Determinants of self-rated health, minority status, and access to health services among official language minority older adults in Canada

Abstract

Studies in countries across the globe and in Canada show that people from minority communities generally tend to be in poorer health, experience a greater burden of disease and disability than the general population. A 2008 World Health Organization (WHO) report on the Social Determinant of Health stressed that the high burden of disease and disability around the world is due to a great extent, to poor and unequal living conditions which are the consequence of deeper structural conditions such as poor social policies and programmes, inequitable economic structures, and deficient politics. In Canada, there is a growing body of evidence suggesting a negative impact of health disparities on Official Language Minority Communities (OLMCs), especially on Francophones outside of Quebec. In order to better describe and understand the situation of Official Language Minorities (OLMs), especially of Minority Francophone older adults living outside of Quebec, two national surveys were used: The 2006 Canadian post-census Survey on the Vitality of Official Language Minorities (SVOLM) and the 2007 Canadian Community Health Survey (CCHS). Descriptive, and multivariable analyses were conducted, followed by minority Francophone community members’ feedback on the findings. A qualitative analysis of provincial/territorial French-language (English in Quebec) services policies or legislations was subsequently conducted with an in-depth focus on the Government of Saskatchewan French-language Services Policy and an assessment of the potential impact of these policies on the health of OLM older adults. This study showed that minority Francophone older adults consistently rated their health more poorly than their counterparts in the general population but the study failed to demonstrate an association between OLM status and self-rated health, due to low representativity of the OLM population in the sample. However, the sense of belonging to, and vitality of minority community were constructs associated with better self-rated health for minority Francophone older adults while high concentration of minority group was associated with poorer self-rated health. Feedback from Francophone community members emphasized the detrimental role of assimilation, systemic and structural inequities, and unfavourable policies as contributing significantly to the low vitality of their communities and eventually to health disparities. Adopting new sampling approaches for OLMs, addressing minority Francophones’ contextual realities, enhancing access to health services in French, improving the linguistic environment, and developing more supporting policies, would help improve the condition of minority Francophone older adults in Canada.