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Bridging the Language Divide in Health

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Bridging the Language Divide in Health News Bridging the language divide in health While the English language dominates much of the world’s public health information, several initiatives are underway to provide such information in other widely spoken languages. Patrick Adams and Fiona Fleck report. “A close relative had been diagnosed “The trend towards monolingual- that information affects everyone from with a rare disease. We searched for ism is far from decreasing, with the clinicians and patients to public health information on it in Arabic and found hegemonic use of one language, English, managers and policy-makers. websites that were unstructured or were over the other five United Nations (UN) One of the most popular health essentially chat forums,” recalls Dr Ma- languages,” the UN Joint Inspection information websites, Wikipedia, col- jid Altuwaijri. Unit concluded in a 2011 report on laborates with Translators Without “But when we searched in English implementation of multilingualism in Borders to bridge that divide. With the we found a wealth of good quality in- UN organizations. help of the global network of translators, formation.” As part of the UN system, the World Wikipedia Medicine has built a large As co-founder of the Saudi Associa- Health Organization’s (WHO) six official collection of articles in more than 100 tion for Health Informatics, Altuwaijri languages – Arabic (242 million na- languages and has at least some medical was well placed to help his relative, given tive speakers), Chinese (1197 million), content in more than 250 languages. his expertise in information technology English (335 million), French (76 mil- and fluency in English. lion), Russian (16 million), and Spanish However, globally only an estimated (399 million) – are the first languages 600 to 700 million people have English of only 2.4 billion people, according The as a second language, like Altuwaijri, to Ethnologue: Languages of the World, trend“ towards in addition to some 335 million native 18th edition – less than half the world’s monolingualism is English speakers, with varying degrees population. far from decreasing, of fluency. In addition, German (78 million with the hegemonic That leaves most of the world’s native speakers) is an official language use of one language, population – some six billion people – in WHO’s European Region and Portu- with little or no access to a large body guese (203 million) in WHO’s African, English, over the other of public health information because it European and Americas Regions. For na- five United Nations is in English. tive speakers of other languages, such as languages. Language can be a barrier to ac- Hindi (260 million native speakers) and UN Joint Inspection Unit cessing relevant and high quality health Bengali (198 million), the unmet need ” information and delivering appropriate for health information may be great. health care – an unmet need that is English has long been the lingua “We did a lot of work for the Ebola amplified on a global scale. franca of scientists – including those outbreak with Translators without Bor- working in public health – and while ders and others because most informa- more WHO publications and web pages tion on Ebola was in English, which is are produced in English than in any only spoken by 15–20% of the popula- other language, WHO publications ap- tion in West Africa,” says Wikipedia pear in more than 70 languages. editor Dr James Heilman, adding: “Now All WHO’s official documents, such as we have content on Ebola in around 115 World Health Assembly reports and reso- languages.” lutions, are translated into the six official In addition, some United States- languages, but this is not the case for the based websites provide multilingual rest of WHO’s publishing output, including health information, such as the Health technical reports and clinical guidelines. Information Translations collaboration Moreover, WHO launched its six-language and the National Network of Libraries multilingual website in 2005, but most of of Medicine. its web content is still in English. While a few projects are making While Portuguese is the world’s more multilingual public health infor- sixth most spoken language (after mation available in many widely spoken Chinese, English, Hindi, Spanish and languages, the overall dearth of such Arabic), most Portuguese-speaking sci- information produces a divide between entists seek to publish their work in Eng- the health-information haves and have- WHO lish to gain wider circulation, according nots that is exacerbated by poor internet to a study published in a report for the connectivity and unreliable electrical European Molecular Biology Organiza- supplies in developing countries. Cover of World Health Statistics 2015 – one of the tion in 2007 by Rogerio Meneghini. For Dr Alfredo José, director of the WHO publications that is published in all six official In public health, the linguistic national library in Mozambique, health United Nations languages. disconnect between those providing professionals in this Portuguese-speak- health information and those who need ing country – where half the population Bull World Health Organ 2015;93:365–366 | doi: http://dx.doi.org/10.2471/BLT.15.020615 365 News lives below the poverty line – have often in local languages, including 30 centres to reduce the risk of clinical errors by felt linguistically isolated, surrounded by across the European region alone; WHO inviting Russian experts in the relevant Anglophone countries. works closely with governments and fields to review the clinical content of the In 2005, WHO established the eP- collaborating centres on an ad hoc basis translations before they are published, ORTUGUESe programme, to increase to translate its publications into local Kaygorodova says. access to health information in Portu- languages. “If it’s a translation of a press release, guese as part of a collaboration with The documentation centre in Mos- for example, then approximation is fine. Angola, Brazil, Cabo Verde, Guinea Bis- cow, established in 1994, has played a But translations of guidelines for health sau, Mozambique, Portugal, Sao Tome & key role in providing WHO publications professionals must be precise and accu- Principe and Timor-Leste. in the Russian language online and in rate because mistakes can kill,” she says. “We started by developing a na- print, as part of a collaboration with the What these WHO programmes tional virtual health library in each of Russian government. have done for Portuguese and Russian- the eight Portuguese-speaking coun- A recent analysis showed that 70% speaking countries and people, WHO’s tries, which can be adapted to local of the 880 251 people, who used the Global Arabic Programme has sought to needs and conditions,” says Dr Regina centre’s online library between October do for health professionals throughout Ungerer, who has led the programme 2009 and May 2014, were from the Rus- the Arabic-speaking world. for the past 10 years. sian Federation, 10% from Ukraine, 6% The WHO Arabic Programme “The virtual library allows countries from Kazakhstan and 3% from Belarus, aims to disseminate the work of WHO to have their own technical and scientific while users from other countries consti- through Arabic publications, make reli- portal providing a local directory of tuted less than 1% per country. able and current health information and health events, websites and legislation “We were amazed to see we had research outcomes available in Arabic, that can be accessed by anyone with an users from 50 countries, not only from and establish networks and knowledge internet connection,” Ungerer says. the Commonwealth of Independent communities in Arabic translation, ter- The virtual library platform was States, but also Latvia, Israel, the United minology and publishing. developed by the Latin American and States, the United Kingdom and other Although Arabic is an official UN Caribbean Center on Health Sciences countries,” says Tatyana Kaygorodova, language, Arabic speakers still struggle Information best known by its acronym who runs the WHO Moscow documen- to access reliable health information as BIREME, part of WHO’s regional of- tation centre. in their native language. Searching in fice for the Americas. In 2012, WHO established a pro- vain for reliable health information in “With the ePORTUGUESe net- gramme funded by the Russian govern- Arabic “was what triggered the idea for work, we are empowered,” says José. ment to increase the number of technical our study,” says Altuwaijri. “Brazil and Portugal contribute docu- WHO publications in Russian, such The study published in 2009 by ments to the virtual health library, and as clinical guidelines, and to establish Altuwaijri and colleagues at King Saud we’re connected to other Portuguese- a mechanism for consulting Russian- bin Abdulaziz University for Health Sci- speaking countries through the online speaking public health experts on which ences in Saudi Arabia, in collaboration discussion group.” publications they needed most. with the Health on the Net Foundation A network of documentation cen- An important part of the project and the University of Geneva, found tres globally provide WHO publications is to improve the quality of translation that just over 4% of all Arabic health information websites met international quality standards. In light of their findings, Altuwaijri and colleagues recommended the estab- lishment of an Arabic health informa- tion foundation to govern and accredit Arabic health websites and an Arabic health encyclopedia. Initiated in 2010 by King Saud bin Abdulaziz University and the Saudi Association for Health Informatics, the King Abdullah bin Abdulaziz Arabic Health Encyclopedia came together with support from several international partners. Comprised of translations contrib- uted by health professionals from across the Arab world, the encyclopedia is still in its early stages, but Altuwaijri believes WHO it’s already having an impact: “The doctors I’ve spoken with, once they’ve Tatyana Kaigorodova (left) and Katerina Zimina working in the WHO documentation centre archive in been introduced to the encyclopedia, Moscow.
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