Health and official language minority community in Canada

The objective of this article is to report on the health issues related to belonging to an official language minority community in Canada: Francophones living in predominantly Anglophone provinces and territories.

Following a recommendation of the Royal Commission on Bilingualism and Biculturalism (1963–1971), the Canadian federal government adopted the Official Languages Act (1969) making English and French, of equal status, the official languages of the country. First repealed in 1988, the Act was amended in 2005: the addition (point 41.2) amended the Act by strengthening the enforceability of provisions incumbent on the federal government (Government of Canada 2011). By article 41, the federal government undertakes to: support the development of linguistic minorities; promote full recognition of the two official languages; take measures to ensure progress towards equality of status and use of French in Canadian society.

Considering this constitutional obligation to protect official language minority communities and this responsibility for taking appropriate measures to ensure progress towards equality of status and use of French and English in Canadian society, no study had to date verified the link between the minority situation and health in Canada.

Official language minorities in Canada

From the outset, a portrait of the Canadian linguistic situation is essential. Of the 10 provinces and three territories, only the province of Quebec is predominantly French-speaking (85.7% French-speaking / 13.4% English-speaking; 6,373,225 French-speaking / 994,275 English-speaking). Among the predominantly English-speaking provinces and territories, New Brunswick (32.7% French-speaking / 67.2% English-speaking) and Ontario (4.5% French-speaking / 93.4% English-speaking) have the highest percentages of French speakers. Moreover, it is in Ontario, the most populous province in Canada, that we find the greatest number of Francophones outside Quebec, namely 537,595 Francophones out of the 997,125 Francophones in the country (excluding Quebec); they thus represent almost 54% of the francophone population outside Quebec. On this scale, New Brunswick follows with 23.5%; Alberta (6.3%) and British Columbia (6.2%) follow. nationally, there are nearly 2 million (1,991,850) Canadians living in a linguistic minority context, in English in Quebec and in French in the other Canadian provinces and territories.

The Canadian government has a duty to define an implementation plan for the legislative provisions to fulfill its commitment to the equality of the two linguistic communities. This planning culminated in 2003 with the document entitled “The Next Act: New Momentum for Canada's Linguistic Duality” (Government of Canada 2003). According to this plan, the federal state intends to revitalize linguistic duality. It targets its intervention in five areas: education, community development, the federal public service, early childhood and health. In the health sector, the plan was based on the recommendations of the advisory committees of Francophone minority communities and Anglophone minority communities (Health Canada 2001). These reports highlighting the difficulties encountered by these communities within the Canadian health system have led to two national initiatives as potential solutions to problems relating to the health sector: the creation of the National Consortium for Health Training, dedicated to the training of health professionals. health professionals in order to serve linguistic minorities, and the networking of those involved in the planning and organization of health services under the aegis of Société Santé en fran?ais and the Community Health and Social Services Network of Quebec.

The conceptual framework

In Canada, as elsewhere, health inequalities are increasingly well documented and highlight the importance of social determinants as an explanatory factor for differences in longevity and health. Since the publication of the Lalonde report in 1974, entitled “A New Perspective on the Health of Canadians” (Lalonde 1974), health has begun to be considered in a multidimensional manner considering the role of biological, behavioral, environmental and medical factors at the same time. During the 1980s, the Ottawa Charter for Health Promotion identified three major Canadian health challenges: 1) reducing health inequalities, 2) increasing prevention, 3) creating healthy environments (Epp 1986). Finally, during the 1990s, a group of researchers from the Canadian Institute for Advanced Research (ICRA) proposed a more integrated approach to health which would become the population health approach. The work entitled “To be or not to be healthy” (Evans et al. 1996) offers a framework for analyzing all the determinants of health and their interactions. The authors raise an unprecedented paradox for developed countries, namely the existence, but above all the persistence of health inequalities.

Social inequalities are defined as the result of an unfair distribution of resources such as money, education and power and are the basis of the theory of health inequalities (Wilkinson 1996). The main thesis that prevails in this field of research is that of social position, the “Status syndrome”, as Michael Marmot (2004), the pioneering researcher in the field, calls it; individuals at the bottom of the social ladder are sicker and die earlier, regardless of the health problem. Thus, the feeling of inferiority, living conditions in poverty, adversity, stressful life events and power relations constitute the social determinants at the source of the health gradient, that is to say health disparities between individuals and social groups.

The documentation available on the health of official language minorities is not very abundant and often partial. On the one hand, for technical reasons, due to the fact that the linguistic variable is either absent or not standardized in our information systems (administrative health data, data from population surveys), and on the other hand because of weak research infrastructure and low number of researchers.

The study resulting from this work on the determinants of health in minority situations as part of the Canadian National Community Health Survey (CCHS) ( Bouchard et al. 2009c ) was preceded by two other studies: the studies of the Public Health Research, Education and Development Program (REDSP) of the Ontario Ministry of Health directed by Louise Picard (Picard and Allaire 2005) and the study under the direction of Léandre Desjardins on health at New Brunswick (Desjardins 2003). The main results show that the Francophone population of Ontario is older, that it is less educated and that it has an income below the provincial average; that she perceives herself to be in poorer health, experiences more limitations in her daily activities and adopts a lifestyle that is more unhealthy in terms of smoking, alcohol consumption and diet (Boudreau and Farmer 1999). As for Francophones in New Brunswick, if the state of health has improved since 1985 (Robichaud 1985), the Desjardins report (2003) shows that certain regions continue to present indicators that are more unfavorable to health, as well as notable failures in terms of infrastructure and hospital equipment, in particular in the regions of Campbelltown and Miramichi. Pronounced disparities between the north and the south of the province in terms of the doctor-to-population ratio were noted.

In an article published in 2009, it was demonstrated that an association between being Francophone in a minority situation and perceived health.

The study reported that the French-speaking minority perceived themselves to be in poorer health than the English-speaking majority, both for men and women, but when we adjusted for various socio-demographic and health variables, there remained a residual disparity among French-speaking men. could attribute to the factor of "minority life."

These results raise an important fact that had never been explored in the Canadian context of official languages. As the literature has amply demonstrated, age, sex and income are the main determinants of health, but living in a linguistic minority situation had not, until now, been documented. Thus, the minority - majority ratio seems to reflect social inequality and access to resources which, in addition to other determinants of health, de facto contributes to disparities in health. The study shows the importance of deepening and better understanding all the determinants of health as well as the interactions between contexts, local living environments, the impact of policies and the determinants of health as well as the interactions between contexts, local living environments, the impact of policies and the determinants of health as well as the interactions between contexts, local living environments, the impact of policies and health.

Language is at the forefront of communication between health professionals and the population and the impacts of language barriers on health are increasingly well documented. In the Canadian context of the two official languages, an equitable health policy must henceforth take into consideration the linguistic minority situation as a determinant of health.