Raquel Diaz

ELI program
Session 2
November 2016

How a First Language Acts as a Barrier and Impacts on Health and Health
Care of Immigrants in The Unites States.
The United States has the largest immigration population in the world.
Currently, approximately 11% of the American population is foreign-born
individuals. (US Census Bureau Demographic Internet Staff, 2012) (Schmidley,
2001) Immigrants are a vulnerable population in terms of public health as
studies have demonstrated; they are disadvantaged in many essential aspects
of health such as insurance coverage, service utilization, health awareness, and
health status. The factors attributing to their vulnerability involve in major parts
of socioeconomic, demographic, and psychological areas, among these, stress
and language barrier are two important contributors. (Ding & Hargraves, 2009)
Immigrants differ in many aspects of their lives from the US-born, among them,
health is one of the most important and challenging issues related to this
population. Language as a barrier impacts on health and health care of
immigrants in the Unites States, the interpreters with good training could be a
good solution.
In the past half century, the United States has seen a dramatic change in
the composition of its immigrant population because the countries of origin have
sifted from Europe to Latin America, Africa, and Asia. (U.S. Census Bureau,
2013) As the immigrants from non-English speaking countries increase, more

immigrants in the US have language barriers but despite of it few studies have
explored the health of immigrants who have language barriers.
The relationship between the physician and the patients is built through
communication and the effective use of language, which allows a good
anamnesis of the patients. Language is the means by which a physician
accesses a patient's beliefs about health and illness (Kleinman, Eisenberg, &
Good, 1978) and it makes the medical interview in the most powerful tool of the
clinician. (Coulehan & Block, 2001) (Lipkin, Quill, & Napodano, 1984)
Furthermore, it is through language that physicians and patients achieve an
empathic connection that may be therapeutic in itself. (Suchman & Matthews,
1988). Frequently health professionals commit stereotypical errors, including
omissions, additions, substitutions, or other editing, which may result in serious
semantic distortions and negatively affect care. (Marcos, Uruyo, Kesselman, &
Alpert, 1973) (Launer, 1978) Inadequate communication can have tragic
consequences, for example: the misinterpretation of a single word led to a
patients delayed care and preventable quadriplegia. A Spanish-speaking 18
year-old had stumbled into his girlfriends home told her he was intoxicado and
collapsed. When the girlfriend and her mother repeated the term, the non
Spanish-speaking paramedics took it to mean, intoxicated; the intended
meaning was nauseated. After more than 36 hours in the hospital being
worked up for a drug overdose, the comatose patient was reevaluated and
given a diagnosis of intra -cerebellar hematoma with brain-stem compression
and a subdural hematoma secondary to a ruptured artery. (The hospital ended
up paying a $71 million malpractice settlement.) (Flores et al., 2003)
Compared to US citizens without a language barrier, immigrants are

more likely to report poor health and especially newcomers have great
disadvantages in health care access, insurance coverage, health service
utilization, and community support.

(Ding & Hargraves, 2009) Yet many

patients who need medical interpreters have no access to them. (Timmins,

2002) Professional interpreters are formally trained and demonstrate a high
degree of proficiency in communication between languages, minimizing the
effects of language difference.
However professional interpreters are rarely available in health care, as for
example New York City, which has one of the largest limited- English-speaking
populations in the country, does not employ professional medical interpreters in
its public hospital system and most US physicians are probably not sufficiently
bilingual to practice in a language other than English. On the other hand the
interpreters also commit stereotypical errors, including omissions, additions,
substitutions, or other editing, which may result in serious semantic distortions
and negatively affect care. In one observational study, analysis of recorded ad
hoc interpreter assisted encounters demonstrated that 23% to 52% of words
and phrases were incorrectly translated. (Carrasquillo, John Orav, Brennan, &
Burstin, 1999)
In addition to these consequences, the long-lasting effect of stress and a
language barrier may lead to poor health. Therefore, immigrants with a
language barrier need special attention in the monitoring of their health status,
in providing necessary health services and social supports, and encouragement
in adapting to the new environment, this will increase the possibility of
preventing stress associated health problems and benefit both this population
and the whole society in the long term. (Ding & Hargraves, 2009)

References
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