When I was in elementary school, I was Mom’s right-hand man when it came to interpreting official documents, work emails, or American jokes. How 20.3 percent of the US population, I grew up in a predominantly non-English-speaking home, since Korean is my parents’ native language. Of all the strange translations my mother consulted me on, those related to healthcare were always the most difficult. Even today, as a medical student, I find it difficult to fully understand the fine print of insurance policies and terms and conditions. So if the US healthcare system and its medical jargon are already confusing enough for fluent English speakers to navigate, how difficult is it for patients with limited English proficiency (LEP)?
In a country that describes itself as a melting pot, how do we address the unfair association between low health literacy and adverse health outcomes?
According to the US Department of Human and Health Services (HHS) Health literacy is the ability to access and understand health information and services that can be used to make informed decisions and take care of one’s health. There is a strong correlation between low health literacy and poor health outcomes, due to under-utilization of immunizations, routine check-ups and other preventive services. Even something as simple as taking a pill once a day can be extremely dangerous if misunderstood than taking it eleven times a day. This is the reality for many LEP patients.
In other words, this leaves us with vulnerable patient populations – and as the former Surgeon General wrote, dr Regina M BenjaminPoor health literacy causes “increased prevalence of health inequalities among older adults, racial/ethnic minorities, recent refugees and immigrants, low-income individuals and non-native speakers of English”.
Although they exist 22.4 million Asian Americans, there are a limited number of US-based studies of Asian American health literacy, let alone Asian American health in general. In view of this research gap, we turn to a Study conducted in Norway who found that language barriers made it significantly more difficult for Thai and Filipino immigrant women to understand the Norwegian healthcare system. The same is true for individuals in the US, where being from a minority ethnic group or being an immigrant with a language barrier further complicates navigating an already unfamiliar, overly complex healthcare system.
research by dr. Chen and colleagues found that a significant number of Chinese LEP immigrants showed higher health literacy when communicating in Chinese than in English. This result was consistent across all fronts when measuring health literacy: functional health literacy, interactive health literacy, and information assessment. Once again, we are shown that language barriers can directly contribute to health disparities in the Asian American immigrant population.
Additionally, it is important to recognize that these health disparities affect disproportionately underrepresented ethnic minorities, even within the larger Asian American population. A study has specifically addressed the health inequalities faced by Hmong Americans who are the third lowest income group among all ethnic groups in the United States. This study is particularly noteworthy because it suggests that “it would be important that health information is not only linguistically consistent, but also presented in a way that takes into account the patient’s existing cultural understanding of health and disease.” Put more simply, we should hire interpreters who understand not only the language but also the culture and background to better serve each healthcare individual.
Under Title VI of the Civil Rights Act, Executive Order 13166And Section 1557 of the ACA, federal agencies must provide appropriate interpreting services for LEP patients. But in 2016, the American Hospital Association found this out only 56 percent of hospitals Respondents offered language and translation services. Also during Section 4302 of the ACA prescribed stricter data collection standards, less than the half data on language needs reported by commercial, Medicaid, and Medicare plans. While some interpreting services are already available, they are not always available in all languages, inexpensive within the healthcare system, or known and accessible to LEP patients.
However, several studies repeatedly show that comprehensive Interpreting services are directly responsible to improve healthcare and outcomes for LEP patients. Therefore, we need to focus on improving interpretation services to better address the unfair correlation between low health literacy and poor health outcomes.
Improved interpreting services can be made possible through the following three steps: 1) HHS should be held accountable for offering a wider range and quantity of interpreting services, 2) medical interpreting training should place more emphasis on the importance of cultural competence during interpreting, and 3) the CDC’s Immigrant, Refugee, and Migrant Health Division can increase the scope of health research that focuses on underrepresented populations.
So, I ask our government’s policymakers, will you finally embrace our country’s notorious identity as the so-called melting pot of the world? It’s time we lived up to the name and worked to provide better health care for all of our employees.
Stella Cho is a medical student.