Lost in translation: Addressing language barriers in healthcare

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Older people are often seen as a homogenous group. This can mean certain groups of older people are hidden from policy and services, none more so than older people who experience language barriers.

The 2011 census of England and Wales shows that 863,000 people do not speak English well or do not speak English at all, and many of these will be older people[i]. One of the biggest challenges this group faces is access to health and care services. This blog explores some of these challenges.

What are the problems within healthcare services for older people with language barriers?

Equality

Poor language proficiency of a carer or service user can result in unequal access to quality healthcare[ii][iii]. They may have reduced frequency of referrals and follow ups from health professionals, and they may have to wait longer for services[iv]. Consequently, the access and use of primary care is in fact comprised[v].

863,000 who report poor English levels[vi] are at risk of unequal access to care and this may also have gendered implications too. For example, there is a growing older population of widowed Asian women with language needs in Bradford[vii] and there is a growing number of Somali women with language needs in London[viii]. It is paramount that health and social care services address language barriers if they are to uphold equal access to quality care.

Costs

Research shows that people with low levels of English, especially those from deprived communities are likely to treat illnesses as a form of crises, and therefore likely to use services in the form of a ‘medical emergency’[ix][x]. Arguably, therefore not only are healthcare services failing to provide equal care, it is also costing the sector, and therefore cannot be ignored.

This group is in poorer health

Language barriers have age related ramifications too. There is a higher proportion of people aged 75 and over who are non-proficient in English to report ‘not good’ health[xi]. In fact, as the data shows below, those aged 75 and over who are non-proficient are twice as likely as those whose main language is English to report to have ‘not good’ health. In light of an ageing society, low levels of proficiency in English is something that we should expect, and therefore we need to plan this into our services.

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General health by proficiency by age, England and Wales, 2011
Source: ONS, 2013.

Conclusion and what can be done

 

This issue is a difficult one, and one that cannot be solved easily. Policymakers within healthcare cannot ignore this issue if service providers are to deliver equal access to quality healthcare. Furthermore, in the context of both an ageing, and an increasingly diverse society, language barriers are to be expected and therefore services need to consider this in any plans to improve healthcare services.

Duty of providing equal care: The ageing and diverse nature of society means that all aspects of delivery needs to be person centred.

Challenging internalised assumptions: Everyone is not the same, and therefore medical/care decisions should not be based on prejudiced assumptions around ‘cultural practices’ of these groups.

Investment in language services: Policy makers need to invest in English courses targeted to older people.

Use of Technology: There is the need to improve translation services by using technology such as video/voice over. 9 cooperative hospitals in California used a shared video interpretation service which routed translation requests to a call centre style system staffed by trained bilingual staff[xii]. Healthcare services need to look at similar technology in the UK in order to innovate current translation practices.

Amna Riaz
Policy and Research Assistant

Notes

[i] ONS, (2013) ‘2011 Census: Detailed analysis – English language proficiency in England and Wales, Main language and general health characteristics’ [Online] Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/language/articles/detailedanalysisenglishlanguageproficiencyinenglandandwales/2013-08-30 [Accessed/04/12/2017].

[ii] Greenwood, N., Habibi, R., Smith, R. & Manthorpe, J., (2015) ‘Barriers to access and minority ethnic carers’ satisfaction with social care services in the community: a systematic review of qualitative and quantitative literature’, Health & social care in the community, 23(1), pp. 64-78.

[iii] Woods, M. D. & al, e., 2005. Vulnerable groups and access to health care: a critical interpretive review, s.l.: National Coordinating Centre NHS Service Delivery Organ RD.

[iv] (ibid)

[v] Gerrish, K., Chau, R., Sobowale, A. & Birks, E., (2004) ‘Bridging the language barrier: the use of interpreters in primary care nursing’, Health & social care in the community, 12(5), pp. 407-413.

[vi] ONS, (2013) ‘2011 Census: Detailed analysis – English language proficiency in England and Wales, Main language and general health characteristics’ [Online] Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/language/articles/detailedanalysisenglishlanguageproficiencyinenglandandwales/2013-08-30 [Accessed/04/12/2017].

[vii] City of Bradford MDC, (2010) ‘BME Older People’s changing care needs: Today and Tomorrow, Bradford: City of Bradford MDC [Online] Available at: https://www.futureyears.org.uk/uploads/files/FINAL%20-%20BMEOlder%20Peoples%20Changing%20Care%20Needs%20-%20Adnan__s%20report%20-%20Nov%2010%20PDF.pdf [Accessed 4/12/2017].

[viii] Abdullahi, A; et al., (2009) ‘Cervical screening: Perceptions and barriers to uptake among Somali women in Camden’, Public Health, 123(10), pp. 680-685.

[ix] Woods, M. D; et al., (2005) ‘Vulnerable groups and access to health care: a critical interpretive review’, s.l.: National Coordinating Centre NHS Service Delivery Organ RD.

[x] Malzer, S., (2013) ‘A Report On Barriers to Accessing Health and Social Care Services for Older People from Black and Minority Ethnic Backgrounds in South Glasgow’, s.l.: The Advocacy Project.

[xi] ONS, (2013) ‘2011 Census: Detailed analysis – English language proficiency in England and Wales, Main language and general health characteristics’ [Online] Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/language/articles/detailedanalysisenglishlanguageproficiencyinenglandandwales/2013-08-30 [Accessed/04/12/2017].

[xii] Masland MC, Lou C, Snowden L. (2010) ‘Use of Communication Technologies to Cost-Effectively Increase the Availability of Interpretation Services in Healthcare Settings’, Telemedicine Journal and e-Health 16(6):739-745.

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