Senate report spotlights language barriers to health access 

Ruby Pratka

Sherbrooke Record, Local Journalism Initiative 

A recent report by the Standing Senate Committee on Official Languages has emphasized the challenges members of official language minority communities – both English-speaking Quebecers and francophones living outside Quebec – face when trying to access health care in their primary language. 

The committee, chaired by the Acadian senators Allister Surette (Nova Scotia) and co-chair Rose-May Poirier (New Brunswick), heard from 121 witnesses and received 36 written briefs over a period of 18 months. Committee members tabled the final report in February. 

“This report is directed at various federal ministers and partners in an effort to ensure equitable, safe and quality care,” committee members wrote in a summary. “It advocates for the right of health system users to receive services in a language they understand and in which they would like to be understood. Accordingly, this approach would lead to improved health outcomes.”

The committee recommended that the federal government tie the health transfers it sends to the provinces to respect for the Official Languages Act and reinforce funding for community organizations that support access to health care for official language minority communities. It also recommended enhancing funding for minority-language education programs for health care professionals and making foreign credential recognition easier for immigrant health professionals who are bilingual. 

Further recommendations included standardizing “active offer” – the idea that care in a person’s preferred language will be offered to them without having to ask – and ensuring that private companies partnering with provincial governments to provide health care respect this principle and consult communities; improving data collection and having the federal government work with provincial and territorial governments to develop a pan-Canadian telemedicine strategy in official language minority communities. The report also mentioned specific practices in place in certain communities, such as indicating a person’s preferred language on their health card, creating a directory of bilingual health professionals and putting posters up to make patients aware of their language rights; neither of these practices are in place in Quebec.

 The committee invited all provincial and territorial governments to present or provide written submissions; Quebec was one of six provinces that did not take part. 

“Although the federal government does not deliver health services directly, except to certain groups, it does provide funding and play a leadership role in respecting the language rights of Canadians. In the wake of a pandemic that affected the health of Canadians on many levels, and with a surge in new practices—such as the use of telemedicine, artificial intelligence or private health care services—it seemed appropriate to consider the challenges facing the Canadian health care system in terms of official languages,” committee members wrote. “Research has confirmed that language barriers in health care lead to increased risks on a number of levels. Conversely, receiving health care in one’s own language is an indication of the quality and safety of care, according to the vast majority of the evidence heard.”

They noted that Quebec faced particular difficulties in recruiting bilingual staff and ensuring home care and other services for anglophone seniors outside of Montreal. “People cannot exercise their language rights due to the limited human, financial and material resources available,” they observed. 

“This [study] is interesting, in that it was the first in-depth study looking at minority-language health care across Canada. Witnesses talked about their struggles and how [language] could affect health outcomes and willingness to seek care,” said Townshippers president Don Warnholtz, a former member of the provincial access committee on English-language health care. “The risk of errors increases when people can’t describe their symptoms or give informed consent in their preferred language.” 

“One of the things that is really important is that the Senate is working on improving data collection and planning, to see where and when people can’t get services,” he said. “It’s important to recognize that the anglophones in Quebec are a minority-language community and they have many of the same challenges that [francophones outside Quebec] face.” 

He said the Eastern Townships was relatively fortunate in that the region had a critical mass of English-speaking patients and professionals and a local health authority that “has recognized that language is a determinant of health.” Although language laws place limits on the “active offer” principle and on English-language signage, subtle workarounds such as the sunflower program, where health professionals who are comfortable providing English service wear sunflower pins, make access to services easier; Townshippers is also advertising for a bilingual “patient navigator” position to support anglophone patients who may have trouble navigating the health system on their own, similar to the one in place in the Quebec City region. 

Jennifer Johnson, executive director of the Quebec City-based Community Health and Social Services Network (CHSSN), said the report was an “important tool” in light of the new Official Languages Act and Quebec’s attempts to complicate access to federal funding for community organizations like CHSSN, Townshippers and their partners. “If someone from the Ministry of Health and Social Services looks at it, it can help them understand the challenges.” She emphasized the importance of asking for English services. “The burden rests on the client to request services in English, and that is the most important message to get out there – everyone should be asking for services in English even if they don’t think the services are available. If they don’t ask, they won’t be counted.” 

“The Ministry of Health and Social Services (MSSS) recognizes that in some regions or settings, it may be more difficult to find a staff member sufficiently comfortable in English to communicate easily,” Quebec Ministry of Social Services spokesperson Marie-Claude Lacasse said in a statement acknowledging the report, after the print edition of this story went to press. “The MSSS has indicated that in such cases, measures must be implemented (e.g., a service corridor, using another service provider, or using an interpreter or simultaneous translation). These guidelines are found in the Guide for Developing the Program for Access to Health and Social Services in English. Santé Quebec is now responsible for ensuring that these guidelines are followed. Efforts must continue.”

With files from QCT staff