Ottawa, March 11, 2004
Research and Health in Official Language Minority Communities
Speaking Notes Workshop entitled “Needs, Gaps and Opportunities: Improving
Access to Health Services for French and English Speaking Minorities”
Canadian Institutes of Health Research
Dr. Dyane Adam - Commissioner of Official Languages
Check against delivery
Ladies and Gentlemen,
According to Chinese tradition, you pay the doctor only when you are healthy, as it is his responsibility to ensure that his patients lead a life that is conducive to physical and mental well being. If they fall ill, it means that the doctor has failed and he is not paid until the patient recovers. This concept of medicine is based on a preference for prevention and on the recognition that health care entails more than the mere treatment of clinical symptoms. To promote health and to understand the factors that affect it, it is necessary to take a comprehensive view and address the underlying causes of illness.
Health is a priority for all Canadians, but this concern is felt more by official language minority communities. They are faced with language barriers every day, since communication plays a central role in the delivery of health care. The Supreme Court has, furthermore, reaffirmed the legal obligation of the Government of Canada to protect minorities, which is one of the pillars of Canada’s constitutional framework1. Also, Part VII of the Official Languages Act sets forth the government’s commitment to enhancing the vitality of official language minorities. Accordingly, the Canadian Institutes of Health Research share this special responsibility. The situation of official language minority communities must also be taken into account when considering policies that affect access to health care.
At this roundtable, I would like to emphasize the importance of research in developing health care policies and programs designed for official language minority communities, and I would like to propose a number of avenues for research that would help expand their access to health care.
I. The role of research in the development of health care policies
Research plays a dominant role, not only in the formulation of new treatments, but also in the implementation of health care programs and policies. To act effectively, the government needs accurate and reliable data about the targeted area of intervention.
There are at least six key points, not necessarily listed in chronological order, at which research and policy come together, and where the former sustains the latter:
1. the legislative process;
2. policy development;
3. policy implementation;
4. the forming of legal arguments;
5. the assessment of the impact of government intervention; and
6. community activism.
To present an idea or influence decision-makers, whether it be in the context of draft legislation, a policy or a program in the area of health care, the argument must be based on credible, empirical data. When arguing before the courts, lawyers need empirical studies in order to assert the rights of citizens, including their language rights. For example, in the case of the Montfort Hospital, the legal system reached a decision favourable to the Francophone community. It based its decision specifically on research showing the importance of institutions in fostering the vitality and development of communities2.
Researchers can provide decision-makers and stakeholders with a relevant, sound and varied body of knowledge and in a given situation they can highlight issues and resources to meet objectives. This is why research should examine health from numerous perspectives if it is to address the various needs of Canadians.
Gaps in research on health care in minority communities
We must take advantage of the fact that health care is currently a priority to initiate research into the impact of linguistic variables on health in minority communities. We specifically need to cast a critical light on the various models of service delivery tailored to this context. Let us not forget, however, that health care is not limited to service delivery, but is related above all to living conditions in communities. In short, there is a clear link between health and the social, economic and cultural vitality of official language minority communities, to name but a few of the factors at play.
There have been a number of attempts to identify ways of improving health care in Canada and of promoting its linguistic component. There was, for example:
- the Romanow Report3;
- the Kirby Report4 of the Standing Senate Committee on Social Affairs, Science and Technology;
- the Study of the Federation of Francophone and Acadian Communities, entitled Santé en français: pour un meilleur accès à des services de santé en français, which means Health in French: For Improved Access to Health Care Services in French;5 and
- the Report of the English-Speaking Catholic Council on the future of health care in Canada6.
There are, however, few studies on health care in minority communities.
The government must ensure that all the public sector data is accessible for health care research. This issue must be addressed from many perspectives, and specifically from the linguistic one. I would also suggest avenues for research that, I believe, could contribute to the development of official language communities and to the improvement of the health care services available to them. These avenues include:
- the need for a conceptual, methodological framework to support and monitor the health of official language minority communities;
- the importance of updating the full range of factors that affect health care in minority communities;
- the crucial role of language in the delivery of health care services; and
- the organization of health care services and the importance of prevention.
In light of the number of research-related issues that need to be addressed, the creation of a research institute, dedicated to health issues affecting official language minority communities, would seem appropriate. Furthermore, the House of Commons Standing Committee on Official Languages had already made a recommendation to this effect. I urge the institute to further explore this option.
II. Research avenues
A conceptual and methodological framework to support and monitor the health of official language minority communities
First of all, we need a conceptual and methodological framework to support and monitor the health of official language minority communities. Increasing the effectiveness of government programs and initiatives on the ground requires an analytical model of the state of health in the communities, including their needs, their specific characteristics, the key stakeholders and the institutions involved. The issues and the needs, the opportunities and the challenges, are not the same everywhere. To foster the development and vitality of communities and to articulate their demands and their expectations, we must identify the main factors affecting this development, the issues involved and the constraints that must be overcome.
This model should make it possible to emphasize the fields of action and the effective practices, to include indicators that are more focused and proven in the performance evaluations of the health care system, and to identify the factors that must be considered in forming health care policies.
Factors affecting health care in minority communities
Communities may face a variety of specific problems, such as higher rates of seasonal employment, lower levels of education or a higher differential rate of unemployment. They must sometimes cope with formidable social handicaps and a lack of cultural activities.
For example, the Francophone community on the Acadian Peninsula is facing an economic crisis due to the contraction of the fishery, which is the main industry in the region, and due to the resulting level of unemployment that brings with it a whole series of social problems.
A parallel development has been noted in the Eastern Townships, where the Anglophone community is losing its young people because of a lack of employment opportunities. As a result, the population is aging more quickly. This aspect of decline has a number of repercussions on health in the broader sense, to the extent that these phenomena are accompanied by the residents’ inability to build a future.
Another example, in New Brunswick, is that the social development of some communities is regressing because of the disappearance of the forest industry and the announced shutdown of the mining industry in an area that, in the 1970s, was thought to contain the world’s largest zinc deposits. Hope has faded and the promises of successive governments now fall on deaf ears.
In the West, outside the urban areas, farmers, grain producers and ranchers face similar challenges.
Given the size of these communities, the effect of economic disruption on a portion of the population places the entire community in a perilous position, bringing with it all the associated social and health problems.
This is why we need focussed research on the impact of a contracting population, socio-economic deficits, the lack of social services, cultural atrophy in minority communities and any other factors with a critical impact on physical or psychological illness. This would yield reliable indicators relating to the appearance of serious social and medical problems.
A specific model is needed of the inter-relationships between all the factors identified and their potential impacts, in keeping with the specific characteristics of each region. This type of model would form a basis for proposing programs and action strategies that would more effectively address the needs of these communities.
Language of service
There is a considerable body of research showing that language barriers have negative impacts, particularly on access to health care services and on diagnosis.7 The language factor also tends to reduce the exposure of some communities to promotion and prevention programs. In addition, language barriers diminish the efficiency and satisfaction of health care workers.
Research into the impact of the linguistic dimension would enable us to better understand and highlight the importance of linguistically and culturally appropriate communication on the delivery of personalized services, diagnoses, clinical findings and appropriate use of services.
Beyond health care delivery, the linguistic and cultural dimension undoubtedly affects the management of services, and this impact should be documented.
The organization of health care services
The organization of health care services must also be appropriate for minority communities. Based on research, appropriate models of delivery and types of service must be developed to make the most of the investment in health care.
In the current medical context, where attempts are being made to reduce the costs of treatment and of hospital stays, the language factor and the human dimension assume critical importance. The restructuring of services frequently places a heavier load on families. And when they can no longer bear the burden, the communities are ultimately called upon to do so. Minority communities, however, have few resources and few institutions to cope with the demand. Research would also serve to identify new ways of equipping communities to assume this social burden and to prevent their members from becoming disadvantaged. This is an issue of equality of opportunity.
Information and prevention
There is one final area in which research could make a major contribution, that of prevention and awareness. The aim is to highlight effective communication strategies and approaches to make members of these communities aware of better ways of looking after their health and of managing it throughout their lives.
To be effective, it is essential that these programs reflect the realities of the communities, which is why it is so importance to have scientific data about them. Based on studies of this type, knowledge could be more effectively disseminated through information and education programs, allowing individuals to evaluate and improve their own health. Prevention is undoubtedly of benefit to all Canadians, but it is even more essential for minority communities due to the relative shortage of services available to them.
Conclusion
In conclusion, we must promote quality health care that reflects Canada’s linguistic dimension. This obligation, combined with the imperatives of community development, demands that our concepts and tools evolve in step with the social and cultural changes occurring in Canada today. It is up to you to promote this development, to shed empirical light on the issues we face today and to suggest ways in which we can achieve our social goals.
Research would appear to indicate that knowledge of an official language is itself, ultimately, a factor affecting health, one that interacts with socio-economic status, ethnicity and other factors that have not yet been clearly identified. A great deal of work remains to be done, however, to put in place concrete strategies and action plans that address the needs of communities and that make the linguistic dimension an asset rather than an obstacle in the context of universal health care.
Notes
1 Reference re Secession of Quebec, [1998] 2 S.C.R 217.
2 Lalonde v. Ontario (Health Services Restructuring Commission) (2001), 56 O.R. (3d) 577 (C.A.).
3 Commission on the Future of Health Care in Canada, Final Report. Guided By Our Values: The Future of Health Care in Canada, November 28, 2002, http://www.hc-sc.gc.ca/english/care/romanow/index1.html.
4 Standing Senate Committee on Social Affairs, Science and Technology, The Health of Canadians - the Role of the Federal Government, October 2002, http://www.parl.gc.ca/37/2/parlbus/commbus/senate/com-e/soci-e/rep-e/repoct02vol6-e.pdf
5 Fédération des communautés francophones et acadiennes, Santé en français: pour un meilleur accès à des services de santé en français, June 2001.
6 English-Speaking Catholic Council, Brief and Recommendations on the Future of Health Care in Canada, March 25, 2002.
7 Cf. the study by Sarah Bowen, Language Barriers in Access to Health Care - Barrières linguistiques dans l'accès aux soins de santé, Health Canada, November 2001.
