Ethnicity, Language and Immigration Thematic Series
Health care professionals and official-language minorities in Canada, 2001 and 2011 Ethnicity, Language and Immigration Thematic Series
Health care professionals and official-language minorities in Canada, 2001 and 2011

Acknowledgments

We would like to thank Jean-Pierre Corbeil, in charge of the language statistics program at Statistics Canada, for his ongoing help and useful suggestions during the writing of this publication. Thanks to Roger Guillemette and François Rivet of Health Canada and François Nault, Director, Health Division, Statistics Canada, for their judicious comments and suggestions. Our most sincere thanks also go to Michael Wendt, Scott McLeish and François Verret for their methodological advice. Finally, the authors would like to thank Karine Garneau and Deniz Do for their contribution in the final stages of this report.

This study was made possible through financial support from a consortium comprised of Canadian Heritage, Immigration, Refugees and Citizenship Canada, Health Canada and the Department of Justice Canada.

Introduction

Language is an important factor in accessing health care for linguistic minorities, particularly on first contact with a health care professional (Bowen 2011). Family physicians, nurses and pharmacists provide frontline health care, as do paramedics. For psychologists and social workers, communication—and therefore language—is a key working tool during consultations with clients.

Since 2003, Health Canada has been supporting activities to improve access to health care in French outside Quebec and in English in Quebec, including the training and retention of bilingual health professionals, through the Official Languages Health Contribution Program (OLHCP).^{Note 1} Over a 15-year period, thousands of additional health care professionals, including family physicians, psychologists, physiotherapists, nurses, pharmacists and several types of technicians, have received training in French in universities outside Quebec that are members of the Consortium national de formation en santé (CNFS). In Quebec, McGill University has coordinated an initiative to provide language training to more than 12,000 staff members in the health and social services system. It has also set up an internship and bursary program for bilingual students to foster better access to health care in English.

In 2009, on behalf of Health Canada, Statistics Canada published a report entitled Health Care Professionals and Official-language Minorities in Canada: 2001 and 2006. The report painted an initial portrait of the pool of certain groups of professionals who provide or are likely to provide health care services to English and French linguistic minority communities. In a way, this report builds on the one released in 2009—it provides a more detailed portrait of official language trends in specific health occupations by comparing 2001 and 2011 data.

The first objective of this report is to present detailed statistics on the number of health care professionals by various linguistic characteristics. The tables presented in the appendix provide the reader with exhaustive and valuable information. This report also aims to estimate how and to what extent the availability of official-language minority health care professionals in Canada has evolved over the 10-year period during which the federal government took action to improve access to health care in official-language minority communities (OLMCs).

Health Canada has sought Statistics Canada’s expertise to evaluate how, in the official minority language, health care services are offered, as well as the availability of health care professionals who are providing or are able to provide care and services. Part 1 of this document paints a portrait of the pool of health care professionals in the minority population in 2011. The portrait also includes a description of the health care professionals who were using the minority language at work in 2011 or who reported having the ability to conduct a conversation in that language. Changes in the number of health care professionals and in the health care services offered in the minority language between 2001 and 2011 are also examined. Part 1 of this document presents this overall portrait of the pool of health care professionals serving or likely able to serve OLMCs.

Part 2 of this document examines the balance between the “offer” of and the “demand” for health care services in the minority language. Health care services have been offered increasingly almost everywhere in the minority language in Canada. Between 2001 and 2011 were minority-language health care services offered according to the demographic evolution of the minority population? Were health care services offered at an increased rate in areas where the minority population has experienced the strongest growth? The analysis shows that is usually not the case. Data analysis by group of professionals to this effect will enable Health Canada and postsecondary educational institutions to identify health care-related human resource needs, and create policies and training programs to expand the professional workforce in the areas with the greatest need.

The data presented in this document are from three sources: the 2001 Census of Population long form; the 2011 Census short form; and the 2011 National Household Survey (NHS). Analyses are performed at the provincial level, and at the sub-provincial level for the three provinces with the greatest official-language minority populations. The data for this portrait of health care professionals who serve official-language minority communities or who are able to provide health care services in the minority language are presented by geography—in the descriptions and detailed data tables in Appendix B.^{Note 2}

The analyses in this document begin by addressing health care professionals as a whole. Nine groups of professionals are also examined specifically. The initial groups of health care professionals are the same as those presented in the 2009 report—registered nurses and registered psychiatric nurses (nurses); general practitioners and family physicians (physicians); psychologists; and social workers.^{Note 3} Four additional groups have also been added and the residual category has been modified.^{Note 4} The additional groups are pharmacists; licensed practical nurses; ambulance staff and paramedics (paramedics); and nurse aides, orderlies and patient service associates (nurse aides).

Part 1

Canada outside Quebec

According to the National Household Survey (NHS), there were 885,375 health care professionals in Canada outside Quebec in 2011.^{Note 5} Of those, 11.7%, or 103,830, were able to conduct a conversation in French, and 45,450 used French at least regularly at work. In addition, 38,655 health care professionals were part of the official-language minority.^{Note 6}

The 38,655 health care professionals in the francophone minority represented 4.4% of all professionals, a relative weight slightly greater than that of the francophone minority in the total population (4.0%).

Members of the linguistic minority were overrepresented in some health occupations—specifically among psychologists (6.1%); paramedics (5.6%); social workers (5.2%); and nurse aides (5.2%). In contrast, pharmacists (3.2%) were under-represented in the francophone minority.

The relative demographic weight of the official-language minority decreased between 2001 and 2011 in Canada outside Quebec^{Note 7}. The same holds true for most of the occupations observed. The most notable exception is physicians, where there was an increase in the relative weight of the francophone minority—in 2011, 4.2% of them were in the minority, compared with 3.7% in 2001.

Whether health care services are offered in the minority language is not only determined by the fact that members of the minority are in a health care profession. The ability of health care professionals, including non-Francophones, to conduct a conversation in French is an indicator as to whether health care services could be offered in French for the official-language minority.^{Note 8} In 2011, 11.7% of health care professionals in Canada outside Quebec reported having the ability to conduct a conversation in French, down from 12.4% in 2001. The ability to conduct a conversation in French is declining for several groups of professionals—nurses (10.1%, down from 10.6% in 2001); psychologists (20.9%, down from 23.2% in 2001); social workers (13.5%, down from 14.3% in 2001); and nurse aides (9.2%, down from 10.1% in 2001).

The trend is the same for the use of French by professionals at work. Another way to determine whether health care services are offered in the minority language is to look at health care professionals who use French at least regularly at work.^{Note 9} In 2011, 5.1% of health care professionals used the minority language at least regularly at work, compared with 5.4% in 2001. The use of French at work is declining in a number of groups of professionals, particularly among nurses (5.0%, down from 5.6% in 2001); psychologists (6.8%, down from 7.9% in 2001); paramedics (6.6%, down from 7.7% in 2001); and nurse aides (5.5%, down from 5.9% in 2001).

However, all these downward trends exist in the context of a growing workforce. The number of official-language minority health care professionals able to conduct a conversation in the minority language or use that language at least regularly at work increased between 2001 and 2011 in Canada outside Quebec as a whole, for virtually every health occupation observed. The reason for the relative decreases combined with workforce increases is that the number of health care professionals who are not in the minority and are unable to conduct a conversation in the minority language or are not using that language at least regularly also increased, and even more rapidly.

Atlantic

In the provinces of Newfoundland and Labrador, Prince Edward Island and Nova Scotia, the total number of francophone health care professionals increased 40.3% between 2001 and 2011, to 1,470 in 2011. In most of the groups of professionals, the number of people able to conduct a conversation in French increased more than 40% between 2001 and 2011. The number of Atlantic health care professionals outside New Brunswick who used French at least regularly at work increased 29.9% between 2001 and 2011, from 1,150 professionals in 2001 to 1,490 in 2011.

In New Brunswick, the number of minority-language health care professionals increased nearly 40% over 10 years. Similarly, the number of professionals who reported having the ability to conduct a conversation in French or who used French at work increased more than 40% between 2001 and 2011. For each indicator, the number of physicians and nurse aides in New Brunswick increased substantially over 10 years—more than 50% in each case.

In northern New Brunswick,^{Note 10} the total number of professionals went from 5,930 in 2001 to 7,705 in 2011, an increase of nearly 30%. In comparison, there were 8,055 professionals in southeastern New Brunswick in 2011, up 47.6% from 2001. The number of professionals who reported having the ability to conduct a conversation in French increased 28.3% between 2001 and 2011 in northern New Brunswick and 60.3% in southeastern New Brunswick. Similarly, the number of professionals who used French at work increased 27.9% over 10 years in northern New Brunswick, while it increased 56.8% in southeastern New Brunswick.

The number of physicians increased considerably between 2001 and 2011 in both New Brunswick regions. This is also the case for nurse aides in northern New Brunswick. As mentioned above, the presence of French is strong among certain groups of professionals at the provincial level, as is the case at the regional level. That is the situation for social workers and psychologists, in particular; conversely, however, the presence of French is not as strong among paramedics in northern New Brunswick and pharmacists in southeastern New Brunswick.

Ontario

There were 414,990 health care professionals in Ontario in 2011, of which 18,845 were francophone, an increase of nearly 20% between 2001 and 2011. Among the groups of health care professionals, the number of francophone licensed practical nurses, paramedics and nurse aides grew considerably faster than the total number of francophone professionals in Ontario. Conversely, the number of francophone nurses grew more slowly than the total number of francophone professionals in the province.

In 2011 there were 53,200 professionals who reported having the ability to conduct a conversation in French in Ontario, up 21.8% from 2001. Similarly, the number of professionals who used French at work increased 20.8% between 2001 and 2011. In 2011, three health care professional groups were distinguished from the rest by a more frequent use of French at work—psychologists, physicians and paramedics. The number of paramedics and nurse aides who reported having the ability to conduct a conversation in French or who used French at least regularly at work in Ontario increased more rapidly than the total number of health care professionals between 2001 and 2011.

Between 2001 and 2011, the number of francophone professionals increased 19.4% in southeastern Ontario,^{Note 11} amounting to 1,990 such professionals. In 2011, 3,040 health care professionals reported having the ability to conduct a conversation in French in southeastern Ontario, an increase of 20.5% compared with 2001.

In northeastern Ontario, there were 4,100 francophone health care professionals in 2011, an increase of 18.3% compared with 2001. The number of professionals who reported having the ability to conduct a conversation in French in northeastern Ontario increased 26.9% over 10 years—6,785 professionals were able to conduct a conversation in French in 2011. In northeastern Ontario, the number of nurse aides increased sharply between 2001 and 2011 for all French-language indicators such that the number of francophone professionals who reported having the ability to conduct a conversation in French more than doubled during the period. Conversely, the number of francophone nurses in northeastern Ontario declined 12.9% between 2001 and 2011.

In Ottawa, the number of francophone health care professionals increased faster than the francophone population. There were 7,045 francophone professionals in Ottawa in 2011, up 20.4% from 2001. A total of 14,895 health care professionals reported having the ability to conduct a conversation in French in Ottawa, an increase of nearly 25% compared with 2001. The professionals able to converse in French represented 41.9% of all health care professionals in the city.

In 2011, the number of professionals able to conduct a conversation in French was 9,330 in Toronto, or 9.3% of the health care professionals in the region. Pharmacists and paramedics who reported having the ability to conduct a conversation in French or who used that language at work increased 89.9% and 241.5%, respectively, between 2001 and 2011. However, fewer licensed practical nurses and nurse aides were able to conduct a conversation in French in 2011 than in 2001 in Toronto.

Western Canada

The number of francophone professionals declined between 2001 and 2011 in the provinces of Manitoba and Saskatchewan. It dropped from 2,280 professionals in 2001 to 2,155 in 2011—a 5.3% decrease over 10 years. The francophone population of Manitoba and Saskatchewan also declined over the period, from 59,930 people in 2001 to 55,660 in 2011—a 7.1% decrease. The number of health care professionals who reported having the ability to conduct a conversation in French increased 21.3% between 2001 and 2011. The number of health care professionals who used French at least regularly at work increased approximately 10% during the same period. The number of professionals who used French at work increased between 2001 and 2011 in most groups of health care professionals in the region. However, the number of nurse aides who used French at least regularly at work decreased 21.2% over 10 years.

In Alberta, the official-language minority population increased more than 20% between 2001 and 2011. Similarly, the number of francophone professionals increased between 2001 and 2011. There were 2,240 francophone professionals in Alberta in 2011, up 34.3% from 2001. In 2011, nearly 10,000 professionals reported having the ability to conduct a conversation in the minority language in Alberta, up 33.8% from 2001. The number of professionals able to conduct a conversation in French increased in every group of health care professionals except for physicians, where there was a 7.8% decrease. The number of nurses who used French at least regularly at work more than doubled between 2001 and 2011 (123.1%)—from 185 professionals in 2001 to 410 in 2011.

In British Columbia, the number of francophone professionals increased 20.4%. The number of professionals who reported having the ability to conduct a conversation in the minority language increased 30.4% between 2001 and 2011—from 9,455 professionals in 2001 to 12,325 in 2011. The use of French at work also increased between 2001 and 2011. The number of professionals who used that language at work was 1,415 in 2011, up 42.2% from 2001.

Quebec

In 2011, there were 289,845 health care professionals in Quebec according to the National Household Survey. More than one-half of those (53.6%) reported having the ability to conduct a conversation in English, representing 155,265 professionals. More than one-third of health care professionals in Quebec reported using English at least regularly at work.

There were 29,640 Anglophone health care professionals in Quebec—10.2% of the professionals in the province. For the sake of comparison, the relative weight of the Anglophone population in Quebec was 13.5% in 2011. The proportion of Anglophone professionals is below the threshold in all observed professions, except for physicians, where it rose to 16.1%.

The ability to conduct a conversation in the minority language varied very little for health care professionals in Quebec between 2001 and 2011, going from 52.8% to 53.6%. The variations were also weak in each of the observed occupations. However, this ability varied considerably from one group of professionals to another. It was lower among licensed practical nurses (32.1%) and nurse aides (34.2%), whereas it was higher among pharmacists (77.7%) and physicians (89.3%).

Similarly, the regular use of English at work varied little between 2001 (34.5%) and 2011 (35.5%). In 2011, 28.4% of licensed practical nurses used English at work—an increase compared with 2001 (22.0%). In other occupational groups, there were slight increases (nurses, psychologists, pharmacists) or slight decreases (physicians, social workers, paramedics).

These variations in proportion, however, coincide with a general increase in the number of health care professionals. Increases were observed in all groups of professionals and according to all linguistic indicators, except for rare cases where the workforce was stable.

Regions in the province of Quebec^{Note 12}

There were 25,460 Anglophone professionals in the Montréal census metropolitan area (CMA) in 2011, up 30.6% from 2001. There were also 74,370 professionals who used English at least regularly at work, in 2011, up 30.9% from 2001. The professionals who used English at work in 2011 represented just over 1 in 2 professionals (52.3%) in the Montréal CMA. Nurse aides were less likely to use English at work (41.2%), while physicians were more likely (68.7%). The number of professionals in the Montréal CMA able to conduct a conversation in English went from 73,750 in 2001 to 95,340 in 2011, representing close to two-thirds of all professionals in the region.

The number of Anglophone professionals increased 32.1% in Estrie and southern Quebec (from 970 health care professionals in 2001 to 1,280 in 2011), while it increased 84.2% in western Quebec (from 585 health care professionals in 2001 to 1,075 in 2011).

There were 11,875 professionals able to conduct a conversation in English in 2011 in Estrie and southern Quebec, up 32.5% from 2001; and 8,920 in western Quebec, up 41.9% over the period. Professionals able to conduct a conversation in English represented more than one-half of all professionals in these two regions—51.8% in Estrie and southern Quebec and 58.8% in western Quebec. The proportion of professionals able to conduct a conversation in English is particularly high among physicians (90.5% in Estrie and southern Quebec and 92.6% in western Quebec).

There were 260 Anglophone professionals in eastern Quebec in 2011. The number of health care professionals, like the Anglophone population in the region, remained fairly stable between 2001 and 2011. The number of health care professionals able to conduct a conversation in English increased from 3,760 in 2001 to 4,110 in 2011, an increase of 350 professionals. The proportion of health care professionals able to conduct a conversation in English, however, declined during the same period in Eastern Quebec from 29.5% in 2001 to 28.2% in 2011. The use of English at work also increased slightly.

In Québec and its surrounding areas, there were 570 Anglophone professionals in 2011, an increase compared with 2001 (385 professionals). The Anglophone population increased 22.4% during the same period, reaching 18,965 individuals in 2011.

The number of health care professionals able to conduct a conversation in English increased in Québec and its surrounding areas, both in number and proportion, from 14,945 (33.8%) in 2001 to 21,080 (36.6%) in 2011. An increase can be observed in almost all of the observed occupations, except for physicians, where there was no change. Trends are similar for the use of the minority language at work.

Part 2

Balance between offer of and demand for health care services in the minority language

In Canada outside Quebec, the francophone population grew 2.0% between 2001 and 2011^{Note 13}. In Quebec, the Anglophone population grew 15.2% over the same period. However, demographic growth varied from one region to another, for both Anglophones in Quebec and Francophones in other provinces and territories. Factors such as intraprovincial and interprovincial migration and a differential ability to attract immigrants made it so that the demographic growth in official-language minorities was substantial in some regions and very low, if not negative, in others. In this context, has the offer of health care services in the minority language followed the demographic evolution of the official-language minority population between 2001 and 2011?

Comparing offer and demand

Between 2001 and 2011, the minority francophone population declined in a number of regions in Canada, specifically in the Atlantic provinces (except for southeastern New Brunswick), northeastern Ontario, Manitoba and Saskatchewan. Assuming that health services were offered in the minority language according to demand^{Note 14} during the period, the number of health care professionals able to conduct a conversation in French in these regions should have decreased or at least increased more slowly than in regions with demographic growth.^{Note 15}

Conversely, there should be a greater increase in the number of professionals able to conduct a conversation in French in regions where the minority francophone population grew—southeastern New Brunswick, Ontario (except northeastern Ontario), Alberta and British Columbia. Likewise in Quebec, where there was virtually no growth in the Anglophone population in eastern Quebec, Estrie and southern Quebec, while there was very strong growth in Québec and its surrounding areas, western Quebec and the rest of Quebec.

However, the data presented so far show that the number of professionals who reported having the ability to conduct a conversation in the minority language increased throughout Canada between 2001 and 2011. Therefore, observing simple changes in the number of professionals able to conduct a conversation in the minority language does not make it possible to verify whether the services were offered according to demand from a provincial or regional perspective. Is the number of health care professionals in a given province or region increasing more quickly or more slowly than observed elsewhere? Demographic growth is clearly not the only factor affecting health care services offered in the minority official language. Other factors such as the number of members of official-language minorities pursuing health occupations or increases in bilingualism among professionals who initially did not know the majority language may also contribute to an increase the health care services that are offered in the minority language. Aside from these language criteria, there has also been a general increase in the health care services offered in Canada: in 2011, there were 35.5 health care professionals per 1,000 residents in Canada as a whole, while the proportion was 29.7 professionals 10 years earlier.^{Note 16}

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Ratio of health care professionals able to conduct a conversation in the minority language per 1,000 population

The ratio of health care professionals per 1,000 population is widely used in studying the offer of health care services. However, the ratio is poorly suited to evaluating the offer of services in the minority language. The first reason is that the numerator and denominator used to calculate the ratio come from two different variables: knowledge of official languages for the numerator and the first official language spoken for the denominator. Therefore, the numerator is not necessarily a subset of the denominator, unlike commonly used ratios.

In this particular situation, the ratio becomes highly sensitive to changes in the denominator. That is, changes in the minority population have a much greater effect on the resulting ratio than changes in the number of professionals. As a result, the number of professionals able to conduct a conversation in the minority language per 1,000 population (of the official-language minority) is usually much higher in places where the minority population is small, and vice versa. For example, in this study, the ratio of health care professionals able to conduct a conversation in the minority language per 1,000 minority-language population in 2011 varies from 38.6 in southeastern Ontario to 1,111.5 in Québec and its surrounding areas. Similarly, this ratio is 135.0 in Alberta and 65.9 in New Brunswick.

As well, if a given geography is compared at two points in time (e.g., in 2001 and 2011), the ratio will likely vary much more if there are significant changes in the minority population, while the measure is much less sensitive to changes in the number of health care professionals. For these reasons, the ratio of health care professionals per 1,000 population, while highly effective in other cases, is poorly suited to studying the offer of services for official-language minority populations. It is not useful to adequately evaluate access to minority-language health care for the populations in question.

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To properly evaluate the balance between offering and the demand for health care services, the effect of demographic growth must be separated from other factors.^{Note 17} The number of professionals able to conduct a conversation in the minority language that would be expected^{Note 18} for each geography of interest as a result of demographic change, if the effect of all other factors remain the same across geographies,^{Note 19} can then be compared with the actual number observed in 2011.

Francophones outside Quebec

For Francophones outside Quebec, health care services were not offered in French according to demand. In general, in regions where the minority population has declined, the number of health care professionals able to conduct a conversation in French has increased more than expected, while the opposite has occurred in regions with strong demographic growth. There are, however, a few exceptions.

Atlantic

In Newfoundland and Labrador, Prince Edward Island and Nova Scotia, the official-language minority population decreased 9.5% between 2001 and 2011. Under these circumstances, the number of health care professionals able to conduct a conversation in French could still be expected to increase slightly.^{Note 20} Yet, in 2011, there were 5,830 professionals able to conduct a conversation in French in Newfoundland and Labrador, Prince Edward Island and Nova Scotia, an increase greater than the changing demographics of the minority population could have hoped for. When the data are broken down into groups of professionals, the same can be seen in most categories, except for nurse aides able to conduct a conversation in French, who are less numerous than expected.

Similarly in New Brunswick, despite a 1.2% decline in the francophone population between 2001 and 2011, the number of professionals able to conduct a conversation in French in 2011 was considerably higher than expected.

More specifically, in southeastern New Brunswick, the number of professionals able to conduct a conversation in French increased sharply (60.3%) in a context of generalized growth in the minority population (9.1%). The increase in the number of the professionals potentially able to provide services in the minority language in 2011 was greater than expected (by 890). Similarly, a number of professionals able to conduct a conversation in French that was higher than expected as a result of demographic change was observed in northern New Brunswick (by 505).

The number of observed professionals was higher than expected in other occupational groups. However, there was a shortfall in some occupations. That was the case for paramedics—in the province, 435 professionals who could potentially provide services in French were expected in 2011, while only 305 professionals were counted.

In the Atlantic provinces, therefore, the increases in the number of health care professionals who could conduct a conversation in French were greater than expected. However, that was not necessarily the case for every group of professionals observed.

Ontario

In Ontario, in all regions with demographic growth, the number of professionals able to conduct a conversation in French was lower than expected.^{Note 21} The differences were especially substantial in Ottawa and Toronto. In each of the two cities, more than 1,400 fewer professionals able to conduct a conversation in French were observed than expected in 2011. The differences were substantial mostly for nurses, physicians and social workers. Fewer professionals were also able to conduct a conversation in French in southeastern Ontario, although to a lesser extent (240 in the region).

The minority population declined in only one Ontario region between 2001 and 2011—northeastern Ontario. The number of professionals able to conduct a conversation in French in that region was higher than expected (by 550). There were fewer nurses than expected who could conduct a conversation in French and more nurse aides who could do so.

Therefore, in Ontario there were fewer professionals able to conduct a conversation in French in 2011 than expected as a result of demographic growth in the minority population, and an average change in factors unrelated to demographic evolution for Canada outside Quebec.

Western Canada

Two cases in the Prairies were observed. First, in the provinces of Manitoba and Saskatchewan, there was a decline in the francophone population combined with an increase in the number of professionals who reported having the ability to conduct a conversation in French between 2001 and 2011. The increase was greater than expected—6,785 professionals were able to conduct a conversation in French in 2011, although 6,630 professionals were expected to be able to do so, given demographic changes in the official language minority group.^{Note 22}

Conversely, there was strong demographic growth in the francophone population of Alberta (21.3%) between 2001 and 2011. Despite an increase of nearly 34% in the number of professionals able to conduct a conversation in French, there was a shortfall of nearly 1,000 professionals compared with the 10,590 expected in 2011.^{Note 23} There were shortfalls of nurse aides (155), physicians (255) and other health care professionals (895). On the other hand, 435 more nurses than expected were able to conduct a conversation in French.

Finally, in British Columbia, the number of health care professionals able to conduct a conversation in French was virtually equal to the number expected as a result of demographic change. Thus, with a 4.7% increase in the francophone population between 2001 and 2011, British Columbia was the only province in which the change health care services offered in the minority language equalled the change in demand.

Despite this parity, the number of professionals able to conduct a conversation in French was lower in three groups of professionals—nurse aides, social workers and licensed practical nurses. Conversely, the number of nurses and other health care professionals able to provide health care services in French was higher than expected.

In short, for Francophones outside Quebec, demographic changes in the minority francophone population did not make it possible to predict changes in the number of health care professionals able to conduct a conversation in French. That means that, within the limits of the proposed analysis, changes in health care services offered in French observed between 2001 and 2011 did not follow changes in demand, that is to say that they were more important, or in some cases, less important.

Anglophones in Quebec

A similar analysis can be conducted on a provincial level for the Anglophone minority in Quebec to evaluate the extent to which health care services offered in English followed demand. The minority language population grew in most Quebec regions between 2001 and 2011, with increases in the Anglophone population as great as 53% in the city of Laval. The minority population did not decline in any Quebec region but, in some cases (eastern Quebec and Estrie and southern Quebec), there was very little, if any, growth in the Anglophone population. The number of professionals able to conduct a conversation in English increased in every region, but the increases were smaller in Montréal (metropolitan area and island), Laval and eastern Quebec. In those regions, there were sizeable shortfalls of professionals able to provide health care services in English—as many as 1,640 in the Montréal region.^{Note 24}

Montréal and Laval are two Quebec regions where the Anglophone population is larger and the growth in this population from 2001 to 2011 was stronger. In Laval, there was a higher number of health care professionals able to conduct a conversation in English—lower than might have been expected^{Note 25}—and in most professional groups.^{Note 26} The situation is similar on Montréal Island. However, many groups had more professionals than expected (nurses, physicians, psychologists and licensed practical nurses). In eastern Quebec, the number of nurses and other professionals able to conduct a conversation in English was lower than expected. In the other groups of professionals, the difference between the expected and actual numbers was too small to come to a conclusion.

Conversely, western Quebec, Estrie and southern Quebec, and Québec and its surrounding areas present a different portrait—the number of professionals able to conduct a conversation in English increased more rapidly than expected as a result of demographic change in the minority group. The number of professionals able to conduct a conversation in English was 265 more than expected in western Quebec; 1,460 more in Estrie and southern Quebec; and 375 more in Québec and its surrounding areas. In that regard, for most groups of professionals, the number able to provide health care services in English was either higher than expected or the differences were too small to establish whether there was a surplus or lack of services. The number of professionals was only lower than expected for nurses, physicians and licensed practical nurses in Québec and its surrounding areas.

In short, as was observed for Francophones outside Quebec, the conclusion could not be reached that increases in the health care services offered in the minority language were consistent with demographic changes in the English-speaking population of the province of Quebec.

Conclusion

This study was conducted as part of Health Canada’s Official Languages Health Contribution Program (OLHCP). As the objective of this program is to improve access to minority-language health care services in communities, Health Canada wanted, through this study, to determine the status of human resources in the health care field responsible for providing or able to provide health care services in the minority language.

The purpose of this portrait of professionals who provide or are able to provide services to the minority-language population is to identify official-language minority professionals, those who used the minority language at work and those who knew that language, and to look at the balance or imbalance between offering minority-language health care services and the demand for those services.

Part 1 of this report paints a portrait of health care professionals in 2011 and examines the change in their numbers between 2001 and 2011. First, a general increase in the number of professionals can be seen during that period. Similarly, there was a widespread increase in the total number of official-language minority professionals who reported having the ability to conduct a conversation in the minority language, as well as those who used that language at least regularly at work.

In Part 2 of this report, it can be seen that offering health care services in the minority language has generally not followed the demographic evolution of the minority population. Except for some cases,^{Note 27} there were increases in the health care services offered in almost all of the observed geographies. However, the purpose was to estimate to what extent an observed increase at the provincial or regional level was faster or slower than elsewhere. As well, in a number of the regions, there is a lack of professionals who can provide health care services in the minority language, while in other regions there are more professionals than expected. British Columbia is the only place where the number of professionals who are able to provide services in French has followed the demographic evolution of the minority population.

Therefore, changes in the number of professionals able to provide services in the minority language are not exclusively the result of demographic changes in the official-language minority population—either among Anglophones in Quebec or among Francophones in the rest of Canada. Other explanatory factors such as, attracting and retaining international, interprovincial and intraprovincial migrants; offering and promoting language training in the second official language; and promoting health care services in the minority language. These definitely affect the total number of health care professionals, as do official-language minority health care professionals, those able to conduct a conversation in the minority language, and those who use the language at least regularly at work.

Note, however, that there is no acknowledged and agreed upon statistical definition of “offer” of and “demand” for health care services in the minority language. In the context of this paper, the offer is basically defined as the count of professionals who have the desired language characteristics. This leads to the distinction between the potential for offering health care services in the minority language (or “maximum estimate of the offer,” obtained using the indicator of the knowledge of the minority official language) and the actual offer (or “minimum estimate of the offer,” obtained using the indicator of minority language use at work). The definitions selected nonetheless have numerous limitations. Aside from linguistic considerations, the number of professionals is not the only indicator for health care services offered in the minority language, and this indicator alone does not necessarily reveal all the nuances that should be highlighted.

A sharp increase in the number of health care professionals in Canada is the result of the combination of three main factors—a population increase that leads to an increase in the number of professionals, but not necessarily in the ratio of professionals available per resident; an increase in part-time work, which also leads to an increase in the number of professionals, but not necessarily the number of medical procedures performed; and investments in health care.^{Note 28} However, these factors may have different effects on the health care services that are offered in the minority language—the minority-language services offered may increase as a result of the growth in professionals, even though the minority population may be declining; part-time work may foster an offer of bilingual health care services; and federal government investments may target minorities. In short, the number of health care professionals is an imperfect indicator, but it nevertheless provides relevant information to the extent that minority-language services offered still depend on the ability of professionals to serve clients in the official-language minority.

Another considerable limitation involves geography: the presence of professionals at the provincial or regional level is not necessarily a reflection of sufficient services offered locally. Although the portrait presented here seems to suggest that the number of health care professionals able to provide services in the minority language is adequate in some regions, the reality is more complex. For health care services to be truly available to the official-language minority population, a number of factors must coexist—the availability of professionals, as examined in this report, is but one of those factors. Other factors regularly identified in minority-language health care services include the organization of services; service plans tailored to each community; promotion of second-language use among professionals; professional recognition of bilingualism; promotion of services provided; visibility of available services; and the provincial or territorial legal or regulatory framework governing the services offered in the minority language.^{Note 29}

The balance between the minority-language health care services offered and the demand for them depends on a number of factors that cannot be measured directly using census data. Although the census is an abundant source of information on occupations, practices and language knowledge, the respondents’ answers say little about the minority-language services that are actually offered or the actual demand for them. Only a detailed analysis of linguistic interactions among health care professionals and clients can provide information on the true offer of and demand for services in the minority language. That kind of analysis cannot be performed without data dedicated to this topic obtained through a targeted survey.^{Note 30}

Finally, despite the inherent limitations of using census data, which cannot provide specific information on the services provided in the minority official language or on the actual demand for services in that language, this report is a source of information for renewing Health Canada’s Official Languages Health Contribution Program in 2018 as part of the federal government’s official languages strategy. In addition to targeting specific occupations for increasing bilingual staff, this analysis allows for the identification of needs that may be addressed via other strategies, including the use of specialized interpreters in the health care field or telecare in areas where official language communities are remote or dispersed.

Appendices

Appendix A.1: Sub-provincial regions

Appendix A.2: Groups of health care professionals

Appendix A.3: Methodological notes

Appendix A.3: Note on National Household Survey (NHS) data

Appendix A.4: Methodology used to calculate the expected number of professionals in 2011

Appendix B: Data tables