IN THE RIGHT WORDS: Addressing Language and Culture in Providing Health Care ISSUE BRIEF NO. 18 AUGUST 2003 BASED ON A GRANTMAKERS IN HEALTH ISSUE DIALOGUE SAN FRANCISCO, CA IN THE RIGHT WORDS: Addressing Language and Culture in Providing Health Care ISSUE BRIEF NO. 18 AUGUST 2003 BASED ON A GRANTMAKERS IN HEALTH ISSUE DIALOGUE SAN FRANCISCO, CA © 2003 Grantmakers In Health. All materials in this report are protected by U.S. copyright law. Permission from Grantmakers In Health is required to redistribute this information, either in print or electronically. This publication is available on-line at www.gih.org. GRANTMAKERS IN HEALTH iii Foreword As part of its continuing mission to serve advancing research; and roles for trustees, executives, and staff of health foundations in supporting improved foundations and corporate giving language access, including examples of programs, Grantmakers In Health (GIH) current activities. convened a group of experts from philanthropy, research, health care practice, The Issue Dialogue focused mainly on and policy on April 4, 2003, to discuss the activities and programs that ensure roles of language and culture in providing linguistic access to health care for all effective health care. During this Issue patients. Although language and culture Dialogue, In the Right Words: Addressing are clearly inseparable, a full exploration Language and Culture in Providing Health of the field of cultural competence and Care, health grantmakers and experts from initiatives that promote its application to policy and practice participated in an open the health care setting are beyond the scope exchange of ideas and perspectives on of this Issue Brief. The day’s discussion did, language access and heard from fellow however, raise provocative issues of culture grantmakers who are funding innovative that are reflected throughout this report. programs in this area. Together they explored ways to effectively support Special thanks are due to those who partici- comprehensive language services, including pated in the Issue Dialogue, but especially the use of interpreters and translation of to presenters and discussants: Ignatius Bau, written materials. J.D., program officer at The California Endowment; Maria-Paz Beltran Avery, This Issue Brief synthesizes key points from Ph.D., senior project director at the the day’s discussion with a background Education Development Center; Alice paper previously prepared for Issue Chen, M.D., M.P.H., Soros Physician Dialogue participants. It focuses on the Advocacy Fellow at the Asian and Pacific challenges and opportunities involved with Islander American Health Forum; Pamela ensuring language access for the growing Dickson, M.B.A., senior program officer number of people who require it. Sections at The Robert Wood Johnson Foundation; include: recent immigration trends and Maren Grainger-Monsen, M.D., director demographic changes; the effect of of the bioethics in film program at language barriers on health outcomes and Stanford University’s Center for health care processes; laws and policies Biomedical Ethics; Carola Green, program regarding the provision of language services coordinator at Vista Community Clinic; to patients, including an overview of public Timothy Henderson, M.A., vice president financing mechanisms; strategies for for programs at Quantum Foundation, improving language access, including Inc.; Terry Hernandez, program officer at enhancing access in delivery settings, Mid-Iowa Health Foundation; Vivian promoting advocacy and policy change, Huang, M.H.S., senior policy analyst at improving interpreter training, and the California Primary Care Association; iv IN THE RIGHT WORDS Lindsay Josephs, program specialist at Schwartz, Ph.D., vice president of GIH, Endowment for Health; Kelvin Quan, and Angela Saunders, communications J.D., M.P.H., chief financial officer and manager at GIH. Judy Frabrotta of general counsel at the Alameda Alliance for Frabotta Company also contributed to this Health; and Mara Youdelman, J.D., report. Lauren LeRoy, Ph.D., president and LL.M., staff attorney at the National CEO of GIH, moderated the Issue Health Law Program. Dialogue and provided editorial assistance. Rea Pañares, M.H.S., program associate at This program was made possible by grants GIH, planned the program and wrote this from The California Endowment and The report with editorial assistance from Anne Robert Wood Johnson Foundation. GRANTMAKERS IN HEALTH v About Grantmakers In Health (GIH) is a • Resource Center on Health nonprofit, educational organization Philanthropy. The Resource Center dedicated to helping foundations and monitors the activities of health corporate giving programs improve the grantmakers and synthesizes lessons nation’s health. Its mission is to foster learned from their work. At its heart are communication and collaboration among staff with backgrounds in philanthropy grantmakers and others and to help and health whose expertise can help strengthen the grantmaking community’s grantmakers get the information they knowledge, skills, and effectiveness. GIH need and an electronic database that is known today as the professional home assists them in this effort. for health grantmakers and a resource for grantmakers and others seeking expertise • The Support Center for Health and information on the field of health Foundations. Established in 1997 to philanthropy. respond to the needs of the growing number of foundations formed from GIH generates and disseminates conversions of nonprofit hospitals and information about health issues and health plans, the Support Center now grantmaking strategies that work in health provides hands-on training, strategic by offering issue-focused forums, guidance, and customized programs on workshops, and large annual meetings; foundation operations to organizations publications; continuing education and at any stage of development. training; technical assistance; consultation on programmatic and operational issues; • Building Bridges with Policymakers. and by conducting studies of health philan- GIH helps grantmakers understand the thropy. Additionally, the organization importance of policy to their work and brokers professional relationships and the roles they can play in informing and connects health grantmakers with each shaping public policy. It also works to other, as well as with others whose work enhance policymakers’ understanding has important implications for health. of health philanthropy and identifies It also develops targeted programs and opportunities for collaboration between activities and provides customized services philanthropy and government. on request to individual funders. Core programs include: GIH is a 501(c)(3) organization, receiving core and program support from more than 200 foundations and corporate giving programs each year. vi IN THE RIGHT WORDS Diversity Statement GIH is committed to promoting diversity and GIH uses the term, diversity, broadly to cultural competency in its programming, encompass both differences in the attributes personnel and employment practices, and gov- of individuals (such as race, ethnicity, age, ernance. It views diversity as a fundamental gender, sexual orientation, physical ability, element of social justice and integral to its religion, and socioeconomic status) and of mission of helping grantmakers improve the organizations (foundations and giving nation’s health. Diverse voices and viewpoints programs of differing sizes, missions, deepen our understanding of differences in geographic locations, and approaches to health outcomes and health care delivery, and grantmaking). strengthen our ability to fashion just solutions. GRANTMAKERS IN HEALTH vii Table of Contents Introduction . .1 Changing Demographics, Changing Needs . .1 Health Consequences of Language Barriers . .5 More Than Words: The Role of Culture . .8 Laws and Policies for Ensuring Language Access . .9 Strategies for Improving Language Access in the Health Care Setting . .16 Conclusion . .39 References . .41 GRANTMAKERS IN HEALTH 1 diverse languages and distinct cultural Introduction perceptions of health. Public policy “Imagine pulling in a and private efforts from nonprofit Mutual understanding between providers member of the custodial organizations, health care systems, and and patients is essential for achieving foundations have made some progress in staff to help you deal with satisfactory health care outcomes. confronting these problems and providing Physicians must be able to obtain an the nuances of an resources for action, but more remains to accurate reading of the patient’s symptoms be done. Foundations can play an international business deal. and medical history, and patients must be important role in helping ensure that all able to grasp the nature of their condition You can’t.” patients have access to linguistically and and the recommended course of treatment. culturally appropriate health care services. Often, life-altering decisions regarding ALICE CHEN, treatment alternatives must be based solely ASIAN AND PACIFIC on information about risks and benefits Changing ISLANDER AMERICAN communicated in the span of a brief office Demographics, HEALTH FORUM visit. Even for those who are fluent in English and acculturated to the American Changing Needs medical system, the complexity of informa- tion coupled with the emotion and anxiety The U.S. experienced 13 percent of illness creates substantial opportunities population growth between 1990 and for miscommunication. Under even the 2000. During