Section 4: Conclusion
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The purpose of this overview of the characteristics and language use of certain groups of health care professionals who serve or might serve official-language minority communities (OLMC) is, on the one hand, to compare the proportional distribution of these professionals to those of minority populations and, on the other hand, to determine how many of these health care professionals use the minority language at work or know that language.
This study was conducted in the context of the Government of Canada's Roadmap for Canada 's Linguistic Duality 2008-2013 1 and Health Canada's Official Languages Health Contribution Program. 2
Since the goal of this program is to improve access to health services in the minority official language for OLMCs, Health Canada wanted to ascertain through a statistical study what the human resource situation is in providing or capable of providing health services in the language of the minority.
Although many of the statistics presented in this study may at first sight seem to indicate that in certain regions the number of minority official language or bilingual health care professionals able to provide services in this language is sufficient or adequate, the reality is much more complex and more studies will be necessary to better understand the situation in Canada as a whole and in the specific regions where OLMCs are found.
In order for services to actually be available and effective, several factors must exist to create the conditions necessary to actively provide those services, one of which is the availability of health care professionals. Among the other factors most often mentioned in relation to minority language health services are: organization of services, service plans adapted to each community, the value placed on the use of the minority official language by professionals, professional recognition of bilingualism, promotion of the services offered, the visibility of the available services, and the legal or regulatory framework at the provincial or territorial level governing the provision of minority language services.
The demographic situation of OLMCs varies from one region of the country to another. Apart from their demographic characteristics, disparities among communities are also observed in health determinants. For example, income levels and social status, social support networks, education and literacy, to name only a few, are all determinants that vary among communities.
This report first presented results from the 2006 Census and then compared those results with those from the 2001 Census. Overall, these results reveal significant differences among the provinces as well as among regions in Ontario, Quebec and New Brunswick.
In Quebec, the use of English at least on a regular basis by health care professionals is widespread. Thus, while the official-language minority population constitutes 13.4% of the province's total population, over 50% of doctors say that they use English at least regularly in their work. However, among nurses, social workers, psychologists and other health care professionals, those proportions are between 30% and 35%. Moreover, health care professionals practicing in Quebec have a very high level of knowledge of English. Of course, such results do not necessarily mean that all of Quebec's Anglophones obtain services or can get served in English when interacting with health care professionals. However, the data do indicate a strong presence of English in professional medical practice.
Outside Quebec, Ontario and New Brunswick, results in the provinces and territories generally reflect the small numbers and proportions represented by OLMCs there. That being said, we note however that in some provinces, the use of French at least regularly at work is sometimes greater than the relative weight of the French-language population. Moreover, the proportion of health care professionals who state that they can hold a conversation in French is much higher than the proportion of those who use it at work.
The case of Ontario is noteworthy in this regard. For example, 23% of the province's doctors can converse in French, but 7% use it at least regularly at work. When we look at the situation and compare the proportion of the first official language spoken by doctors to that of the population, we note that in Northeastern Ontario, for example, Francophones represent 25% of the population while 7% of doctors have French as their first official language. In the Southeastern part of that province, those proportions are 41% and 32% respectively.
As we pointed out in the first pages of this report, access to health services in the minority official language as well as the supply of such services by health care professionals depend on several factors and cannot be measured directly using Census data. Factors such as the proximity of minority service users and providers, the active offering of those services and the degree to which users ask for them greatly influence the language orientation of professional/user interactions.
Moreover, as Carter 3 points out, a distinction must be made between services in the minority language provided on a voluntary basis and acquired rights to access such services. When there are legal obligations ensuring access to services, as is the case in Quebec, New Brunswick and certain regions in Ontario, challenges with facilitating access to those services are very different from situations where such obligations do not exist.
Finally, since a large proportion of the French-speaking population outside Quebec (39%) state that they feel more at ease in English than in French, as is shown by SVOLM data (2006), conclusions drawn from comparing the relative weights of French-language populations and the use of this language at work by health care professionals must take such information into account. For example, in 2006, 45% of the French-language population outside Quebec lived in municipalities where they represented less than 10% of the population. Of these, 59% said they were more at ease in English than in French.
The Census is a valuable source of information on professions, language knowledge and use at very detailed geographic levels. However, respondents' statements regarding minority language use at work say nothing about either the demand for or supply of services in this language. Only a detailed analysis of linguistic interactions between health care professionals and patients that take the context of these interactions into account can tell us about the actual supply of and demand for services in the minority language. In this regard, the Survey on the Vitality of Official-Language Minorities (SVOLM) contains useful information on the language respondents use when they meet with health care professionals. For example, in Quebec, 72% of English-speaking adults say that they use only the minority language when visiting their family doctor (52% with a nurse). In Ontario, the proportion of French-speaking adults who use mainly or only French with their family doctor is 31% while in Manitoba it is only 14%.
This report provides a first general analysis of the characteristics and language use of health care professionals in relation to their relative share of the official-language minority populations in the provinces and regions. Thus, a number of possible areas of exploration might be looked at. This study is a guidepost to a better understanding of obstacles in accessing health services in minority official languages in Canada. It raises part of the veil covering this very complex situation and thus paves the way to other avenues of research useful to the development of public policy. Given the differential results observed from one region to another, one possible area of study would be to show how the relative weight of minority official language speakers and their concentration in certain municipalities or neighbourhoods are related to different language use. It might be useful, for example, to combine SVOLM data with the statistics presented in this study by examining, on the one hand, issues related to the demand for health care services and the actual use of the minority language in interactions with health care professionals and, on the other hand, the numbers, characteristics and language use of these professionals within OLMCs.
Another possible area of study would be to examine the relationship between living in an urban versus a rural area and receiving or not receiving services in the minority language. Many health services are mainly provided in urban areas while people living in rural areas or far from urban centers no doubt have more difficulty accessing health care professionals who use the minority official language.
Future studies might also focus on the characteristics of specific groups of health care professionals that were not studied in this report. Provided the sample size is sufficient, it would be useful to present the trends and the geographic distribution of these professionals and information on their ability to speak the minority official language.
This report is intended as a first step in exploring pools of health care professionals capable of providing services in one or the other minority official language in Canada. Despite the severe limitations of the Census when analyzing small populations or small geographic units, Census data, in conjunction with other data sources, is a very useful source of information and provides a good reference base for orienting future work aimed at furthering the study of access to health care in the minority official language.
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