Notes for an address
by the Honourable Stéphane Dion
President of the Privy Council and
Minister of Intergovernmental Affairs

Speech delivered at the Symposium
on the Creation of a French-language
Health Network for Nova Scotia

Dartmouth, Halifax

May 23, 2003

On behalf of the Prime Minister of Canada, the Right Honourable Jean Chrétien, and my colleague the Minister of Health, the Honourable Anne McLellan, I would like to tell you that the occasion we are marking today is of great importance to the Government of Canada. I would like to thank Mr. Stan Surette for having invited me. It is a privilege for me to be attending the launch of Nova Scotia’s French-language health network.

I am proud to say that the Government of Canada has collaborated in the creation of this network, through contributions by Health Canada and Canadian Heritage’s Interdepartmental Partnership with Official-Language Communities (IPOLC) program totalling $ 25,000.

But the establishment of this network is the product of cooperation with the Association des Acadiennes de la Nouvelle-Écosse, the Regroupement des aînées et aînés de la Nouvelle-Écosse, the Collège de l’Acadie and the Université Sainte-Anne. The Fédération acadienne de la Nouvelle-Écosse (FANE) also played an important role. FANE has coordinated this large-scale project, from the regional consultations in May 2002, the provincial forum "Santé en français" on June 15 and 16, 2002, through to the tabling of the report on health services in Nova Scotia on September 21, 2002. The federal Minister of Health, the Honourable Anne McLellan and the Honourable Jamie Muir, then Health Minister for Nova Scotia, welcomed your efforts to take the initiative on the health file in your communities.

The present and future participation of the Government of Canada in your new health network, as in the other provinces, is part of the important health component of The Action Plan for Official Languages that Prime Minister Jean Chrétien released on March 12 at the Cité collégiale in Ottawa.

I would like to tell you the story behind the preparation of the health component. It is worth knowing, because it testifies to the exemplary cooperation between the Government of Canada and citizens devoted to the cause of French, in their communities and in our country. It is exemplary because the approach we took was one of close consultation and hard work on both sides. Exemplary also, because the result helps to address a real and pressing need.

The story begins in June 1998, when the Fédération des communautés francophones et acadienne (FCFA) du Canada announced it was commissioning a study on health among Francophones and Acadians. From listening to its members, the FCFA saw clearly that access to French-language health services was a major problem. The events in connection with the Montfort hospital contributed to that awareness.

The study was released in 1998, entitled Gardons notre santé : Étude sur le dossier de la santé chez les francophones et Acadiens. Its author, Mr. Paul Charbonneau, drew a picture of French-language health services available in minority communities that was not comforting. There is a shortage of health professionals in many communities, no policy on French-language services in a number of provinces, and major differences among communities depending on their demographic and social situations, the population’s level of education and their history.

The first study recommended broadening the analysis and obtaining a more accurate assessment of the situation. In February 2000, the FCFA announced it was undertaking a second study. That study was released in June 2001. Entitled Improving Access to French-language Health Services, the study stated the problem in unequivocal terms, reporting on:

"...difficulties in recruiting and retaining staff in rural or outlying areas, an almost complete dearth of reliable data on the communities being served, occasional problems in fitting into the overall health system, a still weak community involvement in health issues in many of our communities, and under-utilization of new technologies."¹ [Translation]

On April 4, 2000, the Honourable Allan Rock, then federal Minister of Health, announced the establishment of the Advisory Committee on Francophone Minority Communities. The Committee’s mandate was to advise the Minister and help him better orient Health Canada’s policies and programs. The Committee had two co-chairs: the Associate Deputy Minister of Health Canada, M^me Marie Fortier, and the President and CEO of St. Boniface General Hospital, Mr. Hubert Gauthier. The contribution of Mr. Gauthier and his team was decisive and noteworthy and we should all applaud them, both him and the members of his committee.

With the financial assistance of Health Canada, the Committee undertook another study, again coordinated by the FCFA. Even larger in scale than the first two, this study, released in June 2000 under the title Community Health Services in French,² demonstrated beyond all doubt the needs that existed, indicating specific problems: limited access to services, discrepancies between provinces and regions, a Francophone population that was older, less present in the labour market, less educated and more widely dispersed than the Anglophone majority. Above all, the study highlighted the importance of language in the effectiveness of care provided. Being cared for in one’s own language is a need felt by even the most bilingual among us. When we are sick, we want to speak and hear our mother tongue.

Community Health Services in French provided the Advisory Committee with the foundation for its reflection. The Committee submitted its recommendations to Minister Allan Rock, who in turn released them in September 2001.

The Committee highlighted five intervention levers:

• networking,
• training of health professionals,
• primary health care,
• use of technology,
• availability of information.

The Committee’s initial proposals to the Health Minister were received with some scepticism, not only by the Government of Canada, but by provincial governments as well. They were felt to be too ambitious. Even though the objectives were considered laudable and the needs real, the cost of the implementation – $270 million – seemed high. Indeed, I can recall a meeting of Francophone Affairs ministers on September 28, 2001, in Edmonton, where the Committee’s recommendations got a rather chilly reception. Your Minister responsible for Acadian Affairs, the Honourable Neil Leblanc, attended that meeting as did I. The exchange between the ministers and Mr. Gauthier was polite and frank. The door remained open, and no one got discouraged. The Committee members got back to work with determination.

They reformulated their project with the help of Health Canada. They changed the scope of the recommendations and the initiatives considered, bringing the cost down to around $125 million. They submitted them to Health Minister Anne McLellan, who expressed optimism.

When ministers responsible for Francophone Affairs had an opportunity to look at the new project, in St. John’s on October 4, 2002, the reception was much more positive than a year earlier. The ministers described the plan submitted to them as realistic.

Before that meeting, my speech in Whitehorse to the FCFA on June 22, 2002, confirmed that health would have an important place in The Action Plan for Official Languages. Joining words to actions, I announced, on behalf of my colleague Health Minister Anne McLellan, the provision of $1.9 million from the $800 million Health Transition Fund, whose creation was announced at the First Ministers’ Meeting in September 2000. The health network for Nova Scotia’s Francophone and Acadian communities, which is the subject of this symposium, is a tangible result of that funding commitment.

At the same time as this work was being undertaken in Francophone and Acadian communities, Quebec Anglophones were mobilizing as well. Health Canada struck an advisory committee on Anglophone minority communities in October 2000. Although working in a different context, the Committee took a similar path to that taken by Francophone minority communities, and submitted its report to the federal health minister in July 2002. The report proposed an overall action plan to improve access to English - language health and social services.

This brings us to the fall of 2002, when budget planning was starting to get tougher. You know what it is like preparing a budget: it is like a funnel with many filters: projects crop up everywhere, and only those that are the best justified, the best prepared, are retained. If the Government, especially the Prime Minister and the Finance Minister, were to accept that official languages would be a major priority in the next budget, the Action Plan had to be seen as one of those well-prepared, well-justified projects.

I will admit that I did not get everything I wanted from the Finance Minister, the Honourable John Manley – that never happens – but I got a good part of it, for which I am indebted not only for his support for the official languages cause, but also to all of the preparations that communities made with my colleagues and me, for almost two years. The best example is perhaps the one I have just described in connection with the health component:

two years of hard work by all parties. If we had not undertaken all those studies together, all reformulations and answered tough questions, if we had not had all those exchanges, we would not have succeeded. The Finance Minister would have invested elsewhere, on better designed projects whose social utility had been better demonstrated.

What did we obtain, as a result of that common effort? Just what is this health component of the Action Plan that received the seal of approval from the demanding Finance Department? Let me describe its main characteristics.

The health component allocates funding totalling $119 million over five years to the following three priorities:

• training, recruitment and retention of health professionals,
• networking,
• primary health care.

This investment includes the $89 million announced in the February 2003 Budget to implement health training and retention initiatives for health professionals and to fund community networking. It also includes $30 million reallocated by Health Canada to initiatives providing primary care in minority situations in either official language.

Under the Action Plan, minority Francophone and Anglophone communities in minority situations will share $75 million over 5 years for training and retention of health professionals. The Consortium francophone de formation et de recherche en santé, a body created in 1999 comprising nine Canadian Francophone minority institutions at the university and college level – such as the Université Sainte-Anne – that provide French - language training in the health sector, will receive $63 million. Quebec’s Anglophone community will receive $12 million.

The investment will help alleviate the shortage of health professionals, increase health training capacity, and help ensure that future practitioners can work in their own language and in their communities of origin.

For Francophone health professionals outside Quebec, this will mean:

For Anglophone health professionals in Quebec, the funding will include:

We can create a network like the one that is the subject of your symposium, but there must also be a way to make it function well. The funds and networking measures in the Action Plan will help you do that.

Communities will receive $14 million over five years for networking: $10 million for Francophones in minority situations and $4 million for Anglophones in Quebec. Networking will support the creation of solid and enduring links between all health sector stakeholders. It will channel the energies of institutions, health professionals and the strength of communities to ensure the provision of health service delivery in a patient’s official language.

Finally, the Action Plan allocates $30 million from the Primary Health Care Transition Fund envelope reserved for minority official-language communities, of which $20 million will go to Francophones in minority situations and $10 million to Anglophones in Quebec. That envelope is notably for health care better adapted to regional realities and communities, within provincial and territorial health care systems. The funding will help enhance access to primary care, make services more effective and improve patient satisfaction.

Health Canada will be evaluating initiatives to ensure they attain the stated objectives and produce the results. These evaluations will help to determine the relevance of activities, make changes as required, improve performance, and take into account the implications of initiatives for communities.

So this is the health component of our Action Plan, which is the basis for today’s event: the launch of the Nova Scotia’s French-language health network.

This story, which began in 1998, has shown how effective cooperation can lead to an initiative designed with communities, for communities. It is not easy, it calls for a lot of perseverance, as governments are beset on all sides by pressing needs and do not have the resources to address all of them.

The politicians you elect and the public servants who support them, with whom you have been working for a number of years, genuinely want to make real, lasting progress. Continue to help them to help you. On the health front, you have done so in an exemplary fashion. The end result is truly an example for us all.

1. MBeaulieu Développemtent organisationel et Formation inc., Improving Access to French-language Health Services, (Fédération des communautés francophones et acadiennes (FCFA) du Canada, June 2001), p. 2.
   
2. MBeaulieu Developpement organisationel et Formation inc., Community Health Services in French: An Analysis of four Existing Models in Francophone and Acadian Communities – Executive Summary, (Fédération des communautés francophones et acadiennes (FCFA) du Canada, June 2000, 28 pages).