Language Barriers and the Pandemic.
During the summer of 2020, Texas experienced a significant surge of coronavirus infections and hospitalizations. As in other parts of the country, large cities, such as Dallas and San Antonio saw significant increases in COVID-19 cases. Often, such infections disproportionately affected communities of color and people who are limited English proficient who are in critical need of qualified and legally compliant language assistance to ensure their health and safety.
Non-English Speakers in Houston
Houston is one of the largest cities in the United States, with a population of more than 2.3 million people. According to the U.S. Census American Community Survey, more than 45% of Houston residents speak English and another language, which is a greater percentage when compared to the United States as a whole (20.5%), Texas (34.6%), and the Houston metropolitan area (37.2%). Texas has one of the largest LEP populations in the U.S., with more than 14% of state residents not being proficient in English. Harris County, where Houston is located, has one of the nation’s highest LEP percentages, with Spanish speakers as the largest non-English spoken language group.
As the Houston Chronicle reports, the city’s Hispanic population has been at the forefront of the rising infection rates.
“Over the last two months, rapid case growth among Hispanic residents has drastically outpaced COVID-19 spread among other ethnicities, the Houston Chronicle reported, with up to 65 percent of those hospitalized being of Hispanic ethnicity. Latest available data from the U.S. Census Bureau show that Hispanics comprise the majority of Harris County’s population, accounting for 43 percent of residents.
Public health experts and agencies have outlined several reasons for this health disparity. According to the Centers for Disease Control and Prevention, many Hispanics work in front-line industries that require they interact with the public for long hours; live in multi-generational households in densely packed communities; rely on public transportation; and are almost three times as likely to be uninsured and therefore less likely to seek medical attention.”
The Language Barrier and COVID Impact
The language barrier is a substantial cause of the disparate COVID impact experienced by Houston’s Hispanic community.
According to the Chronicle:
“…The Hispanic community is being disproportionately affected by the pandemic, and experts say language barriers and lack of translated health information are a big reason why. In response, hospitals and health departments are hastily launching marketing campaigns, increasing community outreach efforts and altering translation services to accommodate the surge in Hispanic patients.
When July Garza sought out a COVID-19 test in early July, the mother of eight had lost her sense of taste and smell and couldn’t catch her breath. Worried she might have the coronavirus, Garza spent two days trying to get tested at the Santa Clara Family Clinic off Telephone Road in south Houston. She paid $110 for a blood test that came back “negative,” the word circled and underlined twice. She was relieved.
The next day, she passed out in the shower. It just got worse and worse, Garza, 29, said. I have eight children at home, three with medical conditions… and one already started getting symptoms.
Garza later discovered the test she had taken was for COVID-19 antibodies – not the virus. In hindsight, she said she had noticed multiple patients complaining in Spanish to a front desk employee about tests they had been given. She remembers seeing one bilingual staff member in the packed waiting room of mostly Hispanic patients and noticed all of the paperwork was in English.
I felt taken advantage of…I wasn’t the only one, Garza said. It was wrong, they should have explained, taken more time and used more safety precautions…
Lack of Information
Dr. Luis Ostrosky, infectious diseases specialist with UT [University of Texas] Physicians and McGovern Medical School at UTHealth, said Hispanics may have a genetic predisposition for more severe forms of the deadly disease due to conditions such as diabetes and obesity being more prevalent in the community. Many also have limited access to care and wait until their conditions worsen or it is too late to see a doctor.
Another explanation is misinformation within the community and attempts to minimize the disease as not a dire emergency,” Ostrosky said.
Ostrosky said at the start of the pandemic, health officials like himself saw a lack of health information and public materials being made available in Spanish. Gov. Greg Abbott’s office releases COVID-19 information through a resource website that fails to adequately translate the information into Spanish, the Texas Tribune reported. Abbott’s office does not offer translated versions of press conferences or news releases.
Health experts say these language barriers can leave some of the most vulnerable populations unaware of critical health information such as where to receive free testing, how the virus spreads, the different tests being offered and when to see a doctor.
…what happened to patients such as Garza is another problem the pandemic poses for vulnerable populations: addressing language barriers and lack of communication within hospital and clinics that are swamped with requests for help. It’s unfair. There should be more help for those that don’t speak English and for those who are not from here,” Garza said. They are just stuck at home having to deal with this illness by themselves and no one is there for them. There should be more translators, more places that can help.”
In addition to the spoken language barrier, cultural differences and illiteracy in the native language also negatively affect communication without necessary planning. Ensuring that people understand critical, life-saving health care information is always legally required and vitally important. Such understanding is exponentially more important in a national emergency.
Federal Language Access Requirements
As the US Department of Justice has stated:
“…complying with [federal language access] requirements becomes even more important during emergencies and disasters in order to ensure that no one is unjustly denied the services and support they need during times of crisis, when their physical safety or well-being are often at greatest risk, and when many of the resources they might otherwise have drawn upon for support may not be available. Proper planning to comply with [federal] requirements avoids complications imposed by the exigencies of emergencies and disasters.”
Illiteracy and Other Cultural Barriers
The Chronicle reports:
“Another component to addressing language barriers is the fact that some people are illiterate and cannot easily understand translated health materials. Hope Clinic, a federally qualified health center in Houston, hires within the ethnic communities it serves and helps staff become representatives of their communities so they can help disperse information those residents may not find elsewhere.
They understand the cultural aspect and they understand the barriers,” [Hope Clinic COO Shane] Chen said. “You need to have a person or representative to at least get the message out so that it is…shared layer by layer by layer all the way down to those who are illiterate and vulnerable.
Impact of Language Barriers During the Pandemic
According to the CDC, little is still known about COVID-19 and immune response. Chen said addressing language barriers and the pandemic’s effect on non-English speaking populations requires more than just increasing translation services and access to health materials, but also requires ensuring that education continues even after a patient’s recovery.”
Cathy Easter, senior vice president of community development for Houston Methodist Hospital, recognizes that the pandemic has revealed serious health disparities and language barrier issues that impact patient care. They are among her pandemic health care takeaways.
“Because of Covid-19, these issues have been highlighted and more people are aware of the challenges that underserved communities face, whether those be around payments and access or around language barriers,” Easter said. “That to me is really another barrier to address.”
© Bruce L. Adelson 2020. All Rights Reserved The material herein is educational and informational only. No legal advice is intended or conveyed.
Bruce L. Adelson, Esq., is nationally recognized for his compliance expertise. Mr. Adelson is a former U.S Department of Justice Civil Rights Division Senior Trial Attorney. Mr. Adelson is a Department of Family Medicine faculty member at Georgetown University School of Medicine where he teaches organizational culture, implicit bias, cultural and civil rights awareness.
Mr. Adelson’s blogs are a Bromberg exclusive