THE STANDING SENATE COMMITTEE ON OFFICIAL LANGUAGES
EVIDENCE
OTTAWA, Monday, May 6, 2024
The Standing Senate Committee on Official Languages met with videoconference this day at 5:01 p.m. [ET] to study matters relating to minority-language health services.
Senator René Cormier (Chair) in the chair.
[Translation]
The Chair: I am René Cormier, senator from New Brunswick, and chair of the Senate Committee on Official Languages.
[English]
Before we begin, I would like to remind all senators and other meeting participants of the following important preventative measures.
To prevent disruptive — and potentially harmful — audio feedback incidents during our meeting that could cause injuries, we remind all in-person participants to keep their earpieces away from all microphones at all times.
[Translation]
As indicated in the communiqué from the Speaker to all senators on Monday, April 29, the following measures have been taken to help prevent audio feedback incidents:
All earpieces have been replaced by a model which greatly reduces the probability of audio feedback.
The new earpieces are black in colour, whereas the former earpieces were grey. Please only use a black approved earpiece.
[English]
By default, all unused earpieces will be unplugged at the start of a meeting.
When you are not using your earpiece, please place it face down, on the middle of the round sticker that you see in front of you on the table, where indicated.
Please consult the card on the table for guidelines to prevent audio feedback incidents.
[Translation]
Please ensure that you are seated in a manner that increases the distance between microphones. Participants must only plug in their earpieces to the microphone console located directly in front of them.
These measures are in place so that we can conduct our business without interruption and to protect the health and safety of all participants, including the interpreters. Thank you all for your cooperation.
Now, I wish to invite committee members participating in today’s meeting to introduce themselves, starting on my right.
Senator Poirier: Good evening and welcome. Rose-May Poirier from New Brunswick.
Senator Mégie: Good evening. Marie-Françoise Mégie from Quebec;
Senator Clement: Bernadette Clement from Ontario.
[English]
The Chair: Thank you. I wish to welcome all of you and viewers across the country who may be watching. I would like to point out that this meeting is taking place from within the unceded traditional territory of the Algonquin Anishinaabe Nation.
Tonight, we continue our study on minority-language health services by welcoming researchers and organizations able to address the theme of vulnerable communities and health professionals and post-secondary institutions, two of the six themes of our study.
On our first panel, we welcome in person, Dr. Don Thiwanka Wijeratne, Associate Professor, Division of General Internal Medicine, Queen’s University. Welcome to our meeting.
Joining us by video conference, we welcome Dr. Richard Musto, Clinical Professor, University of Calgary; and Carmen Loiselle, Director and Principal Investigator at Dialogue McGill, and Professor in the Faculty of Medicine and Health Sciences at McGill University.
Good evening and thank you for accepting our invitation. We will now hear each of your opening remarks. They will be followed by questions from the senators.
The floor is yours, Dr. Wijeratne.
Don Thiwanka Wijeratne, Associate Professor, Division of General Internal Medicine, Queen’s University, as an individual: Thank you very much, everyone.
Honourable Senate committee and other members of the audience, I appreciate and value this opportunity given to me to be a witness in this discussion.
I’m very passionate about this topic as a BIPOC Canadian and an immigrant to this country. I immigrated to Canada in 2008 after finishing medical school in Sri Lanka. I’ve since trained in Canada and have been working as an internist for over eight years and now I am an associate professor at Queen’s University.
On a day-to-day basis, I see numerous patients who speak minority languages. In addition, I do population health research focusing on immigrant health and health care access. This enables me to talk about this topic and I value this opportunity.
I would like to talk about three main domains. First, I want to acknowledge some of the nuances of minority language in health care; second, I will talk about what actually works in our health care setting; and, third, as a health care worker, I may make some recommendations going forward.
I find there are a lot of nuances when we talk about minority language and health care because when a patient only speaks a minority language, there is no argument that they are at a distinct disadvantage. The patient is not able to communicate, there is poor access, and so on.
Unfortunately, it is not limited to that. Language is often only a vessel that has many other factors that influence health care access to these patients. Language is intertwined with culture, values, expectations and roles of each person that plays a direct influence on the person’s behaviour to health care access.
Barriers with minority languages are also unique to different clinical situations. We would like to talk about language and access but each clinical situation is different. For example, with a primary care or outpatient setting the focus may be on setting symptoms and care provision, doing some basic investigations, whereas if you talk about an urgent care setting, or ICU setting, the focus may be on having more important decisions about goals of care and determinants of health, which is more of a conversation that leads to goals of care types of discussion.
Similarly, in an in-patient setting, the conversations might be around nursing care, self-care and nutrition. I would like to emphasize that, in each of these clinical settings, the requirements and the needs can be unique. Acknowledging that and being context specific will be helpful.
The other vulnerable population I would like to talk about is patients who speak a minority language but also who are older. Unfortunately, this compounds the issues of regular physical, mental barriers to access.
Now let’s focus on what actually works in our health care setting. This is purely based on my experience. Caregivers are a fantastic resource. They bridge the gap for language limitations, especially with family-class sponsorship. All the patients are sheltered by family members who help navigate their health care needs. Unfortunately, that comes with a price as well. There is a lot of sensitive information that the patient may not be able to channel through their caregiver, which is often a family member. And there is always potential for coercion, especially when it comes to the goals of care discussions and decisions on power of attorney for personal care as well as finances. So, I think that needs to be considered when we talk about caregiver support dealing with minority language issues.
I think multilingual staff is an asset to any institution, and that we should strive toward having a greater representation of multilingual staff, which I think is a distinct advantage.
Another thing that works is interpreter services available as a hotline. Most health care institutes have access to a 1–800 number, which I think is underutilized. At the moment, in our hospital, we use it for important family meetings and decisions about care, but it’s less utilized for day-to-day care. Just to cite an example, for some of my colleagues working in the UK, the NHS model is such that a patient who speaks a minority language and who comes to a clinic has access to a hotline that is available in a clinic setting, and at the click of a button they can access a live interpreter. That type of access would be fantastic, and it’s an extension of the services we already have in place.
Next, very briefly, I would like to move on to a couple of recommendations from the perspective of a health care worker. As I said before, caregiver support should be a complementary service and should not be substituted, especially given the vulnerabilities relating to coercion with patient care. I think another intervention we can implement is that all institutions can make an active, dynamic repository of their employees and the languages they speak. I speak Singhalese, but, unfortunately, I think most members of my hospital are not aware of that. So, I think having a repository within the institution and linking that to a hospital electronic medical record or an on-call schedule, so we know — if the need arises — which health care workers will be available at that time. This can have an incentivized model, and that’s something we can work on, given the current resources we have.
I think the use of technology is underutilized. We have done informal surveys, and we know that over 70% of patients who are over 65 — in fact — have access to a smartphone, and they are able to communicate using a smartphone. Simple interventions like a patient portal in their own language and using medical versions of apps like Duolingo, for example, are very practical things that we can incorporate into patient communication. Sometimes, using non-verbal language cues and pictures — like a simple tab format at the patient’s bedside to be able to communicate for usual care needs — are very practical things we could implement.
I would like to conclude by introducing a theme that I’m passionate about, and this is a request to all the committee members. I think a lot of what we have discussed is based on assumptions. We assume people who speak minority languages are disadvantaged, and I’m not discrediting that. But I think there is a large knowledge gap, and there are assumptions there. The reason I bring that up is that people — like myself doing population research — have discovered that patients who speak minority languages and immigrants to this country may, in fact, have a healthy immigrant effect when they initially come into the country. In the first 5 to 10 years, based on how their primary care visits work, screening for cancers, et cetera, they might have a healthy immigrant effect.
The Chair: Perhaps you could conclude because you are over your time. You will have a chance to have more input with the questions.
Dr. Wijeratne: My conclusion is that I think there are a lot of opportunities to do population-level research using the existing databases, including the immigration database. Thank you.
The Chair: Thank you, doctor. Now we turn to Dr. Musto. The floor is yours.
Dr. Richard Musto, Clinical Professor, University of Calgary, as an individual: Thank you very much for this invitation to appear before you on this important matter of minority language health services. I am a settler of Irish and English ancestry and have the privilege of living and working within the traditional territories of the peoples of the Blackfoot Confederacy, the Tsuut’ina Nation and the Stoney Nakoda First Nations, all of whom are signatories of Treaty 7. Calgary and area are also within the homelands of the Métis Nation of Alberta, Region 3.
As a public health and preventive medicine physician, I work within the Indigenous Wellness Core of Alberta Health Services and I am also a clinical professor at the University of Calgary. Both as an administrator and clinician, I have witnessed inequities in access to care and health outcomes related to poor communication stemming from limited proficiency in one of the official languages. I believe the effective implementation of barrier-free access to professional interpretation in all health care settings, including help lines and virtual clinics, to be a vital contribution to bringing the quality of care provided more in line with the principles of equity, inclusion and social justice.
Language is an integral component of culture and the identity of both individuals and communities. Language rights are recognized by our own Canadian Charter — although I gather that the interpretation of its application continues to evolve — and the United Nations Declaration on the Rights of Indigenous Peoples. The availability and promotion of professional interpretation contribute to a welcoming and safer health service environment for persons with low proficiency in English or French, including many Indigenous peoples and immigrants, while a positive experience with it helps to reduce hesitation in seeking care.
The research literature on the effectiveness of interpretive services in improving health care is continuing to evolve. A preference for professional interpretation has emerged for both care providers and clients with a positive impact on perceived safety, compliance with prescribed care and subsequent access. Unfortunately, there is as yet limited evidence about its economic impact as reflected, for example, in hospital length of stay or readmissions or repeat emergency department visits.
Risks associated with the use of family members — particularly children, other staff members or untrained interpreters — have been identified, including errors of omission, substitutions and editorialization, and for children, stress related to a role they are not sufficiently developmentally mature to assume.
As for challenges, a common pushback from clinicians is that the clinical encounter will take twice as long as usual if an interpreter is present. However, this has not been identified as an issue in the published literature to date, but certainly should be examined. Similarly, the incremental cost of the service is a concern yet, as mentioned earlier, there may be a significant return on investment because of improvements in the quality of care.
Health care providers will require training in the use of the service, including cultural competency and an understanding of health literacy. Ease of access is important for both the practitioner and the client, and centralization of the booking process can address this.
In terms of recommendations, I have five:
First, make access to trained interpreters — whether face-to-face, virtually or by telephone — mandatory in federally delivered health services.
Second, provide financial incentives to provincial health systems to establish and maintain well-coordinated access to trained interpreters.
Third, in collaboration with accreditation agencies, develop and implement national standards for interpretation services in health care.
Fourth, work with national professional colleges or associations to incorporate competencies in utilization of interpreters in training curricula.
Finally, fund research into implementation and evaluation of interpretation services in health care.
Thank you for this opportunity.
The Chair: Thank you very much, Dr. Musto.
Now, Ms. Loiselle, the floor is yours.
[Translation]
Carmen G. Loiselle, Director and Principal Investigator, McGill University (Dialogue McGill): Hello. I would like to thank the Standing Senate Committee on Official Languages for this invitation to discuss access to health and social services for official language minority communities.
I am a professor at McGill University and the principal investigator at Dialogue McGill.
[English]
Dialogue McGill is based in the Faculty of Medicine and Health Sciences at McGill University, and it has been funded since 2004 by the Health Canada Official Languages Health Program.
Dialogue McGill’s purpose is to build capacity of bilingual health and psychosocial services professionals in Quebec to specifically ensure that English-speaking Quebecers have access to the full range of services in their own language.
More specifically, Dialogue McGill implements initiatives designed to build, train and maintain a sufficient complement of professionals capable of providing services in English and French. We meet this mandate through the development, implementation and testing of initiatives in partnership with the Ministère de la Santé et des Services sociaux, public health and education institutions, community organizations and other relevant stakeholders.
Today, I chose to focus on three key points: One, English-speaking communities in Quebec are a diverse and potentially vulnerable minority group who are increasingly documented to experience worse health outcomes than their French-speaking counterparts.
Second, there is an ongoing need to address staff shortages and out-migration of bilingual health professionals from the public to the private sector. I will give examples of statistics on that.
Third, given ongoing health care reforms in Quebec, service performance evaluation through research is essential to ensure optimal services access and quality for the English-speaking minority. I will briefly review issues according to each point.
My first point, English-speaking communities in Quebec are diverse and potentially vulnerable.
Canada is recognized and celebrated for its cultural diversity, with Quebec holding a unique status of being the only province with English as its official language minority. This uniqueness continues to stimulate reflections and questions surrounding the specific needs of Quebec’s official language minority communities compared to their provincial counterparts.
According to a 2021 Statistics Canada report, English-speaking communities account for 13% of Quebec’s 8.7-million population. These communities are heterogenous, with 37% having immigrated to Canada from another country.
According to a recent Community Health and Social Service Network report, nearly a third of English-speaking communities are also members of a visible minority.
Language is recognized as a significant social determinant of health. It is found that patient-professional miscommunication is associated with a higher likelihood of medical errors, adverse events, increased morbidity and mortality and low satisfaction with the care being received. And I have the reference for these studies.
Higher language fluency and concordance, therefore, contribute to more positive health-related processes and outcomes. Individuals who typically get by in their daily lives using a second language report higher anxiety when dealing with health-related issues resulting in hesitancy to access or avoidance of needed services.
For instance, a Dialogue McGill-funded a study of 314 English-speaking participants living in Quebec showed a significant relationship between anxiety to communicate in French and patients’ unwillingness to use services.
Another Dialogue McGill-funded study among 531 French- and English-speaking Black adults found that over 25% of the English-speaking group reported language-based discrimination, so that was 25% compared to the 7% of the French-speaking respondents.
The English-speaking participants also reported facing more barriers to accessing mental health services and lower mental health compared to their francophone counterparts.
Second, there is an ongoing need to address staff shortages and out-migration of bilingual health professionals from the public to the private sector.
In Quebec, there is a limited number of professionals who speak English fluently, with most concentrated in Montréal. Whereas 98% of Quebec professionals speak French, only 55.7% report being able to speak English. Six out of ten professionals who do speak English are working in Montréal, highlighting a higher need for English language training in remote regions.
In response, Dialogue McGill provides language training to over 1,750 health and social services professionals each year.
In 2022, Dialogue McGill conducted a survey among 668 participants who took our language training courses. The sample included professionals in health services, psychosocial services, front desk workers and other professions. We found that after taking our English language courses, a higher percentage of time was spent speaking English with patients, 18% prior and 24% post course attendance. This shows that language training initiatives can have a real-world impact.
Concerned about the fact that many English-speaking professionals leave the province post-graduation, my team recently conducted a study with native English-speaking university students enrolled in health and psychosocial services programs. We assessed potential predictors of them staying in Quebec post-graduation.
When 189 students were asked what is the likelihood that you will stay in Quebec one year after graduation, 30.2% reported that it was unlikely. The primary reasons included: French language requirements, 40.4%, family, 26.3%, and career and financial reasons, 24.6%.
For professionals who stay to practise in Quebec, there is a perplexing increase in transitioning from public to private practice. For example, between 2015 and 2023, the number of psychologists in public practice annually dropped from 2,400 to 1,800. Conversely, during this same period, the number of psychologists practising in the private sector increased from 2,700 to 3,400. Dialogue McGill seeks to address this out‑migration as well as staffing shortages with bursaries to bilingual students in exchange for one year of service in the public health sector, with placements in remote regions as a priority. Given that health service access is a moving target, we appreciate ongoing discussions with policy-makers.
The Chair: I’m sorry, Ms. Loiselle. I will ask you to conclude before we go to the question and answer.
Ms. Loiselle: I would like to conclude by expressing Dialogue McGill’s appreciation for the initiative that the Government of Canada funds through the Action Plan for Official Languages.
[Translation]
On behalf of Dialogue McGill, thank you for this invitation and for your time. We look forward to answering your questions.
[English]
The Chair: Thank you to our three witnesses. We will now go to the Q and A. I will give the floor to the deputy chair of the committee.
Senator Poirier: Thank you all for being here. My first question is for the doctor who is here with us today. In your experience, what are the barriers faced by internationally trained health professionals in terms of credentials recognition? What can the federal government do to ease these barriers for internationally trained health professionals who wish to immigrate and practise in Canada?
Dr. Wijeratne: I think that is a great question. Thank you. I think the main barrier is getting into a training program. As you know, becoming a practising doctor here is twofold. One is the set of exams and credentialing which most international graduates actually meet standards. Number one, their medical schools are accredited, and there is a body that makes sure that the proper credentialing and accreditation happens. There are Canadian licensing exams that are quite stringent, and most people pass them really well.
There is a cohort of over 3,000 to 4,000 such candidates who are, unfortunately, waiting to get into a training program which is very limited. Sometimes the number is as small as 200 positions per year for a cohort of 3,000 to 4,000 able graduates, and the number keeps on increasing on an annual basis.
Also we don’t have a mechanism to identify practice-ready physicians. By that I mean specialists who are practising and who have a lot of experience in their own countries. Unfortunately, they come here and have to start all over again because, in the recent past, they changed practice-ready assessment that was in place where physicians were able to start practising in their chosen profession with the practice-ready assessment.
Currently, such physicians who are specialists can join an academic institute and then get an academic licence, but in terms of a community need for a larger community, that is not in place. The bottleneck, unfortunately, is the number of residency positions available for training of physicians.
Senator Poirier: Do you have anything to propose to us that the federal government could do to improve the foreign-credential recognition for the francophone or bilingual health professionals?
Dr. Wijeratne: For bilingual health professionals, depending on the practice location, if there are physical limitations to the number of positions available, they could provide an interim licence within an institute and have a supervisor supervise these candidates. That’s a great opportunity because that large cohort of people whom I was talking about have actually done their exams, and they are looking for an opportunity to practise here. If there’s supervision within the same institute offering a provisional licence, that would be fantastic.
Also, we already have the concept of physician assistants, for example, who are trained here with two years’ training and who joined the workforce as health care workers. Why not consider that for international graduates who are trained with six years of medical school and often with clinical experience? And we attribute that to lack of Canadian experience.
I am an international graduate, and I appreciate that I’ve learned the ropes of the Canadian health care system, but that’s definitely something trainable within a short course.
Senator Poirier: My second question is for Dr. Musto.
When you did your presentation with your recommendations at the end, you talked a lot about the interpreters who could help to solve the interpretation situation. Are there any statistics to give us an idea of how many people we would need to answer this need? Do you feel that interpretation would take away some of the frustrations that may be out there when you can’t get access to the language of your choice? Should priorities be put more on the interpretation service, or should we continue focusing more on trying to find the bilingual staff there immediately? Is one different from the other? I want more thoughts from you on that, if you can.
Dr. Musto: Sure. Thank you. In Alberta, which is a whole-province integrated health system, we largely use an online service. You can, in some languages, have interpreters present but, mostly, it’s done by telephone or by virtual connections. When somebody presents with a need, you can get the interpreter in the right language within minutes.
I’m not sure of the source of that language line. It may not be Canadian. In that case, it’s not a matter of needing to train the interpreters.
The second part of your question, could you just repeat, please?
Senator Poirier: We are focusing a lot on the issues around people demanding service in one of the official languages of our country. Sometimes, the problem is the ability to recruit enough people to answer the need.
Interpretation is always a way to help, but do you feel it would be better for the country to focus on more interpretation right now to meet the need? We need more manpower. That’s one of the main things we’re hearing everywhere — the lack of manpower in the languages we need to offer. We’re hearing so much of that, but right now I’m hearing from you that interpretation could work maybe a whole lot better in certain areas of the country. That is if I’m reading you right. Otherwise, it would take years and years to get the trained staff needed to provide the languages in person.
Dr. Musto: Right. Because of the availability of these language lines, we can at least have the service available. We still need to train staff in order to use it appropriately. That was the reason for my comment about evaluation. Essentially, we have access to the interpreters now, but we do need to continue emphasizing the recruitment of people with various language skills.
Senator Poirier: Can we have enough people to do interpretation across the country? Are there any statistics to show how many people we would need to do that, to answer that need?
Dr. Musto: Again, it’s a matter of picking up the telephone for us in Alberta. There is no number of people whom we have to train. Rather, we need to train our staff to use it appropriately. We need to get past barriers such as “Oh, it takes too long. I don’t want to bother with that.”
Senator Poirier: Thank you.
[Translation]
Senator Mégie: My question is for Dr. Musto.
In your studies on interpretation, did you measure bias? For example, when the patient has something to confide, are they more likely to do so when they are accompanied by a family caregiver than they would be if a complete stranger is doing the interpretation? Have you looked into that?
[English]
Dr. Musto: There’s actually very limited research on that. The research that has been done gives preference to professionally trained interpreters. The main challenge for the health care worker is availability. That’s probably what I would say on that. I am sorry, I had another idea to share, but I have forgotten it at the moment.
[Translation]
Senator Mégie: If it might jog your memory, I was asking about the reliability of using a family caregiver as an interpreter as opposed to someone who is brought in by phone.
[English]
Dr. Musto: Well, the people who are brought in by phone are trained in interpreting in health services. What happens too often is interpretation by a staff member who uses the language but who may not actually be an interpreter. It may be a cleaning staff member or another health professional who is not involved in that individual’s care nor knowledgeable about the issues that person is presenting with. There’s a concern there that, again, the accuracy of the interpretation will not be appropriate.
[Translation]
Senator Mégie: Thank you, sir.
My next question is for Dr. Wijeratne.
I think I heard you mention that some provinces began introducing provisional licences during the COVID-19 crisis to get more internationally trained professionals working faster. Do you have any data from the provinces that have been doing that?
[English]
Dr. Wijeratne: During COVID, Alberta, Saskatchewan and Ontario had such a mechanism in place. To my knowledge at the moment, Ontario does not continue to do so. I can’t speak to the other provinces, because I practise in Ontario.
As I said before, that model is fantastic because we have the knowledge and the skills already available. Especially in the context of primary care and urgent care, I think that’s a valuable resource we can tap into, to mitigate some of the wait times and the patient load for sure.
Also, I’m proposing to have is a supervised system where there will be better integration of these graduates, similar to what we currently work on as a physician-assistant model.
[Translation]
Senator Mégie: Thank you. I know it is difficult because a team of senators with medical expertise conducted a study. We called on medical schools and colleges of physicians from the various provinces to go back to this method, and they were passing the buck back and forth.
Who should we be looking to in order to adopt this approach?
[English]
Dr. Wijeratne: I’m cognizant of not making any political commitments and statements. My view is purely based on my knowledge as a clinician and my colleagues with whom I’ve worked that have international training. I know that people like me are capable and they have the ability. They have done their credentialing and their exams. These types of people should be recognized, ideally in the mainstream, if not with other secondary options that are available, similar to a physician-assistant program.
I am unable to comment about who should be making that decision, but I do know that the resources are available and it’s a fantastic resource that we can tap into.
[Translation]
Senator Mégie: Thank you. I have a question for Ms. Loiselle. I’m from Quebec, and when I say that English speakers in Montreal have a harder time getting treated in their language at hospitals, people look at me and ask me if I’m joking because, in everyday life, everything on the other side of Saint-Laurent Boulevard is English, even the hospitals.
I know that the workforce isn’t the same everywhere, so can you tell us, based on your research, in what regions of Quebec English speakers are more affected by a lack of services in their language?
Ms. Loiselle: It depends on whether the institution is designated bilingual. Of course, it would be easier to get bilingual services or English services in a CIUSS in west-central Montreal.
People would have a harder time in other regions where there are no CIUSSes that are designated bilingual.
Take for example, the CIUSSs in Montégérie or the Eastern Townships. In some regions, such as Abitibi-Témiscamingue, it is more difficult to get such services. When we talk to people and meet with the teams in those areas, we see that English speakers have a harder time getting care in their own language. There is also Quebec City, where there are military colleges, and people come from all over Canada. When these people need to access care in Quebec City, they face language barriers.
Senator Mégie: Thank you.
Senator Moncion: My first question is for Ms. Loiselle. You mentioned language barriers. I find that odd because, when we spoke to people in the North, we learned that they use interpretation services, but they often do it using a tablet because sometime people up north do not speak French or English. They speak Inuktitut. Health care professionals there manage to provide services to their patients using tablets that they carry around with them. That is what we were told. Why could this type of service not be offered to English speakers in rural areas who need to express themselves in one language or the other?
Ms. Loiselle: When you talk about tablets, are you talking about communicating using a tablet like an iPad?
Senator Moncion: That is what we were told is being done up north. They have what is called fly-in staff. Often the patients don’t speak English or French, so the doctors have to speak to them in Inuktitut and they manage to treat those patients. We heard the same about northern Quebec and the Northwest Territories, where there are 26 or 27 languages spoken. Patients are still getting treated. Meanwhile, people in some provinces are having a hard time getting treated in French or English because of a lack of interpretation. I have a hard time understanding that way of thinking when we have technologies that can give us access to the information in another language.
Ms. Loiselle: There are all sorts of interpretation and professional interpretation technologies available.
In a CLSC where there are 100 languages spoken, a person can come in and, within one minute, the staff can connect to a professionally trained interpreter online. These services are available and used in CLSCs. There were some questions earlier about interpretation. According to the work Sarah Bowen has done in Canada, professional interpretation is much better when it comes to reducing errors and bias. Yes, there is evidence that professional interpretation works better than using untrained interpreters. I wanted to mention that because the subject was raised earlier. The research shows that fewer medical mistakes are made when professional interpreters are used.
It is worth exploring the online interpretation services that are available with various companies, but when we are talking about the official minority language, then the ideal situation would be to have bilingual health care professionals just about everywhere. I am a nurse and psychologist by training. Things happen very fast in a clinical setting, so it helps a lot and it greatly reduces miscommunication and mistakes when staff members are proficient in the language.
As we enhance our knowledge in this area, I think that we need to differentiate between interpretation for community care and interpretation for hospital care. That is my position.
Senator Moncion: Thank you very much. My next question is for Dr. Wijeratne. You spoke about access, or about barriers and credential recognition.
[English]
That is, recognizing credentials from doctors who are coming from other countries. You said that you did not necessarily have a solution to provide for fixing the problem when physicians come here to Canada and want to practise. There’s a program in Winnipeg — and I’m sure you’re aware of that program — where doctors come from abroad and they are integrated into the program. Within a year, they get their credentials and they can become physicians in Winnipeg.
Is this a program that could be broadened to the whole country and maybe help with the fact that we have physicians that could be recognized and become —
Dr. Wijeratne: To answer this question, 100%. I’m an advocate for that, and that can be implemented across Canada. It’s not that we don’t have eligible candidates. Within each province we have such eligible candidates. How that leads into whether they’ll be hired mainstream versus using some type of monitored and supervised mechanism, that’s up for discussion, but the integration piece is required, and in my opinion, it is generalizable to all across Canada.
If I may give a small opinion on your previous question about access, that’s the very point that I’d like to make, because in this discussion, we do have a lot of assumptions that language is a barrier. We need to support it, and I completely agree. But I think the part that we are missing is the study of that and the research of that.
Why I think that is important is if we don’t measure health outcomes that are related, the patient satisfaction that is related, the patient-related outcomes, I think we are missing the point, and that’s the very reason. We have the infrastructure to do that.
As a population researcher, I can tell you that there are health administrative-related databases, especially in Ontario, that can be linked to the Immigration, Refugees and Citizenship Canada, or IRCC, and immigration database, and that’s the work that I do. The IRCC database has information on their language proficiency, information on citizenship and last country of permanent residence. These are all health determinants that we can study.
The advantage of that is not only are we able to monitor health outcomes over time but also identify vulnerable, targeted populations that we can then specifically develop informed strategies looking at those vulnerable populations, and that’s the very point that I wanted to emphasize. As a Senate committee, if you can facilitate some funding to do that type of research, for people like us, that would be super helpful not only to understand the knowledge gaps, but also moving forward to see how the interventions make a change in patient care and outcomes.
Senator Clement: Thank you to all the witnesses. I’ll start with Dr. Wijeratne and continue on the point you just raised. Was that where you were going when you were raising the healthy immigrant factor?
Dr. Wijeratne: Absolutely, it’s only through research recently that we acknowledged that an immigrant coming into the country may have certain health care access parameters that are better than a long-standing Canadian resident. We do know that they probably use primary care more. They’re likely seeking more primary care, and that may last up to about five years.
But what we don’t know is how that actually transpires into different disease models, cancer and chronic disease. What we don’t know is, does this continue on to curative treatment? If a person develops a cancer, do they get the appropriate therapy and does that actually change outcomes? There are so many unanswered questions, and that’s why I think it’s important.
In some of the preliminary work that we have done, I’ve looked at language proficiency and adverse drug events with blood thinners, and in fact, these patients who are immigrants may have less unplanned health care visits, so that needs to be studied more. Patients with limited language proficiency, in fact, because of their caregiver support, may have less urgent care visits.
These are some of the hypotheses that we need to identify without making assumptions — I’m not discrediting the need. The need is there, we need to find solutions. Studying that more systematically would be super helpful so we can do targeted interventions.
Senator Clement: You had this idea about a dynamic repository of languages within an institution, so understanding the inventory of people who can provide services. But you’re presumably a busy doctor. You wouldn’t necessarily be able to leave your practice to provide. I’m interested in how you make space for non-official languages in a space? How would you use such a repository? Do you have an example of where you used your language to provide services to a patient and that made a difference?
Dr. Wijeratne: Absolutely. Right now in the ward that I work, if there’s a patient who speaks my native language, I would probably know. Even within the hospital, no one would know. To operationalize this, I think it’s quite simple.
Number one, you identify people working in the hospital who have some medical background, so it has to be a health care worker, physician, et cetera. If that repository is documented and linked to an electronic medical record or an on-call registry, that would be a very valuable resource.
Everyone works on a shift basis. When I’m not on clinical service, I would love to know about that type of thing. With modern-day technology, it could be an app that would have a notification, saying there’s a patient in this ward who is in need of interpretation, and you can accept it or decline it based on your availability. It expands the resources that are available and having a small incentivized model.
For example, as a clinician, I do e-consults, so the family doctor is using a portal, email me clinical questions, and it takes about 15 to 20 minutes for me to answer that, and I do that during my spare time when I’m not on a clinical service.
A small incentivized mechanism can, I think, be implemented well. I know it’s institution-specific. This something doable with the existing resources that we have.
Senator Clement: Thank you. Professor Loiselle, you gave quite a lot of statistics around different populations having different barriers, and you mentioned Black English speakers, referring to intersectionality there. Have you studied the impact of that? I know you have a number, but have you studied how that affects their access to care?
You also talked about language training initiatives having a real-world impact. How do we do that with a very busy health care provider schedule? How do we make that possible for them to actually have the time to take language training?
Ms. Loiselle: The first part of your question was around a study that Dialogue McGill funded. Researchers at McGill studied — during COVID especially — the mental health and physical health of Black, French speaking and Black English speakers, so looking at the differences between them, and documenting that there were more negative issues among the Black English speakers than the Black French speakers. That was the work that was done we funded. I can definitely provide more information on the report for this study. Your second question was —
Senator Clement: Which training initiatives have a real-world impact? And I’m wondering how you insert that into a busy health care provider schedule.
Ms. Loiselle: COVID had the advantage of having most of our language courses now on line, virtual, so some are synchronous and some are asynchronous. We have an increase in the number of professionals taking our courses because they can take them outside working hours. We provide incentives, bonuses. They are more symbolic, but we are providing bursaries for students who are in health and social service programs, doing their bachelors to take language classes, and we have used those incentives to make sure that we have people taking the courses, and it shows because 1,750 a year are taking our English courses. That is a good number, and it’s repeated.
I think we’ve had success. We’re hoping to increase that number if we can, but it shows that there is an interest in language courses for health care professionals, yes.
Senator Clement: Thank you.
The Chair: I have a couple of minutes to ask some questions too. My questions are focused on what the federal government can do to help solve the issues that you all raised.
I will start with Dr. Musto. You spoke about national standards in health care. Did I understand well that you mean language national standards in health care? Is what that you were talking about?
Dr. Musto: Yes. All of our health services are accredited by, for example, Accreditation Canada, and there are standards that institutions must comply with in order to continue to be accredited. I would like to see a standard around the availability of competent interpretation services that each institution must offer to their clients.
The Chair: Do you have an idea what the federal government could do in either its agreements with the provinces and territories or how it could help achieve that goal?
Dr. Musto: First, through dialogue with institutions like Accreditation Canada. It’s important to approach them directly. I don’t think the provinces would need to be consulted because the standards are developed based on the evidence in the literature. The different institutions — not so much the province, the government, but the institutions — collaborate on the development of the standards. Again, the touchstone is what does the literature say?
The Chair: Thank you for that. Health in Canada is a big issue. It is a whole ecosystem. What can the federal government do in terms of research? You spoke about the difficulty, the need for data and for more information. Do you have any idea what the federal government could do in terms of research? Do you think, for example, that language should be a determinant of health? Should it be part of that? Should we revise or review the Canada Health Act to include specific comments on official languages so that the federal government could help provinces and territories better? What are your thoughts on that, Dr. Wijeratne and others?
Dr. Wijeratne: I think there are two components to that question. The first component is that language is important. It is a determinant, but it is one determinant of many. I can speak to immigrant cohorts.
As I mentioned before, a multitude of things go on with language, for example, the different roles that individuals pose. In certain cultures, it’s unnatural for patients to seek attention and speak to a physician. That is usually channelled through a family member. That’s just one example. Understanding and having a more wholistic approach to be able to look at these variables not only from population-level registries but also from qualitative work. We have that infrastructure. That’s the key thing I want to emphasize. There are researchers within that infrastructure currently doing that work and they need an enabling piece which might be simply funding for an analyst and a qualitative researcher. We know the questions that need to be answered. We know what the potential hypothesis is, namely, the federal government funding is available for this type of work, that would be super helpful to bridge these knowledge gaps.
The Chair: Do you want to comment, Ms. Loiselle?
Ms. Loiselle: Yes. Your question made me think about how the Canadian Institutes of Health Research decided at some point — because sex and gender were a significant determinant of health — that this would be part of all grants that they would have to address. I wonder if we should invite all researchers writing grants relating to health and social services to include language in their data analysis to see to what extent it is a social determinant of health and what the predictors of outcomes are when it comes to language. There could be a push to invite all initiatives that are research-based to include language and to see what we get. That would be one suggestion.
Increasingly, we are seeing professional interpreter tools being developed and offered as a fee for service. I think there is a role there for the government to see what exists out there. We have had two examples today. I know several in Montréal that are using different tools and pay a monthly fee to have access from 60 to 125 different languages — that is, professional virtual interpretation. That is the way to go for best practices. Is the government in a position to see what’s out there? What are best practices? Which ones would be more promoted because there are doing a better job in terms of outcomes? I think there is a role there to get a bigger picture of what is being used right now as we speak.
Dr. Musto: If I might add, I certainly agree that it is a brilliant idea to have the Canadian Institutes of Health Research include something around language as a regular part of the applications. They can also do a competition around implementation science about implementing language interpretation. That would be a valuable thing to do.
In terms of different options, the one that we use in Alberta is actually available to many of our partners as well. Essentially, it makes it easier for providers. They don’t have to look at which one they have to use for which person. It provides interpretation in 240 languages. In the past year, there were requests for over 100 languages. Almost a quarter of a million patients accessed that. Yet, I believe it is still under accessed. We need some research around implementation science. How do we do that better? What are the incentives? The federal government could have that role — that is, supporting research, getting the standards, accreditation groups and providing incentives to the provinces to actually implement that service.
For me, it’s a quality care issue. When we see there is a patient harmed, it comes up. We must not allow that to continue.
The Chair: Thank you so much, Dr. Wijeratne, Ms. Loiselle and Dr. Musto for your recommendations. I think we heard today that professional interpretation is key in making sure that we can deliver services in both official languages throughout Canada. You will help our report for sure by your comments and recommendations and by your knowledge. Thank you very much.
[Translation]
Colleagues, we are resuming the meeting to continue our study on minority-language health services under the theme of health care professionals and post-secondary institutions.
We now welcome in person from the Alliance des femmes de la francophonie canadienne Nour Enayeh, president, and Soukaina Boutiyeb, executive director.
Good evening. Welcome and thank you for being with us.
We will start with your opening remarks and then move on to questions from senators.
Ms. Enayeh, the floor is yours.
Nour Enayeh, President, Alliance des femmes de la francophonie canadienne: Good evening, Chair and committee members.
On behalf of the Alliance des femmes de la francophonie canadienne, or AFFC, I would like to thank the Standing Senate Committee on Official Languages for giving us the opportunity to present our recommendations on minority-language health services.
My name is Nour Enayeh, and I’m the president of the AFFC. With me today is Soukaina Boutiyeb, the organization’s executive director.
We are a feminist non-profit organization dedicated to raising awareness and promoting the role and contribution of the over 1.5 million francophone and Acadian women living in minority communities. The AFFC is fortunate to have the support of a network of 14 member organizations in eight provinces and one territory.
For the francophone and Acadian women we represent, accessible health care services in French are a priority. It is important to be able to use accurate and precise language to prevent misdiagnoses. The francophone and Acadian women’s community and organizations must be involved when ensuring access to equitable health care and services in French in every province and territory and in promoting those services.
Although it is possible to talk about health in a general sense, it is important to recognize that francophone and Acadian women do not have the same needs. Our needs differ from those of men, and they differ from those of each other since we are not a homogenous group. Intersectionality is part of our identity, and our varied needs must be taken into account. We are francophone women who are white, racialized, young, older, immigrants and queer. We are women with disabilities, family caregivers and more. That is why it is so important to develop a national health care strategy for francophone and Acadian women.
What is more, a more comprehensive gender-based analysis plus is essential for our incredibly diverse communities. To do that, disaggregated data must be collected and considered. The lack of research on diversity shows that more funding is needed in that area.
We often think about health from a personal perspective, but many women provide care to other people. They are known as caregivers. Their work is essential, but it receives little or no recognition.
Given that health affects many aspects of life, interdepartmental cooperation should be a given. That would make it possible to share health-related knowledge and ensure that the government is working with community organizations on the ground.
The AFFC would like to present the following recommendations to the committee. First, the federal government should develop a national health strategy for francophone and Acadian women that covers primary health care, mental health, long-term care, sexual and reproductive health and preventive health.
Second, the federal government should ensure that francophone and Acadian women have access to equitable services and to existing health resources and it should facilitate access to those services and resources by promoting them through various communications channels. Third, the federal government should require comprehensive gender-based analysis plus, or GBA+, and ensure that the results are made available to the public.
Fourth, the federal government should expand research funding and collect disaggregated data that takes into account the intersectionality of the population. Fifth, the federal government should enhance the caregiver tax credit to recognize the work of these individuals and provide them with financial support.
Sixth, the federal government should ensure interdepartmental co-operation on health issues, while taking into account a holistic view of the social determinants of health.
Mr. Chair and members of the Standing Senate Committee on Official Languages, I thank you for your attention. Soukaina Boutiyeb and I will be pleased to answer any questions that you may have.
The Chair: Thank you for your presentation and for those extensive recommendations.
Senator Moncion: Thank you, ladies, for being here with us today.
When you spoke about a lack of research, you mentioned caregivers, issues surrounding women’s health care and the national strategy that you want the federal government to implement.
Can you tell us how the federal government could make that happen? I know that you are talking about developing equitable services and increasing funding for caregivers, likely through tax credits, for example. However, a national strategy that favours only one segment of the population may not be seen as favourably as a strategy that would apply to the whole population, so I would like to hear your comments on how we could do that.
Ms. Enayeh: Absolutely. I will let Ms. Boutiyeb talk about the strategy, which would be based on a study of women’s needs.
However, as we all know, health is something that affects the entire population. Women are disproportionately affected because of intersectionality. They are affected by many determinants of health, but even more so by intersectionality. That is why we think that a study of the overall population would not look at intersectionality and how it affects women in any detail.
That is why we need a study to understand the needs of women, a study that would explain how to establish a broader strategy, because if women’s health is well managed, then entire population will benefit. I will let Soukaina talk about the strategy.
Soukaina Boutiyeb, Executive Director, Alliance des femmes de la francophonie canadienne: First, I think we need to adopt the premise that there are definitely inequalities when it comes to the accessibility of health care services for women.
We need to take that primary need into account. The Canada Health Act is meant to guarantee equal access for everyone, but we know that is not the reality.
A national strategy would ensure that a particular group of a particular population that needs help would get help in developing practical strategies and guidelines to improve access to, promote and guarantee health care for that particular part of the population, in this case francophone and Acadian women.
One may wonder whether this would divide the population by focusing on one region as opposed to another or on one population as opposed to another, but the reality is that that is something that is done.
When it comes to immigration, I can tell you that Immigration, Refugees and Citizenship Canada, or the IRCC, contacted us about implementing a national strategy to improve the experience of immigrant women. I can give you the heads-up that this strategy will be coming out in the next few weeks. In fact, the IRCC is the one that recognized that immigrant women needed more support and that the services that they are being offered do not meet their actual needs. That is why we need a strategy and a study with short-, medium-, and long-term objectives. That will help us to develop public policies and projects that adequately meet the needs of the population.
Because of that, we figured that if a department is doing it, then why not have a strategy that is truly focused on the needs of women?
We know that the world is changing, that needs are changing. The population is growing, and so is the number of different realities. Things are completely different in urban areas than they are in rural settings. What is more, to date, we don’t have any real statistics on how many women have access to family doctor who can speak to them in French. We tried to find that information, but it just isn’t out there.
There is a lack of data, and the government must establish practical guidelines about where we are going to guarantee such access.
Senator Moncion: Thank you very much.
Senator Poirier: Thank you for being with us. In September 2020, you published a report entitled Rapport de l’enquête pancanadienne sur les priorités des femmes francophones et acadiennes du Canada. In that report, you indicated that access to French-language health care was a priority.
According to that study, 56.5% of francophone and Acadian women said that they were not satisfied or somewhat satisfied. Why were these women not satisfied? What were the issues?
Ms. Boutiyeb: The answers varied from person to person, but the main reason was access to French-language health care, the ability to communicate with health care providers in their own language, and here we are not even necessarily talking about the person’s mother tongue, but just about them being able to speak to someone in French.
That is often a challenge for immigrant women. In some areas, it is luxury just to be able to talk to a health care provider at all. People need to have access to that. Because of labour shortages and problems with the health care system, people sometimes have to wait months or even years just to have access to a doctor.
The other thing is that, when we talk about access, we are sometimes talking about specific needs, such as reproductive health or access to abortion. The reality there is not the same in every province and territory. As we have seen, because of clinic closures, some women have to go to other provinces to get access to such services.
These injustices and this inequity towards women show that there is a real need, and so one of our recommendations is to create a specific strategy to determine what type of health services and what sort of equality we want to provide for francophone and Acadian women.
Senator Poirier: Do you see a difference in the challenges women face depending on their age group? For example, often, older women lose the family doctor that they have known their entire life because the doctor is retiring. Do you see a difference, or do the statistics show that there is a difference depending on the age of the patients?
Ms. Boutiyeb: That is a very good question. Our study did not go into that kind of detail, but one thing that is worth noting is that not everyone spends their whole life in the same region. Some people move, and that is becoming more common, which makes access to health care even more complex. Sometimes people have access to health care in one province, but if they have to move because of their age or because they want to be closer to their family, then it may not be as easy for them to get access to health care in another province.
The experiences that women are having make it even more clear that there are inequities when it comes to access to health care.
Senator Poirier: Are you getting funding from the federal government under the new action plan to improve access to French-language health care for women? Are you getting funding?
Ms. Boutiyeb: As an organization? For the AFFC?
Senator Poirier: I am talking about funding under the new program. Is your association receiving funding?
Ms. Boutiyeb: We are not getting funding for women’s health. Funding does exist for some organizations that deal specifically with access to French-language health care or promoting health care in French, but there is not necessarily specific funding allocated for women’s health.
When we talk about health care, we need to view it through a lens that is focused on the needs of francophone women. The president of our organization can tell you more about that because she works in that area.
Ms. Enayeh: In my everyday life, I’m the director of RésoSanté Colombie-Britannique, a network affiliated with Société Santé en français. Société Santé en français receives federal funding, but it is up to the network to determine whether women have specific needs.
As part of my work, I did a webinar with Zakary-Georges Gagné on intersectionality in the health care system, and the statistics show that women are disproportionately affected, particularly racialized women, such as Black women. What we are seeing is that health research focuses mainly on men rather than on women. There are also Muslim women and queer women in the Canadian health care system, for example. We can see that the numbers are really going up, but, once again, because of the lack of cooperation between departments, it is up to the organizations on the ground to decide whether to create projects specifically for francophone women in the area of health.
Senator Poirier: Do you have any statistics that show that it is more difficult for francophone women to access to health care in their language than it is for francophone men? Are there really statistics that show that women are more vulnerable than men?
Ms. Enayeh: Women are more vulnerable than men in general. It is just that being a member of an official language minority community adds another layer to all of that. There are already inequities between the needs of women and men, and if we add language into the mix, then we are just adding another layer.
Do we have statistics that show that it is more difficult for women to access services than men? No, but we do have statistics that show inequities in the services offered. Once again, this does not pertain specifically to francophone women as compared to women in general. It is just that language adds another layer.
Ms. Boutiyeb: One of the recommendations has to do with the lack of data. It would take research to get solid evidence on that.
We are discussing the realities that we hear about on the ground through our organizations and studies. To get solid disaggregated data, we need to do the research, and the government needs to invest in this area.
Senator Poirier: It is hard to know where to start without any data.
Ms. Enayeh: That is exactly the problem, particularly in provinces that do not have a French-language services policy. For example, I live in British Columbia and we just got a French-language services policy, but there is nothing really comprehensive or that pushes for services for francophones.
We see that in general for francophone women. For example, there is a lack of organizations and services for abused women in Canada. Through research, we know that they are at a much higher risk of being affected by dementia, for example, but we do not have enough data and services to prove it. We do not have enough prevention services.
Senator Clement: Hello to our two witnesses. Thank you for your excellent work. I hope you know how much hope the Alliance des femmes de la francophonie canadienne brings to people across the country. It is important that you know that.
I live in Cornwall. Two women who work in my office, Emma and Amina, recently met with representatives of an association that promotes immigrant health. It is a volunteer organization that helps immigrants navigate a very complicated system. This organization brings cultural competency that the provincial and federal governments do not have. I don’t know whether you can comment on that. What do we need? Often volunteer organizations and people on the ground from local organizations without funding are the ones who are doing the cultural competency work.
Ms. Enayeh: That’s right.
Senator Clement: What do we need to do to support these organizations in our system?
Ms. Enayeh: That is why funding for community organizations is so important. It is much more effective when community organizations work together, for example, when there is communication between organizations working with new immigrants, organizations working with women and health organizations, but there has to be enough funding for those organizations to do that, otherwise people become exhausted from trying to do all of that work, and those people are generally women.
That is why funding for community organizations that help people, but people in general— It is the same thing when your colleague was talking about seniors or young people. It is the same thing. When these organizations have enough funding and they have the time, the opportunity and the resources to work together, that is when things can really get done. We really need to look at the work from a holistic perspective, just as health needs to be looked at from a holistic perspective. Community work in minority communities must be holistic. That can’t happen without adequate funding. We always end up with organizations that are fighting for their share of the pie and working in silos because they do not have enough resources to do everything. They need enough funding so that they can work together. We see on the ground what a difference that can make.
Senator Clement: Systemic racism.
Ms. Enayeh: Oh yes.
Senator Clement: Yes, in the health care system. Do we talk enough about that? You just described intersectionality that makes us even more vulnerable. As far as the health care system itself goes, do we talk about the fact that systemic racism has an impact and that the federal government should recognize that? Do you agree with what I just said?
Ms. Enayeh: Absolutely. I completely agree with what you just said. That is a problem that we see every day. Are we talking about it? We are starting to. The term “intersectionality” is starting to be recognized. As I was saying, if we look at health from a comprehensive, holistic perspective complete with the determinants of health…. We are starting to see that, but the statistics show that we haven’t gone very far in that direction.
For example, we know that Black women are not treated the same way. Their pain is not treated the same way. We know that when women in general say that they are in pain…. There was a study done on endometriosis, and it was the same thing. It’s normal for a woman to be in pain. When she gets her period, it’s normal for her to be in pain. When a woman has a disability or is of a certain age or a certain weight…. There is also fat phobia. If a woman is the one in a precarious situation, it adds layers and layers of inequality each time. Women’s health really isn’t taken seriously.
I experienced it myself. I had the same health problem as my husband and the care that my husband received for exactly the same symptoms was very different. I didn’t believe it at first, but everyone kept drawing my attention to it and saying to me, “Are you sure it’s not because of your race or your hijab or because you’re a woman?”
When my husband had exactly the same health issue two months later and I saw the difference, then it became obvious. At the same time, there was a report indicating that more studies need to be done on Muslim women in Canada because they don’t have the same…. They do not receive equal health care services. I didn’t want to believe it, but it was too obvious.
Senator Clement: Do you have anything to add?
Ms. Boutiyeb: Certainly. When it comes to the reality on the ground, unfortunately, I need to bring things back to the importance of data and a national strategy. That is what is going to enable us to really shed some light on what is happening on the ground, to understand what is happening and to get the government to implement practical measures. That will help us to know what we should be doing to make sure that the health care system is fair and equitable when it comes to accessibility and promotion. Obviously, when we talk about health care, we are talking about physical and mental health and well-being.
From what we are hearing, unfortunately, the reality on the ground— We hear stories here and there, personal stories, that show that the system is very inaccessible and that people are not being taken seriously. There is also ageism. Women are being told, “You’re too young to be in that kind of pain. That is something that only happens to older people”, or vice versa. There is certainly a need for education and training for health care providers, who are doing excellent work, of course. There is no doubt about that. However, there may be a need for training so that our society is more sensitive to the various issues related to intersectionality. There is always work to be done to improve as a society. There again, a national strategy would enable us to shed light on that.
Ms. Enayeh: We know that the research is not detailed enough when it comes to gender, language and other determinants.
Senator Clement: Okay. Thank you.
The Chair: I will continue in the same vein and ask you a few questions. First, I want to thank you for being here and for your work.
Senator Clement asked some questions about systemic racism. I would like to better understand how you identify the challenges associated with the delivery of culturally appropriate services. We talk a lot about that. There is intersectionality. Could you define or name the main things that we need to think about when we talk about culturally appropriate services to help us to better understand?
Obviously, we know that there is a connection between language and culture. At the same time, we know that when we are having a conversation with someone in the same language, we feel as though we understand each other, but there are more complex issues at play when it comes to the delivery of health care services. Culture is an almost invisible aspect behind the scenes.
How can we better address these issues? How should training for health care providers take into account those elements? I’d like to hear your thoughts on that.
Ms. Enayeh: I can give you a very specific example. In British Columbia, we have an upcoming project with the Department of Health to open a community health centre.
I am working on it without having any real experience, so I am calling other centres to find out how they work. The director of one of those community health centres gave me this very specific example. She is a very experienced social worker. She has all the necessary education and she is extremely competent. The problem is that, despite all of her education and skills, she is not the right person for this job because she doesn’t understand cultural differences. She works with a lot of refugees and newcomers from all cultures. This is not a francophone organization, but it shows that someone can be competent in a given field without having the ability to understand different cultures. The organization did everything to find the right person for the job, but she does not understand the cultural nuances.
Working with refugees is very different from working with immigrants. Refugees have experienced trauma and have cultural beliefs. I also worked with Syrian refugees. I was doing interpretation. When we talk about sexual and reproductive health, for example, there is a way of approaching that.
I remember that it took a lot of time with the Syrian refugees. They arrived very quickly and did not have time to adapt. We understood that you cannot just go up to a woman from that culture and say, “Here are some contraceptives”. You have to understand how to approach those things.
The thing about the francophone community is that it is multicultural. It includes different cultures, with refugees from Africa, the Middle East, Asia and Europe, and each individual has a different background. If we do not understand those nuances, then the services that are provided will not be effective, even if the staff is competent, and these people will not want to stick around.
The Chair: Should the national strategy that you mentioned include cultural competency training as well?
Ms. Enayeh: Absolutely. It is the same thing as working with a trans person, for example, someone who identifies as a woman, who has become a woman. How can anyone work with that person if they are not culturally sensitive? The same goes for Indigenous people.
The Chair: What types of services are you talking about? You spoke about inequities in the delivery of services. Looking in from the outside, we could be surprised to learn that there are inequities in the way services are provided to men and women in Canada.
Where do you see the most inequity in service delivery? Do you have any data on that subject? Is there a certain type of service? Are we talking about primary care or more specialized care? Are we talking about long-term care? In what areas of our health care system are you seeing the biggest inequities between men and women?
Ms. Enayeh: Unfortunately, on the ground, I would say that it is in every type of service.
Whether it is pain management, reproductive health, heart health, mental health, we see inequality in all the services, unfortunately.
The Chair: I have to insist: What are these inequalities attributable to? If I go to the hospital for emergency service, are women treated worse than men? I want to know why.
Ms. Enayeh: I think it is a misunderstanding of pain and symptoms. Again, it comes down to the research.
If, for example, research has been done on how men feel pain, but the same has not been done for women, or if people have some form of prejudice, it has an impact.
There is a lot of prejudice. I come back to the example of Black women. Some people think that black skin doesn’t feel the same as white skin. These are myths, and there is a severe lack of education on that.
The Chair: You talked about having correct data and the importance of research and education.
The examples that you just gave are a bit surprising. We can assume that it comes from a lack of education or from prejudice and discrimination.
Ms. Enayeh: Exactly.
The Chair: In your recommendations, you talk about interdepartmental collaboration. Can you name the various departments that you have identified that should be part of that cohort of departments that would help improve delivery and care?
Ms. Enayeh: Yes. When it comes to prevention, we will mention, for example, the Public Health Agency of Canada. If this agency can talk to Women and Gender Equality Canada, for example, that is where work can be done on certain inequalities. We are also working with IRCC with newcomers. That is where the work can be done.
Ms. Boutiyeb: And with Employment and Social Development Canada, ESDC.
Ms. Enayeh: Yes, with ESDC too, exactly.
Ms. Boutiyeb: I would like to add something regarding the question you asked earlier. One of the principles that we must keep in mind, which is still used in the feminist movement and also in the Canadian francophonie, namely “by and for”.
When we try to provide services and to have this concept of affinity or cultural understanding in delivering services, we need to make sure that we have people at the table who come from this culture, who have an understanding and who are in a position to recommend adequate courses of action to health care professionals in order to ensure that they provide fair services to the target population.
The Chair: That is exactly right.
With the first group, there has been a lot of talk about professional interpretation and access to professional interpreters in terms of language, but from what you are saying, we need culturally adapted professional resources, meaning that these professionals need to be able to put cultural issues in their proper context.
Ms. Boutiyeb: Exactly.
The Chair: Do you have any specific recommendations with respect to access to cultural services through the use of interpreters to make sure that people understand? Are there any services that the government should support in its strategies or collaborations with the provinces, for example?
Ms. Boutiyeb: One of the recommendations that we would like to put forward is with regard to the issue of superficial diversity. Superficial diversity does not mean that we are going to have a single person representing all refugees, regardless of their origin, because that person is a refugee and will be able to guide us on how to provide services to francophone refugees in Canada. We need to consider this intersectionality.
The other recommendation is about the importance of comprehensive GBA+. It allows us to make sure that, from the beginning, in everything we put forward, the data we have, the measures we are implementing and everything that we are creating are adequately responding to the needs of the target population.
Those would be the first two points.
Ms. Enayeh: I would add that we need to emphasize the concept of “by and for”. We must get these professionals to understand that they have to get help on the ground every time from health care professionals who come from these communities.
If we know that we are going to work with a specific community, we need to be on the ground, in the provinces. Every province and every minority language community is different.
Even with all the education in the world, one cannot know everything about every community. We have to take each case individually and develop this reflex of reaching out to the communities to develop an understanding of the communities we are working with.
The Chair: We also need more cooperation between health care institutions and civil society organizations and more support and funding to help with that.
Ms. Enayeh: Absolutely, with grassroots organizations on the ground.
The Chair: Alright, thank you.
Senator Moncion: My question is about rural versus urban communities, because there is a huge disparity in terms of services. I am not convinced that people in rural communities are worse off than those living in urban settings.
I live neither in a rural area nor in a big city. However, I am very well served where I live. When I look at Northern Ontario, I think that service distribution is pretty good.
I would like to hear your comments with respect to the services offered in major urban centres, with population taken into account. I would like to know if you experience the same issues in rural areas.
Ms. Enayeh: I can use once again the example of British Columbia, which I know very well because I live there. There are very few services in French in rural areas. As part of a project on which we are working at the provincial level with telemedicine, we see that the department, at this time, is not very open to this, and there are very few services offered in French. For English speakers, in terms of services, there is a lot less pressure on health care facilities. The issue is with services in French.
Senator Moncion: Still, there is a large francophone population in British Columbia.
Ms. Enayeh: Fifty per cent of the francophone population is located in the greater Vancouver area and widely dispersed. It is a big province, and unfortunately, many cities do not have a large enough francophone population.
Another problem is that there is no French language services policy, and therefore no obligation. In some places, francophones in general have no access to services in French, because there is no policy and there are not enough health care professionals to provide it.
As part of my work, I found another problem. Some health care professionals would be able to provide services in French in those provinces but are not confident enough to do so, because they have been educated in English. These professionals speak French very well but lack the confidence to do so. All they would need is one or two classes to get them up to speed. It would be a solution. In rural areas or in the regions where there are francophones, funding for classes is all that would be needed. We mentioned it a moment ago: it would take very little for these professionals to have enough confidence to provide services in French.
Senator Moncion: Are there any places in Canada that are best-in-class when it comes to providing services? I went to Winnipeg, and there is a cooperative community health centre focused on immigrant services. This centre worked very well and offered mental health, child care and medical services. Are there any exemplary places that we could use as examples and whose models could be replicated elsewhere?
Ms. Enayeh: I was just about to mention Winnipeg as an example. In Alberta — in Calgary I believe — they tried to replicate this model and it did not work, because, once again, every community is different. How the community is concentrated or dispersed if very much a product of each province’s French-language services policy. That is a major factor in the equation.
Ms. Boutiyeb: What is important is the co-operation between the health care system and the community network. We need to reach out to those two sectors’ movers and shakers to respond appropriately.
I have no perfect and concrete example to offer. However, in Orléans, right here in Ottawa, there is a community centre on Mer Bleue Road that works in collaboration with Montfort Hospital. Patients who need health care or community services can turn to this well-established centre, which has its own offices. Whether it is seniors or caregivers, services are provided in the same building, which makes navigating the system easier for patients instead of letting them find a doctor or community services by themselves. When everything can be found in one place, things can be easier.
The Chair: I have one last question on the issue of rural versus urban. Some rural areas have amazing services. However, rural communities are often more homogeneous and have less diversity. Regarding culturally appropriate services, have you identified issues associated with the homogeneity of the population in rural areas that leads to a lack of understanding and education specific to rural areas?
Ms. Boutiyeb: I would prefer to talk about a vision for the future. One of the things to consider is the idea of having this kind of reflection on the health care system. We want communities to grow and we encourage immigration. Communities may be homogeneous now, but there are also host communities in rural areas.
How can we be forward-thinking and proactively ensure that there are services in place to adequately meet the needs? It is right at the start, when we are setting up health services, that we need to act and view things through the lens of intersectionality to meet the linguistic and cultural needs.
The Chair: Thank you very much Ms. Enayeh and Ms. Boutiyeb. You have wonderful names and we need to know how to pronounce them properly. Thank you for your participation and for being here this evening. I also want to thank you for the way in which you celebrate the diversity of the Canadian francophonie. I am a francophone who was born here and who lived in a certain environment. Today, I believe that the presence of a great diversity in Canada enriches us greatly. I know that you, as organizations and as individuals, celebrate this diversity. You also help us to celebrate it and see it as a way for our communities to grow.
Thank you to both of you for being with us this evening.
Colleagues, for our third panel, we will continue with the theme of vulnerable communities. We now welcome Zakary-Georges Gagné, Communications and Membership Lead for The Enchanté Network.
Good evening. Welcome and thank you for accepting our invitation. We will start with your opening remarks and then we will go to questions. You have the floor.
Zakary-Georges Gagné, Communications and Membership Lead, The Enchanté Network: Thank you very much, Mr. Chair [Cree spoken].
Good morning, everyone. My name is Zakary-Georges Gagné. I use pronouns “Elle” and “la” in French as well as feminine gender agreement. My traditional name is “Twisted Wind”, which is what I just stated in Eastern James Bay Cree, the language of my ancestors and my family. I am of mixed heritage: My mother is a Quebecer of French descent and my father is Cree from the Waswanipi Cree First Nation, in Northern Quebec. I am from the Beaver Clan. I am two-spirit and Communications and Membership Lead for The Enchanté Network.
I am pleased to be here today to highlight the need to work together to improve access to health services in French to everyone, regardless of gender, with a particular focus on gender-diverse people in our communities.
We are at a crossroads to ensure the well-being of people of the 2SLGBTQI+ community. In Canada and around the world, attempts to limit or prevent access to gender-affirming health services yeas are made, many of them through legislation. Prejudice, refusal to offer services, invalidation or humiliation are daily realities for two-spirit, queer and trans people who are trying to access the health system, whether for routine care or gender-affirming or sexual health services.
I am here to remind you of the urgency of taking into consideration the barriers and challenges, the realities and more specifically the essential needs of the 2SLGBTQI+ community when it comes to health care. As the largest network of 2SLGBTQI+ organizations in Canada, The Enchanté Network works alongside more than 230 organizations and groups that serve different communities. Those 230 organizations and groups are experts on 2SLGBTQI+ issues, have ideas for bringing transformative change and are ready to work in collaboration. Health, and particularly improving access to health services, is one of the main issues that are a number of members of The Enchanté Network are focusing on. We truly hope that you will reach out and work with us to create a radically safer and more caring future for everyone, without exception.
To create that future, here are my three recommendations:
First, make sure that every recommendation, every initiative and every investment in rooted in intersectionality. I am very happy to have heard Nour Enayeh, who spoke before me, mention this.
2SLGBTQI+ communities are fluid and diverse. People who have more than one marginalized identity face significant challenges and barriers.
In a recent survey titled “Back to Our Roots”, we consulted 400 2SLGBTQI+ and Black people. We found that 83% of 2SLGBTQI+ and Black people said that the health professionals they consulted were moderately informed, very little informed or not informed at all about their 2SLGBTQI+ identities, and 87% said the same thing about their racial identity. Those numbers are quite high.
Queer francophones are faced with the same issues. The French language, being binary and sometimes slow to evolve, creates obvious barriers to the affirmation of gender-diverse people, both within our communities and in the health care system. Academic and community resources in French are still extremely limited, and this lack of resources creates delays in the inclusion of 2SLGBTQI+ people and less informed services, both within the francophonie and the English-speaking population.
Adopting intersectional approaches that promote self-determination and collaborative participation and are trauma-informed is essential.
Second, I urge you to invest in and focus on sustainable initiatives and sustainable programs by and for 2SLGBTQI+ people. I want to emphasize the “by and for” concept today. I also invite you to have confidence in our communities; for decades, we have been compensating for the flaws and shortcomings of the systems and finding alternative solutions within our communities. In the “Back to Our Roots” survey, 18% of respondents said that they turn to health care professionals for advice on sexual health and gender-affirming care.
Finally, I invite you to prioritize joy and beauty within the policies and initiatives that are developed. It is necessary to develop initiatives that promote and amplify beauty and that speak to the core of the two-spirit, queer and trans experience. There are many barriers and challenges, but the breadth of the two-spirit, queer and trans experience is also filled with resilience, brilliance and celebration. Our solutions must reflect all of these aspects.
Thank you for your attention and your open-mindedness. I look forward to further discussing this with you, answering your questions and creating together a radically safer future for everyone. Chi-meegwetch.
The Chair: Thank you very much for your presentation. We will move on to questions and answers. I will first give the floor to the Deputy Chair of the committee, Senator Poirier.
Senator Poirier: Thank you for being with us this evening. As coordinator of francophone engagement for The Enchanté Network, what are the challenges you hear the most about from your members in terms of access to health care services in French?
Zakary-Georges Gagné: Let me give you a personal example. During my first year at The Enchanté Network, I worked as coordinator for francophone engagement, and I am now with the communications and membership team. Here is a very personal example in terms of access to services that many people in our communities have experienced. When I personally decided to access gender-affirming services, I cannot even ask if those services are available in French.
I live in Kingston, which is a semi-urban area, but when I access these services, I first have to ask myself, when talking about mental health or gender affirmation, if I will be targeted because of my gender identity or my indigenousness. Am I going to be invalidated or discredited, because I do not know the systems well enough, because I do not know myself well enough? I am young, also. Sometimes I will be told that I have to wait and that it is too early to do certain things.
I have a lot of questions: Does the person who provides the service will recognize my identities, know how to talk to me and how to affirm my gender, will be aware of the necessary procedures and ways to support trans and two-spirit people through their transition? After asking myself all of these questions, I cannot afford to wonder whether those services will be available in French or not, because I would certainly take a very long time to get services in French in a city like Kingston. In many cities outside Quebec, services in French that are not only affirming but also well informed are extremely limited. Often, people who identify as 2SLGBTQI+ are refused services. It will sometimes be assumed that these people have mental health issues when all they need is to be supported through a social, legal and medical transition.
So there are a number of barriers to accessing and obtaining services before even trying to navigate the system.
Senator Poirier: In your opinion, is Health Canada doing enough to take into account the needs of official language minority communities who are also part of the 2SLGBTQI+ community, and why?
Zakary-Georges Gagné: I think that there is a lot more work to do than what is being done right now. Earlier, Ms. Enayeh talked about interdepartmental collaboration. I think there are connections to be made between Health Canada and the work being done in that department with the Federal 2SLGBTQI+ Action Plan launched in August 2022. How can we ensure that 2SLGBTQI+ communities are represented within a much greater community, the Canadian francophonie? Often, we tend to dilute our impact on double minorities within these communities, because we just want to have services in French. It is the basic thing that we want first and foremost: services in French. How can we make sure that we have services in French that are good for everyone and not just for the majority? They do say that services already exist and are good for everyone, but we know that this is not the truth. I think that there is more and more work to be done to connect Health Canada’s work with what is being done by various departments, such as Women and Gender Equality Canada and the Federal 2SLGBTQI+ Action Plan.
Senator Poirier: I know that you have made recommendations regarding where to begin and what can be done. Do you have any more recommendations to improve the situation? How can the federal government do more? Can you tell us about other challenges besides those you already mentioned?
Zakary-Georges Gagné: Canadian 2SLGBTQI+ organizations need funding. When we ask our 230 members what their number one priority is, most mention funding. And they are not simply talking about funding for a one-year project that will not be renewed even if it is vital for the community.
Senator Poirier: Are you saying that you have no funding at this time?
Zakary-Georges Gagné: The Enchanté Network?
Senator Poirier: Yes.
Zakary-Georges Gagné: No, we do have funding. Many of our members, however, no longer receive any. They spend a tremendous amount of time developing important programs for their community, but they are told that they cannot apply for projects that have already received funding.
Capacities and initiatives are being created to meet the needs of the communities, and 2SLGBTQI+ organizations in Canada are more than capable of serving the communities, especially in terms of health. However, they do not have the means to continue to develop these programs because their funding runs out after a year and they cannot apply for additional funding to keep their projects going. One of the key recommendations is to provide sustainable funding, core funding, to provide for ongoing operations, not just for programs, but to retain their staff and keep projects and initiatives going, not just for a one-year or three-year period, but on an ongoing basis.
Senator Poirier: Thank you.
The Chair: I have a supplementary question. Do you have any data or information to determine whether there are funding inequalities between francophone and anglophone organizations? Is it only a matter of perception, or is there specific information that point to the underfunding of francophone organizations?
Zakary-Georges Gagné: In 2022, we surveyed queer and trans organizations across the country. We managed to get 52 organizations from across the country to put their data together to determine where their funding came from and what it was being used for. I am very pleased with the report that was released earlier this year by the committee. Unfortunately, there is a small flaw, in that some of the data in the report does not differentiate between francophone and anglophone organizations. I can use the situation in the Atlantic as an example. There are about six, seven or eight Atlantic organizations that serve the francophone and Acadian 2SLGBTQI+ communities, and every year, Women and Gender Equality Canada only gives funding to one of these organizations for a year or two. After that, they give their funding to another organization.
Figuring out where the funding is going in the region is like playing Russian roulette. The Atlantic is a large and diverse region where every organization should have access to guaranteed and stable funding instead of stealing the money from one another as they currently do. Who is going to have the best funding application? Who is going to get the money? One organization being granted funding means that another one will not. It is the same thing in western Canada, in the north and in the Atlantic.
The Chair: Thank you.
Senator Clement: Thank you for being here. It’s really good to have you here. I like your use of the words “radically safer.” I had the same question as Senator Poirier on funding. You just talked about the fact that we only fund organizations that have cultural expertise, which creates competition between them and that’s terrible.
I’d like you to tell me more about French as a binary language and how all that has an impact on the trans community in particular. Also, could you tell us about your suggestion to structure recommendations around joy and beauty?
[English]
In the Black community, we talk about Black joy.
[Translation]
We don’t talk about that enough. We talk about the challenges, the anger, the issues, but rarely do we mention the joy. I don’t know if that’s the same idea.
Zakary-Georges Gagné: Thank you for the questions. First of all, when you talked about the organizations that have the expertise, I would add that they also train health professionals in the private and public systems. They develop training initiatives to improve those systems and then they don’t get any funding. I wanted to add that. These organizations have skills and they share them as well.
In terms of inclusive language and barriers in French, French is a very religious, colonial language. Intrinsically, it’s a language that came to our lands with the arrival of the Christian Catholic Church, which passed it on to the Indigenous communities and created colonies throughout the lands of Turtle Island. This religious and colonial heritage is felt in the rigidity of the French language.
English often uses adjectives, verbs and determinants that don’t require choosing between masculine and feminine, whereas if you’re speaking to me in French, I can know how you perceive my gender with every sentence. I’ve already heard a “he” or a male adjective. It can make me feel very uncomfortable in the conversation, but above all, it can make me feel misunderstood. I will probably want to withdraw from the conversation because I don’t think you’ll be able to understand more than my gender, to understand my ideas and my realities, the shoes I walk in. We can think of determinants, adjectives, pronouns and common names.
There are methods that are developed to talk about inclusive language. There’s also neutral grammar. On October 4, 2022, the Government of Canada issued guidelines for the use of gender-neutral language that talk about doublets. So we talk about “participantes” and “participants” or we recommend using the midpoint to get “participant.e.s.” When you read it, you simplify it like that. There are a lot of other things. For example, if I talk to you about your “partenaire,” I would then have to say “sa partenaire” or “son partenaire.” So, there are always gaps in French that force us to choose a gender, which complicates the representation of fluidity in queer, trans and two-spirit experiences.
Your last question was about queer joy. It’s very similar. Obviously, Black joy, queer joy and trans joy are different realities. Those in the margins of a community come together. We have to be together to be resilient, to get through the challenges and, thanks to these connections, we develop exponential relationships that allow us to experience layers of emotion that heterosexual or cisgender people couldn’t understand. It’s not that they can’t access them, it’s that they’re not on the margins of the community and so aren’t forced to rely on each other because of their gender identity or gender expression and identity.
So for me, queer joy, for example, it can mean that when I get together with friends to talk about how my week was, it’s really refreshing to be able to talk to people that I don’t have to explain all the little codes to, all the innuendoes, all the nuances in my experience, because they also experience it.
By coming together and understanding each other, we can develop ways to support each other that are probably much more effective than what the health systems and mental health service providers could offer me as support, because I’m talking to people who are experiencing the same things I am and understand me.
We can celebrate that and find beauty, because we can overcome the challenges and issues when we come together.
[English]
Senator Clement: This is a personal question. I wonder, do you know if trans and queer communities are inspired at all by the civil rights movement and by the work that Black communities in the U.S. did in the 1960s?
[Translation]
Zakary-Georges Gagné: I think there are undeniable parallels, in part because the gay rights movement was also started by trans women and people of various genders who were Black, Latinos, and Indigenous. I think these movements are intrinsically linked and inseparable.
There are certainly influences on the strategies we use to advocate and talk about our identities. For example, in our communities, many people forget to recognize their roots. When we talk about intersectionality, we’re talking about a movement and a piece of advice that was presented by a Black woman, Kimberlé W. Crenshaw, who talked about injustice in terms of the employment of Black women, but now it’s being used for many concepts. It’s often used incorrectly as well, because we’re talking about the intersection of identities, but it’s the relationship of those entities with power systems; that’s intersectionality.
I can be a lot of things, and if the systems treat me well, we’re not talking about intersectionality, because I’m just me and the system serves me well, so it’s okay. The issue is with relationships: How can you hit on the systems and everything that I am?
I think we forget to thank, to show our gratitude to our roots in the American Afrofeminist and civil rights movements.
[English]
Senator Clement: You don’t forget to do it.
[Translation]
Zakary-Georges Gagné: Thank you.
Senator Mégie: Thank you for being here.
I heard you talk about the rivalry between the various groups, who are all fighting over budgets since they all share the same goals.
Do you think there’s a way for the federal government to allocate funds globally instead of handing out small amounts? As for you, as smaller groups, would you be able to come together in a more constructive way when you get funding?
I’m sure that you’ve already thought about this, or that your group has. Do you see something beautiful on the horizon?
Zakary-Georges Gagné: Thank you for your question, senator.
That is the very point of The Enchanté Network. The network was created in 2018 because the various pride centres weren’t able to connect, because projects were duplicated and knowledge and experiences were never shared within our organizations. That’s why The Enchanté Network was created.
In 2021, we published a recommendations report for funders, to provide advice on how to provide informed funding programs, particularly for 2SLGBTQI communities. There are already a lot of recommendations in there, so I won’t bother rereading them.
Right now, in terms of collaborations, the systems aren’t encouraging our organizations to work together. They encourage competition and a scarcity mentality, whereas there would be ways to include 2SLGBTQI organizations to develop truly collaborative funding programs so that they can inform the processes.
When we talk about collaborative processes, it’s not just the evaluation of the applications for collaborative funding, where community members are invited to evaluate the applications for funding that are submitted; this means involving community organizations and queer communities in developing funding programs so that these programs truly represent the funding needs.
I believe that by involving them in the development of a funding program within various departments that want to support the well-being of 2SLGBTQI communities, eventually, we would develop funding channels that would encourage collaboration and alignment of networks — such as The Enchanté Network — and there might be ways to fund a national organization like The Enchanté Network that would then distribute to its members, more specifically and more actively, the funding they need.
We know our members, we work with them every day and we know which members could work together and which ones would benefit from community connections. We already do that; every week, we have networking and community connections programs. Why not trust organizations such as ours to disseminate this funding and allow for more relevant, collaborative and inclusive programs to emerge from these projects?
Senator Mégie: You also mentioned earlier that your organization could meet health professionals on the ground to educate them on your reality. I think that it would be a positive thing if that happened more often.
Did you get any positive feedback on the experiences you’ve had doing that? Did that result in fewer negative reactions to members of your communities when they come into a hospital environment? Could you tell us a bit more about that?
Zakary-Georges Gagné: The Enchanté Network sometimes offers training to community health centres or organizations that provide training. For example, I can think of the Learning Network out of Western University, which provides training and professional development opportunities for professionals who serve survivors of sexual and gender-based violence.
When we offer these courses, we quickly realize that people don’t need to know the entire 2SLGBTQI lexicon or to experience our realities all the time, but they need to change the way they perceive these differences when they serve these people. So, in these training sessions, we build confidence just so that we’re not afraid to talk about these things. We deconstruct the preconceived ideas and biases that influence how people are served.
We see real change when we conduct surveys after conferences or training. People tell us that they feel more comfortable talking, asking questions and starting a dialogue. When we talk about building solidarity with people who aren’t part of our communities, we often tell them to go and read in their living rooms, because there are podcasts and movies available. This self-directed work is very important to reduce the emotional work that diverse people need to do and the microaggressions they experience when they educate their peers. However, this self-directed work will never eliminate the fear of saying the wrong thing, of offending someone or of espousing totally erroneous notions.
What we’re trying to promote — and what some of our members are also promoting — is the need to start a dialogue. Non-queer organizations need to speak or develop a partnership or connection with a 2SLGBTQI community, group or organization. The simple fact of having these relationships will lead to the emergence of initiatives and of collaborative funding requests.
Specifically, I’m thinking of an organization in our network called TransEstrie and also of the Coalition d’aide à la diversité sexuelle de l’Abitibi-Témiscamingue, two organizations that work with CIUSSS or health services groups to create health navigation corridors for trans and 2SLGBTQI people. These organizations have connections with 2SLGBTQI communities, so they can inform their communities about all the services that are offered and support them when they have to deal with those services. It makes it easier for us to go to a doctor and not know whether he’s going to serve us in the way we need or whether he’s going to understand us. Our organizations can work together to develop these channels; that makes it much easier for members of our communities to access them.
Senator Moncion: I’d like to thank you for your testimony. I’ve learned so much.
Earlier, you talked about people who are unfamiliar with the subject and you said that they should be encouraged to get informed. I realize that your network is organizing and seems well organized.
I’d like to come back to the provincial government’s funding. You receive funding from the federal government, but the provincial government still has a role to play, surely.
I know that when she was premier of Ontario, Ms. Wynne was open to education. We have to start somewhere. She was talking about different sex education in schools. The current premier has changed everything with respect to education and the openness that we should be showing the general public today, regardless of the choices people make and with all due respect for people’s choices. I’d like to know what kind of barriers you’ve encountered, for example, with the provincial governments.
Zakary-Georges Gagné: I’m the former president of an organization in our network called FrancoQueer, which is an association for Franco-Ontarian 2SLGBTQI+ folks. I understand the reality of the provincial government, which wants to serve the many francophone and 2SLGBTQI+ communities.
What I would say, since I’ve not been in this position since September 2023, is that there are some concerns about working with 2SLGBTQI+ organizations within governments. There is a desire, even in the various departments, including the Ministry of Education, to fund initiatives, because when I was president of that organization, we were constantly contacted by schools and school boards to develop alliances between gays and straight people and to develop training initiatives for school staff. There was a lot of money to invest through the councils, but the Ministry of Education should also invest in such initiatives to ensure safe spaces for students. On the other hand, there is a fear of doing so, because there is pushback on the part of some parents who don’t want their children to have access to that. It’s a very small minority that reacts that way, but that’s always going to come out in the media, for example.
The media’s not going to cover the many training courses that are offered every year thanks to organizations like FrancoQueer; it will cover the parent who sent a letter to his school board to call out an initiative involved with affirming queerness.
So there are fears of reprisal and fears of public perception that have an impact on relations between provincial governments and 2SLGBTQI+ organizations. I’m thinking in particular of Saskatchewan, Alberta and New Brunswick, whose provincial governments are actively developing policies to influence and rally students in schools and youth on hormone therapy and various medical transition procedures. We can see that governments aren’t very open to working towards 2SLGBTQI+ inclusion and well-being.
Senator Moncion: I think everyone understands that prejudices are often taught to children by parents, because children don’t have prejudices. We have an example in Quebec, where drag queens went to libraries to read stories to kids. I thought that was a fantastic idea, because I thought that kids don’t see who’s behind the character; they see a character, a colourful and beautiful person. Children see a fairy telling stories.
However, the bias very often comes from fear, lack of education, lack of openness, lack of respect, which often leads to all kinds of things on social networks that turn into hornets’ nests of ugliness.
I’d like to come back to the issue of funders. You talked about francophone organizations that will receive funding. Does the funding come from the federal government and go directly to your organizations, or does it go through the provincial government, which in turn gives the funds back to you?
Zakary-Georges Gagné: I’d say that in Western Canada and in Central Canada, it’s mainly the federal government, specifically Women and Gender Equality Canada and Canadian Heritage, that fund these organizations. Sometimes, Health Canada and Employment and Social Development Canada develop collaborations, whereas in provinces like Quebec, which has an office against discrimination, homophobia and transphobia, and in other provinces in Eastern Canada, there is also provincial funding that goes directly to these organizations.
Last March, The Enchanté Network had the opportunity to develop the Rainbow Resilience Fund. We received an investment of approximately $550,000 from Canadian Heritage to fund 22 projects in Canada to counter hate movements. These initiatives exist to help pride organizations develop security procedures for their festivals and train their employees on crisis management and de-escalation of conflicts. So we were able to fund such projects.
I’d say that most of the time, the funds come from the federal government. Some regions that are more privileged have access to provincial government funding, and we have just received a very innovative investment from Canadian Heritage to fund our members to develop initiatives to fight hate, in particular.
Senator Moncion: This is so interesting.
There’s the whole social enterprise sector in Ontario — I’m talking about Ontario again because I’m much more familiar with that province. What kind of openness is there for Social Enterprise Ontario to develop businesses that would become sustainable?
Zakary-Georges Gagné: I can’t speak to Ontario specifically. However, in the past year, we’ve had a funding project to develop the skills of our members to help them understand what a social enterprise is and what benefits a social enterprise would have for them, that is, developing stand-alone funding and meeting specific needs for their community while generating revenues to fund their core operations.
We received funding for these training sessions. We have equipment and training that we’ll provide to our members once again — I believe it will be on May 15 and 16 — but unfortunately, we’ve not received any funding to continue to raise our organizations’ awareness of social enterprises.
Unfortunately, I wasn’t responsible for this project, it was my colleague Sam. But if I’m not mistaken, it’s one of the Government of Canada’s most important initiatives, the Investment Readiness Program, the IRP…. I can’t remember the exact name, and I think it was cancelled. This initiative is no longer available for organizations to obtain funding to help them start their social enterprise.
It’s always the question. We want to do it, but do we have enough staff to develop this social enterprise and make it run, when our staff’s salary is tied to programs and they can’t spend their time on programs other than those for which they’re funded?
That’s created a lot of problems. Now, we have to turn to volunteering so that members of our community who need services develop social enterprises for an organization, so that they can potentially receive services afterwards. It’s a never-ending cycle: How do we develop these social enterprises and what kind of impact will they actually have on the stability and sustainability of our funding?
Senator Moncion: Speaking of impact, do you work with Impact ON?
Zakary-Georges Gagné: No, we’re not working with Impact ON.
Senator Moncion: I’d invite you to check with this organization, which is doing a lot of start-up and work to enable social enterprises to develop in Ontario. They have access to some start-up funds and will be able to help you with business plans, continuity plans, etc., which could be a good complement to your work. The objective of Impact ON is to enable social enterprises to develop and become autonomous. Thanks to them, all kinds of things are happening. This can also be worthwhile for the networks, when the networks intersect, so that you can work together because your objectives are the same.
We know that, from a social standpoint, you’ll grow more by working together than by working in silos, as you’re currently required to do, and by keeping the funding in dribs and drabs to say that there’s a bit here and there.
That’s why I was asking you about the relationship between the federal government and the provincial government and the openness of elected officials on all the issues affecting 2SLGBTQI+ communities. I don’t even have the right acronym, but I think it’s important for development and continuity.
Zakary-Georges Gagné: Thanks very much for the recommendation.
Senator Poirier: Do you have members across Canada?
Zakary-Georges Gagné: In every province and every territory.
Senator Poirier: Do the members of each province have a network that they can use to work with them?
Zakary-Georges Gagné: Not always. One of the most established networks in Canada at the provincial level is the Conseil québécois LGBT, an organization comprising over 70 members in Quebec, but elsewhere, organizations from larger cities often act as informal networks. I’m thinking of Pride Winnipeg, for example, which has developed ways to support the different pride organizations in that province, both rural and urban pride. There aren’t a lot of networks being developed in the provinces and territories. In the North, there’s a single 2SLGBTQI+ organization per territory: Queer Yukon, Positive Spaces Nunavut, and the Northern Mosaic Network.
Senator Poirier: Your members aren’t all francophone. There are as many anglophones as francophones.
Zakary-Georges Gagné: Yes, I’d say they’re mostly anglophone, actually.
Senator Poirier: Does your data indicate a disparity in health care access? Do your anglophone and francophone members encounter the same challenges, or do your francophone members encounter greater challenges?
Zakary-Georges Gagné: It all depends on the type of service. If we’re talking about routine services such as blood tests or regular check-ups, there are more obstacles on the francophone side, because professional training and development resources and scientific medical research are much more developed in English than on the francophone side. English-language health professionals have more open-mindedness or a better knowledge of the realities than their French-speaking counterparts. If we look at gender affirming services, it’s the same everywhere in both languages.
The waiting lists are endless for access to a nurse practitioner who will help us in the process. When I began my medical transition, there was a year to a year-and-a-half wait time for access to gender affirming services at the trans clinic in my region, which serves several different municipalities. It’s a whole region, not just the city. It’s a big part of eastern Ontario. It’s the same thing in big cities, where there are delays of several months just to have access to a trans clinic to affirm their gender in one way or another, according to the wishes of each trans or non‑binary person.
It all depends on the service. I think that, where regular services are concerned, there are more obstacles on the francophone side, but where affirming health care is concerned, the obstacles to access are just as great in English as they are in French.
Senator Poirier: Thank you.
The Chair: From what you’ve said, it’s clear that the health issues of 2SLGBTQI+ communities are in the delivery of professional services and in the ability to be sufficiently trained and educated to take your needs into account; it’s also clear that there are a lot issues at the community level.
I try to keep all that in mind when I think about the health needs, and particularly what kind of intervention the federal government can do to help improve health care.
On your site, you outline three key calls to action for the Federal 2SLGBTQI+ Action Plan that would be essential to advancing the health, safety and rights of 2SLGBTQI+ communities, including $25 million in annual funding for organizations.
Has the federal government responded to your calls to action? If so, do you see a positive impact on access to health services in the minority language for your communities?
Zakary-Georges Gagné: Unfortunately, I don’t have all the answers because I’m not responsible for the management of intergovernmental relations. I don’t do everything at The Enchanté Network. Tyler Boyce at the head office is doing a great job developing partnerships and relationships with the various agencies.
From what I understand about the action plan, there is a great lack of transparency about where we are now and where the money has gone.
When our members ask for updates on this action plan, it’s difficult for us to say what’s happening right now because of a lack of transparency. I’m thinking in particular of the cross-sectoral committee that should be developed through this plan. We’ve not heard about that yet. There’s been no update. It’s difficult to tell you whether the call to action involving the $25 million has been answered, but we don’t know, because there’s no transparency on several levels.
The Chair: The Action Plan for Official Languages is very important. Are you getting any of the funding under the action plan?
Zakary-Georges Gagné: Not at all.
The Chair: Have you made any requests through any of the programs under the Action Plan for Official Languages?
Zakary-Georges Gagné: Not to my knowledge, no. Some of The Enchanté Network’s members have, our francophone members specifically, and maybe also some anglophone members in Montreal and Quebec City. I don’t know if they’ve received any funding or if their requests were denied.
The Chair: In your opinion, since these are two federal programs — the Federal 2SLGBTQI+ Action Plan and the Action Plan for Official Languages 2023–2028: Protection-Promotion-Collaboration — should there be greater alignment, greater collaboration in terms of service provision in order to meet your needs in all their diversity, and in this case, in the minority language, since that’s the question we’re interested in here?
Zakary-Georges Gagné: Are we talking about the two action plans, the Official Languages Support Programs, or OLSP, and the 2SLGBTQI+ programs?
The Chair: Yes.
Zakary-Georges Gagné: Yes, absolutely. There should be more interties between those two plans and how they’re put forward.
Often, francophone 2SLGBTQI+ organizations outside Quebec have to ask themselves if there is a focus on queer funding. So, we know whether we will be part of this funding or whether the LGBT Token project will receive funding from the OLSP to serve the 2SLGBTQI+ community.
So, we’re talking about superficial diversity, especially for the OLSP, where certain groups receive funding simply as a show of support for queer francophones, but there’s no strategy for intentional distribution of funds to francophone 2SLGBTQI+ organizations. There are no francophone network members in all provinces and territories either. There are a few organizations. I believe that there are 22 organizations outside Quebec that serve francophones; that doesn’t mean that their mission is, at its core, to serve francophones, but it may be because they have the required abilities at the moment because of the people who work there.
Honestly, I think that there is a problem of superficial diversity in terms of all the diversities in the Action Plan for Official Languages. We should focus on something other than education, health and immigration through the Official Languages Support Programs and think about our sub‑communities a little more intentionally.
The Chair: Is there enough data to ensure that the federal government can understand the various needs of the communities when it comes to supporting them?
Zakary-Georges Gagné: Not in the least.
I believe that our francophone advocacy organizations in the Canadian and Acadian francophonie aren’t well equipped to carry out these projects. There’s very little collaboration. When I talk about collaboration, I’m not talking about exchanging emails and getting to know each other, but having long-term projects and formal partnerships to ensure that the francophonie and the 2SLGBTQI+ community are connected through the francophonie’s advocacy organizations. You know these organizations. I would invite them, as well as the OLSP, to encourage and facilitate the connection between these major francophone organizations and the organizations that represent and serve minorities in our communities.
The Chair: The previous witnesses recommended greater interdepartmental collaboration at the federal level. What’s your opinion on that?
Zakary-Georges Gagné: I’m of the same mind. Queer people need to be represented and served by all the departments. Queer people need health.
There are queer immigrants who experience very specific realities, both in terms of employment and justice. All queer people live in society as a whole. They’re not just queer people who need queer projects; they need to be represented and well served by all departments. This interdepartmental collaboration is crucial to ensuring that we can thrive in every aspect of our lives, and not just when we receive services from a 2SLGBTQI+ organization. I think of my daily life: ServiceOntario, my doctor. All these services should have resources and plans to ensure that I’m well served and that I can exist in our communities, not only today, but for the rest of my life.
The Chair: My colleagues have no more questions for you. Thank you for being here with us today, Ms. Gagné.
As Senator Moncion said, you’ve been a tremendous source of information not only on health care, but also on the realities of queer people in Canada. You’re living proof that the 2SLGBTQI+ community has much to contribute to our country. You’ve proven that very eloquently this evening. Thank you very much for your participation
We’ll end there. Thank you and have a great evening.
(The committee adjourned.)