More than 24 million U.S. residents speak a language other than English or have trouble communicating clearly without resorting to their native tongues. The new health care plan being debated in Congress promises to bring millions more of these legal immigrants into a system already struggling to communicate with patients in their languages to assure they get the life-saving care they need. Is the health care system ready for more immigrants, even if they are here legally? Why should we embrace any language other than English anyway? Isn't this America?
Given the burgeoning Hispanic population, Spanish is an obvious second language to English and is spoken throughout the health care system in the United States. Still, the more obscure of the 176-plus languages and various dialects used in doctors' offices, at clinics, even in emergency rooms when timely attention matters most, often create the most opportunity for patient harm. Some of these patients are underprivileged, but many are not. Research shows that limited English-proficient (LEP) speakers come from all ages and income brackets. The most pressing language needs might surprise you since you've likely never heard of many of them: Arlington, Virginia, needs Krio interpreters (the language of Sierra Leone, Africa); Denver needs Karen speakers (spoken in Myanmar, formerly Burma); Seattle needs Oromo (Ethiopia); and Phoenix needs Dari (Afghanistan).
Federal law obligates health care providers receiving government funding to ensure language access to LEP individuals who cannot tell their doctor what hurts, but that hasn't always been enough to ensure full adoption and save lives. Without guidance or consistent enforcement, hospitals and other medical facilities have responded to the federal language access requirement in dramatically different ways, with some offering in-house interpreters combined with over-the-phone language interpreting services and others offering much less. Even among those with formal interpreting services, the level of quality varies greatly. Fortunately, the states have started stepping up to strengthen interpretation services. A California law took effect on January 1, 2009, requiring all health plans to offer the same access to language services as enrollees in government plans; Hawaii requires language services in all state programs; Maryland mandates language assistance by hospitals and agencies receiving federal funds; Washington requires cultural competency training for physicians; and New York hospitals must develop language assistance programs.
Between 1990 and 2000, the percentage of Americans speaking a language other than English at home increased from 13.8 to 17.8 percent as the LEP population grew from 6.1 percent to 8.1 percent. As we enter a new decade, we're at a point where this ongoing linguistic change cannot be refuted, and the combination of progressive language law, the expanding needs of an ever-evolving national landscape of patients and just plain common sense have us at a tipping point.
Yes, this is America -- the ultimate melting pot. And, although our country is much more diverse and complex than many of us would sometimes like to acknowledge, these differences make us special and unlike any other nation that has ever been. History shows a strong tradition in the U.S. of eventually assimilating each wave of immigrants into our society, the majority of which do learn to speak English. But, the reality is that in 2010 we won't be a country of one language, or even two or three. We are a country of nearly 200 languages -- and cultures -- and growing. That's a good thing as we all benefit from the diverse backgrounds and cultural differences of each other. And, at some point, everyone has to go to the doctor.
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