THE STANDING SENATE COMMITTEE ON OFFICIAL LANGUAGES
EVIDENCE
OTTAWA, Monday, April 15, 2024
The Standing Senate Committee on Official Languages met with videoconference this day at 5:01 p.m. [ET] to study, in public, minority-language health services and to consider, in camera, a draft agenda (future business).
Senator René Cormier (Chair) in the chair.
The Chair: My name is René Cormier, a senator from New Brunswick and chair of the Standing Senate Committee on Official Languages. Before we begin, I wish to invite committee members participating in today’s meeting to introduce themselves, starting with the deputy chair.
Senator Poirier: Good evening and welcome. Rose-May Poirier, New Brunswick.
Senator Mégie: Good evening. Marie-Françoise Mégie, Quebec.
Senator Clement: Bernadette Clement, Ontario.
Senator Dalphond: Pierre Dalphond, Quebec.
Senator Moncion: Good evening. Lucie Moncion, Ontario.
Senator Aucoin: Good evening. Réjean Aucoin, Nova Scotia.
The Chair: Thank you. Welcome, colleagues. I would also like to welcome one of our French colleagues, Senator Yan Chantrel, the senator representing French citizens living outside of France. We are honoured to have him with us today. Welcome to the Senate and to the Standing Senate Committee on Official Languages.
Colleagues, this evening, our study of minority-language health services continues. We are joined by researchers and organizations able to address the vulnerable communities theme, one of seven themes covered by our study.
For our first panel of witnesses, we welcome in person Jude Mary Cénat, Associate Professor and Director of the Interdisciplinary Centre for Black Health at the University of Ottawa. Welcome.
We also welcome Josephine Etowa, Professor with the Faculty of Health Sciences at the University of Ottawa. Welcome. As well, we want to welcome members of the Health Association of African Canadians, joining us via video conference. From the Université Sainte-Anne, Nova Scotia, we welcome Yalla Sangaré, Associate Professor and Director of the Department of Administrative Sciences, and Malanga-Georges Liboy, Associate Professor with the Department of Education. Welcome and thank you for accepting our invitation. We are ready to hear your opening remarks, followed by questions from the senators. Mr. Cénat, you have the floor.
Jude Mary Cénat, Associate Professor and Director of the Interdisciplinary Centre for Black Health, University of Ottawa, as an individual: Thank you, Mr. Chair, honourable senators, I am pleased to be speaking to you. I was introduced before, but I’d like to just clarify that Dr. Etowa is part of our centre and that she is our scientific director. Please keep that very important information in mind.
My initial remarks will focus on three main points, and I’ll try not to go over my five minutes. I’ll start by speaking about language as a social determinant of health, and then turn to the matter of health service delivery in French in minority communities. Finally, I’d like to talk about double or triple jeopardy minority situations, but primarily, about intersectionality.
First, when it comes to language as a social determinant, research over the past two decades has shown that, in Canada, for francophones living outside Quebec, the mere fact of speaking French is health determinant — a determinant of poor health, compared to the rest of the population. Research has shown that francophones who speak French tend to put off seeking certain health services because they don’t feel comfortable receiving care outside Quebec. This is an extremely important point.
On this point, I’d like to add that these people generally report being in good physical and mental health to the same degree as the rest of the population. That’s extremely important. It might explain certain things as we try to understand the various factors surrounding this issue. I mentioned the delay in seeking care as one important aspect, but quality of care is another. That brings me to my second point — the delivery of health services in French to minority communities.
The first thing we need to understand is that not all Canadians are in the same boat. For people who live in eastern Ontario, things are not the same as they are in the Maritimes or in Western Canada. They’re different. If you live in a rural area, they’re also different. If you’re a francophone and live in Ottawa, you will usually receive lower quality care, but out west, the quality of care is even lower. That also raises the issue of francophone community concentration and dispersion outside Quebec. The more dispersed the communities, the lower the quality of care because fewer services are available in French.
People eligible to receive care in French will often seek care in English if they speak English. Why? It’s because even when care happens to be available in French, the quality of language spoken is not really consistent with the French that these francophones speak. As a result, they often prefer to receive care in English, possibly because of a misconception that care provided in French outside Quebec is not as good as care provided in English.
The other factor to consider when it comes to care is the difficulty in retaining French-speaking health care professionals. The research often points out factors related to salaries and working conditions, but has nothing to say about another aspect identified in our research, which is the significantly greater discrimination that these professionals face. When colleagues and health professionals come from culturally and racially diverse backgrounds, whether Black or Arab, they often encounter racial discrimination. As a result, they don’t want to keep working in such services, and they leave.
This brings me to my last point, double or triple jeopardy minority status, or intersectionality. Last night, I took the time to cross-reference some data that haven’t been published yet. We just published a very important article on racial discrimination in Canadian health services. It’s the first quantitative study of this issue conducted in Canada with Black people. One third of Black people say they have experienced severe racial discrimination while receiving health services in Canada.
In our view, identifying this difference between Quebec and the other provinces was extremely important. We conducted a first study, but chose not to talk about language difference because we didn’t have enough data. Aware of the importance of this factor, we knew that we needed reliable data. Contrary to what we initially thought, Quebec is where Black people reported experiencing less racial discrimination in health services. This is extremely important to keep in mind. However, when we asked them to tell us their perception, those living in Quebec felt that Quebec was where they experienced it the most.
Another important aspect is that people confronting racial discrimination, who speak French and live outside Quebec, experience racial discrimination in health care the most. In fact, based on our understanding and interpretation of these data, they experience discrimination not only on the basis of skin colour, but also based on the language they speak. The people who experience it even more outside Quebec are immigrants who arrived in Canada within the past 10 years, speak French and are Black.
Another extremely important aspect was also examined; Black francophones age 65 and older experience even more racial discrimination in health services.
Incidentally, that’s why, if you ask immigrant or racially diverse colleagues —
The Chair: I’m going to ask you to wrap things up because time is running out. There’ll be an opportunity to say more during the questions from senators.
Mr. Cénat: These colleagues say that they’d refuse to allow their relatives to use health care services unaccompanied, because of their concerns over discrimination, not only based on language, but on skin colour too.
The Chair: Thank you for your statement.
Josephine Etowa, Professor, Faculty of Health Sciences, University of Ottawa: Thank you for the opportunity to share my research with all of you this afternoon. I will just start by the issues I see in the work that my team has done here in Ottawa, in Ontario and across the country.
Consistently, language is a determinant of health, not just health care access but the quality of health as well. Language has been identified as a key determinant. It impacts on whether people can actually go in to get these services. It impacts health care outcomes. It impacts whether they are satisfied with the kinds of services that they’re getting.
It is well documented that Black Canadians experience these multiple and intersecting factors — whether it’s gender, race, language — coming together to compound the issues they face. In our studies, while francophone Black Canadians share a number of experiences with anglophone Black Canadians, they still have additional challenges to deal with when it comes to resources, when it comes to interaction with providers and even when it comes to the availability of organizations in their community that they can go to and get some of the knowledge translation tools that we create and they may not have them in French. This language barrier has an impact on their satisfaction and their use of different services. Ultimately, it will affect costs in the system.
I want to use two of our project examples. One is a provincial study we did in Ontario — we call it the A/C Study — that looked at improving understanding of HIV-associated behaviours and knowledge. HIV is one of the areas where we see stacked inequities in our communities.
Over the last years, I held a research chair in Black women’s health in Ontario funded through the Ontario HIV Treatment Network. Through that work, we consistently saw differences between anglophones and francophones when we asked them about knowledge. More than twice the number of francophone people had no knowledge about HIV transmission and acquisition when you compared anglophone and francophone. Again, significantly fewer francophone people had high knowledge. When we look at even low knowledge, more people from francophone areas have less information or knowledge about HIV transmission and acquisition.
We know that HIV in Canada is one of those areas that affects Black Canadians disproportionately. We talk about 5% of the Ontario population, because Ontario collects data, and we make up a quarter of the new diagnoses of HIV. That has been consistent over the last decade. There’s reduction in other communities, but there’s something not happening in the Black community because we continue to have this.
We are actually worried that when we meet the UN goal of 90-90-90 — 90% of the population would know their diagnosis, 90% of those who know their diagnosis will be on treatment and 90% of those on treatment who have viral load suppression — well, that 10% can be Black Canadians and it becomes a Black disease because then the rest of the country has moved forward and addressed HIV.
These are real issues. One of the other things we have found in our study is the difference in access to a primary health care provider. The francophone group had less access to primary health care providers.
The second story I would like to point to is a national study funded by the Public Health Agency of Canada that looked at the impact of the COVID-19 pandemic on sexually transmitted and blood-borne diseases, including HIV. Once again, we saw differences. We surveyed over 1500 Black Canadians across the country. We also had 17 focus groups with Canadians, not just Black Canadians but also providers and other stakeholders that took part. They pointed again to the lack of resources for francophone communities.
They give examples. For example, in Toronto, there’s one organization somebody mentioned APAA, Africans in Partnership Against AIDS. They said this is a valuable resource that provides services in both English and French. However, they have limited resources and do not have the opportunity to partner with other organizations to scale up that kind of service that provides wider reach in the community.
One of the things they also talk about is the structural racism that exists even in hospitals. In the qualitative part, somebody described it as violence that moves from police brutality right into hospital settings. Where they feel even when hospitals are actually supposed to be in charge of francophone services, you still go there as a Black person and you feel discriminated against. You feel it’s not good for you. Somebody described it as a space of violence.
From what we found, systemic racism is a key determinant that intersects the language barrier, and any effort to address the language issue needs to address the bigger issue of systemic discrimination.
The Chair: Thank you very much, Dr. Etowa.
[Translation]
Yalla Sangaré, Member, Health Association of African Canadians: I’m here with Mr. Liboy. We’re going to try to combine our presentations — we didn’t know how this would work.
My name is Yalla Sangaré. I teach at the Université Sainte-Anne, and I’m going to speak to you about Baie Sainte-Marie, or Pointe-de-l’Église, to be precise. I’m in unceded Mi’kmaq territory. We’re very grateful for the opportunity to speak to your committee.
Today, we’re representing the Health Association of African Canadians, a medical association for African Canadians.
The HAC’s mission is to promote and improve the health of Black communities across Nova Scotia through education, research, public policy recommendations and partnerships with key players in the health field.
Obviously, some of these players are anglophones. Nova Scotia is home to a long-established African-Nova Scotian community. We joined them in the past 10 to 20 years, but they’ve been here since the U.S. Civil War.
Our goal today, since our time is limited — although we will send you a very detailed brief — is to present the results of a project we just completed.
The project was subsidized by Réseau santé — Nouvelle-Écosse and Immigration francophone Nouvelle-Écosse. It studies the health of francophone immigrants living in minority communities in Nova Scotia and their needs in terms of access to physical and mental health services in Nova Scotia.
We analyzed two things: first, the perceptions of francophone immigrants, and immigrants more generally, including the perceptions of Canadians, as well as their perception of the system and their needs. Our results supported a lot of things previously identified by our colleagues, including the fact that speaking French is already a drawback on arriving at hospitals in Yarmouth, Digby or Truro, where the staff are unilingual.
I yield to my colleague.
Malanga-Georges Liboy, Member, Health Association of African Canadians: Thank you for this opportunity.
As my colleague just said, we recently conducted a small research project on the perceptions of people with a francophone immigration background living in Nova Scotia. The study examines what these people think of their physical and mental health and their need for health services in French.
As you know, Nova Scotia is a unilingual province, but its population is extremely diverse. First of all, if we consider the province’s Black population, we note the presence of African Nova Scotians who arrived here during the slavery era. There are also immigrants. Our focus primarily concerned recent immigrants to the province, particularly francophone immigrants. By that, we mean people from Africa, the Sahara, the Maghreb region and international students. A lot of the international students attending our universities are unilingual francophones.
Therefore, in terms of issues related to health services in Nova Scotia, francophones face different challenges. Acadians are francophones too, but they’re completely bilingual and comfortable in both languages. Some even speak more English than French.
Others, however, from Africa and other francophone countries, are unilingual. Their access to health services is therefore a different matter. Health services are primarily available in English across the board. If you’re sick, you’ll end up talking to the paramedics who take you to the hospital, to doctors, generally anglophones — emergency room services are rarely available in French — and nurses, mostly anglophone, or even to specialists, who are anglophone. Therefore, anglophonie is everywhere.
People arriving in this country face a serious problem that puts them under tremendous stress. Hospitals don’t really provide interpretation or translation services. Imagine ending up in an emergency room, sick, where no one understands your language; that’s a problem. It’s what we experience here with international students arriving straight from Africa. Baie Sainte-Marie is also a rural area, and health services are not what they are in Halifax.
We face serious problems and there are currently no solutions. We’ll tell you about our research findings when the discussion begins.
The Chair: Thank you very much. You can share all that with us during the upcoming question period.
Before we begin the question period, I’d like to ask committee members in the room to refrain from leaning too close to their microphones, or to please remove their earpieces when they do so. This will prevent any acoustic feedback from negatively affecting committee staff in the room.
Colleagues, considering the limited amount of time at our disposal, I move that everyone be granted five minutes during a first round of the table, which would include the question and our witnesses’ answers. If time permits, we will make a second round of the table.
Senator Poirier: I thank all the witnesses for joining us this evening.
Mr. Cénat, you mentioned in your opening statement that the Black community receives lower quality health services in relation to language and minority status. You said that language, but also skin colour, account for this.
Do you think the same applies to other immigrants who come here, or is your group more affected by that, and why?
Mr. Cénat: In fact, there are three levels of difference.
The first level of difference is if you consider Black people generally and you compare them to white people, they will say that the health care they receive is of a lesser quality. If you compare a Black francophone person to a white anglophone person, the health care for the Black person is of an even lesser quality. If that person immigrated here within the past 10 years, the health care is of even worse quality. If the person is a Black, francophone immigrant 65 or older, the health care is the worst quality yet.
Senator Poirier: In your applications, have you contributed to any studies or received funding to help you find solutions or suggestions or even to do research? How can the situation be improved? What do you suggest? Have you ever received funding and if so, how much and from whom?
Mr. Cénat: We have received various funding from the Public Health Agency of Canada to conduct this research. First, there was a study on mental health, then a study on COVID-19. As for the Black community only, a study has been under way since October that compares the Black, Indigenous, Asian, Arabic and white communities.
Unfortunately — I should have concluded with this — these studies have barely started. This type of data did not exist in Canada four or five years ago, before the work of Josephine Etowa. Work was being done, but not at all on the intersectionality of language, skin colour and immigration status.
Studies are just starting and unfortunately, there are not a lot of solutions being proposed, but there are some solutions having to do with training health care professionals. In Ms. Etowa’s lab, in my lab and at the centre, generally, some training on mental and physical health has been implemented, on ways to provide cultural care that is adapted to language, but also skin colour. Although this training was developed at the University of Ottawa, oddly it has been implemented in the United States, but we are having a hard time getting it implemented in hospitals here.
Senator Poirier: You also mentioned in your statement that the situation for francophone minorities on the Atlantic coast and in western Canada is even worse than in Ontario. Can you speak to the situation of anglophone minorities in Quebec? Do they encounter the same problems as francophone minorities?
Mr. Cénat: This is part of the results that I tried to study yesterday evening. Oddly, there are no significant differences for individuals who speak English in Quebec compared to those who speak French. We did not find any major differences, both when it comes to access to care and, in the case of COVID-19, trust or mistrust with respect to vaccines, but also vaccination in and of itself.
Senator Poirier: To fix the problem, education, additional funding and human resources are required in order to be able to provide the care; is that it?
Mr. Cénat: First, there is training for the doctors, but the universities and colleges also have a role to play. As Ms. Etowa said, there is a systemic issue, in other words, issues that are not reviewed individually because the person doing the discriminating is going to do so based on language and skin colour.
These are issues that are systemic. They need to be addressed in the hospitals systemically, not just from a training perspective, but the hospitals also need to clearly say that these things are unacceptable. When someone is racist, they are rarely just a little bit racist. Generally speaking, the person thinks that racism is accepted in the service or within the institution. These are things that need to be looked at on an institutional level, but also at a systemic level.
Senator Poirier: Thank you very much.
Senator Dalphond: I will pick up where Senator Poirier left off to try to come up with solutions. You talked about training health care staff. Either we train francophones who will then work in areas where there is a critical mass of francophones, or we also train anglophone health care providers who are bilingual. Do you think that is possible? Are there solutions at our fingertips?
Have you also noticed in some communities, for example with respect to this impact on health care and access to health care, that people are leaving the communities to go to more francophone centres or moving to the border of Acadian regions where there are francophone hospitals and schools? Are they coming to Quebec or northern Ontario where there are francophone hospitals?
Mr. Cénat: First, that is something that has come up in several interviews. People will say, for example, “I moved to Ottawa because where I was living I could not receive care in French”. That is the first thing.
On the issue of training, there are a lot of subtleties to understand. It is not just about not speaking the language. It is about not understanding the language and behaviour of a person who does not speak our language. When you are a doctor, and you do not speak French very well and someone is trying to address you in French, the way you look at that person, the way you treat that person is what counts. It may take you a bit longer to listen to that person, or you might say to the person, “Listen, I do not think I am going to understand everything you are going to tell me, but give me two minutes, I will call a colleague who might be able to help you better or who might be able to help me better understand you”, or you might ask the person to speak slowly.
There is no justification for saying that the person speaks a language that is hard to understand so it is okay to move on to something else or mistreat that person. That is also what we are talking about. It is true that training is not just about the linguistic aspect, but also about the issue of discrimination — how we treat a person who does not speak a language the way we would like the person to speak that language. Some people are going to try to speak English. That is good, it is not exactly right, but we will have the necessary patience to address the person to validate and humanize the care.
In our training, there is a module solely on the issue of drugs, on the fact that it is important to take a humanist approach to drugs. For example, among Black people, there are francophones who do not take their drugs to treat their mental health problem, not because they do not feel like taking it, but because the doctors did not properly explain to them how to take their drugs.
Senator Dalphond: Are there other comments from other participants?
The Chair: Would any of the other witnesses like to intervene? Mr. Sangaré?
Mr. Sangaré: Certainly. I have a quick comment to corroborate everything that the previous witness said. The ethics committee heard recordings of francophone immigrants and several of them said that just the fact that they could not understand what the doctor said was a source of stress.
We interviewed a francophone paramedic who told us that when he brought people to Yarmouth, which is an anglophone region, that while he was there the patient felt relatively safe and sound. As soon as they arrived at the hospital and he had to leave the patient there and the patient realized that the only francophone person had left, the patient could feel his blood pressure go up. The language barrier, the inability to properly express the problem and vice versa, not understanding the diagnosis, is a source of stress in and of itself.
The Chair: Thank you.
Senator Mégie: Thank you to the witnesses for being here with us and for talking about research projects we have been thinking about for a long time. Finally, there is some data.
Among the proposals you made earlier, if I understood correctly, I believe that if we increased the education factor that would help. Would it also help if representation of marginalized communities within health care institutions was increased? For example, if there were more health care professionals in hospitals who spoke French? It may be wishful thinking, but I would like your thoughts on that. In terms of senior management, would this change things, including for those from the same hospital setting? Would special training be needed on issues of equity and inclusion for these professionals? I would like your thoughts on that.
[English]
Ms. Etowa: Thank you for that question.
Education is one aspect of addressing this complex issue. As Dr. Cénat has pointed out, it is a systemic issue that requires a systemic and a multi-pronged approach. Education is great, and we are doing some of that based on the evidence we have generated. Representation is also good, but representation is only the beginning of our walk of DEI, diversity, equity and inclusion.
Once we have representation, we also need accountability measures to look at how people are integrated into the systems. What are the resources given to these people to engage in leadership and to engage in the design of the programs so their voices are truly captured in the practices and the guidelines that people work with? In addition to representation, we need to see inclusion. Really, equity is the peak or the pinnacle of the work we are looking at. Representation is just diversity. It is just the beginning. We need to do more to address the multiple levels.
I also really emphasize the need for francophone Black leadership in the work to address this. Nothing about us without us. How can they be part of the lead in designing this program without the education we are doing now?
Also, how can we target the capacity-building initiatives to go beyond focusing on what we do for the system but what we do for the community? There has to be community-facing interventions, the ability of the community members to recognize where to articulate their needs and advocate for themselves. They need resources to be able to do that in addition to the resources that are targeting the system to engage in this work. It is a multi-pronged approach.
[Translation]
Mr. Cénat: In addition to the staff, without these measures it would be extremely difficult to retain them. It is good to have some, but look at how hard it is for the Montfort hospital to retain francophone health care professionals. That gives you an idea of the problem; it is important to have a healthy environment for these people to continue to hold these jobs.
Senator Moncion: My question is for Ms. Etowa.
[English]
You mentioned the stark inequities that exist between anglophones and francophones. You talked about HIV and the services that are offered to Black Canadians. You just said now — and it’s important — nothing about us without us. How receptive is the government of your needs? What kind of advocacy is done towards the government so that these services are provided for your needs, and about you and with you?
Ms. Etowa: Thank you. That’s a very important question.
Over the last four years, we have seen a difference in terms of actually funding projects in the Black community. We have had a number of projects, both Dr. Cénat and I, working on a number of projects funded by the Canadian Institutes of Health Research, funded by SSHRC, the Social Sciences and Humanities Council of Canada, as well as the Public Health Agency of Canada.
We are doing projects now, and we are identifying some issues. We are also now creating interventions. My lab just launched a critical racial and health literacy program for health care professionals across Ontario funded by the Canadian Institutes of Health Research. We launched that on April 2. We have had a number of people in training every week. We have both synchronous and asynchronous training sessions.
We are seeing progress, but there is still a lot of work that needs to happen, including how we govern this data. Now we are collecting the data. What’s the data governance structure to enable Black people to have access to use the data in real time to be able to advocate for the changes they need? What are some of the accountability structures to look at? These programs were implemented. Are they making a difference in the different health care settings? What differences are they making? How can we scale up some of these interventions that are making a difference? We continue to work closely with different government organizations to advance this work, but work is happening now.
Senator Moncion: You mentioned SSHRC.
Ms. Etowa: Social Sciences and Humanities Council of Canada.
Senator Moncion: The money comes from the federal government. You also talked about the Canadian Institutes of Health Research, the program, but the provincial government.
Ms. Etowa: The provincial government actually funded my research chair, the Ontario HIV Treatment Network. I just finished March 31, 2024. That looked at Black women and HIV in Ontario. We got additional funding from CIHR, Canadian Institutes of Health, to scale that model across Ontario to address HIV among Black women. So I have funding from the province as well.
We still need resources, especially resources in the community itself. That came out loud and clear in our COVID impact and the HIV study that talked about not having enough resources in the community to produce the knowledge-translation tools we are producing in both languages. We are lacking organizations that truly serve both the francophone and anglophone community. We need capacity building for those organizations to be able to carry out that work.
We are researchers. We work with the Interdisciplinary Centre for Black Health. But once we engage in this research and collect the data, we need someone to take it and knock on people’s doors, to do the advocacy work necessary to continue that work. As researchers, we can support them from behind, but when your grant runs out, you can no longer go door to door and continue that work.
[Translation]
Senator Moncion: My question is for Mr. Cénat. You said that people prefer to receive their medical services in English even if they are francophones. I don’t really understand that. If a francophone is served by a francophone doctor, why would he prefer to be served in English?
Mr. Cénat: To better understand, if they can receive real quality care in French, they will receive it in French. If they are receiving care in broken French and they can speak English, then they prefer to speak English. This gives them the reassurance that they will not be disrespected by the health care service and staff. There is a certain disrespect, a certain type of discrimination toward them having to do with the fact that they speak French. They prefer to speak English if they can and ensure that they receive better care.
Senator Clement: First, thank you to the four witnesses. Thank you for your careers. We are so proud to have you here among us and in Canada. Thank you.
[English]
Dr. Etowa, something you said was like a gut punch. You were talking about HIV status and the 90-90-90 and how Black Canadians are being left behind, and the result will be that it will become this Black disease, which will lead to further issues. You talked about this within the context of antiracism. We have a senator, Senator McCallum, who has put forward an antiracism motion. She wants us to consider adding to the Canada Health Act a sixth pillar, an antiracism pillar. I’m wondering what you think about that.
Ms. Etowa: Thank you for that question.
It is not even funny. It is so important, because we have been fighting for this my entire career in Canada. For 30 years, we’ve been asking why racism is not recognized as a determinant of health. Why do we not have one of the pillars? Just like we have gender institutes in the Canadian Institutes of Health Research, why do we not have an institute to address racism? It is so harmful to the health of so many Canadians.
Yes, it is time for racism to be recognized as a determinant of health. It creates a lot of problems for many Canadians and racialized people in Canada, in combination with other factors. Whether it is migration, gender or education, it just compounds the whole issue so that teasing it apart even becomes difficult. When I walk down the street and somebody sees me, I don’t know if it is because I’m a woman or because of my skin colour that I go through some of the things we go through, even as professionals. I think it is an overdue step in the right direction.
Senator Clement: Thank you for bringing your lived experience into your profession as well. I know how difficult that is.
[Translation]
Mr. Cénat, your colleague said that you were conducting scientific research and that you really need the science to be effective for the communities.
We will make recommendations in our study and I would like to know what you want to see in our recommendations. How are the partnerships with the community agencies going? What is missing? What should we add in our recommendations on this issue? I know that you are working with young people and that you do different work with different groups, but there is a lack of resources. How do we add this in a recommendation?
Mr. Cénat: The first thing that needs to be clear is that there is a reception problem. Maybe that could change the results in Canada.
There is a reception problem. For example, training was developed on how to provide anti-racist mental health care. The training was immediately implemented in the United States, including in the public hospitals of New York. So far, we are fighting to find hospitals in Canada that want to implement the training.
Senator Clement: It is not implemented at all?
Mr. Cénat: Currently we have a project with the Royal Ottawa, the Montfort Hospital and two other services for implementing this training, but there is real resistance on these issues when it comes to language and racial discrimination.
I spoke earlier about the study on racial discrimination in health care. These people have a higher incidence of depression, post-traumatic stress disorder and anxiety, and they have less trust in vaccines. Those who have experienced racial discrimination in health care are the least vaccinated.
We need to find a way for health care services to be devoid of racism. It seems to be wishful thinking to say it in that way, but we need to find a way for people who leave university or college to receive adequate training so that a person is not discriminated against based on their spoken language, the colour of their skin or their immigration status.
We have to find a way for every health care provider and institution to ensure that no one who enters their institution becomes a victim of racial discrimination, so as not to break the trust of the person who just received care. When that person’s trust is broken, the thing we need to remember — today we are talking about COVID-19, but it could be the Ebola virus, for example — is that an unvaccinated person is a public health risk to the entire population.
Racism is a problem for people who experience racism, but not just for them; as in the case of COVID-19, and that was proven. It is also a problem for public health as a whole. We all win from living in an anti-racist society.
Senator Aucoin: My questions are for the witnesses, Mr. Sangaré and especially Mr. Liboy. They have to do with the results you got in Nova Scotia.
First, I would like your thoughts — what the colleagues from Ontario said is very interesting and I thank you — on this: are you under the same impression in Nova Scotia? In Nova Scotia, there is a large Black community in Halifax that possibly dates back to the Civil War in the United States, but I would like to hear your thoughts on these two points, if possible.
Mr. Sangaré: Nova Scotia is quite small, so I am very familiar with Chéticamp.
First, I would like to say that some things obviously apply to Nova Scotia. When we look at the Halifax region and everything that happened in Africville, the anglophones are dealing with systemic barriers. I would say that for the francophones it is more recent and may be more attributable to cultural barriers, or the language barrier. I live in Pointe-de-l’Église and I have access to services in French, but a francophone living in Halifax, Truro or Sydney does not have access to services in French.
I will give Mr. Liboy a chance to respond, since time is flying, but I will also answer an earlier question about whether training people makes a difference. The answer is yes, but we have to make sure that the people represent the population.
We have a program with the Consortium national de formation en santé, or CNFS, where we train Acadian francophones studying at Université de Sherbrooke and the University of Montreal who then come back to work in their community. We may be one of the only areas in Canada that does not have a doctor shortage and offers services in French. I am talking about south western Nova Scotia that has access to this service.
Now, we need to make sure that under this program we can also have nurses and doctors who reflect the new reality in the region.
The reality for francophones like us remains the language barrier and that adds to all the rest. The minute you leave here or Chéticamp, everywhere else the barrier is primarily language, then there are all the other factors my colleagues mentioned.
Mr. Liboy: I am just going to confirm what my colleagues said. It is important to train francophones to work in the health care system. There aren’t very many.
If you look at our polls, we had questions to determine whether people had been served in French. Sixty-five per cent of people said no. No one is available to serve in French in our regions. Sometimes we also run into cultural problems. Francophones who come from elsewhere have a way of communicating that is different from the way people express themselves here. You can find Acadian nurses, they can speak the same language, but they do not understand each other. We need to have people who represent the new population arriving in the province, immigrants, francophones from Africa who can work in the health care system, even though it is not easy for them to get a position to work in the province.
We can come to the same conclusion as the studies that were conducted by Professor Cénat in Ontario and in the western provinces.
The Chair: We have a bit of time left, but I want to ask a question.
In fact, when we talk about health care services for the linguistic minority, it is like other sectors. Obviously, the provinces deliver the services. These are issues we are hearing a lot about this evening. We are trying to understand how the federal government can better support the provinces and territories in delivering services. Do you, as a researcher, think that Health Canada puts enough emphasis on the need for disaggregated data, for obtaining more accurate data on the needs of the different vulnerable communities we are talking about this evening?
My second question is the following: Should the Canada Health Act include a specific commitment on official languages since that is not currently the case? Should the Canada Health Act include something very specific on the responsibility for official languages? My question is for our four witnesses.
If you answer quickly, I could give the floor to Senator Moncion for a second round of questions.
Mr. Cénat: This is about two pillars to be added: the issue of racism and anti-racism, but also the issue of language.
There is an entire movement on the issue of racism that is making progress. For Health Canada, the answer is no; not only for Health Canada, but also for Statistics Canada. We are awaiting the results of the latest investigation that was supposed to come out a very long time ago.
The answer is no because generally this information is obtained by referencing several data. These studies are not being done. If they were done, we would already have the data; in addition to having the data, we could have acted more quickly to meet the needs of francophones in minority communities.
[English]
Ms. Etowa: I would like to add to that, to the first question about the disaggregated race-based data. I would support the answer being no for one other reason: the design for systematically collecting this data. We are still trying to figure out exactly what will work for Canada given our universal health care system. We are not exactly like the U.S. We use a lot of data and methods from the U.S. We are still looking at exactly how you design the methods to really tease out the race-based data in Canada. We started collecting data, but we don’t have that data yet. It is still a work-in-progress.
[Translation]
Mr. Liboy: The federal government should legislate on laws dealing with language. This needs to be mandatory. We are in Nova Scotia. It is a unilingual anglophone province. Doctors are not required to provide services in French. More and more francophones are living in the region. International students arrive, become sick and do not know how to get healed in their language. The Government of Canada should do something about this.
The Chair: Thank you very much.
Senator Moncion: I just wanted to know if there are places in the world that might be used as an example so that service provision is more accessible to a diversity of people. Is there a place in the world that is an example of services provided to the diversity of people, especially in the field of medicine?
Mr. Cénat: I have just one example in mind and there are a lot of problems. I am talking about people of Latin American origin in the United States. In some states, these people have access to services in Spanish. In some of the studies I have read, there are plenty of problems that come up. I feel like saying, let’s try to innovate to have a Canadian model that works. It is possible. These things are not impossible. We must begin by saying that the person across from us is human and deserves to be taken care of like anyone else, regardless of the colour of their skin or the language they speak. We should make sure that our doctors and nurses do not leave our universities more racist than when they go in. I fear that is the case these days.
[English]
Ms. Etowa: I wanted to add that one of the things we’re doing is picking best practices from different countries and trying to weave in our own Canadian tailored interventions, so picking the best practices from different places and bringing it together in Canada.
The Chair: Mr. Liboy, Ms. Etowa and Dr. Cénat, thank you so much for your participation in this committee.
[Translation]
Thank you very much for your participation, your comments, and your thoughts. Your expertise will help us in our study.
[English]
We now welcome, in person, Julia Chai, Medical Student at the University of Calgary; Ada L. Sinacore, Board Member of Gay and Grey Montreal and professor at McGill University, with expertise in gender and sexuality; Annie Pullen Sansfaçon, Professor, School of Social Work, University of Montréal, former Canada Research Chair on Transgender Children and Their Families and current Canada research chair on partnership research and the empowerment of vulnerable youth; and by video conference, we welcome Gail Ann Knudson, Professor of Medicine at the University of British Columbia. Welcome. We thank you for being with us. We will start with your opening remarks.
Julia Chai, Medical Student, University of Calgary, as an individual: Thank you, honourable senators, for inviting me to speak with the committee tonight on this critical topic.
My name is Julia Chai, and I am a graduating medical student at the University of Calgary and an incoming resident physician at the University of British Columbia.
Effective communication between a patient and provider is the cornerstone to providing excellent health care. In medicine, we often describe the history or understanding the story of symptoms and experiences behind a patient’s presenting concern as the centrepiece in making accurate diagnoses and directing plans for management. When communication is disrupted or affected in the context of health care, such as a language barrier, this leads to poorer outcomes for the patient. Research has shown that differences in language in health care have an adverse impact on accurate patient assessment and diagnosis, which in turn affects treatment decision-making, as well as shared understanding of conditions and compliance with treatment.
This is not only limited to physician or hospice care, but also in the context of health literacy, health promotion and prevention programs. Language barriers have also been associated with increased risk to patient safety such as in the form of medication errors, ability to obtain fully informed consent, protecting patient privacy and confidentiality, as well as increased lengths of stay in hospital, among other outcomes.
In 2020, I developed a policy brief with the Vancouver FoundationLEVEL Youth Policy Program examining the importance and impact of language barriers in health care quality and accessibility especially for racialized immigrant communities as these groups, along with Indigenous communities, are often disproportionately affected by this issue. There is also something characterized in the literature known as the healthy immigrant effect, where research has shown that the immigrants, when first arriving to Canada, are healthier than Canadian-born populations, but their health steeply declines over time to actually become worse than the general population.
The critical importance of language concordance in health care delivery cannot be ignored. One effective way that health care services have attempted to bridge this gap is through availability and utilization of language interpreter services, which have been shown to significantly improve communication between a patient and provider. However, the availability of these services is inconsistent, as interpretation is often more accessible in resource-rich settings such as hospitals while they may not be available in outpatient settings such as clinics or rural areas.
In the clinic or hospital, we will often see patients who cannot or have difficulty speaking official languages like English have family members or others accompany them to appointments for translation. However, this sometimes hinders the accuracy of translation, and the effects of lack of impartiality and cultural barriers may affect quality of care.
It is also important to note that these encounters or appointments with patients that require translation services will usually take up more and necessary time, and it is critical to ensure these patients are still prioritized while balancing seeing an adequate volume of patients in a busy clinical setting. Physicians should not have to feel rushed when working with these patients to preserve the same quality of care we are providing.
Beyond translation, another key component to improving health care for underserved communities includes diversifying our medical trainees to represent the communities that we serve to also include racial and ethnic backgrounds and ensuring that cultural competency skills are well integrated in the medical curriculum when training the next generation of physicians.
Overall, language concordance is a critical aspect of delivering quality health care in Canada that requires robust delivery and accessibility of interpretation services and culturally competent care, especially for our underserved communities.
Thank you.
The Chair: Thank you.
Ada L. Sinacore, Board Member, Gay and Grey Montreal: Thank you for the invitation to speak with you today.
I am here to speak about 2SLGBTQIA+ older adults. I am defining older adults as those who are 60 and older.
Queer older adults who are English speakers in Quebec face minimally triple jeopardy when trying to access health care. That is, they are confronted with ageism, transgender or homophobia and barriers based on language. Additionally, if they come from other marginalized or racialized groups or have a disability, the levels of discrimination are compounded. As well, older 2SLGBTQIA+ people may have been subjected to conversion therapy, resulting in psychological harm that often results in a hesitancy to seek out care. Oppressive systems and discrimination result in minority stress for queer populations that negatively impacts physical and mental health outcomes and results in a lack of trust for the health care systems and providers.
It is important to note that the members of 2SLGBTQIA+ communities cannot be viewed as homogenous, with different populations facing divergent challenges, and there are age differences in how people have managed these challenges. For example, two-spirited people have complex and specific needs given the history of colonization and the colonizing role of the health care system.
Gay men were highly affected by the AIDS epidemic in the 1980s and 1990s, and some are HIV positive and may have been positive for a very long time. As a result, there may be a hesitancy to access health care due to fear of being mistreated due to their HIV status. Older lesbians also have a history of mistreatment and may be hesitant to disclose their sexual orientation due to histories of poor gynecological care and judgments about breast binding.
For trans and gender-diverse individuals, the health care system controlled their transition process. In Quebec, prior to 2015, bottom surgery was required to change one’s gender marker. As a result, older trans and gender-diverse people may have been subjected to forced sterilization and as a result may be worried about getting access to appropriate care. Those who transitioned or are transitioning since they turned sixty have a different experience; however, ageism can be an issue when they seek out gender-affirming care.
Not only do histories of discrimination and mistreatment by health care providers result in queer people being hesitant to seek out care, providers are often ill-equipped to provide appropriate care. In Canada, 50% of health care providers report never receiving training to work with LGB populations and 60% report never receiving training to work with trans or gender-diverse population.
Moreover, a major barrier to care in Quebec is language. On March 11, 1996, then-Premier Lucien Bouchard famously told English-speaking Quebecers, “when you go to the hospital and you’re in pain, you may need a blood test, but you certainly don’t need a language test.” This citation rings true almost 30 years later as issues regarding minority-language access rights to health care remain largely problematic.
While French-English bilingualism rates are increasing among younger cohorts, those aged 50 and older have the lowest competency in French and thus find it difficult to navigate health services when there is an absence of bilingual workers who can offer support in English.
Recent provincial legislation both in language and health care has created concern amongst our community about being able to access government services. The requirement that services be given only in French and the centralization of our health care system causes us concern. The proposed removal of client and user committees at a local level will harm the surveillance and protection of English-language services.
As these changes are falling into place, we have also noticed increased issues in the lack of available health and health prevention information being produced in English, difficulties in communication with government offices and lack of bilingual staff in health and home care settings. If one’s place of residence falls outside an area deemed to have bilingual services, the situation only worsens.
While waiting lists for health care services concerns the population at large, looking for bilingual services that are both senior- and queer-informed exacerbate the situation especially in regions outside of Montreal. Wait list times for non-emergency interventions are beyond acceptable and, in effect, discourage our population from taking steps to address health issues at an early stage.
Accessing health care is a multi-pronged process that touches on a variety of intersectional lenses, levels and environments. For a minority-language community, it is imperative that access rights be protected. For a queer, elder, minority-language community, the need to inform the community and promote access is primordial.
In closing, the varying health care needs of older 2SLGBTQIA+ communities warrant serious attention from the government in general, especially given the historic mistreatment of these populations. However, specifically, the intersection of access to services in English with being an older queer person creates an untenable situation for older 2SLGBTQIA+ people who need appropriate and competent age-, gender- and sexuality-affirming care.
Thank you.
The Chair: Thank you.
[Translation]
Ms. Pullen Sansfaçon, you have the floor.
Annie Pullen Sansfaçon, Professor, School of Social Work, University of Montréal, former Canada Research Chair on Transgender Children and Their Families, As an Individual: Thank you very much. I’m sorry. I’m just getting over a bout of laryngitis, so my voice is a bit hoarse. Thank you for having me. Today, I’m going to talk specifically about trans and non-binary youth, as well as about young people who discontinued their transition and two-spirit youth, who are at the intersection of transness. We don’t have a lot of data on the language of service for this population, so I will do my best in that regard, and I will talk a lot about the situation in Quebec, or anglophones in a minority context. We did a study that revealed some interesting things.
First, I want to say that trans and non-binary youth face a lot of unique adversity, which puts them at a higher risk of suicide, self-harm and serious mental health issues.
This is not because they are young people with personal problems. It is because they are facing a lot of transphobia and violence in their everyday lives. They often experience situations of gender incongruence, which are situations in which the person feels as though their identity does not align with the gender they were assigned at birth.
The reason why I am explaining this to you is because these young people have serious and specific needs when it comes to health and social services, so we need to have services that meet their needs.
I don’t want to spend too much time talking about the unique nature of trans and non-binary youth, but since that is at the heart of what I am presenting today, I want you to really understand the challenges that these youth are facing.
Youth who have discontinued their transition also have needs. Research shows that, often, they stop taking the medication for their gender transition without medical supervision, so there are serious issues here.
When it comes to two-spirit youth, there are still other challenges. These young people are also dealing with cultural safety issues in addition to language issues. There really are a lot of challenges.
When it comes to services, we see that these young people are afraid of being stigmatized. In general, trans and non-binary youth experience misgendering issues in the health care system. I’m talking here about the way health care professionals address these young people, for example, if an individual identifies as male, but the care provider refers to them to using feminine pronouns. There are already a lot of challenges that create barriers to access to services.
According to a study conducted in Quebec, 24% of these young people are misgendered when they seek services, which often makes them not want to go back. French is a very gendered language. There is a choice between masculine and feminine. Neologisms are not yet accepted, so it is very difficult for young people who identify as non-binary, or neither male nor female, because they are constantly misgendered. They have difficulty expressing themselves because qualifying adjectives are often masculine or feminine, so it is very hard for them.
I’m able to give you some more specific information about language because we did an analysis of a subsample in Quebec. This was a national survey that was conducted all across Canada, but we pulled the data just for Quebec. There were 220 young people who participated. Within that sample of young people, more of the non-binary youth spoke English than French. You will no doubt wonder why. Normally, one would expect a balance between English and French speakers. That is something that we noticed, and it is likely because these young people do not have the words to express themselves. Perhaps francophone youth answered the survey in English because they were worried that they would not be able to express their needs properly in French. That is one thing that we are seeing.
The same survey also showed that anglophone youth are more reluctant to express their needs to their doctor. They worry more about it and have more difficulty doing it. There is something related to language there. It is likely because health care services are not offered in both official languages everywhere. They are mainly offered in French in Quebec.
It is even more difficult to access health care in English in the regions. It is important to reiterate that trans and non-binary youth need to be able to express themselves in both languages, because they often come out in English since the literature and information is mostly all in English. They start thinking about who they are in English before they are able to express it in French. Some research shows that some of these youth will use terms like “they” and “them” in English but use “il” or “elle” in French. They are not able to use their non-gendered pronouns in both languages.
In closing, our trans and non-binary youth have specific language needs. It is important to be able to offer gender-affirming care and general care in both languages, even if these youth are francophone, because they have learned to think about who they are in both languages. It is also important to do all we can to encourage health care providers and social services workers to use neologisms and non-gendered language so that these youth are able to have more effective access to care.
The Chair: Thank you for your opening comments.
[English]
Dr. Gail Ann Knudson, Professor of Medicine, University of British Columbia, as an individual: I’d like to speak more from a clinical perspective than a research perspective today. My name is Gail Knudson, and I use she/her pronouns. I’m a clinical professor at the University of British Columbia in Vancouver. I’m actually speaking to you from Victoria. I’ve worked there for 25 years, as well as at Vancouver Coastal Health. I’ve worked as a consultant psychiatrist, and I’ve worked in transgender health care, trans and gender-diverse health care, as well as sexual medicine.
I have done most of my practice for quite a few years on telehealth because, as the previous speakers have said, there is a lack of access to gender-affirming care in rural and remote communities. I’ve been able to use interpreters when speaking with people who do not use English as their first language. These interpretation services are available through Vancouver Coastal Health.
As Ms. Chai was saying earlier, if we’re speaking with patients in their preferred language, it helps build rapport and trust and ensures capacity for treatment. However, health care professionals may not be able to possess this language proficiency and interpretation services are needed. For example, I’m usually using the services of an interpreter. What I want to do in this case is speak with the interpreter before scheduling the appointment with the patient to talk about their trans competency work and if they have competence in this area.
Also, when seeing the patients or people who are coming for care, make sure that when they’re first coming to care, that their family member is not their interpreter. That’s very important, as Dr. Pullen Sansfaçon was saying earlier. There is sometimes discrimination within the family, and then the patient would not be able to be forthright. Also, it’s important to explain confidentiality and to see that the interpreter they are using will not be speaking to other members of their community. Sometimes, though, people are in situations where the family is very supportive, and it is up to them whether they want to then use their family member as an interpreter.
Also, it’s important that the information — this was said by Dr. Etowa in the previous panel — about trans- and gender-affirming care may not be as widely available in communities whose first language is not English. It’s important to know what services are available and what resources have been translated.
Also, it’s important to know if the person is part of a religious community that does not approve of or recognize trans people. That’s also very important in terms of providing good gender-affirming care, to know the religious background of the person if they have a particular religious faith that they follow.
It is important also to leave a lot of space for questions, as the knowledge might not be accessible in that person’s community. A lot of space must be open to ask questions and also to explain the next steps. This goes back to my first point about having capacity to consent for treatment: does the person understand the risks and the benefits associated with what medical treatment they may be seeking.
In closing, language is an important determinant of health, and it is important that we provide that access for people so that they have the best gender-affirming care. Thank you.
The Chair: Thank you, Dr. Knudson. We will now open the floor to questions from members, with the five-minute time limit for questions and answers.
[Translation]
Senator Aucoin: Thank you to the witnesses for their presentations. They were very interesting. My first question is for Ms. Chai. I was surprised when you said that people are in better health when they arrive in Canada and that their health deteriorates going forward. Does language play a role in that? Does the health of people who speak either French or English when they arrive in Canada deteriorate a little less, or is it the same for everyone who comes here, regardless of language?
[English]
Ms. Chai: From my understanding of the current research with the Healthy Immigrant Effect, first, like you mentioned, immigrants or newcomers to Canada usually come in with better health. They have identified this is likely due to the immigration process and selection process that happens in selecting a certain group of individuals who may be able to contribute towards Canada and in them being healthier usually at the start.
Yes, language barrier has also been identified to contribute to that negative decline, that steep decline. There are also other factors involved, according to research, that contribute to this decline than the Canadian-born population, including increased adversity, increased stress that usually comes with immigration and in being able to navigate a new system, a new environment as well. Language barriers also have an effect on that. In terms of those immigrants who do speak English or French, I’m not too certain if there is research available in Canada or what that literature encompasses, but yes, the language barrier itself has also been identified as a barrier in accessibility and quality of the health care that immigrants usually receive as well.
[Translation]
Senator Aucoin: My question is for Ms. Pullen Sansfaçon or Dr. Knudson. Are the resources adequate? Should Health Canada, or even resource or community groups, be doing more to support these communities?
Ms. Pullen Sansfaçon: The resources are inadequate. We don’t have enough clinics. Young people have access to general care, health care and social services, but they also need specialized care, including gender-affirming care, hormone blockers and hormone therapy. Often, that type of care is not widely available, especially outside the bigger cities. For example, young people outside Montreal have to travel long distances to get care, so no, the resources are not adequate.
The last census showed that 0.79%, or almost 1% of young people were trans or non-binary, and that is a conservative number. When we look at the meta-analyses from around the world, that number is closer to 2.1% because parents are the ones who fill out censuses. That is likely why numbers are lower.
It is important for these youth to have access to this vital care because they do not choose to be trans. It is important for individuals who want to affirm their gender by getting hormone therapy to be able to do so. That has a positive impact on the well-being of these young people, if it is a need, because not all young people need medical care. Social services are also extremely important. I cannot speak for all of Canada because I am not familiar with the situation everywhere, but in Quebec, it is very difficult to access such services, so yes, more care is needed.
Senator Poirier: Thank you for being here.
[English]
I have a couple of questions. We know that the language barrier when it is a minority situation is an issue for everybody whenever the situation is there, but we are also hearing through different groups we have met that there are other barriers over and above just the language issues that are affecting certain groups and certain communities that seem to have a little more of a challenge over and above just the language issue.
This question is open to all or anyone who wants to answer. Knowing that health care is provided by the provinces, in your opinion, what role can the federal government play to improve the delivery of minority-language health services no matter what the challenge is? We are often hearing that there is sometimes in many areas a lack of manpower in the community that can offer that service. I’m just opening up the question. What solutions or recommendations can you give to us that would help, under federal jurisdiction?
Ms. Sinacore: I think that one of the things we need to think about is that while health care is local, the problems are national. While I can speak to the challenges of older adults in Quebec, those challenges are national challenges.
So what do we know? We know that if people are provided with appropriate training to work with older adults, and there are very few people who have that training, then the way they’re going to treat a person is different, and that’s an access issue, whether they are queer or not. I think of working with the national accreditation association, the AAAC, with the accreditors of training for health care providers as well as psychologists, physical therapists, because all of these health care providers have national accreditation. In Quebec, we have a local accreditation but we are also nationally accredited. For example, my program is accredited by the Ordre des psychologues du Québec. It’s also accredited by the Canadian Psychological Association. It is the accrediting bodies that dictate what the training requirements are for students. Those accrediting bodies will say this is what needs to be in the curriculum, and this is what needs to be in the clinical internships and the practicums. If you work with the national accrediting associations, that’s the natural loop that brings that information back into the provinces.
For example, when I was President of the Canadian Psychological Association — I had it sent to you — we wrote a policy statement about cisgender discrimination, and we invited all the national accrediting associations to partner with us on combatting sexist discrimination in health care. I think the federal government can take some of that work on.
Dr. Knudson: Yes, I agree with you. I think that’s very important at that level. Also, that will funnel down into when you are looking at curriculum within the medical schools. That curriculum is based on what you were saying, what the accrediting bodies are wanting to test on. For example, at UBC, we have one or two hours on transgender medicine in four years of training. However, if it was different at a national level in terms of the accreditation bodies and transgender health was part of that need to know and must know, then that would trickle down in terms of importance in the curriculum.
Senator Poirier: Has that ever been discussed or suggested to government? Have you ever talked to the Department of Health federally? Has that suggestion been shared?
Dr. Knudson: Years ago, but maybe it is time to revisit it again.
Ms. Sinacore: I can only speak for the associations I am familiar with, but different associations have shared some of those concerns with the federal government. I know for sure the Canadian Psychological Association has and has been very active in health care issues, but I don’t know that it has been done as a collective in the sense that this is something that is important in all aspects of health care, not just the particular health care aspect that a particular association represents.
Ms. Chai: I also agree with everything that has been brought up. I do believe we should enforce accreditation and really prioritize this curriculum, including culturally competent care for these underserved communities such as Indigenous communities, 2SLGTBQIA+ communities and racialized immigrant communities. These are the populations that physicians in training will see in the community, and I do believe that having an upstream approach by the federal government to ensure these curriculum topics are being prioritized will be important.
On top of that, we need to diversify who we select as the next generation of physicians, really prioritizing diversifying from different sexual and gender minorities, different racialized minorities and students from lower socioeconomic statuses. These are all strategies that the federal government can also prioritize to ensure that our physician population is reflecting the communities we serve as well.
Beyond that, I also want to bring up prioritizing, like Dr. Etowa had mentioned in the last panel, race-based data. It is important in collecting that to ensure that the research being done within the Canadian environment can help inform the evidence-based practice that we can do for the populations that we serve, and especially those who are under-represented.
[Translation]
The Chair: Thank you very much.
Senator Dalphond: Thank you to all of the witnesses. We have been focusing a lot on access to health care services in French and English, but there are many other types of barriers. A doctor may speak the same language as the patient, but there can still be communication barriers. Thank you for reminding us of that.
My question is for Professor Sansfaçon. Since this is the Official Languages Committee, I’ll focus my question on language. I’m a bit surprised that francophones would answer questions about their situation in English because French doesn’t have the gender-neutral language they need to self-identify the same way they can in English, which is more versatile. Is your group or centre working on raising awareness or on preparing manuals or lexicons, so that doctors and health care professionals who meet with patients are able to use more gender-neutral language from the start, so that the patient can self-identify as a man, a woman or a trans person, language that would make it possible to adapt the conversation, to be sensitive to this issue and to encourage communication rather than shut it down or restrict it?
Ms. Pullen Sansfaçon: I don’t have a specific answer to your question about whether these young people answered in English because they’re francophone and they were uncomfortable or vice versa. I would be surprised if there was really such a disparity in the number of English-speaking and French-speaking trans and non-binary individuals. That is why I said that. In my opinion, one of the problems in Quebec is that the Office québécois de la langue française does not recognize the use of neologisms. It is asking Quebecers to use epicene words, which is a good. That’s a good start and it helps us to navigate gender situations, but epicene words are difficult to use in spoken language.
The French pronoun “iel”, which is equivalent to “they” or “them” in English is not one that is commonly used in health care services. In order for that to happen, this pronoun needs to be recognized at a higher level so that its use starts to trickle down to health care services. That’s where the holdup is. What is more, as I explained, young people who are seeking to understand trans issues and trans identity often find information in English, and start thinking about themselves in English. Then there are the parents, family and friends to consider. All of the people in the young person’s social circle have to be educated in order for the young person to be able to express themselves and communicate with those people. It is sometimes easier for the young person to say that their pronouns are “they” and “them” in English.
Senator Dalphond: You are in academia. Do medical schools have courses to raise awareness among medical students? If we talked to them about this issue, then I would imagine that they are just as capable of understanding it as I am.
Ms. Pullen Sansfaçon: I will let my medical colleagues answer that, but I’m still a member of the Ordre des travailleurs sociaux et des thérapeutes conjugaux et familiaux du Québec, and I know that those sorts of skills are not taught as part of the social work curriculum. However, the order does try to recognize professional acts, which is a bit different, but this is not broadly taught. I am a research chair in this subject and I don’t give any courses on gender or transgender youth in my department, so that gives you an idea of how far behind we are. I don’t think that there are any courses in bachelor of social work programs that focus specifically on trans people and gender diversity. There are also LGBT issues, women’s issues and gender relations, so there is a lot to cover. It is difficult for professionals to get that information when that basic training is not included in our curriculum.
[English]
Dr. Knudson: It is the same as I understand in medicine, that it is not standardized across each one of the universities, and there is no national training program in Canada in terms of transgender health. We do have programs globally. WPATH, or the World Professional Association for Transgender Health, has training programs, and those are mostly for health care professionals at different levels.
[Translation]
Senator Dalphond: Am I to understand that you would be in favour…. Education is not a federal responsibility. It is a provincial jurisdiction, but perhaps Health Canada could take an interest in this issue and produce publications and lexicons in that regard that could…. Once people have that information, then they can use it.
Ms. Pullen Sansfaçon: Absolutely, and not just in terms of trans health but in terms of health and social services for everyone.
The Chair: Thank you very much.
Senator Mégie: I was about to ask about the curriculum for health care professionals, including doctors and nurses. While we wait for this information to be included in the curriculum, which is not a simple task, is there a way to communicate with certain organizations, like the faculties of medicine and nursing, to ask them to start by including this information in their continuing education courses? They could start with that in the meantime, because it would be easier to put together a conference with workshops to train people and raise awareness among health care professionals. Have you thought about that?
[English]
Ms. Chai: Absolutely. I think working with our representing bodies within medicine would definitely be one way to go about it. Within medicine, to my understanding as well, there are always opportunities to add on to your medical education even as you become a staff physician or even after you have done all your training, and we call that continuing medical education. Reaching into different types of physicians or medical practices across a diversity of different practices and integrating that would be very important as well as, like you mentioned, getting in touch with national accreditation bodies of the schools.
We have mentioned that many of these initiatives have already been done, mostly driven by students or within the schools on their own, but definitely a push into making this a standard across all medical schools, especially when we are training our incoming generation of physicians, would be very important to ensure that we set up our physicians for success in communicating and working with these different communities.
Dr. Knudson: That’s very important, and I’m very interested in participating in that.
I was a co-author for the education chapter for the World Professional Association for Transgender Health’s Standards of Care Version 8. In the education chapter, we looked globally to see if there were any organizations that had transgender and gender-diverse care in terms of one of their training cornerstones. There are very few if any that have that, so we are not alone.
[Translation]
Senator Mégie: Do new communication technologies provide any language help when it comes to communication between patients and doctors and other health care professionals? Is there a place for new technologies in helping to break the language barrier?
[English]
Ms. Chai: I’m currently in Calgary. I’m finishing medical school there. One of the tools we have in hospitals is something called LanguageLine. It is usually in the form of an iPad on a stand that we will drag along when we talk to patients. It connects us to an interpreter, usually through audio, who will be there as we are standing next to the patient’s bed and will translate back and forth.
Translation and interpretation are very important, especially when we are dealing with patients where English or the official language is not their native language and they are unable to express their needs. The issue here now is that this service is not always available in clinic settings, for example, or if you go to your family doctor or if you have a follow-up appointment. Maybe the person is hard of hearing, and that adds another difficulty so perhaps video calling might be more effective. Additionally, this is also the case in rural settings.
On top of that, these appointments or encounters can take double the time at least because there are two ways of communicating happening. I do not feel it is necessary for physicians or health care providers to feel rushed in these circumstances, especially when they have a lot of patients to see. The issue is more within the delivery and making sure it is available widely across different settings, as well as ensuring we find a way to make sure that physicians don’t feel rushed in these encounters so they still receive the same quality of health care.
Ms. Sinacore: That all works if you can access a physician, but the problem is getting access to that physician. Oftentimes, you are going through somebody, at least in Quebec, who doesn’t speak any English while you are trying to get access to a physician. Or you are making a phone call and the person answering the phone doesn’t speak English or won’t speak to you in English. There is the issue of getting past all that in order to even see a physician and those services perhaps that could happen.
There is also the emergency situation. I know of people who were picked up by an ambulance and the EMTs didn’t speak any English. The person was in their 70s. Even if they spoke French, probably in that kind of situation, they couldn’t come to that language. They were being asked all these questions and being spoken to, further disorienting them and compromising their ability to get quality care. In emergency situations, there may not be time for that kind of translation support. We need to think about more creative solutions. Technology can be one, but we need to think of more creative solutions in order to access care.
To the point about guidelines with language, there is a federal book on gender-inclusive French.
Ms. Pullen Sansfaçon: Yes. There was one that was done.
[Translation]
When we say that populations like trans and non-binary youth are unable to access care, these are not just anecdotes. I have statistics from a national survey that was conducted not just in Quebec but across Canada, which shows that 42% of young people under the age of 25 said that they have a chronic health problem that has been going on for more than 12 months. That is a lot. Of those youth, 43% said that they were unable to get physical health care and 71% said that they were unable to get mental health care. This was a sample of 1,500 youth across Canada. Access to primary care is a real problem.
Senator Moncion: My question has to do with the discussion that we were having earlier. I would like to hear your comments on the medical aspect versus the political aspect of the health care that is offered. For example, if a province has a policy that does not provide services to trans youth and it refuses to implement such a policy, then that will impact the health care services these youth receive from the province. It is the same thing if a province decides not to offer services in English or French. That has an impact. When it comes to the balance between the medical and political aspects, how do they affect each other?
Ms. Pullen Sansfaçon: That is a great question. The political aspect certainly has a role to play when it comes to language. As you know, in Quebec, something has been coming up more and more over the past year or so that is affecting care for trans youth. There are media reports that are saying that this is a social contagion, for example. That severely impairs the ability of these young people to get access to care because some doctors who once prescribed hormone blockers do not want to do so any more because they are afraid of having their name dragged through the mud by the media. There is a political aspect, but also a social aspect in terms of disinformation, which makes getting access to care even more difficult. Here, I am just talking about going out and getting care, because there are also young people who have to talk it over with their parents before they can go and get that care. The disinformation that is being spread will make things even more difficult for these young people. I don’t know if that answers your question, but for me all of that is very closely connected.
Senator Moncion: It becomes a medical problem. What about training, for example?
[English]
Ms. Chai: Absolutely. I was going to speak to that, and 100%, political affairs have a huge impact on medical care as well. We are talking about transgender car, where, if provincially, there is an impact on whether or not transgender care is allowed to be provided, then 100% that will have an impact on medical care as well, especially if there are limitations in what providers can do for their patients.
Senator Moncion: In the LGBTQ community, when we are looking to access to long-term care for couples?
Ms. Sinacore: That is an interesting question. One of the big concerns about entering long-term care is that we’ll have to go back into the closet and that we won’t be able to access care as couples.
One of the things that is also interesting with regard to that question is that older adults are sexually active. We know that in long-term care homes, they have some of the highest rates of STIs, proportionally. The other fear is that people will be treated as asexual and that their identities will be compromised, whether they go by themselves or with a partner. There’s a lot of concern about that.
There’s a lot of concern outside of long-term care. “Should I even be out with my doctor?” We’ve seen over and over again that, as people get older, they’re concerned about being in the closet and being treated in an ageist fashion. For example, if you’re talking about transitioning and somebody is 60 and they finally feel empowered to transition, getting access to that transition is not always easy. There’s also a stigma attached to that, such as questions like “Well, why didn’t you do this sooner?” or “Is it too late for you?”
There are all kinds of issues around what happens with older queer people when going to long-term care, short-term care, getting access to medical care or if you’re looking at access to palliative care. Palliative care is another issue in terms of gender and sexuality — appropriate and affirming palliative care. Remember, we’ve already lived through our epidemic in the 1980s and 1990s, so COVID kind of retriggered people around that. Now, you’re accessing palliative care, and living that again. We need access to palliative care that understands that history that allows people to reprocess that history in a psychologically healthy and appropriate way.
[Translation]
Senator Moncion: Ms. Sansfaçon, you mentioned some statistics, and I would like to ask a statistical question to the researchers in particular.
In June 2019, the House of Commons Standing Committee on Health published a report on the health of 2SLGBTQIA+ communities in Canada and it made the following recommendation regarding the collection of data:
That the Government of Canada, through Statistics Canada, include questions on sex at birth, gender identity and sexual orientation in all its surveys regardless of respondent age and on a priority basis in surveys on health, housing, income, homelessness and the use of alcohol, tobacco and other substances.
Could you comment on that recommendation and tell us where things stand right now? Based on the answer that you gave me earlier, there are some very good statistics out there, and you gave us some for Canada as a whole. However, when it comes to data collection and co-operation between the public and the government, particularly when we are talking about people with diversities, are people willing to share all of that information?
That is a question for the researchers.
Ms. Pullen Sansfaçon: I think it’s wonderful that the government is starting to ask those questions on the census, for example. There are improvements to be made, because there could be challenges, such as under-representation, but it’s great that the government is starting to ask those questions.
The survey that I mentioned earlier was a study that was funded by the Canadian Institutes of Health Research and carried out by my colleague Elizabeth Saewyc. She is the one who took care of this project at the University of British Columbia. She’s a colleague of mine. This national survey focused specifically on trans and non-binary youth.
The question was asked in many different ways to be sure to catch as many nuances as possible. However, I don’t do research on the general population, so I can’t answer your question about whether that is included. I’m always wondering about things like that.
I don’t know if my colleagues have anything to add.
[English]
Ms. Sinacore: One of the things we have to remember is that, because of our histories, people can often be very cautious being out to the government, because the government’s policies hadn’t changed. A lot of these changes are fairly recent. It’s nice to see those questions asked on, say, the census, but there’s a good chance that older adults won’t answer them.
When you look at the numbers of what we believe in terms of statistics about how many 2SLGBTQIA+ people are in the world, the numbers among youth are much higher than the numbers among older adults. Does that mean there are more youth or more people are out now? Does it mean that people are feeling safer to be out? When I was young, for my generation, it was an impossible thing to be. Although things have changed, those histories haven’t gone away for the people who have lived them.
While I think those questions are important, if there’s always a “prefer not to say” option, I would consider how many people are saying “prefer not to say” and I would cross that data with age information to see if that “prefer not to say” question has an age implication. Even for this meeting, when I was asked for my pronouns, I didn’t answer the question.
Senator Moncion: Maybe, Dr. Knudson, you have some comments too?
Dr. Knudson: I’m wondering about not only age but where people live, because if people aren’t feeling safe in rural communities, again, is that going to be reflected?
Senator Moncion: It brings into question the accuracy of the information that is provided to researchers. It could be biased or incomplete.
Ms. Pullen Sansfaçon: There’s a difference in terms of statistics for trans youth across provinces. There are provinces that have more trans youth than others. That tells you that it’s maybe about fear of disclosure more than something else.
[Translation]
Senator Clement: Thank you to the witnesses. You’ve been so clear and eloquent.
[English]
Dr. Sinacore, what you talked about in terms of history is interesting. I wonder if people really are safer now, though, with social media. They’re not, so we still have so much work to do. Thank you for your comments.
Dr. Chai — I can call you “doctor”?
Ms. Chai: In a few months.
Senator Clement: “Almost Dr. Chai,” you referenced your paper. I’ve been looking at it. It’s very clear. You have some good plain language there. That’s important. You also focus on very practical solutions. You say there’s a lack of race-based data and we need cultural competency, and then you suggest working groups of racialized students and physicians getting together.
First, since your paper was written, have you seen any uptake on some of those suggestions? Second, which ones would you prioritize? We’re writing a study, and we’re going to want to put recommendations in. I’d like to hear from you what you might recommend would be a priority.
Then, around the issue of race-based data and the lack of it, can you speak to why there is that lack? I know from a legal aid perspective — that’s where I come from — we have a lack of race-based data because people don’t know how to collect it, are uncomfortable or say they’re uncomfortable about collecting it. There are many barriers around that. I don’t know if that’s the same in the medical profession.
If you can speak to those things, I would appreciate it.
Ms. Chai: Thank you very much.
The time I had written that policy brief was around 2020. I had finalized it a few months into starting medical school. It’s interesting for m, as well, now that I’m at the end of medical school and after seeing things in the clinical environment, and it’s solidified certain points for sure. Based on my experiences of talking to patients, especially patients of racialized immigrant communities, it is clear there is a barrier in communication. I’ve seen the direct impact of how that affects the quality of health care.
The certain points I would really emphasize from that are, first — and it’s not the solution to everything, like we mentioned before — but translation does have a huge impact when the time is appropriate, for sure. I think the delivery and availability of translation and making sure that the translation and interpretation are impartial are very important in the health care setting and within the relationship between the patient and the provider.
Outside of that, I also talked about the creation of resources in different languages as well as visual aids. Again, this is not the permanent solution for everything, but that’s one way to also bridge communication. For example, after a patient has surgery, what can we give to patients regarding steps in recovery from surgery or commonly and frequently asked questions? Can we make sure these resources are available in a written document? Oftentimes, when we’re counselling patients about recovery or treatment, even for the English speaker or the French speaker, a lot of information can be happening at once, especially in a time of stress. Maybe the patient is actually not fully awake from their anaesthesia. Having that information available in a written document so it can be read at home and available in different languages could be one way to bridge that. For patients who are hard of hearing or hearing-impaired, maybe using visual aids, along with the communication, could be another bridge.
Overall, we can focus on communication tools in different settings. We also talked about emergency services and accessing those. These are all different ways to prioritize and make sure there is clear communication and a clear understanding on both sides of what a patient is presenting with or what their concerns are.
I’ll also add the importance of actually talking to those groups. In the previous panel, Dr. Etowa said, “Nothing about us without us.” That rings true in all of these cases. We have to ensure we have those stakeholders on board, at the table, making sure those policies are formed with accurate representation at the table and in those decision-making opportunities. That is very important moving forward.
To your second question, the reason for race-based data, that definitely came into play during the COVID-19 pandemic. In comparison to the U.S.A., Canada had a lack of race-based data, and that impacted our ability to research how different health issues were affecting certain communities. That priority needs to be put in place.
Senator Clement: Isn’t Canada less racist than the U.S.?
Ms. Chai: Racism is still very prevalent at many different levels. Systemic racism, especially, is a key issue that we often see within health care. We also see racism is not just within person-to-person interactions but in the systems that are built within Canada as well, especially, again, disproportionately impacting the racialized minority groups as well as Indigenous communities. We’ve seen how systemic barriers and social determinants of health have a huge impact on not only the quality of health care that they receive but the situations they’re in and the environments that certain communities are raised in.
Absolutely, I think race-based data is just one step to ensuring that we can really prioritize the research and look at informing the practices that we can provide in the health care environment with evidence-driven data.
Senator Clement: Thank you. I think Canada — this is me, now, saying this — doesn’t always want to recognize the depth of the problem. It likes to compare itself to other places, but that means that we’re not really looking at ourselves.
[Translation]
I have a question for Ms. Pullen Sansfaçon. You said that there is a lack of courses at your university dealing specifically with trans health. I would like to know why. People are talking about this, and there is a growing political awareness, even though it may not always be positive. Why have we not made more progress in this area?
Ms. Pullen Sansfaçon: I have a theory about that. I can only speak to social work, not the other professions. Accreditation bodies have a lot of demands, and a bachelor of social work is a three-year program. There are choices that have to be made when designing a program’s curriculum. We can’t include everything. Some things are more important than others. Trans health and intake may be something that is considered less mainstream, less important than other issues. As I said, we have a course called Sexuality, Gender and Social Work, but it’s a drop in the bucket when you look at all the needs. I think that this has more to do with being able to fit everything that needs to be taught into a bachelor’s degree. I’m sure it is the same thing in other professions too.
[English]
Ms. Sinacore: I can only speak to my discipline, which is psychology. I would arguably say there’s a whole list of reasons why these courses aren’t available. Part of it is accreditation. Accreditation standards are beginning to change. In my discipline, in 2022, we published a new set of standards, and 2SLGBTQIA+ health is now an accreditation requirement. How can programs meet that? They can meet it across courses versus piling it in a single course, but seniors aren’t part of the curriculum. No matter what we do, we need to think about things more intersectionally. Everybody has a race; everybody has a sexual orientation; everybody has a gender. If we’re going to look at all these issues, we need to look at them from an intersectional perspective because otherwise we end up creating these silos of identity which don’t work.
Within the curriculum, even when you want to change the curriculum — and I’ve been a professor at McGill for 30 years, and I’ve changed a number of curricula — changing the curriculum can take three to four years if it has to go through the ministry of education. To get a single course in is easier because you can teach something as a current topic or a special-topics course, but to really fundamentally make curriculum changes where they look like the kinds of changes we want takes time, a lot of time.
The second issue is having the expertise to teach it. I’m the only one in my department of 22 faculty who has expertise in the areas of gender and sexuality.
Senator Clement: The only one?
Ms. Sinacore: I teach the one gender-and-sexuality course in our program. There has to be the will of the faculty to do this. That has to happen through — well, what do universities value? They value research programs. There needs to be support for more intersectional research programs so people can develop the expertise in collaborative ways with their colleagues around the university in the province so that when we bring these courses in, we have somebody to teach them, because that’s the other barrier.
Senator Clement: Bam.
Dr. Knudson, I saw you nodding.
Dr. Knudson: Yes, research is key because in looking at the research in terms of trans health education, there aren’t any studies that I know of — hopefully now there are, but when I did the research a couple of years ago, there were no studies looking outside of six months, like pre-test or post-test of intervention of trans care topics that look at long-term take-up in terms of change in attitudes of physicians, increased numbers of patients treated and that kind of thing. If we had the research community or the research buy-in to do these training programs and could have a research component, I think it’s a win-win.
[Translation]
Senator Clement: Thank you very much.
Senator Aucoin: I have a quick question that came to mind when you were talking about statistics. If the questions were asked properly, or if people were comfortable answering them honestly, whether they are transgender, non-binary or another 2SLGBTQIA+ identity, would there be a difference between the answers given by people in big cities and those living in rural areas? Would there be a difference between francophone minority communities outside Quebec and the anglophone minority in Quebec? Those are my two questions.
[English]
Ms. Sinacore: We know that there are big differences in queer health in urban versus rural settings. Oftentimes in rural settings — we can look at this in terms of youth, in terms of across the life span, really — there’s less access. Where are people getting their information? They’re getting their information online, and oftentimes the information they’re accessing isn’t particularly accurate. We see a difference there. Historically, we saw migration into the cities from rural areas because the cities had a more accessible community. Sometimes it wasn’t so easy for us to access, but more accessible, and we see that more and more now.
One of the things we have been doing at Gay and Grey Montreal is a project called Q11, and it’s building a network across Quebec of service providers that have the ability to serve older populations of 2SLGBTQIA+. Even those service providers — I’ve done workshops for some of them — who really want to provide gender-affirming, sexuality-affirming and age-affirming care, they don’t always feel like they have the competence to do so. In the rural settings, there’s even less ability to being able to get access to that. It goes beyond just English; it goes on to competent and affirming health care. We do see a difference between rural and urban settings.
We also see a difference, for example, in terms of the city people choose to live in. Montreal, for a very long time — it still is a destination for trans people because, once they dropped the bottom surgery in 2015, trans people were like, “Okay, I’m going to go to Montreal,” and it is a destination. Actually, in Alberta’s provincial legislation about trans health, they comment in that legislation about trying to keep Albertans in Alberta because Montreal is the destination city for trans-affirming care.
You see people going to different places based on the kinds of needs they may have and based on which identities — because they may have more than one identity in that acronym — depending on the identities they have within that acronym, and then you layer on intersectionality of race, religion, English, et cetera, and it becomes quite complex.
[Translation]
Ms. Pullen Sansfaçon: I don’t know whether the situation has changed in the last year, but to my knowledge, there is only one place where people can get gender-affirming surgeries in Canada, and that is in Montreal. Everyone who needs a gender-affirming surgery, whether they are from Alberta, New Brunswick or elsewhere, has to go to Montreal to get it.
Perhaps a different skill set is needed for surgery, but there are clear standards of care for the prescription of hormones and hormone blockers for people of all ages, for example, the standards set out by the World Professional Association for Transgender Health, or WPATH, which was mentioned earlier.
I think that any doctor who can prescribe medication should understand that this care is really well regulated. We should try to support skills development because I know that some of my colleagues who work in pediatrics in a Montreal hospital are helping other colleagues who work up north learn how to prescribe hormone therapy to trans and non-binary youth.
This is doable and well regulated. It is just a matter of promoting this type of care by showing that it has been carefully thought out and researched using the Delphi technique. In my opinion, we just have to make the process more visible.
The Chair: Thank you. We are about to wrap up. I would remind my colleagues that the rest of our meeting will be held in camera.
[English]
Senator Moncion: I want to go back to an answer that you provided not so long ago about the curriculum changes that need to go through the ministry of education. I go back to the question that I was asking in terms of medical versus political. You were saying that it takes at least three to four years just to get a change to the curriculum. That’s why I was asking the question, to understand the challenges that are associated with new services that need to be provided and the time it takes for these new services to be put into the curriculum and then to be approved. It’s the process and how politics can play into this, university politics and then provincial politics.
Ms. Sinacore: That’s a really good question because, in the policy statement I co-wrote with my colleague Jessie Fossey, we talked about both educational reform as well as health care reform. Without educational reform, we can’t have health care reform.
For example, at McGill, if I want to bring a new course in, that goes through my program, my department, the Academic Policy Committee, and then it goes to a subcommittee of the senate and then it goes to the senate. To bring in one course, which doesn’t have to go to the ministry of education, it’s going to take at least, at minimum, a year.
Now compound that with trying to bring in a curriculum that integrates training around gender diversity and racial diversity, that is consistent with our responsibilities to truth and reconciliation and relational accountability to Indigenous people, that addresses the intersectional concerns of the 2SLGBTQIA+ population, et cetera, that’s a major curriculum change. That’s not a course. Those are topics that need to be integrated across courses, especially because we need to do this in an intersectional way to avoid the silos. They need to be integrated across courses. They need to be integrated in our clinical training. Now you’re talking about a much more significant change in the curriculum. If it’s a significant change, just getting that change through your department is going to take over a year. Then, with time, it goes through all these things.
Maybe it doesn’t have to go to the ministry of education. A major change typically does have to go to the ministry of education. The ministry of education in Quebec currently has been very supportive of gender-diverse education in the schools. The sex education program in the schools has been very progressive, but COVID did a job on it because people stopped focusing on that issue. With the current backlash that we’re seeing against trans and gender-diverse people and the protests we’re seeing in Montreal and across the country with these laws coming in, that politic is going to impact what the ministry of education sees as appropriate curriculum changes.
However, because in my field, the accreditation body is insisting on these changes, we will have leverage. We are saying, as a psychological association, that these are essential changes to provide appropriate and competent psychological care. That’s where health needs can be used to address the politics of what’s happening in the ministry of education. Federally, if these kinds of curriculums are supported, that means the provincial ministries of education are going to have to take them seriously.
I’m not worried about Quebec because I think we have a very progressive education system when it comes to these kinds of topics.
The Chair: Dr. Sinacore, Professor Pullen Sansfaçon, Ms. Chai and Dr. Knudson, thank you so much for your contribution to this committee. I want to thank you for what you are doing for the 2SLGBTQIA+ community. It’s because we have citizens like you that we are more aware of the challenges and that we realize that we still have a lot of work to do to have an equal society.
[Translation]
Thank you very much.
Honourable senators, we will suspend briefly and continue our work in camera.
(The committee continued in camera.)