“Language access is a basic component of provider-patient communication, health education and promotion, and access to health care programs such as Medicaid, Medicare, and the State Children’s Health Insurance Program.”
-Marguerite Ro, Jinny Jihyun Park, Deeana Jang “Language Access”
Introduction Question:
How important is language access in healthcare?
Is language access still an issue within the United States? Do you know of any examples of this?
Suggested Readings:
Language Access for Asian Americans in Health: Trinh-Shevrin, Chau, Nadia Shilpi Islam, and Mariano Jose Rey.Asian American Communities and Health: Context, Research, Policy, and Action. (Ch. 11)
White House Initiative on Asian Americans and Pacific Islanders: Language Access
Language access is one of the largest health barriers Asian Americans face. Often, data collection for public health research is conducted in English or Spanish. Due to high rates of linguistic isolation and limited English proficiency (LEP), surveys can contain large amounts of errors or exclude a substantial number of the Asian American LEP population. Furthermore, linguistic isolation is often associated with lower socioeconomic status and poorer health, thus, surveys skew and underrepresent health inequity within the Asian American community.
In general, 27% of Asian Americans overall are more likely to experience communication difficulties with their provider in comparison to the general population. Furthermore, Asian American patients from the 2001 Commonwealth Fund Survey stated that they prefer trained interpreters over their family members who are often the only option for patients. Patients wanted to ensure accurate interpretations and felt uncomfortable as a result of family dynamics, especially when children were involved.
It should also be noted that interpretations must be both cultural and linguistically translated, this is why trained interpreters are needed in comparison to family members or staff. Due to cultural barriers, patients may interpret different meanings where another was meant. For example, the case of Chul Sun Moon. Chul Sun Moon was a LEP Korean-American who died in at a NYC hospital on July 9, 2004 from a head injury he had suffered a month before.
During his treatment:
- Mr. and Mrs. Moon were given English forms
- Relied on family, neighbors, and Korean-speaking staff to translate
- Faced numerous appointment rescheduling
- Chose not to return to the hospital several times because they did not have insurance and believed applying for Medicaid would affect the children’s immigrant status
- Mrs. Moon faced a total of 3 days and 23 hours without a translator in the hospital throughout Mr. Moon’s trips to the hospitals – she never received an interpreter
- Mrs. Moon was ignored by staff due to her limited English skills
- Mrs. Moon did not learn of the severity of Mr. Moon’s injury until she encountered Korean-speaking nurses at the 3rd hospital for Mr. Moon’s last surgery. She was told to mentally prepare for his passing.
As one of the most linguistically diverse racial groups in the United States, Asian Americans face a major language access challenge. However, language is a basic component of health care and provider-patient communication. Language access services are a critical necessity and should be designed to promote effective communication between LEP individuals and English speakers. For Asian Americans, this is severely lacking.
Discussion Questions
- Does the U.S. government have an ethical obligations to provide equal language access health care services?
- How do you think socioeconomic status and language access affected the care Chul Sun Moon received?
- What section of healthcare do you think it is most important to receive an interpreter? i.e. basic healthcare, emergency care, pregnancy care, etc.
