Despite educational initiatives and myriad public service efforts, the United States’ language barrier persists as a significant problem, one which disadvantages and harms limited English people every day.
In recent years, the United States has seen the biggest wave of immigration since the early 20th century. The number of U.S. residents born in a different country increased by 57 percent between 1990 and 2000, going from 19.8 million to 31.1 million. Most of the new arrivals emigrated from Latin America, although many traveled from Asia and Africa. In comparison, Europe, once the primary source of immigrants, now contributes a relative trickle. Even faced with increased border, port, and airport security since September 11, 2001, large numbers of immigrants continue to arrive in the United States. Today’s immigrants bring with them a diverse range of cultures and, more critically, languages, perhaps more languages than ever before in American history.
In 2013, more than 61 million people in the U.S. reported speaking a non-English language at home, of which approximately 4 out of 10 reported limited English proficiency (LEP). That number rose to nearly 66 million in 2019. Despite the linguistic diversity of the U.S., health professions schools, for example, typically only teach clinicians to communicate with patients in English, resulting in significant gaps in providing quality health care to the growing LEP population.
According to Health Affairs, research has shown that language-discordant encounters—or, in other words, encounters where the patient and clinician do not speak the same language—result in worse health outcomes, reduced access to health information, and decreased satisfaction with care. Conversely, language-concordant care improves health outcomes for individuals with LEP. An objective-in-development of the Healthy People 2030 initiative of the Department of Health and Human Services is to “increase the proportion of adults with LEP who say their providers explain things clearly.”
New reporting reveals that although large LEP populations continue to arrive in this country, the traditional problems the new arrivals encounter remain chillingly like those of years past. Indeed, in many ways, the problems are worse today because they continue and the people, such as first responders, health care providers, and public-school teachers who regularly encounter those who cannot speak English, are themselves burdened by financial limitations and staff shortages.
As reported by The Groundtruth Project in September 2023:
“Every time there’s a neighborhood meeting with the Stockton, CA, Police Department, Griselda Juarez leaves her work early to attend. But more often, she goes back home without having voiced her concerns. Juarez doesn’t speak English and often there are no translation services available to understand what information is being given and to allow her to ask questions.
The potentially dangerous consequences of this language gap were highlighted last October when Stockton officials held a town hall meeting to discuss the threat of serial killings in the city since April 2021. The meeting had no Spanish translation, despite Latinos being the most vulnerable population to this threat due to the number of farm employees leaving home before dawn for work.
The language barrier is also present in doctors’ offices across the country, where Latinos who don’t speak English struggle to communicate with their healthcare providers, increasing the risks for a misdiagnosis or not understanding health care directions and the recommended treatment path. According to the Pew Research Center, 44% of the participants in a 2021 survey said that language barriers are a main contributor to Hispanic Americans having worse health outcomes than other adults in the U.S.
In Manchester, NH, Latinos living with elderly family members who don’t speak English struggle to help them stay active and socially connected. Senior centers offer free classes and activities for older residents, but none of them are in Spanish, nor do they have materials or outreach in their native language. Their explanation for the lack of services relies on stereotypes: Latinos are not interested because, in their culture, the perception is that their family takes care of them.
Although federal law [Title VI of the 1964 Civil Rights Act] requires all agencies that receive federal funding to provide services to those with limited English proficiency, there are gaps in [the law’s] implementation at the state and local level, creating a language barrier that too often presents a danger for the lives of the nearly 16 million Latinos who speak English less than “very well,” according to the Census. For them, something as mundane as a visit to the doctor or a parent-teacher conference can become a fraught interaction where miscommunication can have lasting consequences as was evidenced by the disproportionate impact that COVID-19 had on the Latino population.”
Exacerbating the challenge is often a fundamental lack of trust, between LEP communities and government organizations. Whether arising from mistrust of government in their countries of origin or borne from lack of consistent, competent language services here, the mistrust further impedes providing vital information in languages LEOP people can understand.
For example, a 2013 University of Illinois at Chicago study reported that 44 percent of Latinos surveyed said they are less likely to call the police if they have been victims of a crime for fear of being asked about their immigration status or that of their families.
According to the Groundtruth Project,
“… coupled with the fact that many immigrants don’t know that in many cases they have the right to request an interpreter, this makes an already vulnerable population even more exposed to crime, medical errors and other dangers, also reducing its options to access programs and opportunities that can improve their lives…
In many states, private organizations and grassroot networks have stepped in to fill the gap. In Yakima Valley, WA, hospitals and health care providers pair certified interpreters with the same healthcare providers so that, over time, they learn their speech patterns and way of communicating: “It’s a lot easier and a lot more fluid when we know the provider and how they speak with a patient,” said Angelina Garcia, language access program manager at Memorial hospital in Yakima. “You usually feel a lot more comfortable when you interpret for the same provider consistently.”
The language barrier extends to virtually all government and non-profit provided services, such as domestic violence treatment and counseling, bilingual tax preparation assistance, and care for family members who have disabilities.
However, despite setbacks and service inadequacies, people like Griselda Juarez “…continue to push for solutions, recognizing that increasing visibility and representation can lead to change. ‘I believe that even if we don’t understand, (we should go to the meetings) so they see us and see that people are interested,’ she said.” Perhaps such direct, personal advocacy can be the catalyst to effect change and make communication among people who speak different languages much more of a universal reality than it is today.
© Bruce L. Adelson 2023. 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.