In Canada there are four constituencies who may face barriers to health care due to having a nonofficial first language: First Nations and Inuit communities, newcomers to Canada (immigrants and refugees), Deaf persons, and, depending on location of residence, speakers of one of Canada’s official languages. Access to necessary health services is a right of every Canadian as guaranteed by the Canada Health Act of 1984. However, access has generally been interpreted to mean the absence of explicit financial barriers to care.

It is generally agreed that the best communication is achieved where health care providers and patients speak the same language.

There is compelling evidence that language barriers have an adverse effect on initial access to health services. These barriers are not limited to encounters with physician and hospital care. Patients face significant barriers to health promotion/prevention programs: there is also evidence that they face significant barriers to first contact with a variety of providers.

Recent research that includes the variables of both ethnicity and official language proficiency suggests that in many cases, language, rather than cultural beliefs and practices of patients, may be the most significant barrier to initial contact with health services.

Language barriers have been associated with increased risk of hospital admission, increased risk of intubation for asthmatics, differences in prescribed medication, greater number of reported adverse drug reactions, and lower rates of optimal pain medication. There is also preliminary evidence that such barriers are related to less adequate management of chronic diseases such as asthma and diabetes.

Quality of care for those who are not fluent in an official language is affected through interaction with health professionals who may, because of language barriers, fail to meet ethical standards in providing health care. Language barriers may result in failure to protect patient confidentiality, or to obtain informed consent.

Patients who do not speak the same language as their health care providers consistently report lower satisfaction than those who share the same language as their providers.

A review of the literature reveals consistent and significant differences in patients’ understanding of their conditions and compliance with treatment when a language barrier is present. Findings from these studies are consistent with general research on provider-patient communication, which finds that communication is a key factor in patient adherence to the treatment plan.

Reliance on family members, or untrained interpreters recruited on an ad hoc basis (the most common responses to language barriers in Canada today) poses too many risks to be acceptable.

There is also evidence that language barriers contribute to inefficiencies within the health system.

As evidence related to costs and benefits has mounted however, there is a realization that provision of language access services may result in cost savings to both the health system and the larger society. The focus on reducing health care costs may therefore also serve as an impetus for developing strategies to address language barriers.

excerpted from Sarah Bowen, B.A., M.Sc., Language Barriers in Access to Health Care, 2001; underlinings by

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