Canada. It’s the land of government health insurance and constitutional protection for the rights of the disabled.

It’s also home to 3 million people who are hard of hearing or deafened.

So what’s it like to be a hard-of-hearing Canadian? It’s probably about the same as being a hard-of-hearing person in another country, just different. Let’s take a closer look.

Legal rights and accommodations

Discrimination based on mental or physical disability is unconstitutional in Canada .

Carole Willans-Théberge, a hard-of-hearing lawyer and advocate employed by the Canadian Department of Justice, is one of the founding members of the National Committee of Federal Public Servants with Disabilities and serves as National President of the Canadian Hard of Hearing Association (CHHA). She explains the legal rights and privileges of hard-of-hearing Canadians.

“The rights of Canadians with disabilities, including those with hearing loss, are protected under the Constitution, notably by virtue of the Canadian Charter of Rights and Freedoms.  Notably, Section 15 of the Charter prohibits discrimination based on mental or physical disability.  All of the 10 Canadian provinces have adopted a similar provision in their province’s Charter of Rights, and the three territories are included within the scope of the federal Charter.  In addition, there are a broad variety of federal and provincial legislation (laws and regulations) that contain specific provisions enhancing the protections for persons with disabilities in specific situations.  For example, the Criminal Code of Canada recognizes the rights of persons with disabilities to a full and complete defense in a variety of ways, as well as their right to participate in juries, etc.  The Canada Elections Act provides access to voters with disabilities.  The list is endless.” 

“Because disability rights are constitutionally protected and are recognized in a broad range of legislation, there is no need for the equivalent of an Americans with Disabilities Act.”

“Accommodations in the workplace is the law, notably within the federal public service (federal Employment Equity Act), but also in the public and private sectors, due to the non-discrimination provision contained in the federal Constitution and in the provincial Charters. For the same reason, accommodation to the point of undue hardship applies to public places and recourse can be had to the Canadian Human Rights Commission or to the appropriate provincial Human Rights Commission, depending on the nature of the issue and the appropriate jurisdiction.”

Communications access

The Canadian Association of the Deaf and the Canadian Hard of Hearing Association have advocated for improved access to communications system for deaf and hard of hearing Canadians, and have achieved many victories.

Telecommunications companies provide local relay calls free of charge in Canada through a national three-digit access phone number, which is the same as that used in the United States (711). Long-distance calls are billed at a reduced rate.

Television captioning and public education are other areas of significant progress.  Public-service announcements are shown regularly on TV promoting deaf and other “disabled” Canadians as “abled.”

“The accomplishments over the years have been many,” Willans-Théberge said. “To name only a few, CHHA has advocated for television captioning and has obtained 100% captioning from CBC Canada, a major Canada-wide English-language broadcaster and are moving towards a similar achievement in respect of its French-language counterpart.  A nationwide outreach and information effort to hearing health professionals has recently been carried out, in collaboration with partners in federal government and in the hearing health professions.” 

“CHHA’s success in reaching out to young hard of hearing adults has captured the intention of our sister organization, Hearing Loss Association of America (HLAA), to whom CHHA has provided information to assist in this regard.”

Willans-Théberge cites captioning of Canada ’s parliamentary television channels as a particular accomplishment of her organization.

“Real-time print interpretation (a.k.a. captioning) is one of the methods of communications accommodation preferred by Canadians.  The Canadian Hard of Hearing Association is very proud of its achievements in this area.  This has included working closely with former federal Senator Jean-Robert Gauthier, himself hard of hearing, to ensure full access to both Houses of the Canadian Parliament (House of Commons and Senate) for Canadians with hearing loss by ensuring the provision of good quality captioning in both official languages, English and French, on the parliamentary television channels.  This way Canadians across the country can be fully informed of happenings in the federal Parliament.”

Education access

A sad chapter in Canada ’s history of deaf education ended in 2004 when an out-of-court settlement was reached for some 300 past students of Jericho Hill School in Vancouver for sexual-abuse claims. An investigation concluded that abuse was rampant at the residential school from the 1950s to the mid-1980s, and may have continued into 1991 before the school was closed.

The revelations at Jericho Hill coincided with other changes in society and led to a new government policy for educating students with special needs.

Today in British Columbia, deaf students and others with special needs are integrated into regular public schools where individual education plans (IEPs) are developed that describe individualized goals, adaptations, modifications, services to be provided, and measures for tracking achievement. According to the provincial Ministry of Education, the principle of "placement in the most enabling learning environment" applies when decisions are made about the extent to which an individual student is placed in regular classrooms or an alternate placement.

The trend is similar across Canada . A handful of deaf schools remain open but attendance is dwindling as deaf students are integrated into community schools with hearing and hard-of-hearing peers, often while retaining ASL instruction and the opportunity to participate in extracurricular activities with other deaf students.

Health care, hearing aids and cochlear implants

Understanding Canada ’s medical system can be difficult. Although the Canada Health Act mandates universal access to basic health services on uniform terms and conditions, the 10 provinces are responsible for the delivery of those services to their citizens, and there are many variations in coverage.

For example, the Canadian Academy of Audiologists estimates that up to six in every thousand babies born in Canada have a hearing loss, including profound deafness. Yet Canada lags behind Europe and the United States , where hearing screening for all newborns has been legislated in a majority of states. In Canada , universal screening programs are being implemented only in Alberta , Ontario and New Brunswick .

In Canada , government health insurance for hearing-related illnesses generally covers the care of a primary physician, referrals to specialists such as ENT physicians and any related diagnostic testing and medical treatment, including cochlear implant surgery.

With some exceptions, however, hearing aids and other communication aids are not covered by government health insurance. Most are dispensed privately by audiologists and hearing-aid dealers, or by public-service agencies for the deaf and hard of hearing.

As with other medical devices and services, the prices of hearing aids are often lower in Canada than in the United States . And many Canadians have supplemental “extended benefits” insurance, usually through their employers, to provide at least partial coverage of hearing aids, vision and dental care and other services not covered by government health insurance.

The provision of cochlear implants in Canada illustrates some of the benefits and drawbacks of the Canadian public health-care system. All costs are fully paid but there is often a waiting list for the surgery.

Dr. Sipke Pijl, PhD, director of the Department of Audiology at St. Paul 's Hospital in Vancouver , said the criteria for CI candidacy are fairly standard across Canada and internationally because they are openly stated by the manufacturers. Pijl said word-recognition scores of 55-60% or less would generally make a person a candidate for a CI, but many candidates have much lower scores and they might go to the head of the line.

“We prioritize people on the basis of the severity of their hearing loss,” Pijl said. “I think what is happening with every cochlear implant clinic is that there are increasing numbers of marginal patients wanting implants.”

St. Paul ’s is the only clinic in British Columbia (population 4.3 million) for adults. A clinic at Children’s Hospital in Vancouver performs implants in children.

“Here in B.C., cochlear implants for adults are on kind of a quota system,” Pijl said. “They will allow us to do 25 implants a year. That’s funding from the [provincial] Ministry of Health. Until about three years ago, they would only allow us to do 10 a year and before that it was five a year.”

An implant at St. Paul ’s costs about $35,000 Canadian ($32,000 US) and is fully funded by the government. Patients pay nothing initially but must pay the cost of equipment replacement or repairs not covered by a manufacturer’s warranty.

“The surgery and the entire initial outlay of equipment are all paid for by the Ministry of Health and these devices come with a three-year warranty,” Pijl said. “Once we issue the device to the patient, it’s the patient’s responsibility. I think in the long run people with a CI would pay about the same as people with sophisticated hearing aids.”

Pijl said the average wait for patients to receive an implant in British Columbia is about a year. Until government funding was increased three years ago, the average wait was more than four years.

Pijl said he knew of one patient who bypassed the waiting list and went to a clinic in Seattle for an implant, where he paid upwards of $50,000 for it.

Cochlear Americas, Advanced Bionics and MED-EL implants are offered by Canadian clinics, but many clinics specialize in one brand. And since costs are paid by the provincial governments, patients may be limited to the brand or brands offered at clinics in their home province.

St. Paul ’s implants Cochlear Americas devices, and has done so since 1987. Pijl said the clinic finds it cheaper to have a contract to provide one brand rather than to offer a selection of devices at a higher per-unit cost. The clinic can then use the savings to provide more implants for the same amount of government funding.  However, Pijl said that if a patient insisted on receiving another brand, the clinic would do everything it could to honor the request.

Bilateral cochlear implants are not funded in Canada . Pijl said he has a few patients with two implants but they received a second implant because they had some loss in effectiveness of the first implant.

“These people typically do not use them both at the same time.”

“There are a small number of people who are starting to ask about bilateral,” he said, but it’s hard to justify giving a second implant to someone who is doing well with one device when there is a waiting list for people to receive a single implant.

Still, he admits there are benefits of bilateral implants.

“People with bilateral implants have a better sense of where sound is coming from. They generally hear better in a noise background than people with a single implant.”

Pijl said many people like blending the sounds of a hearing aid in one ear with a CI in the other, and they usually appreciate music better that way.

 “A cochlear implant gives you no low-frequency amplification,” said Pijl, who also teaches a course on cochlear implants at the University of British Columbia .

High-frequency sounds are received at the outer edges of the cochlea, he said. An implant typically goes only about halfway in the 34-millimeter cochlea, not far enough to reach the area that receives low-frequency stimulation.

Pijl has particularly strong views about the merits of bilateral implants for children, and says Canadian audiologists are pressing for governments to fund them.

“If I were responsible for a children’s program, I would consider it malpractice not to implant both ears. If an ear has not been stimulated since early childhood, you cannot get any hearing out of that ear in future.”

He said there is a national move afoot by Canadian audiologists to come up with criteria for bilateral implants.

Summing it up

So what’s it like to be a hard-of-hearing Canadian? Asked whether hard-of-hearing Canadians have it easier or harder than those in the United States and elsewhere, Willans-Théberge responded with Canadian diplomacy.

 “It is my personal view that Canadians are blessed in many ways,” she said. “However we are forever open to learning from our counterparts around the world, including the United States of America .  In testimony of this, we are opening our arms to receive the world at the International Congress 2008, which will be taking place in Vancouver , British Columbia , from July 2, 2008, to July 6, 2008.  The Canadian Hard of Hearing Association and the International Federal of Hard of Hearing People (IFHOH) invite you to attend the first International Congress for persons with hearing loss to be held in Canada in downtown Vancouver .  Young adults from all across the globe will be meeting in Vancouver to discuss the issues of special interest to them.  Congress 2008 is a must if hearing loss has touched your life.  Through an exchange of ideas, CHHA hopes to find out what issues persons with hearing loss in other countries deal with, what has been implemented in other countries and what we can work on as a global community.  The theme of Congress 2008 is A Global Community of Communication.”

Congress 2008 participants may find that hard-of-hearing people around the world all the same, just different.

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