Section 4: Accessibility and use of health care in the minority language

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Section 4.1 Use of health care services
Section 4.2 Language in which services were received
Section 4.2.1 Main language
Section 4.3 Importance assigned to getting health care services in the minority language
Section 4.4 Level of difficulty of getting health care services in the minority language
Section 4.5 Reasons given for why it would be difficult to get health care services in the minority language
Notes

Access to quality health care is a major concern for the Canadian population as a whole. It is no less so for official language minorities. Because of the relative vulnerability experienced by people in need of health care, the ability to understand and be understood by health care professionals is especially important. Moreover, good mutual understanding fosters an effective relationship between health care professionals and the user of services.

The description of the medical history and symptoms, the diagnosis and effective treatment are all dependent on good communication between the professional and the patient. And quite apart from its utilitarian value, access to health care services in the language of one's choice plays an instrumental role in the vitality of the community by providing places where members of the community can express themselves in their language. The institutionalization of health care services in the minority language contributes to the ability to live and flourish in a minority situation.

This section will firstly present findings on levels of use of the main health care services. Secondly, it will present information on the language in which health care services were received. The third part will focus on the importance assigned to obtaining health care services in the minority language, while the fourth part will examine the perceived difficulty of obtaining health care services in the minority language.

Section 4.1 Use of health care services

In the survey, respondents were asked about their use of four health care services: a regular medical doctor, a nurse, a telephone health line and any "other" place they usually go when sick or seeking advice on health matters. Basically, the latter category refers to a clinic, either walk-in or by appointment (45% of responses obtained), a hospital (36%), or a health unit or centre, such as a local community health centre (13%).

According to the survey data, a very large proportion of adults in official language minorities use the services of a regular medical doctor. In fact, 81% of adults reported that they have a regular medical doctor, and of these, 84% consulted him/her in the twelve months preceding the survey. Apart from the regular medical doctor, the other usual place (clinic, hospital or health unit or centre) is the second place or service most often gone to (nearly 70% of adults), followed by the services of a nurse (approximately 30% of adults) and lastly, the telephone health line, reported by 20% of adults. These results were observed among both English-speaking adults in Quebec and French-speaking adults outside Quebec. Moreover, both in Quebec and outside that province, very little regional or provincial variation in this regard is observed.

Section 4.2 Language in which services were received

In light of the information presented on the degree of use of various health care services by adults, it is now important to examine the extent to which the minority official language is used in contacts with the main health care professionals. On this subject, the survey questionnaire includes questions on the language in which adults were served for each of the above-mentioned four services.

In Quebec, the survey results show that 72% of English-speaking adults reported using only the minority language in their visits to their regular medical doctor. Among the 30% of adults who reported using the services of a nurse, English predominated in 52% of cases. Lastly, for the 70% of English-speaking adults who went to another place to receive health care services, English was the predominant language used in communicating with health care professionals in nearly 51% of cases.

Outside Quebec, a small gap is observed between the level of use of the minority language during visits to the regular medical doctor and visits to other health care professionals; 35% of French-speaking adults reported using mostly French with their regular medical doctor, compared to 36% with a nurse and 33% in contacts with health care professionals in other places where they went to obtain care.

Also, outside Quebec, it was only in New Brunswick that French was used more than English. Indeed, 77% of the French-speaking adults in that province reported using mainly French with their regular medical doctor. The proportion rose to 79% for going to a place other than the office of the regular medical doctor to receive health care.

In Ontario, the corresponding proportions are 31% and 20% respectively. Excluding Manitoba (14%) and Nova Scotia (16%), very few adults reported using French with the regular medical doctor.

It is worth noting that in New Brunswick, 90% of French-speaking adults residing in the North of the province reported using mainly French with their regular medical doctor, compared to 80% in the Southeast region and 26% in the rest of the province. In Ontario, seven in ten adults living in the Southeast of the province reported using mainly French with their regular medical doctor. In Ottawa and the Northeast of the province, the corresponding proportions were 45% and 35% respectively. In the Rest of the province, the use of French was very low.

Section 4.2.1 Main language

Considering that a large proportion (39%) of French-speaking adults outside Quebec reported that their main language, that is the language in which they are most at ease, was English, it is important, when analysing the results on the languages used when obtaining health care services, to take the respondent's main language into account. A major distinction must be made between those for whom French is the main language and who do not use that language in getting health care services and those who do not use that language because it is not the one in which they are most at ease.

An examination of the results for all adults living outside New Brunswick reveals that 47% of those for who french is the main language report using only that language with their regular medical doctor, compared to only 5% of those whose main language is English. In New Brunswick, these proportions reach 87% and 26% respectively compared to 54% and 7% in Ontario.

As noted earlier, outside New Brunswick, only 38% of French-speaking adults have French as their main language, compared to 46% who say that English is the language in which they are most at ease and 16% who report being as much at ease in English as in French. In New Brunswick, 81% of French-speaking adults report having French as their main language, while 8% report that they are equally at ease in that language and in English. In Ontario, the corresponding proportions are respectively 44% and 15%.

In Quebec, considering that 81% of English-speaking adults report having English as their main language and 7% report being as much at ease in English as in French, the matter of main language is of little consequence in the overall results.

Section 4.3 Importance assigned to getting health care services in the minority language

The survey contributes a major dimension to the study of health care services in the minority language by asking questions involving subjective perception and assessment, notably on the importance assigned to getting services in the minority language and the difficulty of getting health care services in that language.

The subjective aspect is important and may play a key role in determining language behaviours. In addition, these factors can shed light on some of the issues surrounding the predominance of the majority language in the use of health care services. In fact, the importance assigned to getting these services in the minority language and the extent to which members of official language minorities feel comfortable asking to be served in that language are two factors that deepen our understanding of needs relating to health care services in the minority language.

In Quebec, among adults who were asked the question¹, nearly 75% of the English-speaking population considered it "very important" or "important" to get health care services in English. Among French-speaking adults outside Quebec, the corresponding proportion was 53%.

Outside Quebec, the importance assigned to getting health care services in the minority language can be expected to vary depending on the province of residence. And indeed, New Brunswick stands out with 80% of French-speaking adults reporting that it is "very important" or "important" for them to receive health care services in the minority language. In the other provinces, the proportions range between 23% in Saskatchewan and 54% in Ontario.

Chart 4.1
Proportion of adults belonging to the official-language minority who know both English and French by the importance of getting health care services in the minority language, Quebec and Canada less Quebec, 2006

Note: Please refer to Appendix E to obtain quality indicators (coefficient of variation (CV) for the estimates used to produce this graph).
Source: Statistics Canada, Survey on the Vitality of Official-Language Minorities, 2006.

Chart 4.2
Proportion of French-speaking adults who know both English and French by the importance of getting health care services in the minority language, provinces and Canada less Quebec, 2006

Note: Please refer to Appendix E to obtain quality indicators (coefficient of variation (CV) for the estimates used to produce this graph).
Source: Statistics Canada, Survey on the Vitality of Official-Language Minorities, 2006.

With the exception of Québec and surrounding area, little variation is observed between the main regions of Quebec inhabited by English-speaking adults as to the importance assigned to getting health care services in English.

In New Brunswick, 88% of adults who live in the North of the province consider it very important or important to get health care services in French. In the Southeast and in the rest of the province, the corresponding proportions are 78% and 63% respectively. In Ontario, the proportions of adults who consider it very important or important to get such services are 76% in the Southeast of the province, 65% in Ottawa and 58% in the Northeast of the province. Elsewhere in Ontario, four adults in ten feel this way.

It can be assumed that the importance that official language minorities assign to getting health care services in the minority language varies directly with the proportion that they represent within municipalities (or census subdivisions). For example, the survey data show that outside Quebec, 35% of French-speaking adults who live in municipalities where their relative weight is below 10% assign importance (i.e., "important" or "very important") to receiving health care services in French, compared to 59% of those living in municipalities where their relative weight is between 10% and 30%. Of those living in municipalities where the proportion that they represent is equal or greater than 70%, 87% assign importance to getting such services in French. Nearly 45% of French-speaking adults outside Quebec live in municipalities where they account for less than 10% of the population. Conversely, 18% of French-speaking adults live in municipalities where they constitute 70% or more of the population.

In Quebec, with the exception of those living in municipalities where their relative weight is less than 10%, the proportion of English-speaking adults who say that they assign importance to getting services in English varies less according to the relative weight of their population. Overall, that proportion ranges between 75% and 85%. Among English-speaking adults who account for less than 10% of the population of their municipality, nearly 60% state that they assign importance to getting services in English.

Chart 4.3
Proportion of adults belonging to the official-language minority who know both English and French by the importance assigned to getting health care services in the minority language, according to the proportion of minority language speaking adults in their municipality, Quebec and Canada less Quebec, 2006

Note: Please refer to Appendix E to obtain quality indicators (coefficient of variation (CV) for the estimates used to produce this graph).
Source: Statistics Canada, Survey on the Vitality of Official-Language Minorities, 2006.

However, in light of the survey results showing that 39% of French-speaking adults outside Quebec have English as their main language, the differences observed between the opinions of members of Quebec's English-speaking minority and the French-speaking minority outside Quebec are much smaller when their main language is taken into account. Outside Quebec, 80% of adults whose main language is French assign importance to getting health care services in French. In Quebec, by comparison, 87% of adults whose main language is English assign importance to getting services in English.

Outside Quebec, only one-quarter of those French-speaking adults whose main language is English (who represent 39% of the total) assign importance to getting such services in French². Among those who reported being equally at ease in both languages, the corresponding proportion is 44%.

Section 4.4 Level of difficulty of getting health care services in the minority language

Apart from the importance assigned to getting health care services in the minority language, the Survey on the Vitality of Official-Language Minorities (SVOLM) also measures perceptions regarding how difficult it is to get such services. In general, roughly half of adults reported that it would be "easy" or "very easy" for them to get health care services in the minority language (50% for English-speaking adults in Quebec and 47% for French-speaking adults outside Quebec). These results may seem surprising, considering the predominance of English in the use of health care services, as shown in a previous section. Also, this proportion might be expected to be higher in Quebec, where English is used more often than French in the vast majority of the services used.

However, outside Quebec, the results obtained are strongly influenced by the responses of New Brunswick adults. Outside that province, the proportion of French-speaking adults who stated that it would be "easy" or "very easy" for them to get health care services in French was 34%. The provinces east of New Brunswick and those west of Manitoba, where the proportions of adults served in French are the lowest, have the largest proportions of adults who state that it would be "very difficult" or "difficult" for them to get services in the minority language.

In Quebec, except for Québec and surrounding area (20%) and the rest of the province (31%), there is little variation in this regard between regions; the proportions are in the range of 50%.

It is not surprising to observe just as was seen regarding the importance assigned to getting health care services in the minority language that the demographic weight of language minorities within municipalities affects the propensity to report that it is difficult or very difficult to get health care services for oneself in that language.

Thus, in municipalities where French-speaking adults constitute less than 10% of the population, 66% of them stated that it would be difficult or very difficult for them to get services in French, compared to 32% where they constitute between 10% and 30% of the population, and only 8% in municipalities where their relative weight is 70% or more of the population.

In Quebec, a similar relationship is observed between these two factors. In municipalities where English-speaking adults comprise less than 10% of the population, 47% of them state that it would be difficult for them to get services in English, compared to 22% and 14% where they comprise between 30% and 50% and 70% or more, respectively.

In light of the information presented in this section, the results need to be given a nuanced interpretation. When respondents state that it would be easy to get health care services in the official minority language, this does not mean that they assign importance to getting services for themselves in that language. This may be true for all sorts of reasons, one of them being that the respondent considers him or herself to be bilingual. In fact, the survey results show that among French-speaking adults outside Quebec, survey results reveal that 36% of those whose main language is English feel that it would be easy or very easy for them to get health care services in the minority language.

A similar result is observed for the French-speaking adults who consider that both French and English are their main languages. These results also suggest that perceptions may not correspond to reality in that a person may believe that services in French are accessible but not have the intention or the opportunity to verify whether such a perception is valid.

Chart 4.4
Proportion of French-speaking adults according to perceived level of difficulty of getting health care services in the minority language, provinces and Canada less Quebec, 2006

Note: Please refer to Appendix E to obtain quality indicators (coefficient of variation (CV) for the estimates used to produce this graph).
Source: Statistics Canada, Survey on the Vitality of Official-Language Minorities, 2006.

Section 4.5 Reasons given for why it would be difficult to get health care services in the minority language

The majority of respondents who said that it would be "difficult" or "very difficult" for them to get health care services in the minority language cited the scarcity of French-speaking or English-speaking professionals as a reason why it would be difficult for them to get such services. On this score, the proportions are 74% in Quebec and 88% outside Quebec. The second reason given is a "communication problem," at 26% in Quebec and 11% outside Quebec. The latter reason also suggests a language problem between the professional and the respondent. Adults have a strong impression of a scarcity of French-speaking professionals outside Quebec or English-speaking professionals in Quebec.

This perception was observed in all provinces outside Quebec. More than 65% of adults in each province mention the scarcity of Francophone professionals as the reason for the difficulties they had in getting health care services in French. The second most often-cited reason is also a "communication problem."

Similarly, in all regions of Quebec, a scarcity of English-speaking professionals appears to be the main reason why it would be difficult to get services in English. The proportions range from 70% in the West of the province to 82% in Eastern Quebec.

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Notes

1. The question was asked only to adults who could conduct a conversation in both English and French. It is assumed that those who can conduct a conversation in only one of the two official languages will assign importance to receiving services in that language.
2. This result can possibly be due to the fact that some adults might assign some importance to getting health services in the minority language even if they do not use it themselves in their daily life.