THE STANDING SENATE COMMITTEE ON OFFICIAL LANGUAGES
EVIDENCE
OTTAWA, Monday, April 24, 2023
The Standing Senate Committee on Official Languages met with videoconference this day at 6:02 p.m. [ET] to continue its study on minority-language health services.
Senator René Cormier (Chair) in the chair.
[Translation]
The Chair: Good evening. My name is René Cormier, senator from New Brunswick, and I am currently the chair of the Standing Senate Committee on Official Languages.
Before I begin, I would like to invite the members of the committee present today to introduce themselves, beginning on my left.
Senator Poirier: Rose-May Poirier from New Brunswick.
Senator Gagné: Raymonde Gagné from Manitoba.
Senator Mockler: Percy Mockler from New Brunswick.
Senator Loffreda: Good evening and welcome to the committee. Tony Loffreda, Montreal, Quebec.
Senator Clement: Bernadette Clement from Ontario.
Senator Mégie: Marie-Françoise Mégie, senatorial division of Rougemont, Quebec.
The Chair: I want to welcome you, colleagues, and the viewers from across the country who are watching.
I would like to point out that the lands from which we are speaking are part of the unceded traditional territory of the Algonquin Anishinaabe people.
[English]
Tonight we continue our study on minority-language health services.
[Translation]
We are pleased to welcome Antoine Désilets, Executive Director of the Société Santé en français, and Jacinthe Desaulniers, Executive Director of the Réseau des services de santé en français de l’Est de l’Ontario. We are also pleased to welcome, via video conference, Pierre-Louis Roisné, Executive Director of Réseau Santé Nouvelle-Écosse, Frédérique Baudemont, Executive Director of Réseau Santé en français de la Saskatchewan, and Audrey Fournier, Executive Director of the Fédération franco-ténoise
Good evening and welcome to the meeting. We are ready to hear opening statements from each of the speakers, beginning with Mr. Désilets. A question period with the senators will follow. Mr. Désilets, the floor is yours.
Antoine Désilets, Executive Director, Société Santé en français: Honourable senators, the Société Santé en français is a non-profit organization that increases access to French-language health services in Canada in collaboration with 16 provincial and territorial health networks, that four of my colleagues are a part of.
I would like to congratulate you on your leadership and on the initiative that was taken to launch this study on health services for official language minority communities.
I am here today to talk about the importance of French-language health services in Canada.
While nearly 100% of Canadians use health services each year, francophones still have inequitable access to quality services in their language. According to a recent consultation conducted by Health Canada in 2022, two thirds of francophone respondents had no or only partial access to French-language health services. It is therefore estimated that close to 700,000 francophones in minority situations are directly affected by their lack of access to French-language health services.
Research clearly shows that language is an essential dimension of health and that linguistic discordance is associated with a significant decrease in the quality of services provided and the safety of users. This is reflected, for example, in less reliable diagnoses, more limited treatment options or longer hospital stays, to name only a few issues.
Language discordance also affects your chances of survival — a recent Ontario study in 2022 found that the risk of death for a French-speaking long-term care consumer decreased by about 25% when language barriers were eliminated; that’s a significant difference. In the words of one of the researchers in the study, “If you could invent a pill that reduced your risk of death by 25%, you would be millionaires.”
In practical terms, the lack of French-language health services meant that a young person in the Barrie, Ontario area was involuntarily committed to a mental health centre for an extended period of time because he did not respond well to the treatment offered to him in English — this young person spent two weeks instead of three days in the institution. A senior in Prince Edward Island with dementia went for weeks without speaking to anyone and was perceived as difficult until she was spoken to in French; a person in northern Ontario had the wrong leg amputated as a result of critical communication errors; a 64-year-old francophone woman in Manitoba died of undetected pneumonia in a hospital because she did not speak English; she had been labelled as a difficult patient.
These few examples are illustrations of entirely preventable situations. Added to these is a minority context that reinforces health inequity. Too few resources are available in French to promote healthy lifestyles. The health status of francophone communities is often not a priority for the provinces or territories, nor is it measured.
Currently, there is only one federal program that addresses health promotion in official languages, and it focuses on early childhood. This program is much needed, but many other groups also have needs, such as seniors, people living with mental health issues, youth and many others. The lack of French-language health prevention programs is a factor that affects the health status of our communities.
There are many positive things on the horizon for French-language health. Bill C-13 clearly identifies health as an essential component of the vitality of official language communities. Despite the absence of language clauses in Bill C-13 — a request repeated by several francophone organizations — the bilateral agreements governing health transfers do include a “principle of equal access to health services for equity-seeking groups and individuals, including those in official language minority communities.”
A new action plan will be launched soon, and we hope that this will lead to additional investments. Despite these opportunities, access to French-language health services faces several threats, such as significant labour shortages in the health sector that disproportionately affect minority communities. There are still major challenges with respect to the recognition of the credentials of francophone immigrants. There is an underutilized potential of health skills in Canada.
We still lack clear systemic data on the availability of health services in French, but also on the francophone communities themselves and their needs. Mental health remains an important issue, both in terms of access to a professional and prevention.
To conclude my presentation, there is no doubt that there are inequities related to language in Canada’s health care systems. This inequity has a cost. Because many governments have been slow to develop a real offer of health services in the language of francophone communities, this cost now takes the form of physical and mental pain, misunderstanding among francophones, anxiety, accidents due to poor communication, and so on. Every day, as francophone communities, we pay this cost of health inequities. We can and must do otherwise. Thank you for listening to me.
The Chair: Thank you, Mr. Désilets. We will now hear from Ms. Desaulniers.
Jacinthe Desaulniers, Executive Director, Réseau des services de santé en français de l’Est de l’Ontario: Mr. Chair, honourable senators, thank you for this opportunity to address you on this study on minority language health services. This study is of vital importance to official language communities because when you are sick, you are not bilingual.
First of all, I would like to talk about access to health services in the minority language, which is an issue that persists and has certainly become more pronounced with COVID.
For example, Ontario is one of the few fortunate provinces where there has been provincial health care legislation since 1986 and where there is a high concentration of francophones — over 600,000. I am sad to say that in half of the regions, half of the province, there is no designated health service offering, according to this French Language Services Act.
That means that there are no guaranteed health care services in half the territory, no long-term care beds, no mental health and addiction services, no primary care services, no telemedicine services, and I could go on. So, if francophones are receiving health services in French, it’s a happy accident.
In addition, COVID has unfortunately weakened the supply of health services, which has sometimes made designated services unavailable in French, even in our flagship institutions, such as Montfort and Hawkesbury, to name a few.
We all know that the essential ingredient for providing health services in French is human resources who are able to communicate in French. We also know that there is an unprecedented labour shortage affecting all health care professionals. What is less well known is the fact that there is a chronic undervaluation and under-optimization of human resources capable of delivering services in French.
For example, in Ontario, there are approximately 3,500 designated bilingual positions that are not filled, but there are just as many human resources capable of delivering services in non-designated positions.
This is a huge opportunity cost, a mismatch between capacity, supply and need.
Finally, I respectfully submit that the federal government must continue to play a leadership role in developing data on official language minority health services and in promoting the governance of this data by official language minority communities.
Let me explain. The data I just cited on access and human resources was collected and analyzed by OZi, an organization related to the Réseau des services de santé en français de l’Est de l’Ontario, which was created by the minority in response to a pressing need for data.
Today, OZi is a federal non-profit organization funded largely by federal transfers to the provinces, including Ontario. However, in 2020, after three years of data collection and analysis by OZi, Ontario decided to repatriate this data collection and analysis, along with all the intellectual property associated with it.
Since that time, the data is no longer publicly available. The data is no longer available to the francophone community. As a result, secondary analyses, such as the one on human resources, can no longer be commissioned by francophone community organizations and used for better health system planning. This is a great loss for the communities, and it is an unprofitable federal investment.
In conclusion, I will make two observations and one recommendation.
First, access to quality French-language health services remains an important issue for official language minority communities.
Second finding: The human resources that are able to deliver services in French are not optimized.
I also have a recommendation: The federal government has a leadership role to play in ensuring that data on the supply of, demand for and access to health services for official language minority communities are collected, analyzed and controlled by these communities.
Thank you for listening, and we look forward to continuing the conversation.
The Chair: Thank you very much for your presentation, Ms. Desaulniers.
I will now give the floor to the Executive Director of the Réseau Santé en français de la Saskatchewan, Ms. Frédérique Baudemont. The floor is yours.
Frédérique Baudemont, Executive Director, Réseau Santé en français de la Saskatchewan: First of all, I would like to thank the members of the committee for having representatives from our regions here today. Senator Raymonde Gagné, you are one of the founders of the Réseau Santé en français du Manitoba, and your commitment to the francophonie is recognized by the entire community.
I would like to make special mention of my colleague Annie Bédard, who has told me about the important work you have done in Manitoba.
I would like to begin by talking about a few things that illustrate the reality of our region and our provinces.
First, we have a relatively low demographic weight: In 2016, people speaking French and English represented 8.6% in Manitoba, 6.6% in Alberta, 6.8% in British Columbia and 4.7% in Saskatchewan.
In addition, we have a francophone population scattered over a large territory, with some concentrations in urban centres; St. Boniface is an example, as are a few large cities in other provinces and territories, but there are also many francophones who live in rural communities and are doubly isolated.
There is also a legislative context that is not very conducive to engagement; there is a lack of legislation regarding access to French-language health services; and there are sometimes French-language service policies that are, for the most part, not very prescriptive.
In Manitoba, I must say that four of the five regional health offices are designated bilingual and that there are several institutions, such as the St. Boniface Hospital. I am not going to say more about Manitoba, because I believe that Senator Gagné has much more knowledge than I do.
However, it must be recognized that designated bilingual systems are virtually non-existent in other provinces. Governments, departments and other health structures do not, most of the time, have the reflex to include a francophone lens in their strategies and their analysis of health needs.
The absence of language clauses in health transfer agreements generally results in a lack of commitment by our health care systems to offer health care services in French to francophones.
However, there are hopes and expectations.
In Saskatchewan, within the provincial health authority, a first initiative has been implemented to identify the bilingual capacity of the health system. Beginning to educate the system about active offer, and funding an empathic listening line — the TAO Tel-Aide line — is particularly important for us, especially after this period of COVID, where we have seen an increase in anxiety and depression issues.
This multifaceted initiative is encouraging, but it is tied to one-time funding from Health Canada that ended on March 31, 2023.
A long-term investment would allow us to move on to the next steps, which are to implement an active offer of French-language health services, to make access to the crisis line permanent, and to equip and support health care professionals.
The signing of the bilateral health agreements, which Mr. Désilets mentioned, is a source of hope. We have high expectations for the equity clause, especially for official language minority communities. In Alberta, our colleague Paul Denis is very encouraged by the openness shown by the ministers and public servants. The Réseau santé Alberta has been invited to prepare an action plan for the francophone community. However, all of this depends on the goodwill of decision makers and the approach is not the same everywhere.
I will take some time to talk about the role of our networks in the absence of formal health services. The networks have a key role to play, especially where francophones have little or no access to French-language services.
In Saskatchewan, we have developed a system to accompany patients to their medical appointments. Nearly 90% of users are newcomers.
In partnership with the Faculty of Medicine in Saskatoon and the University of Ottawa, we have developed simulated patient training in language skills for health students. Today, patients are trained across the country and we offer simulated clinics nationally.
Our health networks are addressing the lack of active offer by identifying French-speaking health professionals in our country, and publishing this information for francophones.
Beyond health care, we call on our health professionals to support communities in health promotion and prevention through our forums, symposia and workshops; all the networks hold such events.
Our health networks across the country have expertise, and we feel it is very important to recognize, utilize and build on that expertise.
In conclusion, I would like to say that while respecting provincial jurisdictions, it is important to invest in the long term to enable all health players to act together to actively offer French-language health services to our francophone populations living in minority settings.
Today, access to health services still too often depends on ad hoc and random funding and the goodwill of decision makers.
Our hopes lie in the implementation of a long-term vision, particularly in the context of the new Action Plan for Official Languages.
Thank you.
The Chair: Thank you, Ms. Baudemont. I will now give the floor to Ms. Audrey Fournier, Executive Director of the Fédération franco-ténoise. The floor is yours, Ms. Fournier.
Audrey Fournier, Executive Director, Fédération franco-ténoise: My name is Audrey Fournier and I am the Executive Director of the Fédération franco-ténoise, which is the organization responsible for the Réseau TNO Santé, the French-language health network in the Northwest Territories.
Thank you to the members of the Senate committee for giving us the opportunity today to talk about our particular context and to highlight some of the health issues facing our official language minority communities. For these communities, access to equitable health services in French remains a real issue, even though all three territories, Nunavut, Yukon and the Northwest Territories, have legislation recognizing French as an official language.
Today, I am going to talk mainly about the context of the Northwest Territories, because that is the one I know best, but several observations will still apply to the reality of the other territories. In the Northwest Territories, because of the territorial law, the government is obliged to provide services in French to its citizens. We have a number of interesting achievements, including a Francophone Affairs Secretariat, an Office of the Languages Commissioner, standards for French-language services and communications and, of course, a concept of active offer of services in French.
We are in a good position compared to other communities in Canada. However, and despite obvious work on the part of the territorial government to make communications available in French, getting health care services in French remains very difficult. A survey conducted by the territorial government on user satisfaction with French-language services showed that in 67% of the cases reported, the francophone patient did not receive services in French.
Active offer is made in less than 50% of cases and even when it is made, it does not necessarily result in service being provided in French afterwards. These figures are quite worrisome for us and have an impact on our communities. As my colleague mentioned earlier, not receiving service in one’s own language can have negative impacts on the patient and their health.
More generally, the absence of services in French also has an impact on the vitality of our communities. For example, we have seen some families who have had to make the heartbreaking choice to leave their community because they were unable to obtain speech therapy or child psychiatry services for their children. In order to reduce health inequities and improve the health of communities, we must therefore go beyond active offer and plan for the delivery of health services in French. We need to know the needs, have data, and train and recruit bilingual staff. For years, in the Northwest Territories, the designation of bilingual positions has been postponed for fear of hurting the rest of the population by keeping positions vacant, because it is more difficult to recruit bilingual professionals.
Francophone communities should not be left behind for administrative reasons or lack of political will. Residents of the territories are already vulnerable due to geographic remoteness and often have to navigate a second health system to access specialized services in another province. This significantly increases navigation, coordination and communication challenges and risks to the patient.
To support improved health outcomes for official language minority communities, we encourage the federal government to be proactive and take a leadership role on this issue. In the Northwest Territories, for example, 100% of the funds invested in French come from the federal government. The federal government can demand accurate and comprehensive accountability so that funds are not used to create the appearance of services and are actually used to increase the capacity of the health system to meet the needs of patients in their language.
Similarly, we believe that language clauses in federal-territorial health and social services agreements would ensure accountability of territorial governments and better access to French-language health services for our communities. In this sense, they are an indispensable tool for real health equity across Canada. Thank you.
The Chair: Thank you, Ms. Fournier.
Pierre-Louis Roisné, Executive Director, Réseau Santé Nouvelle-Écosse: Mr. Chair, honourable senators, members of the Standing Senate Committee on Official Languages, the Acadian and francophone communities thank you for this opportunity to appear before you and contribute to this essential study on minority language health services. My name is Pierre Roisné and I am the Director of Réseau Santé Nouvelle-Écosse.
In Nova Scotia, as in other provinces, French-language health care faces similar challenges. French-language health services are haphazard, based on goodwill and not organized in a systemic way.
There is a lack of knowledge or awareness of the importance of language in health care delivery as well as legal obligations and even the existence of Acadian and francophone communities. Information on the language of the patient or on health care professionals is not collected. These issues have a significant impact on the health and well-being of members of the francophone community, particularly seniors.
In Nova Scotia, the francophone population is older than the general population. Statistical variables also show that francophones aged 65 and over are more likely to be disadvantaged with respect to the determinants of health than the general population. Despite this, Acadian and francophone seniors and their families are faced with the lack of a dedicated strategy for French-language health services.
In some counties in Nova Scotia, one in three seniors is francophone. However, no home or part of a home is designated bilingual and there is no structured offer of French-language health services. Although it is an essential premise for any health service planning, the language of patients is not captured in a systemic way. In a survey of long-term care homes conducted last year, the majority of respondents indicated that they had no mechanism to collect data on the languages spoken by residents.
These language barriers impact not only seniors, but also their families. One community member told me that she was relieved that her mother died in the hospital rather than being placed in a long-term care home during the COVID pandemic. At the hospital, she could be present to translate the directions of the hospital staff and accompany her mother. Placed in a home, her mother, suffering from dementia, would have received no services in French, and her daughter would have had to live with the guilt of having let her mother die completely isolated.
However, initiatives in Ontario, Manitoba and Prince Edward Island have shown that it is possible to set up adapted environments to ensure quality of care and a suitable environment for francophone seniors so that they can age and die with dignity.
Canada’s aging population will increase the demand for home and community care services. Most seniors want to age in their own homes, even if they have a long-term health problem that limits their independence. It is crucial that strategies be put in place to provide quality health care in French in the homes of seniors.
Of course, there are many gaps. In 2020, in an effort to better understand the home care needs of the Acadian and francophone population, the Nova Scotia Health Authority partnered with Réseau Santé Nouvelle-Écosse and other community partners to launch The Place We Live: Understanding the Home Care Needs of Nova Scotia’s Acadian and Francophone Population.
The purpose of this initiative was to seek input from the Acadian and francophone population on home care by consulting directly with clients, caregivers and community members. Several issues were identified by Acadian and francophone clients: the lack of French-speaking resources, Acadian and francophone clients not being aware of the services available through Continuing Care Services, the lack of cultural awareness among health care professionals, the lack of regions that can provide home care services in French, and the lack of an established process to identify the patient’s preferred language of communication.
Many challenges exist, but the expertise is available and many initiatives have proven successful. As well, the provincial partners, whether they are community partners or health authorities, are on board. For example, I want to acknowledge the efforts of the Nova Scotia Health Authority, and in particular the Continuing Care Division, to be involved in these discussions.
In closing, I would like to echo the words of the seniors in our communities who, as they face their aging, are asking us very simply and very strongly, “Help us not to die in English.”
Thank you for your attention.
The Chair: Thank you very much for your presentations, which raise important issues. We’ll now move to the question and answer period. I would ask the committee members in the room to refrain from leaning too close to their microphones or to remove their earpieces if they do so. This will avoid any feedback that could have a negative impact on the committee staff in the room.
Honourable senators, as you can see, we have several speakers. We will try to keep to the usual five minutes for questions and answers so that we can hear everyone. So we will start in order. I’m going to give the floor to the deputy chair of the committee, Senator Poirier.
Senator Poirier: Thank you to all the witnesses for being with us this evening. My question is for Mr. Désilets and concerns the consultation between the Société Santé en français, the French-language health networks and the federal government. Are you satisfied with the consultation mechanisms in place? Are they effective? Do they need to be improved and if so, by what means?
Mr. Désilets: Thank you for the question. I think that the consultation mechanisms are quite effective. The last consultation received responses from over 1,500 French and English respondents; in terms of consultation for a department, that is very high. This was in the context of developing the 2018-2023 Action Plan for Official Languages. In terms of the effectiveness of the consultations, I think they don’t always generate the desired results. With Bill C-13, we saw that we needed a central agency to ensure that the various departments act in the same way.
Health Canada’s role must be well defined in the action plan and aligned with the plan’s objectives; there will be work to do at this level. It is not about consultation, it is about collaboration.
Senator Poirier: Are you holding consultations with the government?
Mr. Désilets: With the department, we have two meetings a year of the advisory committee on official language communities and there are ad hoc consultations, including the one for 2022 that I mentioned.
Senator Poirier: My second question is also for Mr. Désilets and concerns the recognition of foreign credentials to facilitate the mobility of health care workers across the country. Do you have any recommendations for the federal government to improve these skills? What role do you think the various professional associations can play in foreign credential recognition?
Mr. Désilets: That’s a good question. In terms of credential recognition, I think that at the federal level, there could be a single entrance exam for the different professions. Many provinces and territories make their own choices, which now leads to different qualifications, for example, between nurses trained in Quebec and those trained in New Brunswick. The tests are not the same.
We can add to this provincial agreements with other source countries of immigration, which also creates differences in mobility. For example, in Quebec, there is an agreement with France, which allows people to come to the country and be retrained fairly quickly, which is not possible in some places. Other provinces want to follow that example and recreate that; New Brunswick is moving in that direction now.
Senator Loffreda: Thank you to our witnesses for being here tonight, and welcome to the Senate. Let us talk about our Official Languages in Health Program (OLHP). What have been the main results achieved with this program? What impact has it had in your communities? Will it correct some of the gaps or shortcomings that you mentioned? If not, why not?
Mr. Désilets: I would like to quickly describe our intervention model. We do not offer any services in French directly. We are financed through federal funds. Our role is to influence the health sector players in the provinces and territories so that they can make the necessary changes.
In terms of impact, over the last 20 years — Health Canada has supported us for 20 years — we have built thousands of partnerships across the country. You know that health is a very complex environment. This has allowed us to position the networks, and there has been an influence on the different legislative frameworks in some provinces. Over the past five years, we have begun to build structuring and permanent tools and a regular service offer. Our role is to engage, influence and mobilize knowledge, and then to develop capacity that will enable these people to achieve the changes we want to see.
There is often a backsliding of our gains. Sometimes it just takes the election of a government or the departure of a champion in a department; there are many reasons why we make gains or have setbacks. We take two steps forward, one step back; it’s a very common situation on the ground that affects our ability to effect lasting change.
Senator Loffreda: Language is a determinant of health, we all agree on that. It is an issue, and we have heard about the gaps and shortcomings across the country. How do we address that? Do we have enough physicians and health professionals to address the gaps that we see across the country right now? You see it everywhere, in any city; there are major gaps. I totally agree that language is a major determinant of health. You talked about a 25% reduction in mortality if you speak in the patient’s language; that’s incredible. How do we address that?
Ms. Desaulniers: If I may respond... We would like to have an answer to your question, but to do so, we would need very specific data. I had the opportunity to share some of it with you for Ontario, because there was an initiative to collect very specific data. So, unfortunately, we don’t have that information.
The professional associations do not collect this information regularly; it varies greatly from province to province. What information we do have is unfortunately anecdotal, thanks to the data I have shared with you.
When we look at Ontario — there are shortages coming up — we see that there is really a sub-optimization of resources and that we could make considerable gains if there were a better alignment between language skills, needs and the places where the services are requested by patients. There are significant gains to be made with the data we have.
There is a study from several years ago — I know you are replacing Senator Moncion — in Northern Ontario that said there are enough French-speaking physicians in Ontario, but they are not well distributed. Recently, we were fortunate to do some work with OZi in Prince Edward Island, which included linguistic identity on the health card. With that, you can look at both sides of the equation and know where the demand is and where people are coming in. We also looked at capacity data and realized that we could increase the capacity to offer French-language services to francophones by more than 50% by simply making this better alignment.
Senator Loffreda: So, it is a matter of planning and strategy across the country to improve everything.
Ms. Desaulniers: Yes, exactly.
Senator Gagné: Good evening, everyone. Thank you for being here and speaking on behalf of your communities, the networks and the Société Santé en français. It is important to have this exchange.
I wanted to come back to a comment you made, Mr. Désilets, about the language clauses. I would like to point out that there were amendments made at the committee stage in the House of Commons regarding the inclusion of language clauses in agreements between the federal government and the provinces and territories. This requires discussion so that it does not fly under the radar.
I would also like to mention that the inclusion of language clauses was highlighted as a priority in the consultation summary report published by Health Canada in 2022.
When the Minister of Health was asked about this issue last week, he mentioned that he was confident about the provisions included in the health transfer agreements recently negotiated with the provinces and territories.
Have you seen the agreements, and do they contain language clauses?
Mr. Désilets: Thank you, Senator Gagné.
Thank you for setting the record straight. It was not clear in my introduction, but I greatly appreciate the work that the committee did to study Bill C-13; you did an excellent job.
Indeed, I heard Mr. Duclos say that; there is also a great deal of goodwill, and this must be emphasized. Currently, there are bilateral agreements between the federal government and the provinces that include a principle of equal access. What remains to be done is to define an action plan to implement this principle.
At this point, we have not had a clear answer from federal and provincial stakeholders as to what an equal access principle looks like. There is certainly a role for us as an organization to provide an answer to the question, but that principle has yet to be defined and there is a risk that it will be defined by political goodwill in different places.
Senator Gagné: To go back to this question of the equality principle, the federal government still has the spending power, for all intents and purposes, because it is the Canada Health Act that governs these agreements and arrangements, the granting of transfers to the provinces and so on.
I would like you to tell us whether you believe that the principle of accessibility in this act covers equitable access for official language minority communities.
Mr. Désilets: I am not a legal expert, so this is my point of view...
My understanding of the principle of accessibility is financial and monetary accessibility. It does not affect accessibility in terms of health outcomes.
Our study of the Canada Health Act showed us that it is a law that ensures the provision of programs by public health systems in Canada, but not in terms of expected outcomes for different populations.
To tie another answer to this one, since we know that there is a lack of data on health status and available services, even if the principle of accessibility allowed us to get that data — hypothetically, but that’s not the case — it would still take the best data to determine if there is really an impact. I would say to you that it’s a good lead, but it hasn’t helped us so far.
Senator Gagné: Can I ask one last question?
Should the Canada Health Act be reviewed to include a specific commitment to official languages?
Mr. Désilets: That is an excellent question. I think we can always improve our various laws. There are probably different principles that we want to see in health care in Canada that could be combined with this legislation.
My understanding is that the objective of the Canada Health Act is to cover public systems. I believe that, in the bilateral agreements mentioned earlier, if we can agree on clear action plans, on clear accountability and on data collection that breaks down the data by official language, we may have a temporary solution, which may not be permanent, but which would allow us to move forward and make progress.
Senator Mégie: My question is for whoever wants to answer it.
Given the observation that you have all made regarding the situation of French in health care and the lack of resources to offer these services to the population, how do you see the arrival of artificial intelligence to offer virtual telemedicine services or other types of services?
Could this be done in French? How do you see that happening?
The Chair: Who wants to answer that question? I’m thinking of Ms. Baudemont, but also of others who could answer that question in terms of the widely dispersed territories.... What role can telemedicine play in that?
Who would like to answer? I don’t know if I’m betraying the senator’s question by talking about artificial intelligence.
Mr. Désilets: Thank you for the question. I hadn’t planned to talk about artificial intelligence today, but I think you are right, that is obviously on the cutting edge. As someone who recently used ChatGPT myself to do some testing, what it can do can be scary.
There is a connection that has been made with telemedicine. Telemedicine is really about delivering existing services in a different way. Artificial intelligence would enhance some services. I think artificial intelligence, de facto, doesn’t really have language issues, or at least doesn’t seem to have a lot of language issues, as I understand it.
I think it can help in terms of diagnostic burden, but there will always be a need for health care professionals. We often talk about the shortage of labour. To be very transparent, it is all Canadians who will suffer from that in future in health care. There are not enough doctors and not enough professionals. There is no reason why francophones should suffer more.
I believe that means such as artificial intelligence are things that should be explored, but especially from the perspective of the Canadian health care system and in a broader sense.
Senator Mégie: In summary, has telemedicine served you well in providing health care in French?
Mr. Désilets: The experience of the pandemic has encouraged the expansion of telemedicine services. Telemedicine is another way of offering a pre-existing service. We are still living with the arrival or growth of telemedicine, and there are still issues around continuity of service. How can we ensure that telemedicine services are well matched with services that must be offered in person? There is certainly a language dimension, but my reading of the situation is that we are still in the process of determining how this will work for everyone. Also, as francophones, we need to make sure that we don’t miss the boat and that we are present. There are committees at the federal level that we sit on to ensure equity.
Senator Mégie: Thank you very much.
The Chair: I have a follow-up question. In the Northwest Territories, what results have been achieved in the pilot project to increase the availability of mental health services in French through telemedicine? Do you have any information to give us on that?
Ms. Fournier: Thank you for the question, Mr. Chair.
I would say that it is difficult to evaluate. There were different outcomes, but in terms of the telemedicine part, it was an agreement signed between the territorial government and a service provider in Nunavut, if I’m not mistaken, to provide services by phone or Skype in French, English and Indigenous languages.
I couldn’t give you specifics on accessibility. From what I have seen, there may have been a lack of communication and knowledge within the community about this new service. That can always be fixed and we can always work on that.
Otherwise, in terms of the service itself, as to whether we can realistically have good service in French consistently and without delay to get the services of a francophone practitioner, I couldn’t tell you, because I think that’s something that hasn’t been evaluated yet.
The Chair: Thank you very much.
Senator Clement: Thank you to all the witnesses; you have really given very clear testimony and it is much appreciated.
I have a question for Ms. Desaulniers, from my region in eastern Ontario, and then for Ms. Baudemont.
I will start with you, Ms. Desaulniers. “When you’re sick, you’re not bilingual”; it’s so well said! I have an English-speaking father and a French-speaking mother, so I dream in English and French. However, when I came out of surgery several years ago, I could no longer speak English. I came out of anesthesia and I didn’t speak English, only my native language. The way you said that is very powerful.
I’d like you to tell me a little bit more about the data, the local control that is lost and the fact that this data is disaggregated. I guess it’s data that talks about language and intersection with race? I don’t know. What would it take for the federal government to get back to a better system where the local level has more control? What needs to be done?
Ms. Desaulniers: Thank you for the question, Madam Senator.
I’ll give you some background on the data project. It was a provincial project that collected data on the system’s capacity to deliver services in French.
There was data on human resources, data on organizational practices and questions that needed to be asked, such as: Is the data on the language of the patient being collected and is it being matched? There was also data on French-speaking patients presenting at the various points of service. The idea behind this project was to use the data as a collective asset; reports are produced at the regional level, but also at the provincial level.
What has happened, one could say, is a good thing; the government has taken responsibility and decided to do this collection by itself.
Unfortunately, some very important functionality for communities was not included in this transfer; secondly, the data is no longer available in a disaggregated format for analysis and review.
What could the government do? I note that a significant investment of $505 million was announced for the Canadian Institute for Health Information, or CIHI, to collect health data. CIHI is an incredible organization that does great work, but I don’t know about their ability to really take a francophone perspective, and what is important for francophones, which is to produce reports that could help us and define some indicators.
I think that’s one of the things that needs to be looked at. It was mentioned earlier that the federal government has the spending power in this regard, but how do we ensure that there is francophone collection, analysis and governance of this data? I think that might be one of the things to consider.
I do not know what could be done, for example, in Ontario, because one of the things that had been ordered was that the data be destroyed, which reminded us of other times in history when important data was destroyed to the detriment of Canadians.
Senator Clement: Thank you very much.
Ms. Baudemont, you talked about newcomers. I would like to know the impact of this intersection. We are francophone, we are potentially racialized; what is the impact of all this on the needs in terms of health care?
You mentioned support services, but what does this community need?
Ms. Baudemont: This community needs support services, but it is probably the community that is most vulnerable in the immediate term when it comes to Canada. They need to be accompanied in the health care system. They need to be supported in terms of translation by our accompaniment service. That’s what we do; there’s a part that consists in accompanying newcomers to help them understand the system and so on.
The other part consists of translation and follow-up to allow these people to have a health pathway that will allow them to live better in a new country.
We know that in our communities, more and more people are arriving from other francophone countries. I would say that one of the challenges is to increase our reception capacity. One of the essential elements is work, of course, but there is also everything related to health, because people arrive with challenges and experiences; they arrive with experiences that are not always easy.
For example, we have begun to receive some funding from Immigration, Refugees and Citizenship Canada in recent years. This allows us, within the networks, to start equipping the workers who welcome newcomers to support them and give them tools. We are talking about vicarious trauma and everything that is similar to post-traumatic stress disorder after difficult experiences. These are the types of tools that are currently being used and disseminated. I think it all has to do with improving and increasing the direct collaboration that we can establish.
We are the conduit between newcomers and the health care system, to get both the system and the newcomers to understand how it all works.
A lot of effort goes into making sure that there is that dialogue and collaboration. I have to say that there is definitely progress. We’re seeing that progress, but as I mentioned earlier, it’s often small steps, because you don’t change an entire system and you don’t serve an entire population in just one, two or three years. It’s something that’s done over the long term, and that’s especially the case for newcomers.
Senator Clement: Yes, we need to go beyond one-time funding.
Ms. Baudemont: Absolutely.
Senator Clement: I really appreciate your answers. Thank you very much.
Senator Mockler: First of all, thank you each and every one of you for being here tonight and sharing your knowledge with us.
I have heard some touching and thought-provoking comments like, “Help us not die in English.” I remember the birth of the Société Santé en français organization very well. You came from far away and did a great job. Thank you to each and every one of you for your leadership.
I would like to hear from the witnesses about the following. Mr. Désilets, you said, “We can do things differently.” That’s important when we hear that from Société Santé en français. What does “differently” mean?
Give me three examples of services in French that you would offer differently to improve services. I would also like to hear from the provinces and territories.
Mr. Désilets: First, we need better legislative frameworks. This is not technically a service, but it is everything that frames the issue of services. The issue of better legislative frameworks was raised in the context of Bill C-13, but also in the provinces and territories.
Second, there needs to be a focus on population health. Currently, all or most official language support programs deal with access to health services; it is absolutely essential, access to services. However, as you noted, when there are labour shortages, there are access issues.
There are many other dimensions to health, such as healthy living, promotion and the whole context of the health continuum. Yet there is almost no investment, so I would say that we need to promote health and focus on the determinants of health.
Third, we need to recognize language as a professional skill. I won’t say any more because I will give my colleagues a chance to speak.
Ms. Fournier: To put it another way, I would say prioritize health care systems and collaboration between health care systems and the community. There was a question earlier about the impact of the Official Languages in Health Program; first of all, we need to build relationships between community organizations, health care systems and service providers. It’s something that is paying off, helping the systems to be more aware of the needs and to better respond to them.
As you can see, we are a national movement with a lot of solutions across Canada. Working with us, for a health care system, opens doors and allows for solutions. That’s really positive.
Secondly, I agree wholeheartedly with the legislative framework and a requirement for governments to deliver results.
On the labour shortage side, in our community, not just in the Northwest Territories, we also have a severe housing shortage.
We’re trying to address the labour shortage, but we’re having a huge problem finding housing for newcomers. People are leaving. They get jobs, but they can’t find housing, so they leave. It’s a one-time problem, but I wanted to mention it.
Mr. Roisné: For my part, I would echo my colleague’s idea to revalue collective impact plans in which funding is both directed to health systems, to encourage them to make changes, but also to the community setting, to support the health system.
There is a tendency to do directed funding where only one partner at the table gets funding, but the other partner is not at that table or does not get the same support to accompany the other partner. It is essential to have a table where we have funding reserved for each partner, which respects the different expertise, in order to be able to go further. The important thing is the circulation of data. It’s good to collect it, but the data must follow.
When we register the patient’s preferred language, this data must circulate and be found in the patient’s medical record. Otherwise, the question of the patient’s language has been asked once, but if the professional who wants to accompany the patient does not have the information on the patient’s preferred language, we have not achieved any change for the patient.
Finally, the system must be strengthened by relying on community initiatives. For example, volunteer training in palliative care has been developed. They are present in the community. They are there to help long-term care homes accompany patients. By strengthening the community, we strengthen the health care system and the supply of health care in French. We are certainly responding to a shortage of health care professionals, because the system is there to help long-term care facilities.
Ms. Baudemont: I’m going to come back to funding, because funding is the lifeblood of the system. We need to have a long‑term vision of access to health services in French for the communities. We need to get away from funding granted for two or three years, whether it is funding that goes directly into the health system or to the various health partners. Communication between stakeholders seems important to me. I dream of a time when, at the national level, we will be able to identify the bilingual capacity of the health system in the same way across the country and to identify the language spoken by patients. This would provide very interesting data.
For the western provinces, which have smaller populations, the first thing is to start identifying bilingual capacity, but also to support the people who have that capacity. I’m thinking of language support training, like the Cafés de Paris programs that were developed in New Brunswick; they are being replicated across the country and are supporting people who are ready to serve the community.
The Chair: Thank you. I’m going to ask a few questions. I don’t know where private institutions fit into your respective environments. Are there any guidelines for service delivery? What role could governments play to ensure that official language minority communities are not penalized in terms of service delivery in the private sector? I would like to hear from Mr. Désilets and others on this subject.
Mr. Désilets: I will let my colleagues who work in the field answer the question.
The Chair: Who would like to answer, based on relevance in the regions?
Ms. Desaulniers: In Ontario, there is a lot of talk about privatization. This is a great concern for official language minority communities, for francophones, because the legislative framework for French-language services will not apply to private institutions. Unless other provisions are made, there is no mechanism for this legislation to apply. That’s a concern for us.
The Chair: What could be the role of governments in this? Could governments play a role?
Ms. Desaulniers: They could, because they’re going to enter into agreements to delegate responsibility for delivering those services. They will fund them. There is an opportunity to impose an accountability framework. Right now, it is possible to have a good accountability framework for public services. In planning or implementation, the process is not very rigorous right now. It’s easy to foresee that it’s going to be hard to do in the private sector.
The Chair: Thank you for your response. Would anyone else like to comment? If not, I have a question for Mr. Désilets on the determinants of health. Maybe my question is for everyone. Language is not specifically a determinant of health. It is linked to culture. Should language be a determinant of health? If so, what impact would that have on program delivery and program and policy definition?
Mr. Désilets: That’s a great question. Language and culture are closely associated in terms of the determinants recognized by the Public Health Agency of Canada. Should language be a determinant of health? In my opinion, yes, and there are more and more studies and research that show that it is an issue that affects the quality of people’s health. To the question you asked — Would it make a difference? — I said the federal government’s support is focused on access to health services, which is one of the 12 determinants of health. I would hope that if a decision is made to adopt a new determinant, official languages, that it would come with programs to support that specific determinant.
The Public Health Agency must diversify its programs that affect official languages. There is a lot of will, but it is also a question of scope and target audience. That is a very good idea, but even if language were one of the determinants of health, there would have to be a change in the current priorities.
The Chair: Thank you very much.
Senator Poirier: Again, thank you to the witnesses for all their good answers. I have a question for whoever wants to answer it. It has to do with the Action Plan for Official Languages. The 2023 budget provides an additional $373.7 million over five years, starting in 2023-24, to support the implementation of the next Action Plan for Official Languages, as well as $117 million over five years, part of which will be used to support the training of nurses and care attendants. Is this enough money to fill the gap? What impact will these funds have?
Mr. Désilets: I think when you ask that question, the answer is rarely yes. It’s not enough. We spent over $300 billion on health in Canada last year, if you mix federal, provincial and territorial investments. I think it was $308 billion last year. The federal contribution is about $40 billion in transfers, but $40 million a year is allocated to the Official Languages in Health Program for two official language communities in 13 health systems. For every $100 spent on health in Canada, one cent goes to the Official Languages Program. This is not enough. It’s not just the federal government’s job to be at the table. The provinces also have a responsibility to provide their own funds for their communities. Will we see an impact? I think we will.
We managed to renew our funding agreement with Health Canada without waiting for the action plan, but this was done on the basis of the 2018 amounts. You’ve seen, as I have, that the cost of living has increased substantially since 2018. So, we’re starting this month with an effective purchasing power that’s down 8% to 9% from what we had in 2018.
That’s an effective reduction in support for official language communities. I hope that the action plan that will be unveiled soon will restore things.
Senator Poirier: What are your expectations of the action plan that will be unveiled this week?
Mr. Désilets: My colleagues have talked about it a bit, but we expect core funding for organizations, not ad hoc funding or funding for short-term priorities. We need to build capacity as community organizations.
In many cases, like the network you see here, these organizations have one or two people in Canada. Their role is to influence a health system. It’s a huge job; it’s David versus Goliath all over. We need core funding to increase our capacity to influence others and then give more back to the communities we serve.
Senator Gagné: I just want to mention that the networks across Canada are doing an incredible job with the limited resources they get, whether it’s from the federal level or others — I don’t know if there are any that get provincial funding. Anyway, I know what kind of human resources or team you have. It’s not a team of a hundred people. Hats off to everyone. I have great admiration for your work.
Right now, millions of Canadians have access to insurance that allows them to access virtual care services. Canadians are starting to want to be served much better virtually. I won’t name one company that I know well that offers virtual care by qualified and caring clinicians. They are also able to offer prescriptions and identify pharmacies, and this is done quite effectively.
Can the Société Santé en français, in collaboration with the networks, even imagine one day having a public virtual care system offered to a French-speaking clientele? We talked about the whole issue of privatization. This is a challenge. It is an issue that is coming back and will come back.
It’s a question that I’m putting to you. I don’t have the answer.
Ms. Desaulniers: You’re absolutely right that Canadians’ thinking is evolving a lot on virtual care. It is no different for francophones. Our network has over 1,000 individual members. When we survey them on this issue, we see changes between five years ago and now. The barriers have come down. We absolutely have to move forward.
To answer Senator Mockler’s question, if there is anything missing, it is rigorous service planning. This planning has a virtual component that could be used and would help us eliminate the geographic barriers, which are huge in our small communities. It starts with planning. We need to understand the needs where people are, know the capacity and match supply and demand. Telemedicine is a great way to do that. It’s not just telemedicine; virtually, there’s asynchronous care that’s done as well. This is another possibility. In our region, there have been many attempts to do this. The challenge is resources. Some regions don’t have a lot of resources — if I think of the Kingston area versus Ottawa, for instance. Even in Ottawa, there is less capacity for providers to do this. The timing may not be right.
You’re absolutely right that it’s a solution, but it takes careful planning and it takes money. We talked earlier about the $117 million for training, but if we don’t put incentives in place to better align francophone resources with francophone needs, we will continue to provide the same type of support, which doesn’t go far enough to provide access to your mother, your father, the children...
Senator Gagné: One of the things I notice is that there are health professionals who find it more attractive to go to work in the private sector, because in terms of salary, it is somewhat more competitive and they do not have to travel. All the benefits of such an environment do not eliminate the importance of having services on site. As you say, I see a paradigm shift.
The Chair: If I can add something in that context, studies show us that internet access is still flawed in many parts of Canada. The digital issue is becoming more and more important. We need to look at it holistically. There is an issue of access in particularly remote areas, the territories and elsewhere. It is an important issue for health and for all of society.
Senator Mockler: Obviously, the work you are doing is very important. We have to walk the talk, as we say back home. I would like to hear from you, Ms. Desaulniers and Mr. Désilets, about the provision of services outside our hospitals, what we call private service, a new concept that is developing in New Brunswick. We have a typical example of what is happening there.
I would also like to hear your views on another aspect relevant to the development of our French-speaking communities, namely the improvement and strengthening of Société Santé en français through daycare centres. I would like to hear what you have to say about this daycare component and Bill C-35. As currently drafted, the linguistic minority is completely absent from the wording of the government’s bill. Several organizations, including the Fédération des communautés francophones et acadienne du Canada (FCFA) and the Commission nationale des parents francophones (CNPF), are concerned about this absence, and rightly so. Do you share their concerns, and what would be the consequences for the future of official language minority communities if the bill is not amended?
Mr. Désilets: I will answer the question on early childhood and child care. You have put your finger on a current issue. I spoke earlier about a health promotion program aimed at creating healthy lifestyles. It’s specifically aimed at early childhood and it’s already linked to child care centres. It is very successful and there is a lot of interest from the Public Health Agency. The agency would like to make it permanent, rather than a one-time program that is renewed at the end, because it has seen what it can accomplish in the field.
Do I share that concern? Yes, I do. As francophone communities, we have specific issues that need to be named in the various legislative frameworks. I spoke about this earlier. In fact, the CNPF is a partner of the Société Santé en français. Its members are supporting us in our various approaches to bilateral agreements at this time, because it has seen for itself the lack of strong provisions for francophone communities in early childhood transfers. They want to learn from their own experience to ensure better health outcomes.
Do I share this concern? Yes, but I am less familiar with the details of Bill C-35, so I will stop there. As for privatization and its impacts, I’ll turn to my provincial and territorial colleagues, who have knowledge of the field.
The Chair: Thank you. Does anyone want to answer that question?
No? If not, that means the question remains, senator.
Mr. Désilets: I will get back to you with an answer.
The Chair: Mr. Désilets is committed to coming back with an answer, senator.
Senator Loffreda: We have talked about a lack of resources for health care professionals across the country. That is a reality that we are experiencing, unfortunately. In terms of finding solutions, what do you propose to do to improve foreign credential recognition and facilitate the mobility of health care workers across the country? Ontario is already doing this. What are the challenges that remain? Would this address the current gaps and provide more services in our language of choice across Canada?
Mr. Désilets: Thank you for the question. There are major immigration objectives in Canada. This is necessary, both for the majority population and for francophones. I talked about the recognition of diplomas, which is lacking. If we bring in more francophone immigrants, people have the professional capacity, but we must increase French-language health services. The more immigration there is, the more we need to ensure that the services follow to ensure that we integrate these people in the right way.
As for recognition and mobility, one of the avenues to be explored in many provinces, before talking about retraining programs and recognizing credentials, should be that you have to demonstrate the ability to speak English. People are brought into French-language programs. They settle in provinces where they are told that there is a francophone community, but that they will have to learn English. They will go to work in any field before they reach a sufficient level of English. The solution is not simple, because the requirements come from the professional orders as well as from the provinces and the federal government. A multi-stakeholder solution is needed. We need to find solutions to the recognition of credentials. This is not just an issue for francophone communities. The issue must involve all health care professionals. This imposes burdensome obstacles that I believe are unnecessary for francophone immigrants who want to engage in this process.
Senator Loffreda: Thank you.
Senator Gagné: I have a follow-up question. Are you participating in the round table with the professional orders to start discussing these issues with a view to eliminating the barriers to interprovincial migration?
Mr. Désilets: The Société Santé en français is very active in francophone immigration strategy. At the government level, there is a lot of appetite for the programs that fund francophone immigration from IRCC, but not for all-language forums.
Senator Gagné: I know there is a table that was set up by the minister with the provinces and territories. I do not remember if there are other community members around the table, but that may be something to watch.
Mr. Désilets: We are not represented there, but we would be interested.
Senator Gagné: Thank you.
Senator Mockler: We look at what is happening across the country, we set targets and we share best practices. There are 16 units within Société Santé en français. Which is the most avant-garde and modern one?
Mr. Désilets: You don’t want me to make friends. They are all equally avant-garde. In Ontario and New Brunswick, there are stronger legislative frameworks, a larger population and more capacity. In areas where there is a lot of success, there are significant challenges. In the Acadian Peninsula, there are many services in French, but when you go outside the Saint John or Fredericton area, they are hard to find. Even in the only bilingual province in Canada, there are still challenges in terms of access. The networks each have their own organizations. They are representatives of the francophone community. The strength of our approach is to adapt the major national strategies to the specific reality of each province or territory.
The Chair: As you just said, Mr. Désilets, Société Santé en français is a network of networks. That’s how the actions get to the field. You talked a lot about the accessibility of services, the lack of human resources and the lack of awareness of the services offered. I would like to know if there are specific issues around service delivery for vulnerable communities. You mentioned seniors. There are Indigenous people, immigrants. I’m thinking of the LGBTQ+ communities. Are there any particular issues or lack of resources that you have identified for these communities on the ground in the delivery of services?
Ms. Baudemont: I would say that, in relation to the LGBTQ+ communities, there is perhaps a greater awareness today. I think of the Assemblée communautaire fransaskoise, which has a pride program. I think that, little by little, there are more and more things that are being proposed, like workshops and activities, especially at the community level.
We’re seeing progress in that area. In terms of vulnerable clients, I think that seniors in our community are in the same situation as Mr. Roisné described. We have an aging community and a lot of seniors who would like to stay in their homes and live there as long as possible. There is still a lot of work to be done when it comes to French-language services in these communities.
The Chair: Do I understand correctly that there are insufficient resources to deal with different categories of vulnerable communities?
Ms. Baudemont: The resources for French-language services are insufficient in general in all sectors, but particularly for the more at-risk clienteles, certainly.
Mr. Désilets: The francophonie in Canada is evolving. One of the challenges is to recognize the intersectionality in our different communities and to recognize the fact that we are francophone as something that brings us together, but which may not be the primary identity of each person. You have put your finger on a challenge. Obviously, in order to have adapted programs, we need more funding. There is an openness and a willingness in terms of addressing the challenges that have been mentioned.
The Chair: I’d like to pick up on the comments of my colleagues to thank you for the work that you do on the ground and the fundamental role that you play for francophone communities across the country. It’s a job that is not well known or appreciated. I thank you for your contribution to our society, and also for your participation in the study we are conducting on minority language health services. It will certainly help us in the development of a report that will be useful to all, including the federal government.
(The committee adjourned.)