Based on data from the 2005 CHSSN-CROP Survey on Community Vitality

1. Access to Health and Social Services in English in Quebec, 2005Highlightsfrom the2005-2006 Baseline Data Report Based on data from the 2005 CHSSN-CROP Survey on Community Vitality

2. Acknowledgements This report was prepared by the Community Health and Social Services Network and its research consultant, Joanne Pocock, for the Networking and Partnership Initiative, a program funded by Health Canada and administered by the Quebec Community Groups Network. The views expressed herein do not necessarily represent the official policies of the Quebec Community Groups Network or of Health Canada.

3. Introduction and Methodology • CROP Inc. was commissioned by Community Health and Social Services Network (CHSSN) to conduct a telephone survey of English-speaking persons across Quebec on a wide range of issues and to survey French-speaking Quebecers on the same issues • 3,129 English-speaking respondents* • 1,002 French-speaking respondents • The CHSSN 2005-2006 Baseline Data Report (3rd in a series) focuses on access in English to health and social services, considering in particular: • Inter-regional realities of Quebec’s English-speaking population • Population sub-groups within the English-speaking population (age, gender, bilingualism, household income, health status) • Situation of minority- and majority-language groups *Note: Given that there is a small sample of respondents in the regions of Bas-Saint-Laurent, Mauricie, Nord-du-Québec and Saguenay, data for these regions should be interpreted with caution.

4. Demographic Profile - Growth and Decline • Generally, the Anglophone population of Quebec experienced a decline in total numbers in the period 1996-2001. Of the 16 Quebec regions, 12 witnessed a decline among the Anglophone population

5. Demographic Profile - Aging • Higher proportion of seniors in the English-speaking population than in the Francophone group • Tendency for the highly educated and skilled to depart from the province, which is the same group noted for its civic participation and local leadership

6. Demographic Profile – Low-income Cut-off (LICO) • Anglophones are 26% more likely than Francophones to have incomes which fall below the LICO (low-income cut-off) • In all regions except Montreal and Nord-du-Québec, Anglophones are more likely than Francophones to be below LICO • Centre-du-Québec (59% more likely) and Mauricie (41% more likely) are regions where the tendency for Anglophones to be below LICO is the greatest • Anglophones in the Bas-Saint-Laurent, Mauricie, Centre-du-Québec, Estrie, Chaudière-Appalaches, Laval and Laurentides regions are more than 20% more likely than Francophones to be living below the LICO

7. General State of Health – Very Good or Excellent • Nearly two-thirds of Anglophone respondents across Quebec assessed their health as very good or excellent compared to other persons their age. • Anglophones in rural or isolated regions (Nord-du-Quebec, Bas-Saint-Laurent, Cote-Nord and Gaspesie-Iles-de-la-Madeleine) as well as Estrie were more likely to have a low assessment of their health. • Household income status revealed the greatest variation in self-assessed health, as those with household incomes of less than $30k annually were much more likely to describe themselves as in poor health and much less likely to describe their health as very good or excellent. Very good or excellent

8. Satisfaction with Access to Health & Social Services • Less than half of English-speaking respondents expressed satisfaction with their access to health and social services in English in their region (45.9%) • The highest level of satisfaction: Abitibi-Temiscamingue, Nord-du-Quebec and Montreal (west) regions (50%+) • The lowest level of satisfaction: Mauricie, Lanaudiere, Chaudiere-Appalaches and Capitale-Nationale • The highest level of satisfaction with access to English language services is found among those Anglophones who are 65 and over. • Those among the English-speaking population who assess their state of health as poor are more likely than those of other health categories to express low levels of satisfaction. 4 or 5 on a 5-point scale

9. Use of Health and Social Services • In each of 5 health and social service settings (doctor in private clinic, CLSC, Info-Santé, hospital emergency room, overnight stay in hospital) Anglophone respondents were less likely to make use of formal public health and social services than their Francophone counterparts. • Among the services used by Anglophone respondents, doctors in private offices ranked highest at 66.5%, followed by hospital emergency or out-patient service at 51%, CLSCs at 46% and overnight hospital stays at 22%. • Info-santé was used least frequently among the 5 services queried with only 19% of respondents having used this important health information service within the previous 12 months, contrasting with 30% of the Francophone respondents who had done so. The rate of use among older Anglophones (65 and older) was even less frequent as less than 1 in 10 used the service. • Only 9.2% of Anglophones 65 years and over used Info-Sante in the last twelve months compared to 17.4% of Francophones in the same age group. 40.8% of Franchophones aged 25-44 years reported having used Info-Sante in the last twelve months compared to 26.1% of Anglophones in the same age group.

10. Recourse to Services and Unpaid Care • A majority (83%) of Anglophone respondents said that they would turn to relatives and friends in the case of illness. Smaller proportions would turn to public health and social services (11%) and community resources (3%). Although Francophones also showed a strong reliance on parents and friends, they were more inclined to turn to public institutions in times of need. • The proportion of Anglophones who would turn to family and friends is consistently high across the regions with the lowest at 70.5% in the Capitale-Nationale region, and the highest at 93.5% being in the Mauricie region, followed closely by the Côte-Nord region at 90.2%. Looking across the regions, we observe that a lower reliance on family and friends tends to be associated with a higher rate of reliance on a community resource. • Anglophones in the Capitale-Nationale, Chaudière-Appalaches and Nord-du-Québec regions are more than three times more likely than those in other regions to turn to a community resource while Anglophones in the Estrie region are almost twice as likely as those in other regions to do so. • Those Anglophones who are 65 years and over are less likely to rely on relatives and friends in the event of illness than other age groups. They are more likely than other age groups to turn to public health and social services and/or a community resource.

11. Recourse to Services and Unpaid Care • Anglophones 45-64 tend to be reliant on friends, or more likely to have nobody to turn to, compared to other Anglophone age cohorts in the same health situation. • Households earning $30k and under are the most likely to turn to public services or to have nobody to turn to. Those earning $50k-$70k are the most likely to rely on a community resource. Those earning $70k-$100k are more than three times more likely to opt for “other” (private or for profit services). • Those Anglophone respondents who assess their health as poor are the least likely to rely on relatives and friends, are more likely to turn to a community resource, and are more than twice as likely as other health groups to turn to public health services in the event of illness. • When age groups are compared, those Anglophones in the 45-64 age group are providing the greatest portion of unpaid care for a person living outside their household and for those other than relatives.

12. Use of English – Doctor in Private Office or Clinic • A large majority (86%) of respondents were served in English when they used the services of a doctor in a private office or clinic. • The use of English with doctors varied enormously across regions with over 90% of respondents in the western and central parts of Montreal and in the Outaouais reporting using English. • In contrast, fewer than half of Anglophone respondents in a number of regions (Mauricie, Centre-du-Québec, Saguenay Lac-Saint-Jean) used English with doctors in private offices.

13. Use of English – CLSC (other than Info-Santé) • Two-thirds used English when accessing CLSC services (67%), • Language use of CLSC service transactions varied tremendously across regions ranging from 80%+ in Nord-du-Quebec, the Outaouais and western Montreal regions compared to less than one-third in the case of Mauricie, Bas-Saint-Laurent, Capitale-Nationale, Centre-du-Quebec and Saguenay-Lac-Saint-Jean. • There is a wide difference within the Montreal region. 80.5% of English-speaking respondents in Montreal (west) received CLSC services in English, compared to 38.6% of respondents in Montreal (east).

14. Use of English – Info-Santé • 63% used English when accessing Info-Santé services. • The language aspect of Info-Santé services also showed wide variation across regions with the Outaouais, Gaspesie-Iles-de-la-Madeleine and western Montreal showing levels above 80% while a number of other regions (Mauricie, Saguenay-Lac-Saint-Jean, Chaudieres-Appalaches, Centre-du-Quebec, Lanaudiere) show levels less than one third using English with Info-Santé. • There is a significant difference within the Montreal region. 81.5% of English-speaking respondents in Montreal (west) received Info-Santé services in English, compared to 48.3% of respondents in Montreal (east).

15. Use of English – Emergency Room • 70% of Anglophone respondents used English in hospital emergency rooms and out-patient clinics. • The use of English varied across regions, with the Outaouais, Abitibi-Temiscamingue and the western part of Montreal showing levels above 80% or more, contrasted with Mauricie, Saguenay –Lac-Saint-Jean, Bas-Saint-Laurent, Capitale-nationale and Centre-du-Quebec where fewer than one in five respondents used English in this setting. • There is wide range of access to emergency and out-patient services in English in the Montreal region. 85.9% of respondents in Montreal (west) received these services in English, compared to 49.4% of Montreal (east) respondents.

16. Use of English – Hospital (overnight stay) • 74% of Anglophone respondents used English in hospitals for visits involving an overnight stay. • 94% of respondents in Montreal (west) used English as did 75% of those living in Monteregie, central Montreal, the Outaouais, Cote-Nord and Nord-du-Quebec regions. • fewer than 25% of respondents in Bas-Saint-Laurent, Capitale-Nationale, Centre-du-Quebec, mauricie and Saguenay-Lac-Saint-Jean were able to do so. • In Montreal, 93.6% of respondents in Montreal (west) received these services in English, compared to 55.1% of Montreal (east) respondents.

17. Use of English – All Five Categories of Service • Looking across all five health situations, Anglophone respondents aged 65 and over tended to be the age group who were the least likely to ask for service in English and the most likely to be served in English. • In transactions with a doctor, CLSC, and Info-Santé those respondents age 15 -24 were the least likely to receive service in English and the most likely to request English service. • In the situation of CLSC services, this group was more than twice as likely as other age groups to report having made a request for English service. • In hospital emergency/out-patient clinic as well as hospital overnight Anglophone women were more likely than Anglophone men to be served in French despite asking for service in English.

18. Barriers to Requesting Services in English • 18% of respondents reported feeling uncomfortable in asking for services in English. • Regions exceeding the provincial average for feeling uncomfortable include Bas Saint-Laurent, Capitale-Nationale, Chaudière – Appalaches, Centre-du-Quebec, Mauricie, Laval and eastern Montreal and Lanaudière. • The most important reasons given for being uncomfortable related to efficiency (25% said a request may impose a burden while 22% expressed concern that a delay would occur) • In the Montreal region, 11.2% of respondents in Montreal (west) were uncomfortable asking for services in English, while 25.9% of respondents in Montreal (east) were uncomfortable.

19. Health Information and Promotion • 73% reported that they had not received any information from public health and social services institutions about access to services in English in the two years prior to the survey. • This level is nearly 90% in some regions (Bas-Saint-Laurent, Lanaudière and Centre-du-Québec). • Some regions (Nord-du-Quebec, Côte-Nord, Capitale-Nationale, Estrie, western part of Montreal) showed higher than average likelihood of receiving information about access to services in English.

20. Health Information and Promotion • When Anglophones did receive information regarding English services it was most frequently from public health services (33.3%) and the newspaper (32.7%). These are followed by community organizations (23.8%). • In the Montreal region, 30.7% of respondents in Montreal (west) received information in English about public health promotion or prevention program from the public health system, while 19.1% in Montreal (centre) and 18.6% in Montreal (east) did so. • Mauricie, Saguenay – Lac-Saint-Jean, Côte-Nord, Nord-du-Quebec, Montérégie and eastern Montreal showed higher than normal tendencies to rely on public institutions for information about services. Respondents in Bas-Saint-Laurent, Chaudière – Appalaches, Centre-du-Québec, Abitibi-Témiscamingue and Gaspésie – Iles-de-la-Madeleine were more likely than normal to rely on community organizations for their information. • Just one in five Anglophone survey respondents had received information about a public health promotion or prevention program in English in the two years prior to the survey. The school system was the most common source of such information (29%) followed by community organizations (28%) and by the public health system (21%).

21. Conclusions and Key Points for the CHSSN Demographic factors and health status inequalities • Serious demographic challenges and differential access to the health and social services system are creating health status inequalities in English-speaking communities in many regions. • Demographic factors are combining to create vulnerable communities. About half of the regions suffering from population decline are also regions likely to have high rates of aging and higher rates of low-income compared to the Francophone population. • Income is a major determinant of health affecting such factors as living conditions, food security, and the ability to adapt and cope with stressful situations. English-speaking communities in all regions except Montreal and Nord-du-Québec are experiencing rates of low income that are greater than the surrounding Francophone communities. • Income gaps between groups increase social problems and health status inequalities. The low-income gap between Anglophone and Francophone communities is 20% or greater in half of all administrative regions in Quebec.

22. Conclusions and Key Points for the CHSSN Linking income, health and satisfaction with services • The study points to a link between income, assessment of health status and satisfaction with services. Survey respondents with annual household incomes below $30,000 were much more likely to describe themselves as in poor health, compared to other income groups. • Those assessing themselves as in poor health are more likely than others to express low levels of satisfaction with access to the health and social services system. Households under $30,000 are also more likely to turn to public services, or to have nobody to turn to, in the case of illness. • Those self-assessed as in poor health are the least likely to rely on family and friends, and twice as likely as others to turn to public health and social services in the case of illness.

23. Conclusions and Key Points for the CHSSN Gaps in access to health and social services in English • In general, a majority of English-speaking people were served in English when visiting a doctor in a private clinic, using a CLSC, Info-Santé, or a hospital. This is testimony to the years of effort to implement the legislative guarantees of services in English. • However, gaps in access to English-language services occur depending on whether an Anglophone is in an urban centre or a rural or isolated region. Gaps within regions occur, for example, between the eastern and western sectors of Montreal. • Some services have a very low rate of use by Anglophones, such as Info-Santé, and some groups experience access differently, depending upon their age or gender.

24. Conclusions and Key Points for the CHSSN Gaps in access to health and social services in English • Less than 50% of survey respondents received services in English in four regions for a doctor, and in over half the administrative regions for CLSC services, Info-Santé, hospital or clinic visits, and an overnight hospital stay. • Perhaps because of the emphasis on services to seniors, English-speaking respondents over 65 tended to be the age group least likely to ask for services in English, but most likely to be served in their language. • In contrast, respondents 15 to 24 were the least likely to receive services of a doctor, CLSC or Info-Santé personnel in English, but the most likely to have requested the service in English. In hospital situations, English-speaking women were more likely than English-speaking men to be served in French despite asking for the service in English. The study points to these situations, which need to be followed up by further research.

25. Conclusions and Key Points for the CHSSN The active offer of services in English • The active offer of services in English is a factor in determining whether services are provided in that language. It often falls on the person requiring service to request it in English. In two regions, over 40% of respondents were uncomfortable asking for services in English, while over one in four persons were uncomfortable making the request in six other regions. • Just under half of English-speaking people who are uncomfortable believe their request adds a burden or it will cause a delay in service. Public institutions need to be aware of this dynamic when planning services for English-speaking people.

26. Conclusions and Key Points for the CHSSN Community organizations • Community organizations and other English-language institutions are playing a key role in regions where communities are vulnerable. English-speaking people in regions such as Québec (Capitale-Nationale) and Estrie are much more likely to turn to community organizations in the event of illness, than English-speakers in other regions. We know that community organizations play a critical role complementing the public health and social services system in both these regions. • English-speakers 65 and older are more likely than other age groups to turn to a public institution and (or) a community resource. We are learning that those with middle-range family incomes are more likely to call on a community organization for help than other income groups. • For health promotion and prevention information in English, our newspapers are matching public institutions as sources of this information. Almost one in four survey respondents received this information from a community organization. This number is much greater in five regions that experience demographic vulnerability. Only 1 in 5 English-speaking respondents received health promotion and prevention in English in the last two years. However, the community’s schools and community organizations were more effective than public institutions in providing the information.

27. Conclusions and Key Points for the CHSSN Challenging the myth of Montreal • Because of the concentration in Montreal of English-speaking people and presence of key institutions, the situation of access to English-language services has been difficult to determine. The survey sampled three sections of Montreal (west, central and east). Major differences in access were revealed, particularly between east and west. • English-speaking people in the East Island are more disadvantaged when requesting services in English from doctors in private clinics, CLSCs, Info-Santé, hospitals and receiving health promotion and prevention information in English. For public services other than doctors, English-speakers in the western part of Montreal were 30% to 40% more likely than their East Island neighbours to have access to these services in English.

28. Conclusions and Key Points for the CHSSN Partnership with Quebec’s health and social services system • Working to address these challenges are English-speaking communities, public institutions, regional agencies and government. Quebec’s initiatives to adapt its health and social services system to meet the needs of English-speaking communities are supported by major contributions from the Government of Canada through an action plan to support English-speaking communities. • This report has confirmed the issues facing many English-speaking communities. It has revealed new information which will help communities and their public partners take action to support community vitality and continue to improve access to the range of health and social services in English.