By the time I was in elementary school, I was Mom’s right-hand man when it came to interpreting official documents, work emails, or confusing American jokes. Like 20.3 percent of the U.S. population, I grew up in a primarily non-English speaking home since Korean is my parents’ native tongue. Among all the odd translations my mom consulted me for, health care ones were always the hardest. Even today, as a medical student, I find it difficult to fully comprehend the fine-print details on insurance policies, terms, and conditions. So when the U.S. health care system and its health care-steeped jargon are already confusing enough to navigate as fluent English speakers, how difficult is it for limited-English-proficient (LEP) patients?
In a country that self-proclaims to be a melting pot, how can we address the unfair correlation between poor health literacy and negative impacts on health outcomes?
According to the U.S. Department of Human and Health Services (HHS), health literacy is the ability to access and understand health information and services, which 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 an underutilization of vaccinations, routine screenings, and other preventive care services. Even something as simple as taking a pill once a day can be extremely dangerous if misunderstood as 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 written by the former Surgeon General, Dr. Regina M. Benjamin, poor health literacy causes an “increased prevalence of health disparities among elderly adults, racial/ethnic minorities, recent refugees and immigrants, low-income individuals, and non-native speakers of English.”
Despite there being 22.4 million Asian Americans, there is a limited number of U.S.-based studies on Asian American health literacy, let alone Asian American health in general. Given this research gap, we turn to a study conducted in Norway which found that language barriers made it significantly more difficult for Thai and Filipino immigrant women to understand the Norwegian health care system. The same holds true for individuals in the U.S., where being a racial minority or immigrant with a language barrier further complicates navigating an already unfamiliar, overly complex health care system.
Dr. Chen and colleagues’ research found that a significant number of LEP Chinese immigrants had higher health literacy levels when communicating in Chinese rather than English. This result was consistent when measuring health literacy on all fronts: functional health literacy, interactive health literacy, and information appraisal. Once again, we are shown that language barriers can contribute directly to health disparities in the Asian American immigrant population.
Additionally, it is important to acknowledge that these health disparities fall disproportionately on underrepresented ethnic minorities, even within the greater Asian American population. One study looked specifically at the health disparities faced by Hmong Americans, who make up the third lowest-earning population among all ethnic groups in the United States. This study is particularly notable because it suggests that “it would be important for health information to not just be linguistically matched but also be presented in ways that incorporate the patient’s existing cultural understanding of health and illness.” Put more plainly, we should be recruiting interpreters who not only understand the language but also the culture and background to better serve each individual in a health care setting.
Under Title VI of the Civil Rights Act, Executive Order 13166, and Section 1557 of the ACA, federal entities must provide adequate interpreter services for LEP patients. Yet, in 2016, the American Hospital Association found that only 56 percent of hospitals surveyed offered linguistic and translation services. Moreover, while Section 4302 of the ACA mandated stricter data collection standards, less than half of commercial, Medicaid, and Medicare plans reported any data on language needs. While some interpreter services are already offered, they are not always widely available in all languages, cost-effective within the health care system, or made known and accessible for LEP patients.
However, multiple studies repeatedly show that comprehensive interpreter services are directly responsible for improving health care delivery and outcomes for LEP patients. Therefore, we need to focus on upgrading interpreter services to better address the unfair correlation between low health literacy and poor health outcomes.
Improved interpreter services can be made possible through the following three steps: 1) HHS should be held accountable for offering a wider range and quantity of interpreter services, 2) medical interpretation training should increasingly emphasize the importance of cultural competency during interpretation, and 3) the CDC Immigrant, Refugee, and Migrant Health department can increase the amount of health care research focused on underrepresented populations.
So, I ask our government’s policymakers, will you finally embrace our country’s infamous identity as the so-called melting pot of the world? It’s time we lived up to the name and worked toward ensuring better health care for all of our people.
Stella Cho is a medical student.