 2001. But now it is time for action.
Governments can work together to improve health care in minority francophone areas. The education sector can show us the way and serve as an example. After the first Official Languages Act was adopted, it was the intent of the federal government to provide equal access to education in French or English for minority language groups and so it created a program supporting official languages in education. Under this program, both levels of government work together to help the provinces and territories pay for the costs associated with minority language education. Today, several governments are aware of the necessity of providing health care services in French to their minorities and they are willing to work with the federal government to achieve this goal. Mr. Robichaud, the New Brunswick Minister for Health and Wellness, wrote us and said:
We count on continued collaboration with Health Canada with regard to improving health care services in French in minority situations.
Mr. Greg Selinger, the Manitoba Minister responsible for French Language Services, is just as clear.
The development and implementation of strategies to move the issue forward and to provide health care services in French must be carried out in cooperation with provincial and territorial governments and their francophone communities. The support of the federal government is crucial and it has an important role to play. The federal government has the means to help the provinces and territories which are ready to take action.
In the long term, it will be important to consolidate past and future gains. We should not have to fight battles that are costly in terms of human energy and money, as we had to recently in Eastern Ontario and New Brunswick to obtain or maintain health care services in either official language.
That is why we are also asking you to recommend adding a sixth principle to the Canada Health Act recognizing that the governments have an obligation to offer health services in both official languages of this country, as they do for education. We would ask you to work in that direction to ensure that the Canadian health system reflects one of the fundamental values of our country: the existence of two official language communities. Offering health services only in English to francophones, as is presently done in most areas of this country, goes against the fundamental rights of over one million Canadian men and women. It also runs counter to common sense. Providing health services to francophones in English is inefficient and costly. We would ask you to take that into account when you make your recommendations to the Canadian government. We thank you for your attention and we are ready to answer your questions.
The Acting Chairman: Before turning to my colleagues for questions, I would like to remind you that simultaneous interpretation is available.
Senator Pépin: Senator Losier-Cool and I went to the meeting of francophone parliamentarians from outside of Quebec that took place in Nova Scotia this weekend and, of course, one of the matters raised was that of health services in French.
One of the witnesses mentioned the lack of reliable data on the state of health of francophones. That does complicate things enormously and we cannot use it as a referral. Why this lack of data? Was anything done with the research institutions to ask them to undertake reliable research in that area? Which of Canada's research institutions have been sensitized to this matter?
Mr. Gour: I would be surprised if they are not sensitized. However, some factors are recognized, like the cultural one, that come into play with regard to the male and female sexes. There are risk factors and determining factors for health. Culture, general beliefs and food habits all play a role. However, we firmly believe that francophones have their own peculiarities in those areas. For example, Health Canada wants to come up with programs focusing on specific populations at risk. There should be more data available. We think that is Health Canada's responsibility. Concerning research institutions, generally you are talking about specific projects. Francophones don't have any infrastructure in the health sector and do not have any money to contribute to research initiatives. There is just about nothing, specifically speaking, concerning francophones in a minority situation. We think this must have a major influence on health parameters, especially when it comes to lack of services in our own language. How does that affect the situation? It means that francophones get poor quality health services, but we do not have any other data in that area.
Ms Friolet: I can speak for my province. The federal government undertook an initiative, those $8 million for minority communities. The provincial government got in touch with us and told us that if we wanted to access those funds, we had to come up with something about health determinants. So was it the egg before the chicken or the chicken before the egg?
As the government never collected any data on the fact that there are no services provided in French, no question was ever asked about the problems this might represent for the francophone communities. We have $8 million and that is rather interesting. Before accessing that money, we have to undertake a study. Do you think that the provincial government will give us the money to undertake that study? Of course not. Will the federal government do it? No, that is not part of the program. The initiative put in place by Mr. Rock, the advisory committee that was set up, was supposed to take care of that problem. The research undertaken by the association came to the conclusion that there is very little data on the health of francophones. How can one participate in prevention programs, et cetera?
Mr. Rioux: That is in the recommendations.
Senator Pépin: I would like us to discuss training in French for doctors and nurses. At Sherbrooke University and in New Brunswick there are centres for teaching and training periods and at Ottawa University, they have training in health sciences. Do you think that there are other establishments in Canada that would have the capability or the infrastructure that is needed to welcome francophones and train doctors, nurses, social workers and so on?
The Acting Chairman: Senator Pépin, I would remind you that tomorrow morning we will be hearing from people from our colleges and universities.
Senator Pépin: Which leads me to my second question. I do not think it is necessary that they be university people, we need people working in the field. How can we encourage our regional youth to get educated in French and then to go back home to their own regions to work where they came from?
The Acting Chairman: Senator Pépin raises an extremely important point. We have to encourage young francophones to seek careers in the health field. You know that the First Nations made major efforts and that quotas were established in faculties of medicine and major efforts are being made in their communities to recruit young people to become health professionals. Finally, if the young people do not choose those professions, you can ask for health care all you want, you will not have anyone to dispense it. I think that recruiting youth and the interest that young francophones must show for the health professions are an important solution. That is what Senator Pépin has just pointed out. It has nothing to do with the teaching institutions themselves and everything to do with the communities. How can you encourage the young francophones to consider those professions?
Mr. d'Entremont: If you go by Nova Scotia's example, Chéticamp and l'île Madame in part, two areas in Cape Breton, you have to realize that in Chéticamp, if you are going to get them out, you have to do it when it is nice out because it is really an isolated area. As they are an hour and a half from Sidney and six hours from Halifax by road, the community grabbed its own boot straps and decided that in order to do something and succeed, you had to do it step by step. You have to get your patients to the family unit of professionals and family doctors. If I take the community where I live right now, we have three doctors for over 6,000 people. They are saying: ``I do not have a life anymore'' and the first thing they do shortly after they have shown up is to pack their bags again. It is not a very attractive place to come to: the three doctors do not want to work together. They are working out of three offices within a half kilometre area while in the other areas the health services were available and in that case the community offered them a centre. Is that a model that should be followed everywhere? It is up to the witnesses to speak. You have both extremes.
But the problem still remains training. Senator Pépin and Senator Morin talked about encouraging our youth to take up those professions. I mentioned Chéticamp before and that is an isolated area in Nova Scotia, but Nova Scotia is actually isolated in relation to some of the larger centres where training is offered in French. The answer seems to lie in the use of technology. We are happy to say that Sainte-Anne University in Nova Scotia is part of the training group. Who is going to recruit? It is up to our community to take care of that and encourage others to do it also. Where it is done, it seems to work.
The Acting Chairman: I am a bit surprised to see that despite the fact that you are the third largest community, you are one of the rare provinces that has no post-secondary education institution in the area of health sciences like Nova Scotia, Alberta, Manitoba, New Brunswick and Ontario. You say that you are the third province in terms of the number of francophones and you have nowhere to train francophones, and that is something I find astonishing.
Ms Friolet: We owe that to history. You have to take Canadian history into account. In Alberta, you have the Collège Saint-Jean that the religious communities left to us when they retired.
When B.C. entered Confederation, we francophones did not have the right to exercise our religion, that was not part of the agreement so schools were always public. Our language was not recognized like it was in the other provinces. This situation is explained through very British immigration. That is a historical fact.
There is a project about this in Mr. Dion's action plan. We are probably the last province in the country that got access to its own school board and that happened in 1996. We had to fight for 25 years and we went to all the courts in the country to get that right recognized under the Constitution but we are catching up quickly enough.
To answer Senator Pépin's question, I think the advisory committee proposed a solution, the five levers, and it is that you cannot do any training without doing any informing. Those five initiatives have to go together hand in hand. That is why we need funds and major commitments. I do not think that we are facing problems any different than those faced by the anglophone community. The anglophones have as many problems convincing people to go and work in their outlying areas and work hard there. It is the same thing. To convince our community or the people in our communities to take up those health services professions, they have to be promoted. Maybe we have given too much encouragement to more liberal professions like teaching or law. We have to offer encouragement for professionals in the health services. At the same time, we have to set up a health consortium with the universities. We also need places to welcome these people. If we do not have any facilities to welcome those health professionals, you can have all the trained people you want, it will not do you any good. You need to have an exchange and we have to use technology.
I was very satisfied when I read the advisory committee's report because its solution made me think of the cogs in a wheel. All this meshes together, and all that is needed is to get government support, not necessarily new funds, but the funds have to be put to better use and we have to use what is already set up for training or setting up networks, and so on.
Mr. Gour: For example, in Ontario there has been a consolidation of the specialists in the area of health and community social services. This organization got funds to promote this sort of thing in grade schools and high schools to attract more people to the health services area. Take the example of a francophone doctor in Hamilton. Francophones there represent 2 per cent of the population. If the doctor sets up a practice he will be serving only 4 per cent of the francophone population so it is reasonable to think that 4 per cent of his patients will be francophone. So he spends 96 per cent of his time working with English-speaking patients. Yes, there is a deficit, we should not deny it. There is also underutilization in some cases. Why? Because there is no francophone infrastructure.
At the Montfort Hospital, for example, all the staff is francophone. Is that the case with the Hôpital Général? Why did Montfort recruit its doctors and bilingual staff or francophone staff and why do other hospitals have so many problems? I am not giving you the worst case, that is the best bilingual institution in Ontario. Let me give you the example of the five community health centres, the community health francophone institutions. They found francophone doctors while the hospital next door mentions that ``it is practically impossible, there is such a lack of professional...'' So they import them from South Africa. I am told that in B.C., up north, a major proportion of doctors was imported from South Africa because they are having problems over there.
Five or six years ago, I met a French psychiatrist. In order to get a visa, she had to swear she would never seek to practice in French in Canada. There is such a need for mental health professionals. There are accessibility problems. We cannot just think about training from scratch. We also have to think about importing trained personnel.
If only we could attract Quebecers to francophone institutions! Unilingual francophone Quebec doctors are not hired by our bilingual Ontario hospitals. The Montfort and francophone community clinics hire them, no problem. We are going to do some recruiting there. Whereas others say:
[English]
We only have 5 or 6 per cent of the population. It would be nice if they were bilingual, but we have such a good, qualified person from South Africa.
[Translation]
You see the problem? These five mechanisms have to work together. There are professionals. They can be found. People need to see to it and to be convinced that we need francophone infrastructures to make those hiring decisions. That is absolutely essential.
Mr. Rioux: I will not repeat what the others have just said. We also have to look at our priorities. It was said that our situation still requires research, and I think that is very important. Mr. Hubert Gauthier, who is now on the board of directors of the institute, has in fact just done that research. It is upsetting, because when you start looking at the statistics, when you do the research, you find — I am talking about New Brunswick — more police officers per capita are required than doctors. That is a reflection of our priorities. When you need one police officer for every 600 people and one doctor for every 900 —
The Acting Chairman: That means there are more criminals than sick people.
Mr. Rioux: You don't know who is going to treat whom. Take New Brunswick, for example. Access to medical schools is limited, and in New Brunswick, when you look at the number of francophones who have access to Quebec universities for training in any giving year, it is 25 students. It just went up. It was 20 before, and just went up to 25. For anglophones, the province reserved 40 spots. Out of the 25 spots per year, 70 to 85 per cent of doctors returned to work in New Brunswick. For anglophones, it is under 50 per cent. Why? Because anglophones can go all over the place for their internship. They set up practice wherever they do their internships. In New Brunswick, they are required to come back to do their internships in francophone hospitals, where they may get jobs subsequently.
Senator Pépin: When they come to do their training, you require from the start that they come back to you.
Mr. Rioux: That is one of the reasons why, when the new legislation on regional boards and official languages in New Brunswick was passed, we were against the Georges Dumont retaining its francophone status. It is the perfect hospital for internships for students who go to Quebec to study.
The Acting Chairman: You are talking about the 25 spots for admission to medical school?
Mr. Rioux: Yes.
The Acting Chairman: Are you saying there are proportionately many more applications by francophones than anglophones?
Mr. Rioux: There are more applications than the 25 spots reserved.
The Acting Chairman: All medical schools receive more applications. Do you think the access rate is higher for anglophones than francophones?
Mr. Rioux: The province reserves more spots.
The Acting Chairman: You make up about 50 per cent of the population.
Mr. Rioux: Thirty-four per cent.
The Acting Chairman: Does that correspond to 50 and 25? Is that fair based on population?
Mr. Rioux: But those students can go and study at other universities. Those are spots that the province reserves, but the student can go to the Université de Montréal, Sherbrooke or Laval.
The Acting Chairman: The reason I ask that question is that tomorrow, we will be meeting university representatives. Do you feel that access to medical school is tougher for francophone Acadians than for anglophones from the Maritimes? If that is true and you can back that statement up with figures, that is something our committee could deal with. Of course, there are always more applications. There is not a medical school in the world that does not turn down some students. Is it worse for francophones? If so, I think that that is an important recommendation the committee should make.
Mr. Rioux: Yes, that is the case, because we have fewer francophone doctors per capita than anglophones, and Dr. Schofield can say more about that tomorrow. He has all the figures and will be able to explain them to you.
Senator Losier-Cool: I would like to thank the Standing Senate Committee on Social Affairs, who saw fit to hear from the witnesses. I would like to thank Dr. Keon and Senator Pépin. I would like to think that by the end of the day tomorrow, other members of the Standing Committee will join us to hear the witnesses and representatives from different provinces.
That said, I would like to welcome you. Mr. Rioux, I really liked it when you said that 84 per cent of francophone communities have no mental health services in French; that made us all smile. I have in mind a song by la Bolduc, an Acadian, called Lorraine Diotte. She sang a song years ago, saying she could not understand how it was that in psychiatric hospitals, the crazy person could speak English, but the psychologists or psychiatrists, with all their training, were never able to understand the other language. That is why there are not more mental health services in New Brunswick. The crazy people learn to speak English. That was how the song went.
I have a specific question for Ms Friolet. Then I will come back to one of the recommendations supported by the four witnesses on the creation of a program similar to the official languages program.
Ms Friolet, did you actually say that the Official Languages Act has not helped B.C. francophones?
Ms Friolet: That is not what I said.
Senator Losier-Cool: That is why I asked for clarification.
Ms Friolet: I was trying to respond to Senator Morin, who was asking why, unlike the other provinces, we did not have any post-secondary educational institutions, for example. In B.C., it took the Declaration of Official Languages and the Charter of Rights and Freedoms before we could demand French schooling.
Senator Losier-Cool: I just wanted some clarification. I would like to come back to the creation of a program like yours. Such a program would probably involve some costs. Has the SCFA thought about how a program like that might be funded? Would such a program be the responsibility of a department, Treasury Board or official languages? The issue of provincial interference would come up in the application of such a program, given the experience with official language programs in education, especially in Nova Scotia. I am in agreement with the idea and the principle, but how could we recommend this program as being applicable?
Mr. Rioux: As far as interference is concerned, health, like education, comes under provincial jurisdiction. If an educational program like that was set up, the same should be possible for health. We should in fact be able to do it even better for health, because we can go by our successful and unsuccessful experiences with education.
Accountability for the money the provinces get should be even greater for health than for education. For example, we will not have to go to court to justify the monies going directly to the provinces for francophone minority communities rather than coming from an overall budget. Those are things that could be corrected.
Money is always the sinew of war. Still, significant amounts will have to be invested in the beginning to start up the system. However, it will be on a continuous basis thereafter. In the education sector, the fact that we have both francophone and anglophone minorities does not mean that we are assessing the costs. Bilingualism is for us a fundamental value of Canada and that is the price that we have to pay.
Clearly, health care is expensive. However, it has been pointed out in various studies and commissions, such as the Romanow Commission or Senator Kirby's study, that the same amount of money could be better used if we had a more targeted approach. In other words, with the same amount, we could do more than what we are doing presently, and I believe that people are aware of that.
We have in Canada some structures that allow us to bring about changes rather quickly, because we are not straddled with centuries-old structures. Our structures are relatively young, a fact which enables us to make some rather quick turnarounds. I believe that when you examine the amounts of money that are allocated, the francophone and Acadian communities throughout Canada have learned to use the monies that they do receive in a very responsible manner and to try and do more with the same amounts. We have learned lessons in the past ten years, and governments could do likewise.
The Acting Chairman: Your point is very important and it is the issue raised by our colleague. In the end, if you do not have access to health care in French, you will receive health care in English and the cost will not be any greater. If, for example, someone falls ill, he will try to obtain health care in French, but failing that, he will be taken care of in English. In either case, money will be spent.
When you talk about money, this is not a new program. We are merely saying that a person will be taken care of either in his or her mother tongue, or in the other language.
I believe that this is an important point. When you talk about new incremental costs, it is important to add that this is not new money, but money that is dedicated to a specific end, and we are asking that it be used in a more efficient way.
Mr. Rioux: I once said to the Minister of Health of New Brunswick, Mr. Robichaud: ``Your department is not a Department of Health, but rather a Department of Sickness.'' There are 80 per cent of people who receive health care to cure an illness, but what is allocated for prevention? Among New Brunswick francophones, we are leaning more and more, together with the Department of Education, on the side of prevention. We target early prevention which, over time, will help to reduce costs.
Even today, in New Brunswick schools, students are unfortunately allowed to smoke, even though we know the impacts of smoking on health, but nobody wants to make the decision to prohibit smoking in the schoolyards.
The Acting Chairman: And soon, they will be able to smoke cannabis. Rest assured that the Committee on Social Affairs is focusing on health and not in this direction.
Mr. Gour: I would like to add a comment on cooperation. We talked about an intergovernmental program and not a unilateral program from Health Canada that would be intruding in this area. You know that there is a lot of cooperation with regard to the support of official languages in education. Why would it be any different in the area of health?
My colleague mentioned a few provinces that have already shown an interest in such a program. Indeed, our association has had discussions with Minister of Health Clément in this regard.
Funds are being spent in Montfort, but as the honourable senator was saying, these are not additional costs, because the Montfort Hospital is one of the most efficient in the province. It has even received additional funds from the Department of Health thanks to this greater efficiency. It costs less to provide health services in Montfort than at the Ottawa General Hospital.
The same goes for community health centres. You know that the provinces are requesting more money from the federal government for health care. The problem is that there is no established principle for allocation.
We are not necessarily talking about additional money. Yes, initially, the infrastructure would cost a little bit more, but eventually, it will not be any more costly. There will be more efficiency because services will be of greater quality.
It is not worth spending money for mental health systems, for example, be they francophone or anglophone, if they do not yield any results. In the area of mental health, communication is even more important. We could spend a lot of money without getting any results in that area.
So we must invest wisely, and that is why we are asking for a sixth allocation principle. Despite the fact that there is in our Constitution an implicit principle regarding the protection of minorities, one of the fundamental values of Canada is duality and linguistic equality. We should be evolving toward equality, but such is not the case in the area of health care.
For example, it is a fact that religious communities were offering health services throughout Canada. There was more than one francophone hospital in Ontario. Today, there is only one left. All the others have disappeared.
Education, the parishes, religion and health were fundamental for French Canadians in minority situations. These services have always been offered by francophone religious communities, but they were provided in French. They no longer exist in French. They used to exist and they no longer exist. So we have undergone a regression. It is not an evolution toward equality in the area of health; it is the opposite that is happening throughout Canada. I could give you many examples.
The Acting Chairman: The time is going by and some important issues have not been addressed. Before giving the floor to Ms Friolet, I would like to ask Mr. Rioux and the other witnesses to paint for us a broad picture of the attitude of the provinces regarding health care in French for minority groups, with the exception of Quebec. To be clear, I would like to know the position of each province: are they favourable, neutral or unfavourable? When scrutinizing the letters sent by various ministers of health, it was interesting to study their reaction because we could see that there was really a great difference from province to province. I will start with Mr. Rioux, but if other witnesses want to talk about their own province, please tell us about the situation there.
Mr. Rioux: In New Brunswick, the authorities are more and more favourable to our views. At the very beginning, when we started to talk about reorganizing health care services, hospital corporations were being dismantled and replaced by regional health boards.
They said that there would be one health care system for all of New Brunswick. More and more, we insist on the fact that there can be one system with services for francophones and services for anglophones. In New Brunswick, access to the health care system was based mostly on proximity, so that it would be possible to have employees work in various places, for example by having employees of the George-Dumont hospital, in Moncton, work in the City Hospital. We are trying presently to have the government understand — and they are listening to us — that it would be more interesting to have a network for francophones with the George-Dumont hospital, where they provide tertiary health care. This would also involve the regional boards in Edmunston, in Bathurst, in Campbellton and in Moncton, who would be working together within the same francophone network in order to share the services and specialties.
We seem to be going that way, and if we get no results we always have the court option, hanging over our heads.
The Acting Chairman: We should not spend too much time on each province. Could you tell us what the situation is in the other provinces? The ones that you know of.
Mr. Rioux: I could not tell you about the other provinces right now.
The Acting Chairman: Could you prepare a report for us?
Mr. Rioux: It has already been done.
The Acting Chairman: We are being told that one province is against any interference by the federal government. It will be important to know whether initiatives such as these ones will be well received by the provinces or whether they will react in an hostile way. Will we have to put in place mechanisms so that the provinces welcome these recommendations warmly? It seems to me to be an important point.
Ms Friolet: You know that in British Columbia there are no services. However, since the $8 million fund for primary care has been announced, our provincial government has approached us. They want to know how they could access it.
The provinces are saying that the federal government left us with a problem and reduced the transfers. I will not lie to you. The provincial government is very reluctant to have to take charge of francophones. It took us 25 years to get a francophone school board. I think we need compassion, here: when one is sick, one should get care in one's own language.
The Acting Chairman: You are saying that British Columbia would be favourable to a program that would include funding and would provide care for francophones.
Ms Friolet: Yes. You know that there are francophone liaison representatives in provincial governments and in intergovernmental affairs departments in each province. We are presently looking at the possibility of an emergency access line. It means that the four health ministers are talking to one another. It is a good sign.
Mr. d'Entremont: In May and June, we discovered in Nova Scotia that the response depended on the people to which we put the question. The response of the population and the response of the leaders is not the same. We put the question to the population: ``according to you...? what do you think...? how do you see...? Is it better, stable or worse than five years ago?'' Sixty thousand 60,000 people responded. Ninety-five per cent of the people in all the regions told us that the situation seemed to be deteriorating.
During the discussion, even during the consultation, the managers of the boards or the regional authorities were present. Unfortunately, they told us: ``We provide translation services.'' And they asked the celebrated question that caused so much grief in the field of education: will the federal government pick up the tab?
At the level of the boards, of the regional authorities, at the level of the provinces — I do not deal with the minister but with his officials — there again, the question is whether the federal government will pick up the tab, or will the anglophones or other groups lose something because of this.
We cannot prove it scientifically because the responses to the questions during the consultations were emotionally driven. In Nova Scotia, we do not wish to relive the nightmares we lived through for too many years in the education field. We could have a similar, and even better, program.
The Acting Chairman: I am going to raise two points that will have an impact on our recommendations. Two events following the tabling of your report seem to me important and will certainly influence the decision of the committee.
The first is the issue of the Montfort hospital. My question is for Mr. Gour. The appeal court decision on Montfort contained a series of very important principles relating to the issue of health care access for francophones. What are the consequences of the appeal court decision on the recommendations you made?
Can this ruling favourably influence the position of your group? If it can, how do you see it? During the whole debate, the whole struggle with respect to Montfort, were you supported by the University of Ottawa?
Mr. Gour: The University of Ottawa played an important role in documentating the data. They provided support and said that for their medical program to be efficient they needed a francophone training facility. There is no denying that the university played a role and helped demonstrate that the Montfort Hospital is an essential institution to protect our minority community.
ACFO is also involved. I know the file since our association was one of the intervening parties in the file tabled before the Appeal Court at that level. Is it particularly significant? Yes. You know that the Ontario Health Minister decided against going to the Supreme Court of Canada knowing that he would certainly lose his case. They did it in an honourable way. They recognized later on that the Montfort Hospital was one of the most efficient hospitals in the province. They have even received additional funds to maintain that efficiency. The Ontario government does not hesitate to adequately subsidize the Montfort Hospital. Are there consequences? I think there are but not at the level of the necessary development. You know that the ruling represents protection. Once we have accomplished something, to withdraw puts us in an even more vulnerable position.
Does that protection give us health services entitlements? If the government wanted to close down the five Ontario francophone community health centres, once again we would have to go back before the courts. I think that we would win on the basis on the same principles. What is important is that the Appeal Court of Ontario and that the review court on the secession of Quebec have recognized the right of minorities to be protected. It is a principle that is not explicit in the Constitution.
The lawyers even asked the province of Ontario whether according to them that right did not exist. The province made no reply to that question. It did not debate the existence of a right to be protected. The Superior Court had already ruled on it. This is why we believe that in these MOUs, in these other acts such as the Health Act, we must stand back a little. That right is already there. Is it less important than to say that there will be universal access, et cetera? That right is recognized by the Supreme Court and by this review of Quebec's secession. Minorities have a fundamental right to be protected and we should evolve towards equality. It is not yet in these MOUs. We know that the federal government will probably give more funds to the provinces — by the way, Ontario is the province that complains the most about the lack of funding.
If the federal government were to say that to really support official languages, we have to give more services to the francophones, that it would be more efficient, et cetera, et cetera, would you be ready to play ball? Our preliminary discussions with the government of Ontario and with the ministry are telling us that they are, but there must be more funds. Ontario does it. The act on French services was a very important turning point.
What we won in Montfort is that the Appeal Court said that the government must respect the French Language Services Act, that this act on French services is a quasi-constitutional act. It has been recognized. Health services are delivered according to the French Language Services Act. Yes, it has an impact because it gives teeth to the act. The government must provide these services.
The Acting Chairman: Is this French Language Services Act an Ontario Act?
Mr. Gour: Yes.
The Acting Chairman: Are there similar acts in other provinces?
Mr. Gour: New Brunswick has a better act.
The Acting Chairman: Two provinces have French language services acts?
Ms Friolet: There is also Prince Edward Island and Manitoba.
The Acting Chairman: So there are four provinces. Is the New Brunswick Act the most generous toward francophones?
Mr. Rioux: Yes, because it respects the equality of both language communities as provided by the Canadian Charter of Rights and Freedoms.
Senator Pépin: If the sixth principle concerning the offer of French language health services must eventually apply, there are already four provinces where this would be more readily accepted. We don't know how this principle would apply in other provinces. Will the federal government be required once again to increase its funding so that provinces can implement these services? There may be other ways of doing it?
Mr. Gour: If a principle is included without a program being established, there will be a lengthy fight in the courts. This program is absolutely essential. There already is an infrastructure in Ontario. The five community health services centres, for example, cost the government $10 million. So, there are already $10 million being spent at this level. The government could say that if there is a 50-50 program — they consider that there already is an additional institution, the Montfort Hospital — we could easily calculate Ontario's contribution to a program.
Because, after all, this is a program that would be obtained through negotiation. It is not compulsory. It is hard to imagine a province refusing access to such a program, refusing funds from the federal government for health care. All provinces and territories are after more funding. The federal government will probably increase its funding. Will the federal government have the gall to respect the fundamental constitutional principles and encourage the provinces, through an incitive program such as the education program, to help provinces put a law in place? Ontario accounts for 5 per cent of minority French speakers.
Senator Losier-Cool: I would like to talk about the issue of departmental responsibility in the creation of programs similar to the Official Languages in Education program. There is no education department at the federal level. Therefore, this responsibility has been given to Heritage Canada, et cetera. Do you think it would be more effective to give this responsibility to the Health Department, when you talk about a similar program for French languages services?
Ms Friolet: I will give you an example that may answer your question. Concerning primary health care, the Department of Health asked each provincial government to submit proposals. It is the same procedure as for official languages programs. However, you are right, at this level this does not involve the Cabinet. But, it is possible to imagine that the provincial and federal health ministers could negotiate and exchange ideas about the program. This could very well be done for a program whose aim is to help minority communities. Concerning the level of funding, in the proposals made by the advisory committee — and when the francophonie team was set up — the amount considered was $250 million over five years.
Mr. Rioux: As far as responsibility is concerned, to answer Senator Losier-Cool's question, Heritage Canada is not the only department responsible for the Official Languages Act. All the departments should be accountable for enforcing the Official Languages Act. In the same way that programs are currently being negotiated by different departments with the provinces, the Health Department could do it while enforcing the Official Languages Act. The interdepartmental partnership program was created for the official languages programs. Mechanisms already exist and there is no need for others to be created. This would be a good opportunity to show that official languages in Canada are not the sole responsibility of Canadian Heritage.
Senator Léger: I would like to say a few words on training. Let take the example of someone who is undergoing cancer treatment, let us say, a woman from Ukraine who cannot speak English. Can this be included in your priorities? You mentioned the community that needs funds. What can we do to help that woman so that the janitor will not be the one whose is called upon to translate? That does happen in our hospitals: when they do not understand someone who speaks French they go and get someone who does.
The Acting Chairman: It is in fact often someone from maintenance or janitorial services that comes and does the translation.
Senator Léger: In other words, in all those priority and major projects that the federal government has identified, have any funds been allocated so that the patient can have access to translation services?
Ms Friolet: No. In British Columbia, if you go to the Vancouver General Hospital, there are translation services in Punjabi, Vietnamese, Mandarin, Cantonese, but not in French. There is a precedent and these are services paid by our province. I am convinced that in other provinces, there are translation services if the personnel does not speak the language of the patient. But in British Columbia, that doesn't exist. They do however offer those services for all those quite complicated languages, I must admit, and I think that a little incentive would help to create that precedent.
We must wake-up the federal government so that it can play its role and encourage provinces to offer those services.
The Acting Chairman: Senator Léger, do you want to add anything?
Senator Léger: No, that is fine.
[English]
Senator Keon: It seems to me, having dealt with this problem professionally as the CEO of the Ottawa Hospital Heart Institute, that there are good facilities for the education of francophones, particularly here in Ottawa. The basic problem is the lack of infrastructure once they graduate. The community clinics that have been established and the fact that the Montfort has survived are big steps forward. The University of Ottawa being bilingual is very helpful. There is a critical mass of people in Quebec who can be hired, at least doctors, and I have found that we have been able to recruit 50 per cent of our medical staff as francophones over the years. We did have to go to France for our chief of heart surgery, but we were able to do that.
The problem for young people coming out of the system is that they have no infrastructure within which to work. You mentioned a francophone doctor working in Hamilton. He is a fish out of water. If there were more French community clinics, networks could grow from those clinics.
Our francophone doctors have good networks in Northern and Eastern Ontario, in Western Quebec and so forth because they get to know the young francophone graduates from the University of Ottawa. They can do a very good job, but for the rest of the province, there is really no such network.
There is another huge problem. We provide five services at the heart institute that are not provided elsewhere in Canada. The Hospital for Sick Children in Toronto provides services that are not provided elsewhere in Canada. However, there is no support or infrastructure of any kind to provide funding for a francophone component to these services. The institution is left on its own to do this.
How much thought have you given to a true francophone infrastructure for the country, because it can transcend provincial boundaries? What do you think it would take in a recommendation from our committee to put such a structure in place?
Mr. Gour: I am glad you mentioned the importance of infrastructures because they are critical.
In Ontario, the francophones favour the concept of community health centres where either one or two doctors are providing primary care.
[Translation]
I think it is essential that, as you pointed out, we develop those services. That could be done through an intergovernmental program whereby the federal government would pay part of the funds, or through Health Canada, even if we may not be too enthusiastic about it, because that department has no program that targets francophones.
Allow me to give you an example. I am a member of the Hamilton-Niagara Community Health Centre; we have a clinic in that region, a French community health centre where two doctors work. The requests for funds for programs that we submit to the Ontario government are in French and can be submitted in French. As for Health Canada, our administrator submits the requests in English because he is afraid that it will take too much time for the federal government to answer; there is no infrastructure or personnel that can receive that document in French. It is somewhat bizarre! Our board of directors told our administrator: listen, it is the federal government, submit your request in French. We get better service from the Ontario Health Ministry than from Health Canada. That's why I hesitate to say that Health Canada should be responsible for that program.
To answer your question, yes, we need tertiary services. It is quite complicated because in Ontario, we still represent only 4 per cent of the population. Let us first establish our primary health network, because that is essential. That is what we should spend our money on to start with.
The Acting Chairman: I would like the committee to be mandated to study the issue of the so-called national services, as there will be more and more of them. Diagnostic or therapeutic procedures are quite complicated, require a lot of equipment and specialized personnel. They are carried out on a small number of citizens and that is why there is only one institute of the kind in Canada.
But there will be more and more of those specialized centres in Canada and what senator Keon recommends is the possibility of receiving patients from all regions of the country. He specifically recommends that patients from outside Quebec have access to health care in French.
This is an important issue because it does not only affect francophones outside Quebec but also francophones in the whole of the country. It is a very important issue.
Mr. Rioux: I believe the discussions you will have during the next two days will provide clarifications, since the groups you will meet are much more specialized than we are.
The core of the report entitled ``La santé chez les communautés minoritaires,'' is that the role of health care community centres is to provide access to front-line services. There are also details about specializations, and the work conducted by the members of the committee will clarify that for you.
I do not want to get into specializations because there are people who are much more qualified than I am to answer those specific questions since they are the ones who did the work.
Ms Friolet: As an illustration, in British Columbia where there are no institutions that currently offer public services in French, aside perhaps from Maillardville, a seniors' residence, where one can ask to be seen by a doctor who understands French.
We have created a list of health care professionals and have suggested that a community clinic be created. These are all private initiatives, and nothing prevents bilingual doctors, psychologists or nurses from offering their services in French.
We want to start our work at that level, and further down the road, we will try to convince the regional health boards to work with these individuals. In British Columbia, where nothing is currently organized, there are two areas where one can receive services in French. We are trying to follow Ontario and New Brunswick's example, all the while turning towards the situation in Alberta, where smaller communities have a doctor who travels every Wednesday to remote communities, whether he is requested to do so or not.
In British Columbia, we are not closed to this idea because there are currently no services offered in French. We want to use everything that is available to us to make services in French accessible. I think this could be done in consultation with health care professionals.
The Acting Chairman: Mr. Rioux, the committee would like to receive the documents which were published since the report was tabled, such as the report from the Forum de Moncton of November 2001. The committee would like to review its conclusions. Mr. d'Entremont, you mentioned a forum that took place in Nova Scotia. Grassroots resolutions of the kind would greatly help the proceedings of this committee.
I would like to conclude by thanking our witnesses. We have appreciated your comments immensely and are certain they will help with this committee's proceedings. We might call upon you in the event that we need further details.
The committee adjourned.