THE STANDING SENATE COMMITTEE ON OFFICIAL LANGUAGES
EVIDENCE
OTTAWA, Monday, May 29, 2023
The Standing Senate Committee on Official Languages met with videoconference this day at 5 p.m. [ET] to study matters relating to minority-language health services; and, in camera, to consider a draft agenda (future business).
Senator René Cormier (Chair) in the chair.
[Translation]
The Chair: Good evening, everyone. I am René Cormier, senator from New Brunswick, and Chair of the Standing Senate Committee on Official Languages.
[English]
Before we begin, I wish to invite committee members participating in today’s meeting to introduce themselves.
[Translation]
Senator Dalphond: Pierre Dalphond from Quebec.
Senator Moncion: Lucie Moncion from Ontario.
Senator Clement: Bernadette Clement from Ontario.
Senator Mockler: Percy Mockler from New Brunswick.
Senator Poirier: Welcome. Rose-May Poirier from New Brunswick.
[English]
The Chair: Thank you, colleagues. I wish to welcome all of you and viewers across the country who may be watching.
I would like to point out that I am taking part in this meeting from within the unceded traditional territory of the Algonquin Anishinaabe Nation.
Tonight we continue our study on minority language health services. For our first panel, we are pleased to welcome Walter Duszara, President, and Katia Toimil-Bramhall, Executive Director, from Seniors Action Quebec, who are here in person. By video conference, we welcome Tenisha Valliant, President of the Black Community Resource Centre.
Good evening. Thank you for being with us. We will hear your opening remarks, starting with Mr. Duszara. A question-and-answer period will follow.
Walter Duszara, President, Seniors Action Quebec: Mr. Chair and senators, we thank you for this opportunity to speak with you on this important subject.
Seniors Action Quebec is a provincial not-for-profit organization that advocates for the needs of English-speaking seniors throughout Quebec. We collaborate with, support and bring together English-language community organizations working to maintain and enhance the vitality, well-being and health of English-speaking seniors. We work in partnership and harmony with community groups, institutions and government agencies to identify needs, gaps and shortcomings in service offerings for English-speaking seniors. We develop and propose policy solutions and policy alternatives in collaboration with our partners that address these needs. We monitor the impact of legislation, policy and program initiatives on English-speaking seniors. We work with all levels of government to identify and address challenges and strategic issues faced by English‑speaking seniors.
We believe that every effort, action or gesture that identifies, addresses and responds to the particular needs of Quebec’s English-speaking seniors contributes positively not only to the vitality of our own communities but to all communities in Quebec.
The recent pandemic came without warning and wreaked death and hardship indiscriminately upon human beings of all ages around the globe. Probably no one in this room has been unaffected or untraumatized to some degree by the ravages of this recent pandemic. Government arguments lauding their responses as being superior to those of other states are cold comfort to those who have lost family members and friends and to the many who continue to cope with the effects of the disease.
Seniors bore the brunt of the devastating effects of COVID. Seniors were the ones who suffered the greatest indignities and injustices as the pandemic ran its course. Public and private seniors’ homes, nursing homes, long-term care facilities and hospital emergency rooms exposed their shortcomings and their abject state of preparedness at the start of the pandemic and in the months that followed. This must never be forgotten.
The pandemic brought into stark relief the fragility, value and importance of every human life and the dignity and justice every life deserves. We all deplored the examples of neglect and dereliction of responsibility we witnessed. We all shared in the pain of families who could not visit or comfort their aged loved ones. We all grieved with families and friends who could not participate in funerals. We all agreed that this was not right. We all were reminded that disease and illness strike individual human beings randomly and without regard to age, status, origin or language. That was, will be and is the case today.
The Quebec health care system, though not perfect, offers care and services that were unimaginable a generation ago. Most Quebec citizens can access a wide range of medical, social and associated care services throughout the vast territory of the province. Most Quebec citizens have access to a support network of community-based services at the level of their municipality. Most Quebec citizens experience little difficulty in receiving information about available services. Most Quebec citizens are able to express their needs to staff within the various institutions providing health services. Most Quebec citizens feel at ease and welcomed in their various institutions, but not all.
Language is often the greatest barrier to access and the greatest source of distress. Access to health care and associated support services for English-speaking Quebecers is often difficult, particularly but not exclusively away from the Greater Montreal area. Unilingual French professional and support staff, French-language information services, information resources on health care and forms are insurmountable obstacles for many. English-speaking seniors are most vulnerable in this respect as they are often least capable in French.
Consequently, we recommend that new mechanisms, procedures and perspectives be developed and adopted by Canada, its provinces and territories to improve access to and the provision of health care and social services for minority‑language seniors that would engage seniors directly as well as those working on their behalf and that would respect the principles of dignity and justice.
Furthermore, we recommend that these perspectives align with the 1946 Constitution of the World Health Organization, which envisaged “the highest attainable standard of health is one of the fundamental rights of every human being …” Acknowledging health as a human right would recognize a legal obligation on the state to ensure access to timely, accessible and affordable health care. It would affirm the state’s obligation to support the right to health, including the allocation of “maximum available resources” to progressively realize this goal. It would require that health policy and programs prioritize the needs of those furthest behind first to ensure greater equity. It would emphasize that the right to health must be enjoyed without discrimination on the grounds of race, age, ethnicity, language or any other factor. Non-discrimination and equality require the state to take steps to redress any discriminatory law, practice or policy. It would reiterate that a rights-based approach requires meaningful participation. Participation means ensuring that national stakeholders, including non-state actors such as community organizations, are meaningfully involved in all phases of programming, assessment, analysis, planning and implementation, monitoring and evaluation.
We would be pleased to engage with you and others to jointly pursue a deeper consideration of these recommendations.
Thank you.
The Chair: Thank you for your presentation, Mr. Duszara.
Tenisha Valliant, President, Black Community Resource Centre: Distinguished members of the Senate and fellow attendees, I stand before you today with the utmost respect and gratitude, acknowledging the important work you undertake in serving the people of Canada. It is an honour to address this committee as we delve into a critical topic that holds great significance for our linguistic-minority communities: minority‑language health services.
I proudly serve as the president of the Black Community Resource Centre, a non-profit organization that since 1994 has been dedicated to serving the English-speaking Black population of Quebec. In additional to my role as president, I bring with me a wealth of expertise in community development.
Today I am delighted to shed light on the Black Community Resource Centre’s Intergenerational Health and Social Program, a transformative endeavour that aims to enhance the lives and health of senior members in our community through a diverse array of workshops and activities.
Before I delve into our programming, it is crucial to revisit and understand the broader context in which it operates. As many of you know, linguistic minority communities across our nation face unique challenges when it comes to accessing health and social services, and our senior English-speaking Black community members feel and know this all too well. Accessing health care services can be particularly daunting for linguistic minority communities. Language barriers often create obstacles, limiting effective communication between health care providers and patients. This can lead to misunderstandings, misdiagnoses and inadequate treatment, ultimately compromising the health outcomes of individuals within these communities.
Statistics from a report published by the BCRC’s research project Black in Quebec highlight that 14% of English-speaking Quebecers are not at all satisfied with their experiences with the health care system in Quebec.
Moreover, as cultural competency plays a vital role in health care delivery, many of our senior members have expressed challenges collaborating with health care providers as they lack an understanding of the cultural nuances, values and beliefs that shape the experiences and health-seeking behaviours of Black linguistic minority communities. Many of our seniors have expressed their own experiences and fears of the potential risks they face, which can impact trust, patient engagement and the overall effectiveness of health care interventions.
At the heart of it lies a commitment to provide participants with engaging and educational experiences that empower our seniors to not only break the social and linguistic isolation that so many feel, but to help them confidently navigate the health and social systems in Quebec that are offered predominantly in French.
Finally, I would like to highlight our valuable partnerships with community stakeholders, including Dawson College student interns who collaborate with the BCRC student program to assist seniors in navigating various health and social programs. One notable program is the adaptive transportation service offered by the Société de transport de Montréal. Many seniors have expressed to us the challenges they face when trying to communicate with the system and its staff. This sadly exemplifies the difficulties they face due to the lack of comprehensive translation accommodations. Language barriers can prevent seniors from accessing critical services and support, leaving them feeling excluded and marginalized. Through our partnerships, particularly with Dawson College student interns, they are providing vital support and helping our seniors overcome these challenges, learn how to navigate the system and ensure that they can effectively utilize the transportation service. This collaboration is further emphasizing the pressing need for improved language translation services and accommodations to ensure equitable access to essential resources and services for all seniors.
In conclusion, honourable senators and distinguished attendees, I would like to express my heartfelt appreciation for the opportunity to address this committee today. This discussion on minority language health services is of the utmost importance, and I am grateful for your commitment to exploring solutions to address the challenges faced by minority language communities. We advocate at the BCRC for increased funding and support for minority language health service programs that cater to the unique needs of linguistic minority communities. Adequate resources and funding will enable organizations like ours to continue to do the work we do, expand our reach, offer comprehensive services and improve health outcomes for marginalized communities.
The Chair: Thank you, Ms. Valliant, for your opening statement.
Before we start questions from senators, I would ask members in the room to please refrain from leaning in too close to their microphone or to remove their earpiece when doing so. This will avoid any sound feedback that could negatively impact the committee staff in the room.
I suggest for the first round that each senator be allowed five minutes including question and answers.
Senator Poirier: Thank you all for being here and for your presentations. It is greatly appreciated.
My first question is — and either one or both can answer — have you received any support from the federal government under the Health Canada Official Languages Health Program? Have you received funding at all?
Mr. Duszara: As an organization, no. We have received funding from Heritage Canada, but not from Health Canada.
Senator Poirier: What are your expectations regarding the increase in English language health funding provided for in the Action Plan for Official Languages 2023-28?
Mr. Duszara: Speaking as an organization, we have no expectations in that regard. We recognize that the resources that have been distributed to our colleagues are probably inadequate given the changes in circumstances over the last three or four years and with the rise in costs. One of the realities all of our colleagues have experienced in the past is that the resources don’t keep up with the increase in costs that are there and, as a result, more and more is needed from volunteers. One of the impacts of the pandemic has been to reduce the number of people who are prepared to volunteer. One of the groups we dealt with said they had 150 volunteers on staff prior to the pandemic to do what they needed to do, and barely were able to do it, and now they are down to 60. The impact has been dramatic in many circumstances. Consequently, we can only ask for an appropriate increase across the board to all organizations for funding.
Senator Poirier: Is it a challenge right now for the health facilities in communities to have access to skilled professionals and health care personnel with the ability to communicate in both languages? Is that a challenge?
Mr. Duszara: I believe it is a challenge for the system to have enough professionals to be able to offer services in general. Nursing staff, medical staff and so on appears to be in short supply, and that was very evident during the pandemic. When you add to that the need for English-speaking or bilingual medical staff, it becomes a greater challenge, and it becomes a greater challenge to all institutions across the province.
The other problem that we face is that a lot of the materials, the information, is not available to patients in the language of their choice, and in the English language in the case of our community. A lot of the regulations and legislation that Quebec has adopted over the last 30 or 40 years serves to make it more difficult for the English-speaking community to access medical services that respond to their needs. The problem is complex.
Ms. Valliant: I would like to comment on the capacity of the current staff in the health care system to address patients in English. To answer your question, no, because every time we hear from our members and speak to our community, the issue continues that there’s just not enough access to services in their language. I echo that answer.
Senator Poirier: Is post-secondary education in Quebec to help the recruitment or the encouragement of students to study in the English language to answer to the need something that’s looked at? Are there enough seats there? Is that a possibility?
Mr. Duszara: I don’t feel I am competent to speak to that on behalf of our organization.
Senator Moncion: My question is on information about the health care received. We have heard that the same situation that you’re explaining in Quebec also exists in Ontario and other areas in Canada. Do you have statistics and data on the problems of accessing these services from English Quebecers?
Mr. Duszara: We have recently submitted a brief to the Quebec government outlining what, in our opinion, are the specific challenges of the English-speaking community. This is now in their hands, as we speak, and is being studied in the context of preparing their next action plan for services to seniors in Quebec. We would be able and prepared to make that document available to you if you like.
What I can say is that the situation in terms of access is variable. It is more acute in the regions because we have smaller communities and sometimes people forget that there are English speakers in every region of Quebec. There isn’t a single region where there aren’t English-speaking people.
The other factor important to keep in mind from the point of view of seniors is that seniors who are English speaking often find themselves in a restricted community in the sense that their children and grandchildren are oftentimes away from the towns and villages where they live and are not available as a first line of support when problems happen and when issues of health and disease strike them. Community groups in the area who support seniors, English-speaking community groups, are active in doing what they can, but again, they are under-resourced. It is not unusual for somebody in the Gaspé having to go for medical services in Quebec City, and that is a day’s journey by airplane. The train isn’t there any more. Sometimes to get from a village to a hospital centre, you’re looking at 100 kilometres. If you don’t have someone able to drive you, you can’t get there. One of the biggest impacts on seniors is the inability to drive. You reach a point where you can’t drive yourself, and in that case your isolation is almost complete.
As seniors age, they lose their support networks, friends and colleagues and become more and more isolated. This is a real problem in many municipalities as the age of seniors is increasing over time. This problem is not a new problem that has been identified by the community. It’s a problem that recurs, and now it has become more acute, and we seem not to be able to have the right conversation. The conversation we have is with numbers, bureaucrats and statistics, and it’s not a conversation that you have about values and the impact on human life.
That’s a dimension that we brought in our opening statement. We think we need to be able to talk to one another differently. We need to be able to reach one another as human beings. We need to be able to respect the precepts that we signed up to in the declaration of human rights. We need to be able to support the orientations that look at health as a right of a human being. I know it’s not a right in our Constitution, and I know that’s a big step to take, but at least we can align our discourse, the way we speak to one another, in such a way that it respects the notion that people have a right and that it’s not a service that is provided from on high to an individual.
Every single human being should be able to have the same access in Quebec to the services that every single human being in Quebec pays for through their taxes; the reality is we don’t have that access. The reality is that there are people who suffer because there is no access to that. Our colleague mentioned that just a few minutes ago. There are people who suffer and do not have the services that their neighbour has, and that’s just not right. We need to be able to talk about that in a frank way and in a way that we listen to one another and we don’t fall back on rules and regulations. We look at the impact of the rules on the human being.
Justice Abella talked about this a few weeks ago in a statement or an interview that she had. She says laws are just rules. It’s the impact they have on the human being that makes them just or not. There are injustices and indignities that people are suffering today as we sit here because of language barriers that are there that don’t need to be there and that should not be there from our point of view. There should not be a discussion around the politics of language when it comes to health services. This should not be something that is an obstacle. It’s just not right.
Senator Moncion: Thank you. I was going to ask about the ear of the government. How open or not open are they to changes?
Mr. Duszara: Sometimes I think that people will say the right things when you talk to them, but when it comes down to seeing services on the ground, they’re not there. There are always arguments and obstacles, and they set up barriers, move the goal posts and put in restrictions, or it becomes something that is supposed to be done by someone else. At the end of the day, things don’t change. It’s Groundhog Day all over again. This is the problem that we have. We feel that unless we turn the page and do something different, the page is going to be blank and we’re going to go right back to Groundhog Day. Things don’t change.
Ms. Valliant: You were asking about statistics and data. One of the things we have been doing at the Black Community Resource Centre is trying to collect race-based data because I am representing this community of linguistic minorities but also of visible minorities. In the Quebec health care system, they do not collect race-based data. We are working hard to be able to collect data on the experiences of the English-speaking Black community in particular. We hope to have some statistics to just strengthen the case that we make here today.
[Translation]
Senator Mégie: My first question is for Mr. Duszara. I’ve heard you talk about people who have serious health problems and have to leave the Gaspé for treatment in Quebec City.
I’d like to know if it’s just a language problem or if it’s more of a health resource problem, because I hear a lot about these resource problems in Quebec, whether it’s for people who speak French, English or any other language. You seem to emphasize that it’s only a linguistic issue. I’d like you to give us a little more detail on that.
[English]
Mr. Duszara: The resources are lacking throughout the province. However, if you are in a community where there is a health centre, a CLSC or a medical centre, and the staff, whatever limits they have, are able to communicate with you in French because you are French-speaking, you have access to what is there. The anglophone who can’t speak French and is faced with the same resource can’t access it because no one is there to interpret it for him and no one is there to be able to explain things to them because there is no one who has the linguistic capacity to do that. Consequently, the unilingual anglophone in whatever situation you find yourself in resources has a deficit, if you like, in terms of their accessibility to the services that are there. That’s not to say that there is a lack of resources or services throughout. It’s just that they are seen to be kind of biased against the anglophone who is unilingual. Children living in Sherbrooke can have access to speech pathologists in Sherbrooke if they are French speaking. English‑speaking children have limited access and have to go to Montreal to get that. Psychological/psychiatric services are the same. Sometimes as a francophone you may be on a waiting list for months, but as an anglophone that could be years.
There is an injustice in the system, and this injustice in the system has been existing there for years and years, and we’re suggesting that going forward we have to address that in a different way, in a way that respects the dignity of human rights, of the human being, and the principles of justice that we signed up to as a country. We speak of our just society, which is an old term but some of us still remember it.
[Translation]
Senator Mégie: Ms. Valliant, you spoke earlier about the assistance Dawson College offers to the English-speaking community. Do they offer post-secondary training or do they set up organizations? Tell us a little bit about how that works.
[English]
Ms. Valliant: Our partnership with Dawson College is in the form of basically having interns, students from Dawson College, interning with the Black Community Resource Centre and offering services to our senior program director. Over the past three years, that has taken the form of the interns using their social work background in particular to support English-speaking Black seniors. They support them in a wide variety of ways. One of them that I highlighted was to help a certain number of seniors in our groups to navigate the STM Paratransit. When those interns came into the BCRC over the summer and addressed the situation with the seniors — the relevant, pressing issues at that moment — what came up was the fact that our seniors were calling to get services from the STM, trying to get transportation to medical appointments, et cetera. They were calling in. They didn’t understand. No one was speaking to them in English, so they said, “Forget about it; I’m not doing it; I don’t have the time,” that kind of reaction. So last year in particular, the interns decided they would build resources to help empower and teach our seniors how to navigate that system in the event that they would interact with the system and not be served in English. So it is a case-by-case kind of support service offered to our senior members, but it takes the form of an internship. Students come into the BCRC, assess the needs of the time of their internship and then provide support services to our senior participants.
[Translation]
Senator Mégie: Thank you very much.
[English]
Senator Clement: Good evening, and thank you to all the witnesses.
Ms. Valliant, I am interested in what you were talking about in terms of intersectionality in response to Senator Moncion’s question around data and collecting data. We need collection of data. If you are not measuring and counting, then how are you able to justify to funders and to the government what gaps there are or what is needed in terms of resources? I want to know what resources you have to do the data collection work you were talking about and what you would need to go further in that direction. That’s my first question.
Also, what kind of collaboration do you have among the organizations that provide services to anglophones in Montreal or Quebec? For example, do you partner with Seniors Action Quebec or other organizations? You talked about Dawson College, but what about the network in general?
Ms. Valliant: I would say that over the last three years, we have been fortunate enough to get funding from both federal and provincial governments to support us in our quest to conduct research and to be able to have race-based data. We are proud to have data that has come out of the BCRC, and I will gladly submit it to the committee. One research project in particular, called “Black in Quebec,” highlights the situation of English‑speaking Black Quebecers in terms of health, education, access to justice and employment.
However, resources are limited, and qualified staff need to be paid to lead this research. We want the research to be sound. That research ended, and it was like scrambling to get more funding to be able to continue it and go deeper. We want to continue it because we don’t want just a snapshot of 2019. We want to be able to continue to update that data.
Right now, we’ve been leaning on internships. We’ve been leaning on the young, English-speaking communities of Montreal to support us with collecting data. We have a project coming up in a couple of weeks, actually, where we will have interns who are young, Black youth interested in research come on and help us collect data through consultation and surveys. I definitely say that just having more grants and funding opportunities to be able to build a case, to access those resources and hire qualified people to help us lead this research is key.
I will also say that in terms of leaning on our stakeholders and other community organizations and institutions, the BCRC has partnered with Dawson College, Concordia and McGill University to conduct research and to deliver services. Most importantly, however, especially speaking about the way we service our seniors when it comes to health, we have leaned on the expertise of community organizations, businesses and professionals in our community to come into our organization and talk to our seniors. We’ve had an English-speaking Black nurse who works at the Glen come in and speak to our seniors and tell them how to complain if the services they received were not up to par or if they were not given in the right language. What steps do you take to complain to the hospital, for example? How do you contact the ombudsman? We’ve had funeral homes come in and speak to seniors — not necessarily related to health — about what to do, how to produce a will and how to prepare yourself for passing. So we have leaned on the expertise of our community to come in and provide access to information for our seniors, especially in our program where we’re talking about health services.
Senator Clement: Your opening statement, Mr. Duszara, was very compelling. My mother died during the pandemic in a Montreal hospital. It was difficult. It was difficult to communicate, get what you needed, plan a funeral and do all of that, so I hear you. I sometimes wonder if we fully understand the lasting impact of the pandemic.
You spoke in your opening statement about suggestions you would have around monitoring and evaluation. I would ask you to lean into that more and give more detail on what you meant by that. I will also ask you the same question about collaboration with other English-speaking or anglophone organizations in Quebec.
Katia Toimil-Bramhall, Executive Director, Seniors Action Quebec: We are still a relatively young organization. I am the second executive director. We’re doing a little bit of catch-up because, during the pandemic, we were all locked down. It was hard having conversations and going out to meet organizations. We are making up for that now. We are doing a lot of kilometres.
Indirectly, the irony of the pandemic is that because we were locked down and were working on projects during that time, we were able to speak to organizations about their programming and the challenges indirectly. There was a very steep learning curve during 2020-22. However, moving ahead, we are in active conversations where we’re trying to understand the realities throughout the entire province. The Greater Montreal area has certain challenges and realities, but things are completely different in the different regions of Quebec. As you said, there is the challenge of resources, but when you factor in the challenge of language, it puts things up to another level, not only for civilians or residents — citizens — but for the organizations that work directly with these seniors.
One thing that keeps coming up again — and we spoke about it — is funding, but it’s also the translation services that the organizations do by default. If someone calls an organization and asks how to do something and they don’t have it in English, someone will find someone to translate it. It is another factor that adds to the limited resources and stress, if you will, on our organizations and staff. This is something we saw during the pandemic. I first started at Seniors Action Quebec in December 2019. It was very intense at the beginning of the pandemic. We had people calling us saying, “What do we do? Where do we go? Who do we speak to?”
Mr. Duszara: There are two parts to your question. In terms of our partnerships, we work closely with all kinds of organizations around the province. On the island of Montreal, there was a table that came together that brought together close to 30 organizations that provide direct services to seniors in the area.
The first question came to me with regard to resources. We don’t get any resources from Health Canada as such, as an organization. However, we do have needs, particularly needs related to being able to be more engaged in policy development, research and communications with the communities and with the community of organizations that we work with. As an organization, we are presently going through developing a strategic plan for the future that will change our way of working. We are presently an organization that works with individual members as the base. We’re moving towards organizational members going forward in order to have an even greater sense of what’s happening in the various communities. Quebec is a huge province, but the English community is small. You almost bump into one other everywhere you go. It’s just the way it is. We need the resources to be able to do the work that we would like to do. We don’t have them at the moment.
One comment with regard to the question of data: I remember Einstein’s statement. Einstein said, “Not everything that matters counts and not everything that can be counted matters.” We sometimes spend a lot of time rehashing the same sorts of information piles and not visiting or addressing some of the other areas that would require a deeper reflection. That’s something that we keep in mind as we work. We don’t want to make work. We don’t want to duplicate work. We don’t want to do things that other people are doing. We ask people to share their information with us as we share with them. We need to be able to work collaboratively as we go forward.
[Translation]
Senator Mockler: Congratulations to all three of you for taking the time to come and see us and bring your concerns to our attention.
[English]
I have a few questions in relation to some of the recommendations that you’ve made, Mr. Duszara. You recommend that new mechanisms, procedures and perspectives be developed and adopted by Canada. Could you explain that? Give us some examples of what is happening now and what you would like to see moving forward?
Mr. Duszara: The big story is Bill C-13.
Senator Mockler: That was my next question.
Mr. Duszara: That’s the big story. Yes, there have been many intervenors in the debate on Bill C-13, as there are in other pieces of legislation. However, there were lots of absent voices as well. We weren’t there, for example. The seniors, as far as I know, were not consulted directly. The organizations who work on the ground, by and large, many of them were not consulted. They are present but they are also absent.
The mechanisms that we have put in place to be able to speak to people are oftentimes daunting for individuals. Remember that many of these organizations are run by volunteers. They are good people with good hearts who have done good things in their communities, but if you asked them to stand up and speak in front of a court, or in front of a table like this, they freeze. They run away. We need to have people speaking on our behalf to do that. We don’t have the resources to do that.
In the health sector — I will speak to the health sector in Quebec — we have access committees that were there. We had difficulty getting membership on access committees. The access committees now will become even more remote with the impacts of Bill 96. There are concerns there.
What happens is that as citizens — and in this case I will restrict the reflections on seniors and health issues — as seniors, citizens who have been contributing to this society all their lives, at the end of the day, we don’t have a voice, place or platform to be able to express our needs, desires and have an ear that’s going to listen to us. Oftentimes, the discussion that takes place is a legalistic, bureaucratic discussion that keeps the human aspect out of the conversation. We’re suggesting that that needs to change across the board.
I know that health is an extremely complex system. It’s complex. The way we deal with health in Canada, as a country, is even more complex than some other areas. I know that health is a jurisdiction of the province, but there should be certain elements and guidelines that are true across the board for everyone.
When you are dealing with people, listen to them. Give them a chance to speak. We’ve done a wonderful job over the last number of years speaking to the Indigenous communities and the issues and problems that they have experienced over many decades. We have issues that affect English-speaking seniors in our provinces who don’t have a voice. This is an occasion for us to speak, and we appreciate it. We need to be able to speak not only to yourselves. We need to be able to speak to the bureaucratic machine called Health Canada. We need to be able to speak to health and social services Quebec. We need to have a door open to us, not to be an afterthought. Oftentimes, we are there saying, “There was an injury. You put a Band-Aid on it. We don’t need a Band-Aid. We need a surgeon.” It’s too late. We need to be able to come back and say, “We are going forward. We are looking at what we’ve learned. It has affected us badly.”
I’ll stop. I saw you put your hands up. I don’t want to stand on my soapbox for too long.
Senator Mockler: It is because the chair is watching my minutes.
Does Ms. Valliant have any comments on the question that I have asked?
Ms. Valliant: No. My fellow guests have put it well. Thank you.
Senator Mockler: Both could answer my next question. You mentioned Bill C-13.
Mr. Duszara: Yes.
Senator Mockler: Have you read Bill C-13 and the impacts of it?
Mr. Duszara: We have gone through Bill C-13. We have seen some of the elements that are there. Perhaps Katia can speak to that a little bit more. Do you have some of the articles that are there?
Ms. Toimil-Bramhall: No, I have the action plan.
Mr. Duszara: The action plan? Okay.
The biggest problem that we have with C-13 is that it seems to integrate Bill 96. It seems to integrate and incorporate those elements of Bill 96 that are most problematic for English speakers. The impact that it may have on seniors is one that could be very detrimental moving forward.
I will give you one example that I’ve just heard about in the last two months. A gentleman, 93 years old, living at home alone. Fine, everything is well. Falls, breaks a hip. That’s very dramatic for a senior person. He gets brought to a hospital in Montreal. He gets the services and help that he needs. He was not able to be transferred to a seniors’ home because there was no place for him. He was left in the hospital. That hospital is on the island of Montreal, but it doesn’t have the bilingual character that all hospitals have. This poor gentleman is in a room by himself, surrounded by staff who cannot — and some will not — speak to him in English. In effect, he’s in isolation. How is that going to help him in any way heal and move forward? The gentleman who has been taking care of this person is at his wit’s end. He can’t do anything for him. He sees this man declining from day to day to day. That’s one example and that’s on the island of Montreal.
Senator Mockler: Ms. Valliant, have you been consulted and have you looked at Bill C-13, which impacts on providing health care services for our people?
Ms. Valliant: No, I have no comment on that bill.
Senator Mockler: Mr. Duszara, you’ve made some recommendations, and they certainly highlight some of the challenges that you have. You’ve proposed some solutions, and I think that’s right. Have you been consulted during the process by the federal government on Bill C-13? Have you been consulted by the Government of Quebec on their language bill?
Mr. Duszara: We have not been consulted directly on Bill C-13 as an organization.
We are a member of the QCGN, the Quebec Community Groups Network. We have spoken to Bill 96 in the context of webinars and meetings that we had. Our voice has been heard internally, but it has not been heard in terms of us speaking to the issue ourselves. With regard to Quebec, no. We have worked with some of the organizations that are under the Quebec Ministry of Health, but we have not spoken directly to the Quebec Ministry of Health on any aspects of Bill 96.
The Chair: I have a few questions before we go to the second round.
My first question will be for Ms. Valliant. You spoke about the necessity to have culturally appropriate services. Could you give us more information on that? What should be done? What are the problems in terms of the services that are not culturally appropriate?
Ms. Valliant: What we often hear from our senior members is that when meeting and speaking with a health care professional, they feel that the way they communicate and the words they use are not translated in the way they think they ought to be. Many of our Black anglophone members are of Caribbean descent. When we talk about the culture of our members, we are talking about people who come from the Caribbean and maybe have a different way of speaking and communicating, and they don’t feel understood. That’s what we’re hearing.
I know this extends past health services, but people who are visiting seniors’ residences or those who are living in homes say that the food is not the type of food they enjoy, or the music and activities. Those are the primary examples I can share without going into detail of the stories of our members.
The Chair: What should be done? Do you have any suggestions as to how to tackle these difficulties? Is it in terms of programs that the homes have, or is it human resources?
Ms. Valliant: What we would hope to see is that the management and leadership who oversee recruitment, onboarding and programs are aware that there are diverse communities who have diverse realities, experiences, history and cultural heritage, and perhaps consult with them or learn about these communities.
The communities we are talking about are smaller. We talk about the English-speaking community of Quebec, and then we narrow it down to the visible minority community. Yes, that community gets smaller, but the Black community is still a significant population within the linguistic minority community. As professionals, it is important to take that extra step to learn, understand and try to accommodate.
The Chair: Thank you for that.
Mr. Duszara, I heard you say that we have to speak to one another differently. I’m hearing from that affirmation the necessity for consulting differently. Do you have suggestions as to how it could work better in terms of speaking to one another differently?
Mr. Duszara: Yes, on a number of levels.
The question was asked earlier about Bill 96. Unfortunately, Bill 96 is interpretable by people. Some people interpret Bill 96 as giving them permission to not be civil to people who are English speaking. We see examples of this. We learned of an example last week when we were visiting with a community group in Quebec City. An elderly woman coming into a hospital setting was greeted by someone at the door, a porter of sorts, and was asked, “Why can’t you speak French?” She was basically harassed and harangued by that person to the point where she broke into tears and needed support from people around her. There is not a straight line between Bill 96 and that kind of behaviour. However, if you look at the kinds of things we see and that are reported to us on a regular basis, it seems that that kind of behaviour, in the minds of some people, is acceptable. That’s unacceptable.
One of the ways we could have improved participation and communication would be a comment from our political leaders to the effect that, “Hey, folks, you don’t do this. This is just not right. Don’t do that to people, no matter where you are. If a person doesn’t speak French, that’s not your business. Serve the person in the best way you can. You don’t have permission to mistreat people or to be unjust to people.” That’s the beginning.
The second point is that we are starting to get invitations at the beginning of processes, which we welcome. In the past, we have often had invitations after the problems came up and were called in to put a Band-Aid on something that needed a greater intervention. We don’t want to put Band-Aids on things. We want to work with government and institutions to be able to develop responses that respond properly from the beginning. You can’t do that if you are invited to the table after everybody has left. This is one way of moving forward.
The other way that we need to move forward as a community is to build our capacity to engage at that level of discourse with government and institutions. You can’t have that with just volunteers unless you are fortunate and the volunteer happens to be a lawyer or a doctor, but that doesn’t always happen. Oftentimes it’s a mom, a farmer, a fisherman or someone who worked in the trades. These are people who are volunteering. They are not used to working in that way. The organizations need to have the capacity to hire people and services and to be able to engage in a proper conversation that’s based on evidence, data and information that you have, and in a manner that you can engage people in a conversation. This is something that we need to do.
Most importantly, we need the folks with whom we talk to respect us as being valid, valuable and appropriate partners in developing the services that move forward. The expertise does not lie exclusively within the institution. The help expertise lies in the community, and the community needs to be involved. In our province, we see more and more movement away from community involvement to a silo of experts who tell you how to do things and what is best for you. We see it in education and we’re now seeing it in health.
Senator Moncion: What we hear from you, sir, we hear everywhere in Canada on the opposite side. At some point, there are solutions out there that we have to work with to take care of this situation because it is uncalled for in our country, anywhere in our country, whether you’re French, English or of any ethnicity.
Mr. Duszara: I agree with you completely on that score.
The Chair: Mr. Duszara, Ms. Toimil-Bramhall and Ms. Valliant, thank you so much for your presentations. This will help our study.
For our second panel this evening, we are pleased to welcome in person Joanne Pocock, Research Consultant, and by video conference Sarah Bowen, Applied Research and Evaluation Consultant.
Good evening and thank you for being with us. We’ll now hear your opening remarks, and a question and answer period will follow. Ms. Pocock, the floor is yours.
Joanne Pocock, Research Consultant, as an individual: Chairman and all members of the Senate committee, it’s a pleasure to be here today. Thank you for the opportunity.
I’m a researcher who has specialized in the study of English‑speaking communities of Quebec and specifically their access to health and social services. Much of my work has been done within the framework of the social determinants of health, which, of course, include access to health and social services.
In my research, I’ve worked extensively with census data, particularly socio-economic variables, as well as with survey data that considers access to health and social services in English, for example, the Canadian Community Health Survey as well as a survey conducted every couple of years of 3,000 English speakers across Quebec.
In my opening statement, I would draw your attention to a few key points that clarify the situation in Quebec.
While Canadians have a goal of universal health care, when it comes to language and access to social services, all is not equal. In Quebec, the guarantee for access to services in English is set out in a series of regional access programs which rely on the initiative and the proactive attitude of community organizations for their input. The current generation of plans was due to be updated in 2021 but have not yet been approved by the government, and the proposed changes to Quebec’s health and social services system may have the effect of reducing the input of English-speaking communities to these access plans, which, of course, may reduce the limited access already enjoyed. As well, the access programs build on the resources — human, technical, financial — of the health and social services system, which varies substantially across regions.
When we consider designated institutions, which are those recognized under the Charte de la langue française, we find that of Quebec’s 25 territories, 13 have no designated institutions, 5 have only one designated institution and 7 have more than one designated institution. Even where guaranteed services exist, language gaps still are present.
The proportion of anglophones working in the health care and social assistance industry — that’s 10.7% — is much lower than their share of the labour force, which is 15.6%. Translation services are not a given among designated institutions. The availability of medical system documents such as health information or consent forms in English is unreliable and can also entail a delay in service. The absence of health professionals and staff from the minority-language community means the lack of an informal network which extends into the community, for example, the advice of a nurse who knows how to negotiate the system informally providing that information in her community, or of doctors on hospital boards who are a voice of the community within the system. This is less likely given the low proportion of bilingual professionals.
Socio-economic status is recognized internationally as a key determinant of health. Low income rates, unemployment rates and the likelihood of living below the low-income cut-off, which is a measure of poverty, are all the more problematic in the English-speaking community compared to their francophone majority counterparts, and these gaps have grown over time. For example, the rate of unemployment for English-speaking Quebec was high at 8.9% in 2016, compared to the level of 6.9% experienced by francophones. According to the most recent census of 2021, the level for francophones remains stable at 6.9%, while that of anglophones increased to 10.9%. Low socio-economic status is an important indicator of a greater likelihood of health problems and an increased reliance on the health system. Let’s look at a few examples.
For those 65 and over — although seniors, I notice, have been introduced — and relocating to residences designed for seniors, their choice is really no longer a choice. If they want to receive service in English, they will need to turn to private services at the average cost of $5,000 and more monthly, or if they and their family are low income and will need to get on the list for less expensive public offerings, they will have to accept that English is not necessarily something to be found among the staff. In other words, service in English could be seen as a luxury which only some can afford and not a right which can be exercised by all.
For parents of young children, where timely diagnosis and treatment of learning disabilities are critical, travelling out of the region for access for testing in English is costly. Then, of course, follow-up for treatment is less likely than for those who don’t face this cost.
English-speaking youth have been especially hard hit by the pandemic period. Access to mental health services in English is not typically available or, again, comes at a prohibitive price.
In terms of research needs, I would mention the lack of a language lens in health research, and there is a need to be sensitive to the sometimes vast differences between Quebec’s regions. Quebec is a territory three times the size of France, and the regions vary tremendously in terms of health services, economic opportunity — the list is long.
It is worth noting that two in five — that’s 40% of English speakers — live off the island of Montreal. These are often rural and remote locations with dispersed populations. Their needs are going to vary, and they need to be served quite differently than those in urban centres where the services are more centralized.
We know the experience of minority-language speakers differs from the majority population, but government research and the evidence base of health administrators rarely use language as an independent variable.
I will leave it there.
The Chair: Thank you, Ms. Pocock.
Sarah Bowen, Applied Research and Evaluation Consultant, as an individual: Mr. Chair and honourable senators, thank you for the opportunity to address you today.
I have a PhD in community health sciences. I’ve worked as a researcher both within the health system and as a faculty member of the School of Public Health at the University of Alberta. My research has focused on the health of underserved populations, with a particular focus on analysis and synthesis of the evidence of the impact of language barriers on health and health care. I have published a number of papers on this topic, beginning with a report for Health Canada in 2001, and I’ve updated this work in several subsequent projects.
Rights to language services differ across the four Canadian minority-language constituencies: official-language speakers living in minority situations, speakers of Indigenous languages, immigrants speaking languages other than English and French, and those who use sign language. However, research shows that the impact of language barriers is similar across these diverse populations.
There is strong and consistent research evidence on the negative impact of language barriers, not only in accessing and receiving formal health services but also participation in health promotion and prevention activities such as management of chronic conditions, cancer screening, childbirth and education programs. Individuals who are not fluent in the dominant language also face barriers to ambient information such as health information received through the media. These barriers are especially important in times of emergency, such as the COVID pandemic.
A language barrier greatly increases the risks of misdiagnosis and inappropriate treatment. We cannot have safe, equitable or ethical care without clear communication. In an analysis I undertook for the Winnipeg Regional Health Authority, I found that 26 of 31 patient safety risks they identified were directly impacted by language barriers. Risks of a language barrier may increase due to the aging process. Elders commonly lose their second language fluency even if they have lived and worked their whole lives speaking the dominant language.
In addition to direct risks to patients, failing to address language barriers affects us all. If presentation for care is delayed, higher intensity services may be required. A language barrier is often associated with increased resource use and length of hospital stay. Repeat visits, additional testing and treatment of complications contribute to inefficiencies in an already stressed health system. Organizations are also placed at risk by failure to obtain informed consent or protect the privacy of patient information — other risks of unaddressed language barriers. Failing to address language barriers is costly.
The research also provides evidence on appropriate responses to addressing language barriers. While it is generally agreed that health services provided in the patient’s preferred language is the best and safest response if the provider is fluent in the patient’s language, this may not always be feasible. In such cases, provision of trained, confidential interpreter services is an excellent second choice. Unfortunately, such services are very often not available, resulting in reliance on family members, volunteers or other ad hoc responses. This response brings many risks.
In spite of compelling research evidence in Canada and internationally, awareness among decision makers of the risks of language barriers remains low. A key challenge today is to promote recognition of evidence of these risks, not only to patients but to the health system itself. There’s also a need to work toward more accurate and consistent data collection of not just patient language but whether language-congruent care is provided. This is needed in order to enable robust research on this important topic.
Thank you. I have not prepared additional materials for this committee, but many of my papers and presentations are available, some of them in translation, and I would be happy to provide the committee with a complete list.
The Chair: Thank you, Ms. Bowen and Dr. Pocock. We are now opening the floor for questions.
Senator Moncion: My question is for Ms. Pocock. You are the author of an article published in 2021 in the journal Minorités linguistiques et société entitled “Quebec’s English‑Speaking Community and the Partnership Approach of Its Networks in health,” and you were referring to that study. In this article, you highlight the importance and potential of forming networks and partnerships to improve access to public health services for official languages minority communities. Could you tell us about that network on health and services and the various partnerships that exist right now in Quebec in that matter? What are the winning formulas for improving access to service through these partnerships, and what are the challenges?
Ms. Pocock: Thank you for the question.
I know that you have received a brief from Community Health and Social Service Network, CHSSN, and in that article they are essentially the model that I explore for partnering and networking. CHSSN is a provincial organization, and they understand themselves to be a network. They have 22 networks around Quebec. That’s called their networking, their NPI, sorry about the language, but you sort of get the picture and why we can call it a network. They’re located in all these different regional communities that I pointed out. One of the advantages of that networking is their ability to work with their regional communities and understand the nature of those communities and how they are distinct from one another.
The partnership part is that in these community organizations, some of them have been around a while so they historically have been present in their regions but now have taken on the mandate of improving the situation regarding health and social services, so they are an organization typically known by their local community, especially the minority language community. In their partnership approach, they go to the health system, and I mentioned the regional access committees. They are proactive in going to those committees and inserting themselves. Some of them become leaders of those committees, even though it is a committee forged by the system, if you like. Through those committees, they become participants in the planning for access to health and social services in English. Throughout all of them, they provide an evidence base regarding the English-speaking communities and their health needs that otherwise that committee would not have access to.
CHSSN and I, with funding from Health Canada — of course, there is never enough funding — have been working for some 20 years in developing an evidence base using census data, survey data, interviews, consultations, panels, you name it. We’ve managed to come up with an evidence base that is regionally nuanced, and we’ve looked at and tracked those changes over time. With the survey data, we’re able to look at the experience within the system itself. We look at five medical situations, doctors in a clinic, what’s the situation in an ER, and how do you access information?
We have armed those organizations, each one participating in a network, to provide that knowledge base for the regional access committees, who then have quite welcomed this knowledge because they are mandated to provide services in English, particularly where there are designated institutions, obviously. That partnership starts right there, and they work together and have increasingly come to rely on one another. More and more, the community organizations find themselves called upon by the system to provide information on the local community so that they can then develop programs that are appropriate to that community.
One of the things that has come out of that networking and partnership is something called the liaison model. This is where you have patient navigators, as they’re sometimes called. You have outreach workers and so on who actually accompany community members, because this organization is beautifully placed to be a mediator between the community and the system. They know the community and its needs, and now they know the system and the difficulties that health professionals face in trying to, in fact, live up to their mandate and grant these services. These liaison workers accompany community members. They’re very proactive in all areas of the medical system. They might show up at an emergency room, which happens to be where anglophones frequently show up because, as Sarah pointed out, due to the delays they experience, they often will push their medical issues to a point of crisis. They then find themselves in the ER, where the likelihood of finding service in English is actually low, and, of course, it’s very costly for the system, as Sarah was also pointing out, to treat problems when they reach that level.
The partnership model has laid the ground for the possibility of this patient navigator, of having someone who can accompany the English-speaking community member and help them navigate the system, which for them, as you’ve heard, is just a maze, and help them at the point of service, translate, access documents, literally understand what’s going on, help them understand what their diagnosis is and what treatment entails, for example.
Did I answer your question?
Senator Moncion: Yes, you have, and it’s very good. You said they receive funding from Health Canada?
Ms. Pocock: The CHSSN receives funding from various sources, and I am not an expert on that. I would let Jennifer Johnson refer to that, but I know their NPI or this network program is at least in part funded by Health Canada, yes.
Senator Moncion: Thank you.
Senator Poirier: Thank you both for being with us today. It is greatly appreciated.
A lot of what we’re hearing is not only happening in the English minority in Quebec; it’s also happening in francophone minority situations across the country. There seems to be issues all over. We hear often that sometimes the money part could help, with more funding coming in. At the same time, we are also hearing that even if the funding was there, you question it and wonder if we have the manpower there across the country to be able to offer enough of the services we need in both official languages.
That brings me to a question that I have. It can be to Ms. Bowen and also to you, if you want to comment on it. What are your thoughts on new health technology and the challenges and the opportunities for better health care access to the language of their choice? Is that something you think could help the situation by health care technology, specifically when there is a shortage of manpower? Is that somewhere we can go, and would that help?
Ms. Pocock: Would you just give us an example of the health care technology you’re referring to?
Senator Poirier: Well, right now — I don’t know if it’s across the country. I know health care is normally under the provincial umbrella. I know, for example, in New Brunswick, when you go into the health care system — we are an officially bilingual province — any doctor in the province can have access to your file, no matter where you go. With the new technologies they have now, like eVisitNB and things like that, people can connect and talk to a doctor online through the new technology instead of going exactly to the doctor’s office. Sometimes, if you’re in a remote area where the language of your choice is not available, the technology could maybe offer you a place within your own province to talk to somebody in the language of your choice, at least as a first step. Some medical issues can be dealt with without going on.
When it comes to seniors, it does become an issue, though — I’m aware of that — because it’s something new to them that they’re not used to it. Some of our seniors, depending on the age, don’t understand this new technology. They don’t know how to connect to it. It seems overwhelming for them, so it’s not always the solution.
In some areas, we’re having issues trying to recruit the manpower we need in the language of the patient’s choice. The funding may be there, but we don’t have the manpower. I’m wondering if that’s a challenge, or is there an opportunity there?
Ms. Bowen: I think there are opportunities.
There are two main approaches to dealing with language barriers. One is that you make sure it’s a language-congruent encounter. The other is that you have trained professional interpretation. Technology actually has far more potential than we’ve ever used to deal with both of those, for example, to link a minority-language speaker to a provider in another location or to provide trained interpretation. Both of those could be done much better than it is being done now. One of the — I won’t say an upside, but one of the impacts of COVID is that it has made us more aware of the potential as well as some of the downsides of technology.
Another area that is getting better but needs to be dealt with, with caution, is our translation apps. They can be lifesavers in some situations, and they’re much better than they used to be. When I was first analyzing that, I was saying, “Stay away from those because the risks are too great.” They are getting better, but we really need to have caution when those are used.
So, yes, I firmly believe there is more potential. We’re not putting enough really serious thought into using the new technologies but also into making sure we’re meeting the standards of what we would accept in appropriate care when that happens.
Ms. Pocock: One of the things that leaps to mind is the incredible barrier posed by the telephone. The complaint so frequently heard is, “We try to phone, and we’re sent on this merry path of ‘Go here; push this button,’ and so on. We don’t get an answer at all or, when we finally get there, it’s a message in a language we don’t understand. All we can do is hang up and hope that we’re contacted in some other way.” That makes me a little skeptical about the technology just because we have on record the extent to which that is so discouraging and will discourage individuals from pursuing services at all.
By the way, I support Sarah in saying these should be looked at and these can be improved. I like the idea of the app for translation.
I think it’s important to recognize the limitations of online consultation, especially with an expert from out of province, potentially, or even out of the region. First of all, there is getting a thorough diagnosis online. I think we are all somewhat inhibited by that when it comes to certain kinds of health issues, right? It could work in some and not in others. But the follow-up has to be local. You go online and get a diagnosis from a doctor at a distance, but then you need to follow up, know where to follow up, how to follow up and where to find English-language services in your treatment. To me, inevitably, it will boil down to some of the very same issues that we have.
Certainly, getting an accurate diagnosis and having a conversation where you understand that diagnosis and understand where to get it treated, how to get it treated, that is a huge missing piece for so many English speakers. “I wish I could have a conversation with my doctor. I wish I could leave the appointment understanding the medical language and the language in English, if possible.” Because all of us, even when it’s our first language, you can struggle when you’re in that doctor’s office. Goodness knows, you probably bring your daughter, your son, your whatever, because it takes about three pairs of ears to sort out what, in fact, is going on, especially in the more critical situations.
I can imagine technology helping to a degree. I think we can improve. We can improve on the capacity for interpretation or translation, but I also have my misgivings as to how far that could go to remedy the situation.
Ms. Bowen: I think it’s very important to be clear about what we mean by technology. When I was talking about this, I was not talking about putting people into voicemail hell, which is what a lot of people have experienced.
Certainly, look at examples. You might be able to have psychiatric services in person — or almost face to face — with a psychiatrist who speaks your language versus being limited to what you can find in your own community. There needs to be caution, but there is potential. We need to be very cautious about what we mean when we say “technology.” It may allow people to have access to services they would not otherwise have. Some of the research on distance technology — and more has been done during COVID — shows that, in some situations, some people are happier with it. So we have to be open to that potential but just evaluate it very carefully as we go forward.
Ms. Pocock: Before we leave that — I’m sorry if I’m taking too much time — there have been programs using online technology for pursuing information. For disseminating information, it’s still very good. There are programs of, “Let’s get the community in the room. Let’s bring a professional online, and they will talk to us today about autism,” or cancer or what have you. That’s something that CHSSN has been doing for years, and with great success, in the area of disseminating information generally. That does promote a conversation. It does begin building trust with the system. With preventive measures — we’ve talked about the difference between a situation of surgery and learning how to prevent these illnesses, et cetera, before we’re in the throes of them — again, technology has great potential and is already being used.
The Chair: Thank you.
Senator Clement: Thank you both for being here. If it’s not already done, it would be great to have links to the research that both of you have done in this area. It’s fascinating.
I will start with Dr. Bowen. I was interested in you saying that there are four categories of language barriers: the immigrant community, official-language speakers in minority communities, Indigenous languages and sign language. Did you say that the impact is the same? A language barrier is a language barrier is a language barrier? Across the board, it’s the same?
Ms. Bowen: I actually said similar, not the same. Constituencies, I would say, rather than categories.
In Canada, those groups are covered by different legislation. They have access to different kinds of language access services, and often different advocates, and sometimes the solutions that they want are quite different. I don’t want to underestimate the intersectionality.
What I’m talking about is the language barrier itself. Now, things may be worse or more complicated if there are other factors for some of those communities. Is my experience as a unilingual anglophone who may be visiting in Quebec and has a problem the same as an Indigenous person who has a language barrier? I would say not. But the impact of the language barrier itself and the potential for risk is there. I’m fortunate enough not to be suffering some of the other dynamics that might get into that interaction.
Senator Clement: Have you done research on the intersectionality and the different impact there?
Ms. Bowen: The focus of my research has been to look at the international literature and to synthesize it and to interpret it in the Canadian context. Have I done that research directly myself? No, I have not. Am I familiar with the research in that area? Absolutely.
Some of the earlier research on language barriers actually didn’t look at language. A lot of it was coming out of the U.S. and was focusing on race and Hispanic ethnicity. It’s only as the research got more sophisticated that they attempted to disentangle — and I think that’s the best way to put it — the independent impact of language and that of racism and of lack of opportunity in some countries, for example, not having a public health care system. Are you in the private system, or do you have nothing? The more recent research actually has done a good job of disentangling that, and what is emerging is that, in many cases, the impact of language barriers — well, it is certainly greater than that of culture. You can’t say it is greater than that of racism. We tended, in the past, to explain things in the terms of cultural differences or treating people differently because of their culture. The research is saying, no, if you allow people to speak for themselves, they will tell you what is important to them. Don’t assume something about their culture. Let them speak for themselves.
Senator Clement: Thank you, Dr. Bowen.
Dr. Pocock, you spoke about the fact that anglophones represent a certain percentage in Quebec but they are under‑represented within the health care sector in terms of providing services. I’m wondering about the reason for that and the impact of that, particularly in the area of mental health services. Could you comment on that?
Ms. Pocock: If I go into the census data and look into the health and social services industry, as Statistics Canada would refer to it, and I look at the various professions — you mentioned mental health, and I would note that the rate of psychologists and psychiatrists who come from the English‑speaking community is markedly low compared to francophones. So you can imagine how that plays into mental health. It is an area of health where language itself is the tool. It is the cure. It is the path to the cure. How can we undertake those cures and healing processes when we’re not using the same language or comfortable in the language being used?
It happens to also be an area where having an accompaniment, having your caregiver come with you or having your family member come with you, can be very defeating. The process is undermined in the presence of my husband in the room translating for me and so on. It’s an area that just doesn’t lend itself to having an interpreter on the scene and working with that, or the app on the phone or something like that. You can imagine where that is the problem.
In terms of generally the representation in the health system of individuals from English-speaking communities, you ask why is that? To be frank, I’m not sure that I can answer that question. One thing about the English-speaking community is it’s very diverse and much more diverse than its majority counterpart, in terms of visible minorities, in terms of religious affiliation, for example, in terms — we could name others. The anglophone community has many more newcomers and a much higher rate of immigrants in its population. As we know, a lot of those individuals face barriers in terms of certification and participation in the health field. A lot of the taxi drivers do arrive here being qualified doctors, but they can’t enter the health system. I know that’s at work. There’s an interest in looking into that and seeing if that can be remedied in some way.
In general, the engagement of the anglophone community with the health system is poor. There are fears surrounding the health system. It’s not easily engaged. I would imagine that that would affect the likelihood of a young person wanting to enter that kind of training and participate in the system. Rumour has it that the language testing is so rigorous that it’s discouraging right off the bat for anglophones, that it is too rigorous. But, again, I’m not in a position to answer that. I don’t want to pretend to know why that low rate of participation is there. I can only tell you that the numbers show it to be so.
Senator Clement: Thank you both for your work.
The Chair: Thank you.
Senator Mockler: To the two doctors, congratulations and thank you for coming in.
I have a few questions on the knowledge that you have of this history. I would like to have your opinion on the following: In the last 20 years, have we had any progress in providing services to our people?
[Translation]
Ms. Bowen, you’ve done a lot of work, it seems, with Société Santé en français. How do you compare what Société Santé en français offers to francophones versus anglophones living in a minority situation outside Quebec?
[English]
Ms. Bowen: I’m really not capable — I don’t have any background in order to answer that question.
Senator Mockler: But you did studies, according to the information that we have, with Société Santé en français?
Ms. Bowen: They commissioned me for one of the research reports I did. That was an update on one of the ones that I did earlier for Health Canada, but I didn’t work for SSF. I have also had interactions with and done presentations for and provided consultation for CHSSN as well in the past. I don’t work for a particular organization.
Senator Mockler: Ms. Pocock, any comments on the question?
Ms. Pocock: I’m hearing the question as: “Have we seen progress and improvements?”
I’m going to go back to the partnership and networking approach and talk about the results that have come from that. Definitely there is an increased awareness at the regional level vis-à-vis their system, especially if they’ve been working with these regional access committees.
There is an increased awareness of the situation of the English-speaking communities and patients. When things began for CHSSN 20 years ago — and I’ve been supporting them in research as a third-party researcher — they would knock on the doors of these potential partners and collaborators, and the health system was surprised to find there was an English-speaking community in the area. They were literally invisible, depending on what region you were in. That partnering and collaborating and the proactive approach of the community organization that opened doors began with awareness.
There is an increased awareness of services that are available by the community, an increased awareness by the system, by the health professionals and so on, of that local community, so that is progress. In terms of these regional access committees where, for example, you have such leadership by the community organization providing the evidence base and the knowledge that the system, in fact, needs to develop its program and act on needs, that has been extremely important, and if I could get a health professional in the room, they would tell you the degree to which they are relying on those English-speaking organizations and how their knowledge has increased. So there is an improvement there.
Of course, there are all kinds of intangible improvements, like the increased trust in the system, the increased likelihood not to delay but to go to the system for the help that I need, and an improved awareness of the prevention program in my community so I can be on track for preventing cancer in my future and what have you. There are improvements I have noted, and an increased satisfaction for all parties involved. There has been some surveying of health professionals, et cetera, who themselves feel that they are more successful in their work because they’re aware and can communicate with these individuals who they could not manage the situation with before.
The Chair: Dr. Bowen, you wanted to add something?
Ms. Bowen: Yes, just a quick word about progress.
There has been some very good work and initiatives done to try and address the need for language access. I’m not going to talk specifically about the situation in Quebec, but across Canada and with other language constituencies, it is very, very spotty. In some areas, there has been very little progress at all. For example, if I were an immigrant arriving in most places in Canada right now, I don’t think that the services would be necessarily any better than they would have been 20 years ago. That’s not to underplay that there has been some really strong initiatives, but they are not consistently funded, they are very rarely built into health system policy, and they vary between the language constituencies themselves.
Senator Mockler: With the experiences you two have, you know Canada, without a doubt. Have you been consulted on Bill C-13, and, if so, when, and what have you recommended?
Ms. Bowen: No, I haven’t.
Ms. Pocock: No, I haven’t.
The Chair: Thank you.
We are almost at the end of our meeting, but I have two quick questions, or one quick question and maybe one longer one.
In your opinion, should language be a determinant of health? We know that determinants are taken into consideration when they are creating programs. Do you think that language should be a determinant of health? Do you have ideas on that?
Ms. Bowen: Well, I think it’s difficult to say language is a determinant of health because it depends where you are speaking what language. Now, is the ability to communicate in the dominant language a determinant of health? It is, because it affects access and it affects quality of care, but I’d be very cautious about saying language is a determinant of health. If you are living in New Brunswick, you are more likely to be poor if you are a francophone. That may not be the case in other provinces. It actually has to do with what language is being spoken and what access to services are there in addition to any prejudices and biases that may be in the system.
Ms. Pocock: Certainly, where there are language barriers, we see a negative impact, and where there are no language barriers, there is a better quality of life and access to services. There has been research that’s actually looking at the francophone community in Ontario. It’s very clear, and the evidence underlines the fact, that if you want to live, and if you want to live as long as you can, make sure you get access to services in your own language. The comparison, the evidence, is clear. Whether that is to say language is a determinant of health, I don’t know, but I tend to think of it that way because I just see the difference between those who are dealing with barriers and those who aren’t. Certainly, where it is compounded with socio‑economic status, for example, the evidence is clear that it marks the difference between quality of life and a lower quality of life.
The Chair: Thank you.
To conclude, what should the federal government do better in terms of federal transfers or other initiatives to help tackle the issues around language barriers? Do you have any ideas on that, Dr. Bowen? We are doing a study, and we will produce a report, and it will go to government. Do you have any ideas to conclude tonight?
Ms. Bowen: Well, of course, it is very difficult with health being a provincial responsibility.
The Chair: Yes.
Ms. Bowen: But I think of the issue of promoting standards and requirements in terms of funding for certain standards to be in place, and also that responses are based on evidence. Some of the responses and what we’re putting funds into is not based on evidence. Those would be the two suggestions I would make.
The Chair: Thank you.
Dr. Pocock?
Ms. Pocock: I would support Ms. Bowen in that statement.
In the models and the approach to health that I’ve shared to you, where successes have been seen, Health Canada has investment in those, and they should have confidence to continue supporting those and, perhaps, to support them even more than they have. The liaison, model, for example, that I’ve suggested, works. It’s effective. It seems to work with the nature of the English-speaking population and its various characteristics, et cetera.
The Chair: Dr. Pocock and Dr. Bowen, thank you so much for your presentations and this great conversation here. It will help us.
Ms. Bowen: Thank you for the opportunity.
The Chair: Colleagues, that concludes our testimonies today, but before we close, we will move in camera.
(The committee continued in camera.)