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Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology

Issue 51 - Evidence

OTTAWA, Thursday April 25, 2002

The Standing Senate Committee on Social Affairs, Science and Technology met today at 11:00 a.m. in order to examine the document entitled ``Santé en français — Pour un meilleur accès à des services de santé en français.''

Senator Yves Morin (Acting Chairman) in the Chair.


The Acting Chairman: As you know, during the next few meetings, I will represent Senator Kirby, who is chairman of the Standing Senate Committee on Social Affairs, Science and Technology. The aim of this meeting is to examine a report following a motion that was sponsored in the Senate by Senator Gauthier. Senator Gauthier does not have access to the discussion at this time, but he will soon be able to participate thanks to the help of a stenographer.

I would like to welcome Mr. Marcel Nouvet, Assistant Deputy Minister, Information Analysis and Connectivity Branch.

How long have you held that position, Mr. Nouvet?

Mr. Marcel Nouvet, Assistant Deputy Minister, Information Analysis and Connectivity Branch: For about two months, Mr. Chairman.

The Acting Chairman: I would also like to welcome Mr. Michel Léger, Executive Director, Official Languages Communities Support Office. Mr. Léger works for the branch of which Mr. Nouvet is Assistant Deputy Minister. You intend to read the document that you have submitted?

Mr. Nouvet: Yes, of course, and I will take about 10 minutes for my presentation.

We are very pleased to have the opportunity to appear before you to give you an outline of the reports that deal with this sector. Michel Léger is here with me today. I would also like to tell you that behind me are two of our valuable colleagues, namely Jacques Cloutier and Louise Bouchard, from Health Canada.

The language of a population is an essential element in improving health conditions and adapting these conditions to one's needs. In Canada, one million francophones live as a minority outside Quebec. Access to health services in French is essential for their well-being and Health Canada remains determined to improve the health of these populations and promote their growth, as stipulated in the Official Languages Act.

That is why Health Canada has created and funded the Consultative Committee for French-Speaking Minority Communities. The study entitled ``Santé en français — Pour un meilleur accès à des services de santé en français'' allows us to better identify what must be done to meet that objective.

Page 2 of the document sets the tone for the presentation. I will be dealing both with the context of this study called ``Health in French,'' its mandate, its scope, the messages it seeks to convey as well as proposed solutions. Since this study was undertaken within the framework of the Consultative Committee for French-Speaking Minorities, I will also refer to the relationship between this study and the final report of the Health Advisory Committee. I would also like to mention what actions and investments our department has undertaken in this file, while explaining the limitations and other considerations.

The study ``Santé en français — Pour un meilleur accès à des services de santé en français'' is the result of a close partnership between the Consultative Committee for French-Speaking Minority Communities, the Fédération des communautés francophones et acadienne du Canada and our department, Health Canada.

The Consultative Committee for French-Speaking Minority Communities was created in the spring of 2000 by Minister Alain Rock with a view to helping him develop Health Canada policies and programs that would foster the growth of francophone communities outside Quebec. I have the privilege of being co-chair of the committee along with Mr. Hubert Gauthier, President and CEO of the St-Boniface General Hospital in Manitoba.

The committee played a pivotal role in preparing this study, whose aim was to provide a better understanding of the issue. The committee requested that this be done so as to lay the ground work for its report, which was submitted to the minister in November.

Page 5 of our handout summarizes the role played by Health Canada. I might point out that Health Canada supplies the secretariat services in cooperation with the Fédération des communautés francophones et acadienne du Canada.

Page 6 deals with the role of the Fédération des communautés francophones et acadienne. They were responsible for coordinating, publishing, distributing and promoting the report. The Federation was particularly active in promoting this study to various francophone groups, the provincial department as well as your Senate committee. That might be one of the reasons why I find myself here today.

Page 7 deals with the mandate of the study. Since, from the very outset, the consultative committee wanted a good grasp of the situation, the research team was given the mandate to first of all, describe the situation in demographic terms, taking into account the health of the francophone communities outside Quebec as well as access to health services. Secondly, they were to identify the means of action that might increase access to services for francophone minorities. They would then recommend possible solutions to the consultative committee.

I will deal with each of these elements a little later. This ambitious study was not done without limitations. First of all, there were the time constraints. We had three months to complete the study because the committee wanted to prepare its recommendations for a possible spring 2002 federal budget.

Then, we had some difficulty in finding data relating to our target population, which meant that our study was based on qualitative data taken from a review of the literature and two questionnaires aimed at identifying the perceptions that people had with respect to access to services and possible solutions. It is not a scientific study, but we feel that it is quite credible.

On page 9 you see the main messages taken from this study. There are eight of them. First of all, there was a lack of information on these communities. With respect to health, there is no reliable information that is common to all minority francophone and Acadian populations.

Secondly, the access problems were quite apparent since the study reveals that between 50 and 55 per cent of francophones have no or rarely any access to health services in French and the level of acceptability is three to seven times lower among Acadian and francophone communities than within the anglophone population. There are wide variances between the provinces and the regions. The situation, therefore, is not the same in each province and within those provinces. There are differences at the regional level. It is important to note this when we consider what type of solution we want to implement.

On page 10, in general, the population within the francophone and Acadian communities is older than that of non- francophone communities and this trend seems to increase in regions where francophones are in a greater minority when compared to the majority population. Secondly, there are certain health determinants that are less favourable for these populations. They have less education, even if progress has been made over the past years, and they are less present in the labour force.

Thirdly, demographic data has confirmed that francophone communities outside Quebec are dispersed throughout the country and it is therefore difficult for these communities to organize to have their concerns heard — and to understand them themselves — in order to voice their expectations for the health care system.

Even more important is the fact that access to health care services in French goes far beyond simply respecting the culture of the user. Language is important for effective care. This is essential to the improvement of an individual's health. The language barrier lessens one's use of preventive services, increases the time required for consultation and adds to the probability of errors in diagnosis and treatment; it affects the quality of services where proper communication is essential, for example, in social services or physiotherapy. The language barrier lessens one's satisfaction and the confidence one has in the care and services that are given.

On page 11, we summarize the avenues for solutions that were identified in the first study. The authors of this study, Messrs Morin and Daniel Denis, suggested numerous avenues in the final report of the ``Santé en français'' study. The possible solutions included eight types of intervention, conditions necessary for winning strategies, the general strategy for action as put forward by the authors of the report, and finally, organizational models.

On page 12 of the presentation you see intervention levers with respect to accessibility. In order to promote better access to health services in French, five levers are proposed. First comes the creation of intake facilities, establishments where health professionals would come together. These are service centres where francophones would be served and treated in French.

Next is the development of networks. In view of the relative size and concentration levels of francophone groups throughout the country, we believe that establishing networks to exchange information would be a concrete way to bring these communities closer together and to put an end to their isolation.

Third is the use of technology, since there is a shortage of health professionals who speak French and because the francophone communities are so widely distributed. Information and communications technologies offer a whole host of possibilities such as home health care, virtual access by health professionals to the services in large urban centres, telemedicine and teleradiology.

Fourth, the deployment of training activities. It is true that there is a shortage of health professionals, something that is even more apparent when it comes to health professionals who speak French and who can provide service to francophone communities outside Quebec. According to the study, it is essential that we provide more French trainees who are students and that this be done as close to their own towns or cities as possible so that they might exercise their profession in their own language within their own community. We know that if these people are trained outside their community, it lessens the chance of them returning to practice there.

The fifth level involves information, research and awareness. We must be better informed about the health and needs of minority francophone communities. The lack of specific data makes it difficult to plan and implement a proactive strategy that would lead to an improvement.

In terms of solutions, the report deals with conditions for a winning strategy. It is suggested that regional differences be recognized when providing for real and potential access to health services in French, which vary from region to region. It cannot be one-size-fits-all. That is why it is important to take into account the specific nature of the various communities. It is recommended that both supply and demand be acted on simultaneously, more specifically with respect to support for institutions and government authorities in their efforts to step up the use of French as well as the necessity to encourage citizens to clearly express their needs.

Thirdly, there is a need for concerted effort by the five stakeholder groups, as was recommended, incidentally, by the World Health Organization. These five groups are health professionals, health managers, political decision-makers, teaching establishments and communities. These five partners must work closely together in a unified effort to improve accessibility.

Finally, it is important to involve francophones in the decision-making structure as well as in managing health establishments so that French will be respected and reflected in the services that are delivered. The report also recommends a general action strategy that would reflect the action levers and winning conditions; the study put forward a four-pronged general strategy for the consultative committee. First, ensuring the expression of needs — of course, if francophones outside Quebec do not always express their needs, the government will be less aware of the requirement to serve them in their mother tongue — creating points of convergence, guaranteeing continuity of services in French and developing new models for delivery. These are the solutions that were submitted to the consultative committee.

The study proposes minimal, basic and advanced levels of service for access to health promotion services, primary and community care, general care in institutions, and specialized care in institutions. The minimal service level would usually consist of access to tools such as a directory of professionals, and documentation in French, while the basic service would involve reception and intake, and access to translation services. Advanced service would be professional services offered in French.

I would like to relate the report we have just discussed with the one that was submitted to the federal Minister of Health. The report we presented was called ``L'étude de santé en français'' and it was intended to help the advisory committee to better understand the situation and prepare the solutions that would be submitted to the Minister of Health. The consultative committee was most interested in the suggestions for conditions that would lead to success and the five intervention levers, the latter being used as a basis for the consultative committee's recommendations.

These are the strategies outlined by the consultative committee for Health Canada. The committee suggested an initiative, an integrated five-year plan based on the five action levers which are networking, training, intake facilities, strategic technology and information, and finally, research and raising awareness. The committee more specifically recommends creating 20 provincial and territorial networks that would be coordinated by a national secretariat. The creation and organization of these francophone community networks will bring together partners for planning, development and support for the delivery of health services in French.

Secondly, a network for workforce training in French should be established; this would be done through $15 million in government funding that would provide for training and the creation of a French training network from the very outset.

Third would come an infrastructure and intake facilities that would allow francophones outside Quebec to have access to primary care in their mother tongue.

On page 18 we discuss two other levers, namely technology and strategic information. The committee recommends a gradual implementation of a health infrastructure and finally, the establishment of a chair or, at the very less, some networking initiative to connect researchers, while increasing the awareness of the other federal organizations to the need for inclusion of the language and culture-related variables in their work.

I would now like to deal with the department's considerations and constraints before explaining what we have done in terms of action and investment. The committee report has not yet been given an official response. I will explain why. The department's response to these recommendations must take into account certain constraints and considerations, among them, the fields of jurisdiction, the sharing of jurisdiction between the federal, provincial and territorial governments, since access relates mainly to provincial and territorial jurisdiction. These governments are responsible for primary care. We were expecting a budget to be brought down in 2002 but that did not happen because of the events of last September 11. The federal budget on December 10, 2002, included no new funding for Health Canada and we know that new investments will be required. However, in the aftermath of September 11, the fiscal climate is much different than it was when we began this undertaking in the spring of 2000. We must also consider the recommendations that have not yet been sent to the minister responsible for the consultative committee for minority anglophone communities, that is to say, anglophones living in Quebec. There are a million of them. A report will be tabled shortly. It is therefore advisable to wait until this report is made public in order that we might join our efforts to better respond to the priorities of the two communities.

We must also consider the official languages renewal initiative led by Minister Dion. We want to ensure that these proposals will truly be part of the global strategy that Minister Dion has proposed and will be bringing forward.

Finally, we are happy and eager to continue working in close partnership with the Department of Canadian Heritage which has helped us from time to time and is co-funding some of the projects that we have approved.

What is our department doing to demonstrate its deep commitment to fostering the growth of francophone communities outside Quebec? The committee was created and funded by Health Canada. We have published and distributed the final committee report to the minister. We financed the ``Santé en français'' forum last November in Moncton during which the consultative committee officially submitted its report to Minister Rock. We support the development of this networking idea by providing funding currently for the preparation of a more concrete action plan so as to specify what measures must be taken in following up related recommendations made to the committee. We have and will continue to fund a number of projects for these communities either on our own or in partnership with the Department of Canadian Heritage. We estimate that almost $8 million has been provided to minority official language communities over the past two years to fund projects that have made a difference within these communities. The amounts were granted through existing programs in response to requests made by the communities.

We will continue to work closely with the consultative committee and offer them support and listen to their suggestions while consulting with them so as to better target our intervention. We have taken steps to enhance the development of the envelope for minority official language communities through existing Health Canada programs and future programs such as the fund to adapt primary care. Mr. Hubert Gauthier was appointed to the board of directors of the Health Research Institutes. His appointment should help us to further emphasize the needs of the communities, something with which he is quite familiar. We will continue doing this through Health Canada's mandate. We continue to closely monitor the advice and opinions expressed by these committees so as to better target our response.

The Acting Chairman: Mr. Léger, have you anything to add to what Mr. Nouvet has told us?

Mr. Léger: I do not think so. Mr. Nouvet said everything there was to say.


The Acting Chairman: Please feel free to ask questions in English, if you prefer. Mr. Nouvet and Mr. Léger will understand.


Senator Comeau: I have a comment with respect to an expression used by Mr. Nouvet, ``francophones outside Quebec.'' This expression raises the ire of a great number of Nova-Scotian francophones. We are not francophones outside Quebec, we are French Canadians or Acadians. We do not want to be identified in terms that relate to Quebec.

We often hear the expression ``English Canada'' and ``French Quebec.'' Some people have trouble with these expressions. When I am told that I come from English Canada, it annoys me.

The report says that he have representatives from Manitoba, from New Brunswick and from Alberta. I see no one representing Nova Scotia, Newfoundland, Prince Edward Island or Saskatchewan. Why do you not have someone from each province?

Mr. Nouvet: We were not there when the committee was struck. I believe that when the committee was created, there had been some consultation with the FCFA. I cannot answer your question.

Senator Comeau: I think the report clearly demonstrates that each province has a different reality. When you have representatives from certain provinces, they reflect the interests and the will of their respective provincial governments.

What happens in New Brunswick is very different from what happens in Newfoundland and Nova Scotia. When such studies are undertaken, if you have representatives, it would be important to broaden the number of representatives or at least take that into consideration in the report. I will not quarrel with the results of your studies at this point. I am simply saying that it leaves you open to questions like the ones I am asking today.

Mr. Nouvet: Thank you for your observation. We will take that into account if we undertake any more studies. Besides having representatives from the provinces, for the community-related aspects, we have two representatives from Ontario, one from New Brunswick, one from the University of Saskatchewan and from the FCFA. The representation was somewhat broader than the question might have suggested, but I understand what you are getting at.

Senator Comeau: I see on this list that there are some individuals from Ontario and New Brunswick, but there is no one from Newfoundland, nor is there anyone from Nova Scotia.

Mr. Nouvet: I agree with you.

Senator Comeau: I have made myself clear. Before coming to the meeting this morning, I read the list of proposed witnesses and I saw that there will be witnesses from across Canada, save for Alberta, Nova Scotia, Saskatchewan and the Territories. The committee might want to have another look at the witness list.

The Acting Chairman: We will make a note of it.

Senator Comeau: You have stated that you cannot proceed at this time because health is a provincial jurisdiction. However, the provinces are also responsible for education. What would prevent you from using the same approaches as those used by the federal government in living up to its responsibilities for the development and growth of minority communities in education? Why could you not do that for health care?

Mr. Nouvet: Nothing prevents us from examining that possibility and we might indeed do that with the strategy we will be bringing forward and which is part of the plan that Minister Dion is preparing. I cannot tell you any more at this time. Of course, this is something that we will have to give serious thought to, because funding that type of service requires a long-term commitment.

Senator Comeau: Yes, it certainly involves a long-term commitment since you must ensure some stability if the federal government becomes involved. Have you consulted the provinces to see whether they might be open to examining and implementing these programs?

Mr. Nouvet: Not to my knowledge. First of all, we must have a close look at this along with the consultative committee to see if we are really ready to consider that type of formula and after that, of course we would consult. It would be premature to do it now.

Senator Comeau: Does the consultative committee still exist?

Mr. Nouvet: Absolutely.

Senator Comeau: Could you broaden the membership of the consultative committee?

Mr. Nouvet: We are meeting at the end of May and this is certainly one of the subjects that we could put on the agenda for our next meeting.

The Acting Chairman: Senator Gauthier, before you begin, as I said a little earlier, before you arrived, the committee is extremely grateful for the work that you are doing. It is thanks to what you have done that we are having this debate and proceeding with this study. On behalf of the Standing Senate Committee on Social Affairs, Science and Technology I would like to thank you for the work that you have done.

Senator Gauthier: Thank you, that is very kind. More than anything else, I am seeking information. There is an organization called ``Intergovernmental Francophone Affairs.'' The coordinator-facilitator is Edmond LaBossière. He lives in Manitoba. Have you had any dealings with this organization?

Mr. Nouvet: Yes. I was not familiar with the organization, because I have only been at Health Canada for a month and a half, but I want to point out that Mr. LaBossière is a member of the advisory committee.

Senator Gauthier: Mr. LaBossière is a key player. I know Mr. LaBossière as I have met him a few times. First of all, each province and territory has a coordinator. I would like to have the list of resource persons. The Senate Committee on Social Affairs, Science and Technology would greatly benefit from that. You neglected to mention that Ontario was not included. However, there are 500,000 francophones in Ontario.

Second, you talked about Mr. Dion's plan. The term you used was ``the reinforcement plan.'' I do not know where that wording comes from.

Mr. Nouvet: I made it up.

Senator Gauthier: Are you directly involved in Mr. Dion's action plan?

Mr. Nouvet: We are directly involved. We are working in cooperation with the team responsible for the matter at the Privy Council. We intend to prepare our response to this action plan.

Senator Gauthier: Mr. Dion has no money. His department is not organized in the same way as the others are. He is a coordinator. Earlier on, you mentioned that $15 million had been set aside for or made available to communities. Can you give me a breakdown of the money?

Mr. Nouvet: Are you referring to the adaptation fund to improve primary care?

Senator Gauthier: That is correct.

Mr. Nouvet: The $15 million has not yet been invested. As I see it, the fund covers a certain period of time and the breakdown and distribution by region is not available. The amount targets francophone and Acadian communities outside Quebec and anglophone communities in Quebec. We plan to work in close cooperation with the advisory committees to determine what needs to be done.

Senator Gauthier: Since you are 1 of the 29 federal institutions that must file an annual report with Ms Copps at the Department of Canadian Heritage, could you send us a copy of your most recent report?

Mr. Nouvet: Absolutely.

Senator Gauthier: And provide specific reference to the steps you have taken to improve the situation outside Quebec in particular. Can you send me a copy?

Mr. Nouvet: Yes, Senator Gauthier.

Senator Gauthier: Under the current negotiations, some structures are funded by the federal government. There are, for example, agreements between the University of Ottawa and the Montfort Hospital. I think that $10 million has been earmarked for training health care professionals.

Mr. Nouvet: Over a three-year period, yes.

Senator Gauthier: There is an agreement between the Dumont Hospital in New Brunswick and the University of Sherbrooke. Has the federal government provided any funding for training?

Mr. Nouvet: My understanding of the situation is that the $10-million fund, which is spread over three years and comes from the Department of Canadian Heritage, will be wrapped up at the end of this fiscal year. When we talk about the need for a consortium that would involve more community colleges and universities, we are thinking about a way of renewing this initiative, which was successful.

Senator Gauthier: Have you analyzed this initiative for the University of Ottawa and the Montfort Hospital? What results have your investments led to? I believe the amount is $10 million for Ottawa, New Brunswick and Sherbrooke. Can you give us a breakdown for that amount.

Mr. Léger: It was only for the National Health Care Training Centre, over three years. There were no other investments, as far as I know, in this area.

Senator Gauthier: There was a $10 million fund invested over three years. How much money was spent on the agreement between the University of Ottawa and the Montfort Hospital? How much money went to the University of Sherbrooke and the Dumont Hospital?

Mr. Nouvet: I am not familiar with the details of the initiative, because I have not had time to examine them. This is a Canadian Heritage initiative. I think it would be more realistic for the Senate Committee on Social Affairs, Science and Technology to obtain that information from Canadian Heritage. If I had that information, I would share it with you.

Senator Gauthier: There is nothing for Manitoba for the time being.

Mr. Nouvet: I think that an investment is currently being made in Manitoba. I had three or four meetings with Mr. Hubert Gauthier, and it seems to me that there is an arrangement with the Saint-Boniface College.

Senator Gauthier: In terms of the networking we will be dealing with, do you have any information on telemedicine and satellite radiology?

Mr. Nouvet: Telemedicine is not part of this new networking idea. The advisory committee is currently working on its vision on that with a view to submitting a business plan. The questions you are raising with respect to telemedicine and telenetworking would be to a larger extent linked to investment for technology infrastructure. Some projects are underway as part of an initiative called ``CHIPP'' in English — I do not know what it is called in French — Mr. Léger could tell you about it, as it involves some of these technologies.

Mr. Léger: It is a contribution fund, that has now been wrapped up, that sponsored 29 different projects for the advancement and use of technology in the health field. In New Brunswick, one of the projects that resulted from this contribution fund is a project on teleoncology that was designed to serve the French Canadians in this region. Other projects have been funded through this program.

I want to emphasize the difference between networking and telemedicine. They are two totally different notions according to the committee report. The networking that we are talking about is not technological in nature. Instead, it involves a group of individuals who want to get involved in their region to advance the cause of French Canadians in other provinces. Telemedicine or telehealth provides medical assistance to francophones when it is impossible for them to obtain specialist services in their mother tongue. Health Canada has done considerable work in that area in developing its information highway on the Internet. Networking will enable many individuals to come together and to be able to make a difference in advancing the cause.

Senator Pépin: There was no budget. Nor did you receive funding to start up your system, but has Health Canada put forth a project to follow up on the recommendations presented at the forum that was held in Moncton in 2001?

Mr. Nouvet: We are currently funding a $300,000 project, which is being headed by the Fédération des communautés francophones et acadienne du Canada. The main objective is to clarify what is meant by networking and to provide us with a business plan for investing in this initiative. The business plan should help prepare the strategy that will part of Minister Stéphane Dion's action plan.

Moreover, we plan to invest in pilot initiatives starting this year. We have not yet clarified which initiatives, but we have funds available to do so. We will not have to wait for the action plan. This year, we foresee investing in consultation with the advisory committee to do the groundwork so if the funds are available the next fiscal year, we will be in a position to start up new projects very quickly.

Senator Pépin: Members of some provincial governments were members of the advisory committee. Didn't that create a mutual aid network among the members of the various provincial governments and the federal government to determine where they could take action and to determine more quickly what needs to be done?

Mr. Nouvet: Of course, we want to work in close cooperation with the provincial and territorial governments. The door is open for the federal government to take action and invest in the area of networking. The federal government can get involved in the area of training that I mentioned. It might well be more complicated in terms of primary care, because it is a provincial and territorial jurisdiction. The partnership will have to be established on a very clear and official basis that would ideally lead to a commitment by the provinces to also continue with networking.

Senator Pépin: The government can initiate networking. You have some pilot projects that you want to start putting in place in this area. Can we hope they will be implemented this fiscal year?

Mr. Nouvet: Yes, Senator Pépin.

Senator Pépin: Appointing Mr. Hubert Gauthier to the board of the Canadian Institutes of Health Research would perhaps be an officious ways of creating a chair for the networking initiative.


Senator Fairbairn: I have two questions. In your references to Canadian Heritage projects, were you referring to language projects, or are there other projects within Canadian Heritage with which you have been associated?

Mr. Nouvet: We were referring to other projects. The Interdepartmental Partnership with the Official-Language Communities, IPOLC, is a fund, whereby, when we approve or invest in projects in the health sector that will serve the community, Heritage Canada will provide matching funds.

Mr. Léger: Over the past two years, Heritage Canada has contributed about $1.9 million, and we have matched that amount for these projects.

These projects are in various domains of health. It could be a project to help single mothers. There are many projects that assist French communities. Heritage Canada matches the dollar amount because those projects, although specific to various areas of health, contribute to providing better services to French Canadians in other provinces.

Mr. Nouvet: They also help us to meet our obligations under Part VII of the Official Languages Act.

Senator Fairbairn: It might be useful, Dr. Morin, if it is not too difficult, to have a breakdown of those projects.

Mr. Léger: We can certainly provide that.

Senator Fairbairn: I am from Alberta where there is a relatively small francophone population, though it is a significant part our history. I know that the association is extremely lively.

If you were to look at the Province of Alberta, in your study, where would your contacts be? Would they be, mainly, in the two major cities? Often, part of the populations of some of the smaller communities in Alberta is francophone, and that is because of their historic background.

How would you target areas in Alberta? Could you also explain the degree of cooperation and collaboration you have with the provincial government in Alberta?

Mr. Nouvet: We plan to invest the money that is available this year in consultation with the advisory committee. We have limited funds, and we want the advisory committee to tell us what their priorities are.

We know, for example, their number one priority is networking. We expect to invest a fair amount in networking, but not to the extent that the committee is hoping to do in the future, which is about $5 million a year.

We have not yet held our meeting with the advisory committee, and people from Alberta are on that advisory committee. We want to spread the money as much as possible, but still have some significant experiences that will serve us to build on initiatives in the future.

I have not had any conversations with officials from the Alberta government on primary care. For us to be involved the primary care area requires collaboration with the provincial government and a partnership. It requires either co- funding or a commitment for the province to take over the financing after a certain point. I am not aware of us having had any conversation like that.

However, we have had some conversations in that regard in other areas. The Yukon Territory is a perfect example. We have asked the territory, ``Are you ready to co-fund this project? If not, at a minimum, are you ready to commit to continuing the service once we have launched it?''

Senator Fairbairn: I wish you well.

The Acting Chairman: I would point out that the chair of the Francophone Communities of Canada is from Edmonton and he appeared before our committee when we were there. He is a very articulate and influential person.


Senator Losier-Cool: I am happy that we are talking about health care services in French. I would have been even happier if it had started 10 years ago. My question is linked to a question of principle in the Official Languages Act. Sections 41 and 42 of the Official Languages Act clearly state the federal government is committed to enhancing the vitality of these communities. The vitality of these communities will be even better if the people are healthy. As a certain comedian once said: ``It is better to be rich and healthy than poor and sick.''

I want to bring the discussion back to the sixth principle that is often presented by minority communities. The Canada Health Act contains a sixth principle, that of linguistic duality in health. We have recognized it in the area of education. Education for francophone minorities throughout the country is accessible. That is not yet the case for health care. Research shows that 50 to 55 per cent of francophones can receive health care in their own language, while it is seven times more for anglophones in a minority situation. I would like to hear your comments on this sixth principle. The issue of health care in French is Canada's social union. Did your committee address that?

This sixth principle leads me to my second question on the profile of people living in a minority. In other words, research has shown that people in British Columbia are healthier, because they have the infrastructure that enables them to be healthier. Has anyone done a profile of francophones? Are more of them obese? Are their lifestyles different? In the end, it always goes back to the first principle.

Mr. Nouvet: I'm going to start by answering your last question. As the report prepared by the FCFA shows, we do not have reliable statistics that enable us to answer this question as to whether francophone minorities are as healthy or less healthy than the anglophone majority. Except that, as I mentioned in the presentation, francophones have lower levels of education than anglophones, and they are less present in the workforce. These results imply that their health would not be as good as that of anglophones who are better educated and more present in the workforce. However, we do not have reliable statistics on that.

Regarding your suggestion to add a sixth principle to the Canada Health and Social Transfer, I have a personal opinion, but I am not able to answer that question. If it were to be debated, it should be debated by Cabinet, and it is up to the Cabinet to take a stand on that. In my opinion, the current studies on potential reforms to the health care system could, at some point, lead us to that. The matter would be debated by Cabinet, and was discussed by the advisory committee.

Senator Losier-Cool: Education is also a provincial jurisdiction. If education is now available and this area reflects the Official Languages Act, it is because on several occasions cases went to the Supreme Court. Just look at the Beaulac decision and the Arsenault decision in Prince Edward Island. In New Brunswick, the Acadians are currently before the courts to express the need for health care as well as education services in French. I understand that that is not your area, but it would be interesting to monitor the outcome of this situation. The issue of the sixth principle was raised on several occasions in presentations by minority groups on health care.

The Acting Chairman: That is not in the report.

Senator Losier-Cool: However, it is in other reports.


Senator Cook: Thank you very much for your presentation and for this document. I have just been able to leaf through it.

I am from the very rural province of Newfoundland and Labrador. Since our discussion is about minority communities and accessibility, it certainly applies to people living in my province.

The French population in Newfoundland is primarily on the mainland, at Cape St. George. I will not get into a long geography lesson, but it is shaped like a bill. The late W.J. Keon was a member of our provincial legislature for many years, and he is the father of Dr. Kevin Keon. When I was a young woman, I remember him saying that he would represent and care for the last lonely fisherman on the bill of Cape St. George.

Today, in Labrador, the six mainly English-speaking communities in southern Labrador have to rely on a French hospital, Blanc-Sablon, in a mainly French-speaking community as the first entry for care. The only tertiary care hospital is on the island of Newfoundland. We also have the islands of St. Pierre and Miquelon 12 miles off our shores. Labrador City has The Fairmont, which services another mainly French-speaking community.

I know that French-speaking people constitute only .4 per cent of the population. Do we count on the radar screen? I pin my hopes for representation of those people on the Canadian Nurses Association. I know that is over simplistic, but I want to ensure that those small areas of rural Canada are considered when the recommendations are made, and that you do not forget about them.

Mr. Nouvet: The .4 per cent is on the radar screen. Due to the recommendation that was made here, we are going to explore the composition of the advisory committee to see whether we can achieve better representation. I believe that the networking initiative is the key priority that comes out of this. It will go a long way towards breaking the isolation of certain groups in certain regions. We talk about networking within regions and also about national networking to break the existing isolation.

Senator Cook: Thank you for that. Perhaps we could look at community health when considering that.

Senator Cordy: Thank you very much for taking the time to be with us this morning. It has been most helpful, particularly for me.

I know that your mandate was to look at French-speaking minority communities and the access they have to health care. I received this document only this morning and have only skimmed through it. I have not seen anything related to health care services provided to French-speaking members of the military. I am not sure that was in your mandate, but is that something you would consider studying?

I also serve on the Standing Senate Committee on National Security and Defence. We travelled to a military base in New Brunswick. I know that there is a shortage of health personnel across the board, and this is also reflected in the military community. Personnel at the base in New Brunswick did not bring their families to the base with them because no French services were offered. Due to the lack of health services in the French language, their families stayed at the previous posting while the members of the military went to New Brunswick alone.

Is there anything that you have looked at or are planning to look at in that regard?

Mr. Nouvet: That is a superb question. The federal government provides direct services to First Nations people, the Inuit, people in prisons, the military and the RCMP. With those groups, the federal government is theoretically in control. Often, care is shared between the federal and the provincial governments. Where we are in control, it is theoretically easier to do something.

The situation you cite was not included in the mandate of our committee, but I can certainly see that, in the future, we will have to look at how we deal with the population that we treat ourselves, because I suspect we would like to provide ``best-practice'' care so that we can speak more convincingly to the provinces and territories about these issues.

Since we did not focus on the military, the work of the committee can only help to the extent that military families receive treatment from the provincial or territorial government. We have not looked at the services we provide from within the government.

Senator Cordy: Are you aware that this is a concern for people serving in the military?

Mr. Nouvet: I was not aware of that.

Senator Cordy: Now you are.

Mr. Léger: We are an active participant in the Health Care Coordination Initiative. It brings together all the players — Veterans Affairs, National Defence, Health Canada and the RCMP. We actively collaborate with them in trying to find solutions to better provide care and services to the federal family, as we call it.

Since we are active participants in the branch that Mr. Nouvet heads, there is an opportunity to ensure that we share the information we gain from these committees and the work we do with this advisory committee and transpose that to the Health Care Coordination Initiative.

For example, there is much work being done on tele-health. We must ensure that tele-health serves both francophones and anglophones. We will explore those opportunities.

We also work with an advisory council to Minister Rock on rural health for the provision of services in remote communities. There are many such opportunities, and the fact that we are linked with all those initiatives will allow us to ensure that we horizontally bridge the concerns and problems between those issues.


Senator Pépin: My question deals with labour training. The committee has found that the majority of francophone students, who undertake studies outside their own region, do not return to their hometowns. The committee has recommended that a cross-Canada consortium for French-language health training be set up. Have specific initiatives been developed to achieve this?

Mr. Nouvet: You want to know whether there are ongoing initiatives?

Senator Pépin: Indeed, I want to know whether anything has been done to try to encourage these students to stay in their own communities. I want to know whether the universities are consulting each other on how to achieve this?

Mr. Nouvet: Under the Heritage Canada-sponsored initiative, which provides for a funding package of $10 million over three years, and which involves the University of Ottawa, some progress has indeed been made to achieving this goal. A consortium has been set up and Hubert Gauthier is participating in this consortium, which includes such partners as the University of Moncton, the University of Sherbrooke, the University of Ottawa and the Saint-Boniface College. All these stakeholders are currently working together to flesh out the initiative — which we referred to earlier — leading to the creation of a consortium. If I am not mistaken, even the University of Alberta is involved in this initiative. The idea here is to create a network and to foster training for people in their own home regions.

Senator Comeau: I would like to pick up on the issue of doctors. How can we attract doctors to hospitals in the regions, such as Nova Scotia and Newfoundland, to name but a few? I have a suggestion for you which I believe would be very effective. If those doctors who were looking into the possibility of settling in Halifax, or elsewhere for that matter, saw bilingual signs, that would confirm in their minds that the people in that particular facility were quite open to French. This is not the case. In areas like this, signs are in English only. This is the reality we are facing. You have to admit that in regions such as Nova Scotia, Prince Edward Island and Newfoundland, to name but a few, French is not welcomed. If doctors see that the hospital operates entirely in English, why would they go there? It is doubtful whether doctors would fancy settling in this region. This is a relatively low-cost approach, but in order to attract these doctors, there would have to be cooperation with the provinces. Sometimes, were there is no pain there is no gain. Sometimes, as painful as it might be, you just have to grin and bear it.

Even if primary health care is a provincial jurisdiction, the federal government must recognize the needs of minority communities. If the federal government were to neglect this responsibility just because it was afraid of getting the provincial governments' back up, then linguistic minorities may just have to shut up shop and be assimilated. I think that we have to look at that possibility, in order to see whether we should move forward or not. I do not want to be alarmist here and I am not claiming that we have got to that stage yet, but I think time however, is of the essence.

Senator Gauthier: Earlier, the issue of the federal government's obligations in terms of health care was raised, but we omitted to mention veterans. I just simply wanted to stress that point.

Currently, negotiations are ongoing between the Montfort Hospital and the Ottawa military hospital. Could you perhaps talk to us a bit about that or is it still secret?

Mr. Nouvet: No it is not a secret, but this issue is the responsibility of the Department of National Defence. The initial update that I received last week indicated that talks were continuing — an agreement did indeed seem possible — between the department and the Montfort Hospital. We believe that these talks could result in an agreement by the end of the year.

Senator Gauthier: You mentioned comprehensive strategies to address the issue of ``French-language health care,'' which is the issue we are currently looking at. You stated that the government intends to address this issue. Could you tell us when the government will indeed be dealing with this issue?

Mr. Nouvet: These issues are debated at cabinet level, but we are currently developing a reply to the report by the francophone advisory committee. We are also awaiting the report by the anglophone advisory committee, because we would like to look at both studies at the same time. I expect the reply to be part of Mr. Dion's action plan. I do not know whether he has set out a time scale, but I expect him to table his action plan some time this year. You would have to ask Minister Dion and the Privy Council themselves as to their exact time scale. We are currently working on including our strategy in their action plan.

Senator Gauthier: Last year, we were told that our action plan would be tabled in the following spring. It is now spring and we are now being told that this report will perhaps be tabled this year or even perhaps next year. I think that you should be developing an action plan, in which the health issue would be a major aspect.

Mr. Nouvet: We are committed to doing that.

Senator Gauthier: Our committee is charged with addressing major issues such as access to health care. For example, 50 per cent of francophone Canadians in this country do not have any access or little access to health care in their own language.

The report states that francophones have less formal education than anglophones. This is quite understandable, because until 1967, in my own province of Ontario for example, 84 per cent of French Canadians left school before the end of 10th Grade because there were no French schools. They just had to make do with what they had. However, in our day, there are French schools. In 1982, the federal government's Charter of Rights and Freedoms made education a constitutional right. Do you not think that the same thing should be done for health care? I think that the sixth principle — linguistic duality — should indeed apply to health care. I think that it is in the interest of all Canadians to protect French minorities outside Quebec and anglophones in Quebec. If we fail to do this, Canada could indeed disappear. If anglophones are no longer able to survive in the province of Quebec, they will leave. It is much easier for anglophones to do this. There are 250 million of them in North America. However for francophones, it is not so easy.

Telehealth represents a major solution to this issue, especially in terms of complex cases. It is important to set up flexible, accessible and generous bodies. It is in the interest of the federal government to preserve these rights. The federal government took action in the area of education, and I think that it is now time for it to do the same in terms of health care.

The situation is quite the opposite in Ontario today. In the past, between 84 and 86 per cent of francophones left secondary school before 10th Grade. Today, we see quite the opposite situation. Ninety per cent of francophones go on to finish their secondary education. In terms of health care, I think that it would be useful to consider the three points that I have just set out, in an attempt to include that in the Constitution. However, we will undoubtedly run into problems with the provinces, since health care is a provincial jurisdiction. The same thing also happened when the federal government took action on education. Could you perhaps give us a few comments on this issue?

Mr. Nouvet: No, however, the fact that we had to put this issue on the back burner last year stems from the events of the 11th of September, which exasperated the downturn in the economy. We tabled a budget in November rather than in February as is normally the case. Priorities changed. Currently, we are all working together with the communities. Mr. Hubert Gauthier is well aware of this, as is his counterpart from the anglophone advisory committee. We are working together to develop our strategy and at the same time, we are continuing to invest. We invested last year, and the year before that and we are continuing to invest. We hope that in the future we will have more money available, so that we can move much more quickly.

The Acting Chair: To conclude, I have two brief questions I want to ask you. You mentioned the French fund, le fonds pour l'adaptation des soins de santé primaires. Is that equivalent to the Transition Fund in English?

Mr. Nouvet: It is indeed.

The Acting Chairman: Minister Rock made an announcement in September or October, in which he announced several tangible initiatives for health care as it relates to language minorities. You can find that announcement on Health Canada's website. At the time, two officials came to see me. The issue was of great interest to me. These officials told me, in no uncertain terms, that the money for language minority health care was to come from the Transition Fund. We are now six months on and you are telling us that despite this announcement, no money has yet been forthcoming?

Mr. Nouvet: You made a reference to the announcement of the part that would go to French-speaking communities in a minority situation. This was announced at the end of last year. To my knowledge, we still have not approved any concrete project.

The Acting Chairman: Are you not surprised that six months after the funding was announced, minority language communities have still not received anything?

Mr. Nouvet: I have not yet met the members of the French-speaking advisory committee but we are having discussion with Hubert Gauthier. Indeed, we are looking at how we could invest money from this fund this year.

The Acting Chairman: Were you not supposed to spend this money during the fiscal year?

Mr. Nouvet: We do not have to spend it in the fiscal year but we are going to spend some money. I just wanted to make that clear.

The Acting Chairman: In other words, the money has not been lost.

Mr. Nouvet: We have four years to spend the money.

The Acting Chairman: My second question deals with the committee recommendations. There are four main recommendations: networking, training, infrastructure and intake centres. All this for a total of $245 million in five years or $40 million a year and $20 million in capital investments. Do you think this is a realistic amount? Do you really think that Health Canada is going to provide $245 million for five years?

Mr. Nouvet: I would say that in the present environment, it is not realistic. We must also consider the needs of the English-speaking minorities in Quebec. It is a key issue that we are going to discuss at the next meeting of the advisory committee.

The Acting Chairman: Health Canada has been an active participant in the committee. In your report you state that, financially, it is not realistic. You are telling French-speaking minorities that there will be major investments, for instance in the intake centres. They are setting up community centres funded by the federal government. Apparently, at the Moncton meeting, everybody was very happy to hear this. Would it not have been better, before issuing a report, to make sure it was financially realistic, when you consider Health Canada's overall budget which we know will not be able to support a $250 million five-year project?

Mr. Nouvet: Your point is well taken. First the report was written and finalized before September 11. Should we have quickly changed it to take the events into account? I do not know the answer. But it was difficult to figure out the impact. Also the report was written at a time when the financial situation was better. It may indeed have raised expectations. So far, I have had very constructive discussions with Mr. Hubert Gauthier and Mr. Paul-André Baril. I think people understand that we are going to have to review some of the investments that were proposed and that we could still do good things with less money.

Senator Gauthier: I would like to make a proposal. I think we should invite the Commissioner of Official Languages before the committee. There is a Canadian association of French-speaking doctors. It might be a good idea to invite them as well as Mr. LaBossière, the provincial intergovernmental francophone affairs coordinator, to find out what is happening at that level. The provinces meet once a year. Last year, they discussed the issue of health care in francophone minorities. We should invite him. Finally, we have talked about Heritage Canadian two or three times. They have money. Also, the Minister of National Defence might have a few things to tell us about what is happening with the veterans and health care on our military bases.

Mr. Nouvet: I think Mr. Hubert Gauthier should appear before your committee. He has been there since the beginning.

The Acting Chairman: He is already on the list of witnesses. Mr. Nouvet and Mr. Léger, thank you very much. We might ask you to come back before the committee after our hearings. We may have other questions to ask you after having heard other your witnesses. Once again, thank you for your presentation and for openness in answering our questions, those of Senator Gauthier being obviously the most difficult ones.

The committee is adjourned.

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