The COVID 19 pandemic has revealed much to be improved in the United States’ approach to health emergencies and the reality of language-based discrimination. All too often, the lack of real time, qualified interpreters and translation of necessary health care information have resulted in individual ad community harm. The reality of health care disparities based on language has been laid bare over and over again since March 2020.
Now, after almost two years of compiling and analyzing pandemic data, health care professionals are publishing the results of their work. Not surprisingly, their studies reveal how often Limited English Proficient (LEP) people have been left behind by health emergency first responders and the nation’s health care system.
“This is one of the first times primary language was identified as a risk factor for hospitalization from COVID-19.”
For example, a recent article, “Racial and Ethnic Disparities in Hospital Admissions from COVID-19: Determining the Impact of Neighborhood Deprivation and Primary Language,” published in the Journal of General Internal Medicine, concludes:
“Unfortunately, the pandemic disproportionately affects the most vulnerable. Similar to our study, other studies found an increased risk of poor COVID-19 outcomes in non- or limited English speakers using different measures. Rozenfeld et al. found primary language other than English was associated with infection risk to a greater degree than race. Karmakar et al. recently found [limited English proficiency] was the most significant predictor of incidence and mortality for COVID-19 when measured at the county level. Strikingly, we also found non-English-speaking patients within each minority racial/ethnic group had a higher odds of hospitalization than those who primarily spoke English. To our knowledge, this is one of the first times primary language, at the individual level within and across minority populations, was identified as a risk factor for hospitalization from COVID-19. The underappreciation of primary language as a risk factor for severe COVID-19 is likely to further these associations…
English proficiency can be closely associated with socioeconomic status as it affects … daily interactions, employment opportunities, and level of discrimination. During the pandemic, much of the information (and misinformation) regarding public health is derived from multiple modes of media, primarily in English. While multi-lingual versions of guidelines from the CDC attempt to mitigate this shortcoming, the rapidly changing COVID-19 information makes media a more convenient avenue to consume information. Community efforts are necessary in assessing and alleviating the disparate outcomes influenced by language proficiency across and within racial and ethnic communities.
Minority communities, specifically non-English speaking and those with lower literacy rates, are more likely to be unaware of public health recommendations and are more susceptible to misinformation, which compounds a deep-seated distrust in healthcare due to historical discrimination and personal injustices. To combat this, we must ensure all forms of communication are available in different languages and with a robust community dissemination strategy. Urgently, we address healthcare providers’ implicit bias, including trainees, to ensure healthcare provision equitably by creating a healthcare community filled with cultural humility…
Minority and non-English-speaking populations are clearly at high risk from multiple aspects of this health crisis …”
“Poor English proficiency is a risk factor for illness… because it affects employment, amplifies health problems related to racial discrimination.”
Another recent study, “Asian-Americans and Pacific Islanders in COVID-19: Emerging Disparities Amid Discrimination,” published in 2020 by the Journal of General Internal Medicine, examined the healthcare disparities experienced by the Asian-American and Pacific Islander communities in the United States during the COVID pandemic and their resultant damaging impacts, highlighting issues of culture, socio-economics, and language:
“AAPIs are at high risk for COVID-19 transmission, in part due to their over-representation in the essential workforce, but also due to cultural factors, such as inter-generational residency, and other social determinants of health, including poverty and lack of health insurance. Some AAPI subgroups also report a high comorbidity burden, which may increase their susceptibility to more severe COVID-19 infection. Furthermore, AAPIs have encountered rising xenophobia and racism across the country, and we fear such discrimination only serves to exacerbate these rapidly emerging disparities in this community…
Minority communities are known to be more exposed to the virus, due to their over-representation in the low-wage, essential workforce at the front lines. They too face challenges once away from work, such as inability to socially distance due to housing density and over-crowding.
Among these frontline workers, Filipino-Americans are at increased risk due to their outsized proportion in the nation’s nursing force. Filipino-American nurses have a lengthy history in the USA, and though they account for 4% of the total nursing workforce, they comprise up to 20% of registered nurses in states such as California. They are more likely to work in acute care, medical/surgical, and intensive care units, thus serving on the front lines of care for patients with COVID-19…
Approximately 1- in-3 AAPIs have limited English proficiency (LEP), although this varies tremendously by subgroup. For example, 78% of Bhutanese-Americans have LEP. Poor English proficiency is a risk factor for illness, serves as a social determinant because it affects employment, amplifies health problems related to racial discrimination, and restricts access to services. For instance, 57% of Cambodian-American women report difficulty accessing care due to a scarcity of interpreters. Not surprisingly, a recent survey found that 9 of 10 of AAPI serving community organizations cited the dire need for COVID-19 resources in AAPI languages. Websites such as translatecovid19.org have surfaced to meet this need, but such efforts require greater support and development.”
US Department of Justice Says “It’s the Law.”
Armed with these and other new studies, governments, health care providers, first responders, and non-profits should fully absorb their stark conclusions to better prepare for the next emergency and work to alleviate life threatening health care disparities. Along the way, lives can be saved and longstanding law about language access requirements can be fully satisfied.
The U.S. Department of Justice has historically been unequivocal about the federal requirements for language assistance and the necessity for planning for emergencies and disasters to prevent language and national origin based discrimination. Such planning helps ensure people have equal access to emergency, life-saving services and information in languages they understand. It’s not just sensible advice, it’s the law.
According to the Department of Justice:
“… complying with [federal legal] 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 Title VI [of the Civil Rights Act of 1964] [language access and assistance] requirements avoids complications imposed by the exigencies of emergencies and disasters.”
© Bruce L. Adelson 2021. 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 faculty member at the Georgetown University School of Medicine and University of Pittsburgh School of Law where he teaches organizational culture, implicit bias, cultural and civil rights awareness. Mr. Adelson’s blogs are a Bromberg exclusive