Question Period Note: Access to Bilingual Health Services for Offical Language Minority Communities

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• Limited access to bilingual health services is a recurring issue for official language minority communities (OLMCs), particularly in rural and remote regions. Since language is essential for effective communication between patients and health service providers, this lack of access to health services in the minority official language has negative impacts on the safety and quality of care that OLMCs receive.
KEY MESSAGES
• The federal government and Health Canada recognize that access to bilingual health services is an important issue because language is a determining factor in obtaining appropriate, quality and safe health care.
• Health Canada has invested $192.2 million from 2018 to 2023 to support community organizations, as well as colleges and universities, to implement initiatives to improve access to health care for OLMCs in the official language of choice.
• Thanks to Health Canada investments since 2003:
- approximately 10,000 bilingual health professionals have been added to provincial and territorial health systems to serve Francophone minority communities;
- more than 12,000 health professionals in Quebec have taken language training to better serve English-speaking communities in the province;
- a health card identifying the patient's preferred language has been implemented in Prince Edward Island; and,
- a language standard has been created and implemented in a number of health facilities across the country.
• On February 7, 2023, the federal government announced that it would increase health funding for provinces and territories by nearly $200 billions over 10 years. One of the principles of these agreements with the provinces and territories will be to take into account the needs of OLMCs as groups seeking equity in access to health services.
• In addition, Budget 2023 confirmed that in addition to the existing funding of $192.2 million that the OLHP will receive between 2023 and 2028, the Program will also receive $14.5 million under the new Action Plan for Official Languages 2023-2028, for a total of $206.7 million over five years, to enhance the capacity to train additional bilingual nurses and personal care workers and to support non-profit organizations that serve OLMCs.
IF PRESSED ON WHAT IS HEALTH CANADA DOING TO ENSURE THAT FRANCOPHONES AND ANGLOPHONES IN A MINORITY SITUATION HAVE ACCESS TO HEALTH SERVICES IN THEIR LANGUAGE …
• The Government is committed to improving access to health services for all Canadians across Canada, in the official language of their choice. This commitment is reflected in the announcement on February 7, 2023, in which the Federal Government announced that it would increase health funding for provinces and territories by close to 200 billion over 10 years. One of the principles provinces and territories have agreed to as part of receiving this funding is to take into account the needs of equity-seeking groups and individual in terms of access to health services, including OLMCs.
• In addition, through other existing funding mechanisms, such as the Official Languages Health Program (OLHP), Health Canada is also committed to investing in strengthening health networks working on minority language issues in all provinces and territories, the training of new bilingual health professionals and the implementation of new projects to improve access to health services in the minority language in Canada.
• Among other things, with a total investment of $206.7 million between 2023-2028 from the OLHP in the context of the new federal Action Plan for Official Languages, Health Canada is maintaining its commitment to improving access to health services for the Anglophone population of Quebec and Francophones outside Quebec in the official language of their choice.

Although the number of providers has increased, when it comes to health services, OLMC patients seeking health services in the minority language are often faced with a number of issues, including a shortage of health professionals able to provide services in the minority language. Recruiting bilingual health professionals who can serve OLMCs in their official language of choice remains a major challenge, particularly in rural and remote areas, as does promoting the minority official language and bilingualism in the workplace.

The results of a consultation conducted on behalf of Health Canada noted that 77% of Francophone respondents residing outside Quebec said that they had challenges accessing health services in the official language of their choice. This proportion rose to 80% of Anglophone respondents living in Quebec.

The ratio of health professionals to OLMC patients must also be considered, as it does not always meet the needs of OLMCs, especially on the outskirts of large urban centers. This particularly affects Francophone minority communities, where 14.7% of British Columbia’s Francophone population lives in rural areas, compared to 37.2% in Saskatchewan, 59.8% in Nova Scotia and 51.2% in New Brunswick (Census 2016).

On the other hand, although some health professionals have primary and secondary education in the minority official language, working in that language can be a challenge unless they have completed their post-secondary training in it.

Despite the evidence on inequalities in access to health services in the language of choice, changes in practice are still not systematically integrated, thus affecting the well-being and health potential of Francophone patients outside Quebec and Anglophone patients in Quebec.

OLMC patients therefore remain at a disadvantage in terms of equitable access to health services. Moreover, the access to health services for these patients is varied, in that the experiences of OLMCs vary from one province and territory to another, or even from one region to another. Despite this diversity, there are common efforts across Canada by several groups working to improve access to health services for patients and the quality of services provided by health professionals.

Several studies conducted for Health Canada indicate that language is indeed a determining factor in obtaining appropriate, quality, and safe health services. Good communication between patients and their health care providers is therefore essential to achieving optimal health outcomes and making good use of health system resources.

Among other things, researchers indicate that poor communication between patient and provider leads to increased feelings of vulnerability, fear and frustration for the patient and the need for more laboratory and imaging tests for the provider to diagnose and treat. Thus, poor communication between OLMC patients and health providers compromises patient safety, as the potential for errors in the diagnostic process, interventions and treatments is increased.

The Canada Health Act establishes broad principles for publicly funded health insurance plans the provinces and territories must fulfill to receive their full cash contributions under the CHT. The Act does not, however, dictate how the CHT payments are to be used or what health services must be provided, and how they are delivered. The principles of the Act are broadly defined so as not to encroach on provincial and territorial jurisdiction in the direct delivery of health care services. The provinces and territories have the jurisdiction to organize and deliver health care services how they see fit to best meet the needs of their residents, including the language in which health services are delivered.

However, the bill to modernize the Official Languages Act (Bill C-13) provides for reinforcements to better support the vitality of OLMCs and recognizes the Health sector as a key sector for their vitality.

The government of Canada has been taking a variety of actions over the years to address these challenges. Since 2003, as part of the various five-year Action Plans for Official Languages in Canada, Health Canada, through the Official Languages Health Program (OLHP), has been supporting initiatives across Canada to improve access to health services for OLMCs.

The program includes three components:
• Health Professional Training and Retention;
• Health Networking; and,
• Innovative projects to improve access to health services in the minority official language.

Approximately 10,000 bilingual health professionals able to serve Francophone minority communities have been trained by the Association des Collèges et universités de la francophonie canadienne – Volet consortium de formation en santé (ACUFC-CNFS) until now and more than 12,000 health professionals have received language training from McGill University or one of its regional partners to serve English-speaking communities in Quebec.

Furthermore, the 2023 Budget confirmed that in addition to the existing funding of $192.2 million that the OLHP will receive between 2023 and 2028, the Program will also receive $14.5 million to support non-profit organizations that serve these communities as well as to enhance the capacity to train additional bilingual nurses and personal care workers, given the most pressing needs in these key sectors following the pandemic of COVID-19.

In addition, on February 7, 2023, the federal government announced that it would increase health funding to the provinces and territories by nearly $200 billion over 10 years. This amount includes $46.2 billion in new funding through new Canada Health Transfer measures, tailored bilateral agreements to meet the needs of each province and territory, personal support worker wage support, and a 10-year renewal and increase of the Territorial Health Investment Fund.

Tailored bilateral agreements will include an action plan describing planned activities, expenditures, expected results and timelines. As these action plans are developed, provincial and territorial officials will have to consider and identify how different population characteristics such as age, gender, and OLMCs can be factored into the design of their planned initiatives.

It is also important to note that disaggregated data, including official languages, will make it possible to report to Canadians on the annual progress made on the current basis of eight common main indicators. The Government of Canada is ready to provide disaggregated data and is asking provincial and territorial governments to do the same as part of their data commitment, which is an integral part of the plan announced by the Prime Minister on February 7.

• In accordance with the principles of the Canada Health Act, provinces and territories are responsible for organizing and delivering insured health services to best meet the needs of their residents, including the language in which health services are delivered.
• However, according to the results of one consultation conducted on behalf of Health Canada, 77% of Francophone respondents residing outside Quebec said they had difficulties accessing health services in the official language of their choice. This proportion rose to 80% of English-speaking respondents residing in Quebec.
• Many Francophone minority communities live in rural areas and this has an impact on their access to health services in their official language of choice. For example, in British Columbia, 14.7% of the Francophone population lives in rural areas, compared to 37.2% in Saskatchewan, 59.8% in Nova Scotia, and 51.2% in New Brunswick (2016 Census).
• Health Canada’s Official Languages Health Program (OLHP) received $192.2M in funding under the Government of Canada’s Action Plan for Official Languages 2018-2023: Investing in Our Future to contribute to improving access to health services for OLMCs.
• Since 2003, approximately 10,000 bilingual health professionals able to serve Francophone minority communities have received training and more than 12,000 health professionals have received language training to serve Quebec's English-speaking communities.