It has been nearly 40 years since the 1964 Civil Rights Act banned discrimination based on national origin. But a recent poll of California immigrants, conducted in 11 languages by Bendixen and Associates, indicates that they still do not receive equal access to health care. The poll, commissioned by ethnic media coalition NCM and sponsored by The California Endowment, shows that language is one of the primary barriers to access to health care in California.
By Elena Shore
Governor Gray Davis recently signed into law two groundbreaking bills that may lead the way in addressing the disadvantages faced by immigrants as a result of language barriers. The first, written by Assemblymember Judy Chu (D-Monterey Park), protects consumers from signing contracts they don’t understand by requiring all contracts to be written in the language they were negotiated in. The second bill, written by Assembly-member Juan Vargas (D-Chula Vista), protects immigrants by requiring immigration consultants to provide their clients with translations of signed contracts in their native language.
But language may be even more critical in health care situations, where a patient who cannot communicate effectively with his doctor may face serious risks to his health and even his life.
Now a movement to improve language access in health care is gaining momentum in the California legislature, where five proposals are currently winding their way through Congress. Written by assem-blymembers and senators from all over the state, these bills aim to put in place regulations that will bring the Civil Rights Act of 1964 closer to reality by assuring that all Californiansregardless of their race or ethnicityhave equal access to health care.
Leland Yee and the Fight to End Kids as Interpreters
Before he became active in the state legislature, San Francisco Democratic Assembly-member Leland Yee witnessed the problem of using child translators as a psychologist. He saw that children were traumatized by the burdens placed on them by continually having to act as interpreters for their parents who were not proficient in English, and being placed in inappropriate situations involving domestic violence, law enforcement, sensitive family matters or health care visits.
“We should be protecting children,” says the assembly-member and former child psychologist, “not forcing them into situations which are damaging to them.”
Passed by the California Assembly in June, Assembly Bill 292 is currently on hold in the Senate where it will be taken up next year. The bill would prohibit children under the age of fifteen from acting as interpreters in any state-funded organization. Hospitals and clinics are already required to provide appropriate interpreters for limited-English speakers.
Leland Yee Addresses the Crisis in Mental Health
Racial and ethnic minorities do not use mental health services as much as whites, partially because they tend to experience a greater stigma surrounding mental health, according to a report by the U.S. Surgeon General. But Leland Yee has noticed that people’s hesitation to ask for help is magnified when mental health providers don’t speak their language or understand where they are coming from.
In Californiawhere 40 percent of the population speaks a language other than English at home, and an estimated 7 million people are not proficient in Englishthe most urgent issue facing the mental health system according to the CA Mental Health Planning Council is the shortage of multilingual and multicultural staff.
Latino, Asian and African American social workers polled say the primary reason for this shortage is financial barriersthey have a hard time meeting the expenses of graduate school while they are struggling with living and childcare expenses. Leland Yee’s Assembly Bill 938 would provide scholarships and loans to mental health providers who agree to serve in multicultural and multilingual communities. The program would be funded by a $10 increase in licensing fees for child psychiatrists, psychologists, marriage and family therapists and social workers.
Sen. Martha Escutia Takes on HMOs
Although there are linguistic and cultural requirements for government sponsored programs such as Medi-Cal and Healthy Families, no such standards exist for commercial health care programs. Senator Martha Escutia (D-Norwalk) plans to expand these standards to California’s HMOs so that they too will be required to provide access to culturally and linguistically appropriate health care services, such as trained interpreters and translated documents.
According to a recent study by the Department of Managed Health Care (DMHC), over 70% of health care providers report that language barriers make it harder for patients to explain their symptoms, ask questions and understand their diagnoses and treatment advice. Patients are also more likely to miss appointments, wait until the problem is bad enough to visit the emergency room, and suffer an increased risk of complications.
“Culture strongly influences the perception of disease, prevention, and behavior modification,” says Escutia. “Without culturally and linguistically appropriate health services, our ability to prevent the spread of communicable disease will be impaired.”
Sponsored by California Pan-Ethnic Health Network (CPEHN), Mexican American Legal Defense and Educational Fund (MALDEF) and Western Center on Law and Poverty (WCLP), Escutia’s bill was recently passed by the Assembly and the Senate and is now awaiting the Governor’s signature.
Manny Diaz’s Cultural and Linguistic Competency Act
Misunderstandings and poor communication between doctors and patients of different cultural backgrounds can compromise the patient’s health and even put his life at risk. According to the Commonwealth Fund, the lack of diversity among health care staff
and a health care system that is poorly designed to meet the needs of diverse populationsmake it harder for patients to receive equal access to the care they need.
San Jose Assemblymember Manny Diaz’s Assembly Bill 801, the Cultural and Linguistic Competency Act of 2003, addresses these problems by encouraging medical communities to develop voluntary cultural and linguistic training for physicians. The bill was recently passed by the Senate and is now on the Governor’s desk.