Christina Eguizabal Love, Psy.D.
Director of Health and Language Access
Office for Health, Equity, Inclusion, and Diversity (O-HEID)
Kennedy Krieger Institute
In the United States, about 1 out of 5 people speak a language other than English at home,1 which equates to nearly 65 million individuals. Those with Limited English Proficiency (LEP) do not speak English as their primary language and have limited ability to read, speak, write, or understand English.2 Providing language access means ensuring that individuals with LEP can communicate effectively to participate in and receive healthcare, an important component of culturally competent services.3 In fact, Title VI of the Civil Rights Act of 1964 and corresponding regulations, including the Affordable Care Act (ACA), indicate that federal agencies and those receiving federal financial assistance are required to provide meaningful access to services for LEP individuals via trained interpreters, translation services, and more.
The ability for individuals to effectively communicate within a healthcare setting is a critical and an important step in eliminating health disparities and achieving health equity.3 Language is a social determinant of health because language barriers contribute to difficulties with accessing healthcare services.4 Language barriers can also contribute to serious health risks for those who have LEP as a result of lower quality of care.5 In the majority of situations, language-concordant care (i.e., a match between a healthcare provider and a patient’s language) improves health outcomes such as having a higher likelihood of receiving preventative health screenings or services.6 However, there is a shortage of health professionals across a variety of specialties who are fluent and able to provide healthcare services in other languages. Moreover, a reliance on unqualified interpreters such as family members can lead to misunderstandings and potentially devastating outcomes, including death.7 Overall, a lack of interpretation services for individuals with LEP in the healthcare setting may have significant effects on patient safety, quality of care, and patient satisfaction.8
The National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care are a set of 15 action steps detailed by the Office of Minority Health (OMH) at the U.S. Department of Health and Human Services (HHS). The aim of the standards is to reduce health disparities and achieve health equity by providing culturally and linguistically appropriate health services.9 For example, the standards include the provision of language assistance to individuals with LEP at no cost to them and in a timely manner, as well as informing all of the availability of language assistance services in their preferred language. Organizations need to ensure the competence of those providing language assistance services and the provision of print and multimedia materials in the languages commonly served by patients and families in the area. Increasing awareness of these standards is an important step in ensuring equitable health services for all. It is also important to consider that language access issues are often “the tip of the iceberg” for individuals with LEP who may also experience difficulties with immigration, discrimination, and poverty among others. Thus, achieving health equity between English-proficient patients and those with LEP will also require addressing root causes and social determinants of health beyond language access.
Dr. Love is a licensed psychologist and pediatric neuropsychologist in the Department of Neuropsychology at the Kennedy Krieger Institute. She provides clinical neuropsychological services to children, adolescents, and young adults with a variety of developmental and medical conditions, primarily within the Epilepsy/Acquired Brain Injury Clinic. She serves as the neuropsychologist for the Philip A. Keelty Center for Spina Bifida and Related Conditions. Dr. Love is bilingual in English and Spanish and has a special interest in working with Spanish-speaking patients and their families. She is also the Director of Health and Language Access within the Office for Health, Equity, Inclusion, and Diversity (O-HEID) where she is working on projects to improve care for individuals and families with limited English proficiency (LEP) at the Institute.
1. Language Spoken at Home. Census.gov. Published March 8, 2022. Accessed September 2, 2022. https://www.census.gov/acs/www/about/why-we-ask-each-question/language/
2. Commonly Asked Questions and Answers: Regarding Limited … – LEP.gov. Accessed September 3, 2022. https://www.lep.gov/sites/lep/files/media/document/2020-03/042511_QA_LEP_General_0.pdf
3. Language Access. Wyoming Department of Health. Published August 23, 2022. Accessed September 2, 2022. https://health.wyo.gov/publichealth/office-of-performance-improvement-and-health-equity/multicultural/cultural/
4. Language as a Social Determinant of Health: An Applied Linguistics Perspective on Health Equity. Language as a Social Determinant of Health: An Applied Linguistics Perspective on Health Equity – American Association For Applied Linguistics. Accessed September 3, 2022. https://www.aaal.org/news/language-as-a-social-determinant-of-health-an-applied-linguistics-perspective-on-health-equity#
5. A Practical Guide to Implementing the National CLAS Standards. Accessed September 3, 2022. https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/CLAS-Toolkit-12-7-16.pdf
6. Diamond L, Izquierdo K, Canfield D, Matsoukas K, Gany F. A Systematic Review of the Impact of Patient–Physician Non-English Language Concordance on Quality of Care and Outcomes. J Gen Intern Med. 2019;34(8):1591-1606. doi:10.1007/s11606-019-04847-5
7. Chen AH, Youdelman MK, Brooks J. The Legal Framework for Language Access in Healthcare Settings: Title VI and Beyond. J Gen Intern Med. 2007;22(S2):362-367. doi:10.1007/s11606-007-0366-2
8. Goenka PK. Lost in translation: impact of language barriers on children’s healthcare. Curr Opin Pediatr. 2016;28(5):659-666. doi:10.1097/MOP.0000000000000404
9. National CLAS Standards – Think Cultural Health. Accessed September 3, 2022. https://thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedNationalCLASStandards.pdf
10. Ortega P, Shin TM, Martínez GA. Rethinking the Term “Limited English Proficiency” to Improve Language-Appropriate Healthcare for All. J Immigr Minor Health. 2022;24(3):799-805. doi:10.1007/s10903-021-01257-w