Latino Policy Institute

Language and Cultural Barriers Hurting Patient Care, Say Physicians

By John Cantlupe, for HealthLeaders Media, February 15, 2010

     Nearly half of U.S. physicians say language or other cultural barriers are obstacles to providing high-quality patient care, according to a study released by the Center for Studying Health System Change.
     Forty-eight percent of all physicians in 2008 reported difficulties communicating with patients because of language or cultural barriers, and said they considered the situation at least a minor problem affecting their ability to provide high-quality care.
     Less than 5%, however, viewed those barriers as a major problem that could result in a disparity of care across ethnic and racial populations, the study reported. Efforts to overcome the obstacles were considered modest or uneven.
     The study, HSC Issue Brief–Modest and Uneven: Physician Efforts to Reduce Racial and Ethnic Disparities shows there is a great need to address the problem of language and cultural communication as the U.S. becomes more diversified, says James D. Reschovsky, PhD, senior health researcher for the Center for Studying Health System Change and co-author of the study. The study, sponsored by the Robert Wood Johnson Foundation, includes responses from more than 4,700 physicians and the response rate was 62%.
     The issue takes on more urgency in the U.S. because an ever-increasing number of people speak a language other than English at home, according to Reschovsky.
     "The challenges physicians face in providing quality healthcare to all of their patients will keep mounting as the U.S. population continues to diversify and the minority population grows," according to the study.
Efforts to reduce the language and cultural disparities face cost and reimbursement issues. "The tools most commonly adopted tend to be the least expensive to implement," the study said. "On the other hand, IT systems that can support reporting on patient care by race, ethnicity or language, as well as interpreter services, are expensive and less common."
     Physicians may overstate their own ability in handling foreign languages. Physician interaction may involve a foreign language spoken by the patient, but the level of understanding on the part of the doctor may not be enough to carry out high-quality patient care, says Reschovsky.
     "If a clinician is using high school Spanish to interpret for his Latino patients, it may not provide the level of communication you want in a clinical encounter," Reschovsky says. "There are also lots of patients who don't have an interpreter. Occasionally interpretation is provided by a family member and that is not necessarily the most optimum arrangement."
     Levels of interpreter services among practioners should be drastically improved, according to Reschovsky. The study found that while nearly 97% of physicians have at least some non-English speaking patients, only 56% were in practices that provided interpreter services in 2008.
     Mai Pham, MD, who works in Bread for the City, a Washington, DC-based clinic, says many physicians and patients face difficulties in overcoming language and cultural barriers, but often these problems aren't articulated—or can't be properly communicated. "Many patients are already feeling vulnerable because they have less information, less expertise, and less control. People can become afraid and insecure, " says Pham, who is also a senior health researcher at the Center for Studying Health Systems Change.
     Healthcare providers have legal obligations to provide needed interpreter services, at least for patients with public insurance. However, physicians in solo and group practices were less likely to adopt measures to address disparities than those in institutional practices, such as hospitals, health insurers, and medical schools, according to the study.

Joe Cantlupe is a senior editor with HealthLeaders Media Online. He can be reached at jcantlupe@healthleadersmedia.com.

Health Care Interpreters: Medical Necessity

The state needs an effective, efficient, transparent and high-quality system that provides not only direct translation but cultural sensitivity. We may never know how many other deaths have occurred because of misunderstandings in the medical community. We do know that when people are unable to communicate with their doctors, serious and costly mistakes can occur.
Read this editorial by Jeannette B. DeJesus, President and CEO of The Hispanic Health Council, published in The Hartford Courant on March 13, 2009.

Latino Policy Institute: Active Communities = Healthier People

In November 2008 more than 150 representatives of Connecticut’s fast growing Latino community gathered in West Hartford for the Latino Health Summit to discuss access to health care.

The event, hosted by the Hispanic Health Council’s Latino Policy Institute, marked a milestone in a journey that began more than 30 years earlier when a group of Puerto Rican leaders in Hartford formed the Hispanic Health Council to address critical health problems plaguing the Latino community.

The Latino Policy Institute, created in 2006 with grants from the Universal Health Care Foundation of Connecticut  and the Connecticut Health Foundation, looks for solutions to the problem of health disparities by addressing the deep-rooted inequities in the nation's health care and economic systems.  Its first project was a report titled: "A Profile of Latino Health in Connecticut."

Its authors discovered early on that comprehensive data about Latino health are hard to come by and what there is often does not take into account the cultural differences among Hispanics of different nationalities. Yet they were able to show that unskilled Latinos had little access to health care in Connecticut.

Latinos make up the largest ethnic group and are among the state’s poorest, sickest and least-educated residents. Latino children have the highest incidence of asthma in Connecticut. Two out of three Latino adults are overweight or obese. Despite advances in treatment and early detection for breast and cervical cancers, Latina women are more likely than their non-Hispanic neighbors to die from the diseases.

And although they comprise 11 percent of Connecticut’s population, Latinos account for 40 percent of those in the state with no health insurance.

At the summit, Jeannette B. DeJesus, president and CEO of the Hispanic Health Council, found the absence of community outrage over the figures troubling. “These are the lives of our people.’’

The summit, she said, was a first step toward creating a network that will work to broaden health care access to improve the lives of Latinos in Connecticut and elsewhere.

 The summit was not a meeting, but a wake-up call, DeJesus said. For emphasis, she organized a rooster crowing contest among the participants.

"I love roosters; they’re in my heart," DeJesus said, adding that they evoke memories of her roots in Puerto Rico. The rooster, she said, has become the Latino Policy Institute’s symbol and logo because it is a perfect metaphor for the urgency with which Latinos must approach the health care crisis facing their communities.

"What we are saying is it is time to wake up," DeJesus said. "It's time to get on our feet."

Read about the Latino Health Summit in The New York Times

Just the facts...Fact Sheets Detail Health and Education Gaps in Connecticut

Get the facts. The Latino Policy Institute has fact sheets on important health and education topics with a special focus on Latinos and African-Americans in Connecticut. Click to download these fact sheets:

Latinos

Latinos Left Behind (economic and insurance gaps)

Obesity and its consequences

Asthma

Cancer

Depression

Sexually Transmitted Infections

Latinos Left Behind in School (achievement gap)

Latinos by Town

Connecticut Coalition for Medical Interpretation

African Americans / Blacks

Overview

Cradle to Grave

Cardiovascular Disease

Diabetes

STIs & HIV / AIDS

Fact sheets are also available for download on our Publications page.

Community Health Providers Urge Congress To Support Health Care Reform Policies That Meet The Needs of Latinos

Hartford, CT—On Sept. 2, 2009, NCLR (National Council of La Raza), the largest national Latino civil rights and advocacy organization in the United States, recognized the Hispanic Health Council for filling health care gaps left by the nation’s broken health care system.
NCLR also released the latest installment of its new series, Profiles of Latino Health: Community Responses to Latino Health Needs, featuring the Hispanic Health Council's Comadrona/Healthy Start program. To read more click here.

Latinos and Health Care: National trends

Looking for more information about Latino Health Disparities? NCLR, the National Council of La Raza, has compiled an interesting set of fact sheets designed to answer the top 12 questions about Latinos and health care. To download NCLR's Profiles of Latino Health click here. You can also find the fact sheets and a lot more informative links to health disparities data on our Resources page.