Ottawa, November 30, 2004
Notes for an address at the First National Research Symposium
on the Health of Francophone Minority Communities
Dyane Adam – Commissioner of Official Languages
Check against delivery
Welcome to you all.
Today, I find myself on familiar territory. As you may already know, I worked for a number of years as a clinical psychologist as part of the Quebec and Ontario health networks. My subsequent experience was in the areas of research and teaching. I hope you will therefore allow me to call you colleagues.
These days in Canada, health is becoming a topic of conversation as popular as the day’s weather. Health receives extensive media coverage. All aspects of services provided are being scrutinized. There is criticism. There is condemnation. There are demands. There is speculation. And there is much being sought. The topic seems inexhaustible, and for good reason.
According to the World Health Organization, “[…] health is a state of physical, emotional, mental and societal well-being […]. It is not merely the absence of disease, dysfunction or infirmity.” This is a very vast undertaking, given that this definition brings into play all aspects of society.
One is unlikely to find a community that is physically, mentally, and socially healthy where no economic development is taking place, where there are no schools in which children can learn in their first language, where there are no places where people can amuse themselves, where there is no cultural creation. And so much more.
I think you understand what I am getting at: one must examine all living conditions within a given community and look beyond numbers and figures if one is to get a clear picture of this community’s health. A healthy community is, first and foremost, a fully developed community.
For Canada’s French-speaking and Acadian communities, health also rests on the psychological security that individuals get from knowing that they will be able to let others know what is ailing them, in their first language. This is simply common sense. I don’t think there is anyone in pain, anyone at all, who is awaiting care in a hospital who would not be worried or feel anxious at being unable to correctly explain what the problem is, in his or her first language! And I think we all know how difficult it is to do that sometimes, even in one’s own language…
This first National Research Symposium on the Health of Francophone Minority Communities is therefore something to celebrate, because it lays the groundwork for health research projects that will help decision makers and stakeholders across Canada better understand the specific needs of our communities.
Significant developments
There have been significant developments over the last two years in terms of the attention being paid by governments to the health of minority groups. In March 2003, the Government of Canada launched its Action Plan for Official Languages. Under the Action Plan, $119 million will be invested in community health over five years.
The national health agreement signed recently by all first ministers mentions for the first time the needs of official-language minority communities. This doesn’t seem like much, but it took a long time for this to come about, although we would have preferred, of course, that this subject be formally discussed during the conference.
Nevertheless, it seems that the political winds are blowing in the right direction…
The role of governments
In my last annual report, I once again asked that federal-provincial-territorial health agreements be adapted to the specific needs of the official-language minority communities in each province or territory and that these include specific provisions on the health services that are to be delivered to them in their language.
The latest health agreement between the two levels of government is a start. However, we hope that individual agreements will be concluded with the provinces so that they can continue to support the efforts to increase health services in French.
Several of the provinces have already committed to building on and strengthening what has already been achieved in terms of health services for minorities. In some cases, all that remains to be done is to formalize these commitments and to provide permanent funding to this end. The federal government must now provide the provinces with the means to uphold this commitment in the long term.
Being able to relieive health services in their language plays a role in the vitality of minority communities.
In order to ensure that a real health program for official-language minority communities is put in place, the provinces must develop service-delivery models adapted to the needs of these communities.
Another useful measure would be for the provinces and territories to support research on the health of their official-language minority.
How researchers can help governments to fulfill their obligations
If you are here today, it is because you understand that one has to strike while the iron is hot. As I have said, there is an undeniable link between the health, on the one hand, and the social, economic, and cultural vitality, on the other hand, of official-language communities. Researchers can therefore provide information on the basis of which politicians and stakeholders can make informed decisions.
Something else that should be done is giving communities as well as political players like OCOL the tools the need to put their case to the appropriate authorities, in order to give some weight to our efforts. We would therefore be better able to explain to the government the needs of linguistic minorities in the area of health, if we had on hand solid studies of different types that could provide a better understanding of the situation.
What exactly do we know about the state of health of Francophones, specifically the most urgent needs of this group that must be met? Yes, reports have been written, and analyses have been conducted. However, no document can be said to be the ultimate authority on the matter. Consequently, it would certainly be useful to take a comprehensive look at the state of health of Francophone and Acadian communities in each province and territory.
What role does Francophones’ first language play with regard to their health? If you visit a unilingual Francophone dentist for an abscess the size of a grapefruit, chances are that the dentist will understand what your problem is before you even say a word! Such is not the case for Francophones suffering from a psychological impairment or psychiatric disorder.
How does the lack of health services in French affect the provinces’ capacity to recruit and retain Francophone immigrants? There is, for example, the case of an immigrant family in Fredericton, New Brunswick, which, for the last nine years, has been unsuccessfully seeking a family doctor who speaks French. This family is considering moving to Quebec. Researchers cannot prevent this family from moving to obtain health care in French. What they can do, however, is show the provincial government that the presence of French-speaking healthcare professionals does strengthen and enrich communities by attracting newcomers.
Of course, one should not overlook the importance of communication when one is dealing with access to health services in French. Let’s imagine for a moment what would happen if all French-speaking healthcare professionals across Canada were to declare themselves as Francophone immediately upon commencing employment. How would patients react if an active offer of services in both official languages were made in this way? Would healthcare professionals be interested in taking part in such a program? That is certainly an interesting question.
- What are the factors that lead health care professionals to settle in one region rather than another?
- What would be the best way in which foreign degrees could be recognized, so that the holders of such degrees could still comply with Canadian competency standards for healthcare professionals?
- What are the specific healthcare needs of women, children, and seniors that have to be met?
- What impact would a complete restructuring of health care at the provincial level have on the Francophone and Acadian communities?
Essentially, research on all health-related issues faced by Francophones is useful, if it helps to pinpoint the areas that should be addressed in priority.
The research data must indicate which situations are unacceptable and spur governments to take action.
Let’s take for example the studies on immigration carried out by OCOL in 2002. Many people believed that immigration was not supporting the development of Francophone communities but did not have evidence to support this contention. It took a study showing that Francophones made up only 1.4% of immigrants to Canada for Citizenship and Immigration to look into the matter and take steps to rectify the situation.
In my view, in the long term, research data on the health of Francophones could also help in obtaining new funding from governments in order to meet specific needs.
Language, culture and health
The international community assigns as broad a definition to culture as the World Health Organization does to health. According to UNESCO, "culture is the whole complex of distinctive spiritual, material, intellectual and emotional features that characterize a society or social group; it includes not only the arts and letters, but also ways of life, ‘ways of living together’, the fundamental rights of the human being, value systems, traditions and beliefs."
In short, culture is not limited to the performance arts. Because every social group has its own way of life and values, this, in my view, implies that health research must take account of this fact, by avoiding standardizing conclusions with regard to expectations, needs, and solutions.
As well, one should not forget that individual behaviour with regard to health matters can sometimes have its roots in the culture of a given community. For example, since the smoking rate among Francophones is higher than that among Anglophones, one can conclude that this is a cultural trait. However, if one looks behind the figures, one may discover that the smoking rate in some Francophone communities is higher as a result of the lower level of education or the unavailability of awareness material in French. This knowledge can thus help us to better target our awareness efforts. Taking this even further, one could also conclude that material used in smoking-prevention campaigns has only a limited impact among Francophones, even when it is written in French, because it is not adapted to the culture of the community. Certainly, the reasons for smoking and the reasons for quitting can be very different from one community to another community. Therefore, not only language but also values come into play.
Let me reassure you: I am not saying that a community’s culture has a negative impact on its health!
In short, the state of health of minority communities cannot be summed up as simply a matter of services. It is by looking at overall health that we will be better able to address the needs of communities.
I therefore encourage you to continue your efforts, and I look forward to finding out what you discover.
I trust all of you will find the symposium to be a most rewarding experience.
