The healthcare system should be accessible to all despite language barriers. This section illustrates legal requirements for language access within healthcare, case studies, and research that has been done to examine the state of language access within the healthcare system.

Legal Requirements

Title VI of the 1964 Civil Rights Act protects individuals from discrimination in programs that receive federal funds on the basis of race, color, or national origin. This definition of discrimination also includes discrimination of people who speak a language other than English. The Department of Health and Human Services set requirements that said that individuals who speak a language other than English cannot be subject to discrimination within health and human service programs. For healthcare services to not be discriminatory they need to have a plan for language access for LEP individuals.

President Clinton issued an executive order, Improving Access to Services for Persons with Limited English Proficiency (LEP), which motivated the Office of Civil Rights to create a Policy Guidance to assist health care providers to meet the needs of LEP individuals. This Policy Guidance put forth four factors to consider when an agency is creating policies to address the needs of the population they serve.

1. Proportion of LEP individuals in the population who are being served or are eligible to be served
2. The frequency of contact between LEP individuals and the service provider
3. The importance of the service the organization provides
4. Cost of providing services, a service provider with a limited budget is not expected to provide service equal to organizations with larger budgets

https://doi.org/10.1007/s11606-007-0366-2

Due to the access to access to resources and importance of the healthcare system, these providers should have well-established and effective language access services. However, healthcare service providers do not always make language access a priority. Once a healthcare service provider accepts any type of federal funds, such as Medicaid, they are legally obligated to follow the standards of language access.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2150609/

Consequences of Inadequate Language Access in Healthcare

To get adequate medical care it is necessary for individuals to explain their symptoms and for service providers to explain the risks and benefits of treatment. If there are inadequate  language access resources within healthcare settings it can lead to devastating health outcomes that would disproportionality affect LEP individuals. This disproportionate effect is the reason that inadequate language access is defined as a type of discrimination against people based on their national origin.

Here are some examples of the consequences of inadequate language access:

• Willie Ramirez was erroneously believed to have suffered from a drug overdose when he has actually suffering from a intracerebral hemorrhage. Willie became quadriplegic as a result, which could have been prevented. The healthcare professionals believed that the Spanish word “intoxicado” was equivalent to intoxicated, while the family was trying to communicate they believed Willie had food poisoning. An interpreter would have been able to explain the difference, but one was not present because each party believed they were communicating effectively.
• https://www.healthaffairs.org/do/10.1377/hblog20081119.000463/full/
• Research looking at access to healthcare among Hispanic adults in rural Texas. It was found over half of this population required a translator when going to the doctor (51.3%) and language barriers were one of the main factors that contributed to low rates of healthcare utilization among this population. Without language access individuals who are non-English speaking are less likely to utilize preventative medicine and only interact with the healthcare system through emergency services.
• Duran, M. (2012). Rural Hispanic Health Care Utilization. Online Journal of Rural Nursing & Health Care, 12(1), 49–54. Retrieved from http://ezproxy.lib.utexas.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=104277459&site=ehost-live
• When looking specifically at Hispanics with diabetes, a study found that 60% of Spanish-speaking patients did not take their diabetic medication as directed compared to 37.5% of their White counterparts. This difference is described as a problem of language access. Diabetes management can be complex and need to be communicated clearly for patients to understand.  When Spanish-speaking patients have an English doctor it leads to lower quality of care because the patients are not able to fully understand what they need to do to manage their diabetes, resulting in long term health disparities.
• https://consumer.healthday.com/diabetes-information-10/misc-diabetes-news-181/language-barrier-may-keep-some-hispanics-from-good-diabetes-care-718880.html

When there is inadequate language access resources non-English speaking individuals are not able to receive the same quality of care as English speaking individuals. This is in violation of Title VI of the 1964 Civil Rights Act, because the difference in care is a form of discrimination by an agency that receives federal funds. To file a complaint to the Health and Human Services Office of Civil Rights go to https://www.hhs.gov/ocr/index.html.

Strategies for Improving Language Access in Healthcare

• Gathering data about the language needs of the population different healthcare agencies serve.
• Determine what vital documents need to be translated and in what languages.
• Making sure that language programs in healthcare setting are effective in gaining informed consent.
• Utilizing teamwork between bilingual staff or translators to make sure that LEP patients understand instructions on how to manage medicine and treatments.
• Make language access and priority by creating task forces with healthcare agencies to create and oversee language access programs.
• Connecting with other organizations to learn about what types of programs have been effective in increasing language access.
• Continually evaluate language access programs and policies to make sure they are sufficient to provide equitable care for LEP patients when compared with English-speaking patients.