The COVID-19 crisis has shown the innumerable ways our healthcare system can meet this challenge – and also how we fail to care for our most vulnerable patients.
In March 2020, as COVID cases began to rise, I spoke to staff at Family Van, a mobile health clinic that provides preventive health services in some of Boston’s most underserved neighborhoods. They highlighted the difficulty of finding multilingual COVID information and how this made it difficult for non-English speaking patients to protect themselves. At the time, neither the CDC nor the state health department had published COVID information in languages other than English, Spanish, and Chinese, so community health organizations had to endeavor to compile multilingual information at short notice.
Over a year later this is still a problem. Many state governments provide limited information about the vaccine in languages other than English, and some do not offer language assistance at all on their vaccine search websites. It should come as no surprise that COVID infection rates are many times higher among non-English speakers, a worrying pattern that reflects previous epidemics.
To date, much of the discussion about improving care for non-English speaking patients has centered on medical interpreters. This is important; Patients who use interpreters receive better preventive care, experience fewer adverse events and take more medication. However, COVID has taught us that it is not enough to have just one interpreter at the point of care. There are many deeply ingrained, historically enforced barriers preventing non-English speaking patients from getting the care they need – barriers that begin well before a patient arrives at the clinic and last long after their appointment – and it is time for broader reforms .
Several programs have recently emerged that provide language-appropriate materials and support. These include government-led efforts to translate outreach information into multiple languages and community-led efforts like the COVID-19 Health Literacy Project, an initiative I started to translate COVID fact sheets into 40 languages.
However, these efforts are still an emergency solution. To ensure that non-English speakers are not sidelined again after this crisis subsides, we need to break down the barriers they face not only in medical care but also in access and processing. We need to recreate every part of a non-English speaking patient’s experience with the healthcare system – before, during, and after an appointment.
Before patients even see a doctor, they must be able to access health information in their native language. Hospitals and clinics can work with interpreting services to translate health information (e.g. patient education materials, public service announcements). Our work with the COVID-19 Health Literacy Project has also shown that many bilingual providers are excited about translating materials into their native language, so health organizations can consider building an in-house database of multilingual staff available when needed.
Health authorities can also play an important role. For example, they could hire translators and make them available on a contract basis to clinical and social facilities in rural or low-income communities, where there is often a shortage of interpreters. That’s why we’re transforming the COVID-19 Health Literacy Project into a new not-for-profit organization providing free translation services to community-based organizations to translate health materials into their patients’ languages.
Efforts to translate health information need to be paired with programs to ensure that this information actually reaches immigrant communities. The key is to bring culturally and linguistically appropriate services to the places where people live and work. The medium is also important; There is some evidence that non-English speakers may prefer text messaging or face-to-face communication. A good example is the fleet of mobile vaccination carts in New York City, where bilingual staff help patients navigate every step of the COVID vaccination process in their own language.
When it comes to the appointment itself, health organizations should strive to match patients with providers who speak their native language. Language concordance is associated with fewer medical errors, better understanding of the disease and treatment plan, and greater satisfaction. Of course, this is not always possible and otherwise qualified interpreters should be used.
After an appointment or hospital admission, patients typically receive discharge instructions detailing their new medication, home care instructions, and follow-up appointments. However, for non-English speaking patients, this document is rarely translated into their native language.
There have been some suggestions to use machine translation tools (e.g. Google Translate) to automate the translation of discharge instructions, but this approach needs to go a step further. We should strive to turn discharge planning into a conversation that non-English speaking patients can actually participate in. For example, doctors can provide patients with their translated discharge instructions before discharge, orally (in the presence of an interpreter), and give patients time and space to ask questions.
In order for these changes to work on a large scale, they must be supported by political reforms. A good starting point is the reintroduction of the language regulations that were withdrawn by a recent HHS regulation. Under the new rule, providers are no longer required to add messages to important messages that inform patients of their right to voice assistance. In addition, the lack of a language access program is no longer a violation of legal compliance for many government-funded health organizations. These changes are a step backwards and can lead health organizations to give language access less priority.
How can we pay for these initiatives? For one thing, since the government is distributing $ 1.32 billion to community health centers under the CARES Act, it could mandate a percentage to build the infrastructure needed to support non-English speakers. Additionally, nonprofit hospitals could tap their community funds – community-based services that nonprofit hospitals must provide to justify their tax exemptions – to fund these programs.
It is evident that our healthcare system is failing patients with limited English language skills, and the time has come to take action, move away from stopgaps and implement sweeping changes that will support non-English speakers across the health continuum.
This is an opinion and analysis article; the views of the views Author or authors are not necessarily those of Scientific American.