COVID-19 has shown us how our health system can meet the challenge, and also how we fail to care for the most vulnerable patients.As COVID cases began to rise in March 2020, I spoke with Family Van staffers. This mobile clinic provides preventive services in some of Boston's most underserved areas. They stressed the difficulties of finding multilingual COVID information, and how it made it difficult for patients not speaking English to take precautions. The CDC and the state health department did not release COVID information in other languages at the time. This left community health agencies scrambling for multilingual information.This problem persists even after a year. Many state governments do not provide information in other languages about the vaccine, while others offer no assistance on vaccine-finder Web pages. It is not surprising that COVID rates are higher in non-English speaking countries. This disturbing pattern mirrors past epidemics.Medical interpreters have been the focus of much of the debate about improving patient care for non-English speakers. This is important because patients who use interpreters have better preventive care, less adverse events, and greater medication compliance. COVID showed us that having an interpreter at the point-of-care is not enough. Many barriers are deeply rooted and historically enforced that prevent non-English speaking patients receiving the care that they require. These barriers exist long after the patient arrives at the clinic, but continue for many years afterwards.Many programs have been created to provide care and materials in a language that is understood by the target audience. These include government-led efforts that translate outreach information into other languages and community-led efforts like the COVID-19 health literacy project, which I started to translate COVID facts sheets into 40 languages.These efforts are only temporary solutions. We must fix the barriers that non-English speakers face in order to ensure they are not left behind after the crisis passes. This includes accessing and processing medical care. Each part of the experience a non-English speaking patient has with the health system must be redesigned before, during, and after an appointment.Before patients can see a doctor, they must be able access their health information in their native language. In order to translate information about health (e.g. patient education materials, announcements) hospitals and clinics can work with interpreter services. The COVID-19 Health Literacy Project revealed that many bilingual providers are eager to translate material into their native language. Health care organizations might consider creating an internal database with multilingual staff to assist as required.Public health agencies could also play a significant role. They could, for example, hire translators to provide remote contract services to social and clinical service providers in low-income or rural communities. This is a great way to help fill the gap when there are not enough interpreters. We also transitioned the COVID-19 Health Literacy Project to a nonprofit organization that offers free translation services to community-based organisations to translate health material into the languages of their patients.Translating health information needs to be combined with programs that ensure this information reaches immigrant communities. It is important to provide culturally and linguistically relevant services to people where they live and work. It is important to choose the medium. Evidence suggests that non-English speakers prefer in-person communication or text messaging. New York City's mobile vaccination van fleet is a good example. Bilingual staff assist patients in their native language through each step of the COVID vaccine process.Health care providers should try to match patients with native-language providers when scheduling appointments. Language concordance leads to fewer medical mistakes, better understanding of the illness and treatment plan, and greater satisfaction. However, it is not always possible so qualified interpreters should be used whenever necessary.Patients are often given discharge instructions after an appointment or hospital stay. These instructions include information about their new medication regimen, home care instructions and follow-up appointments. This document is rarely translated into the patient's native language for patients who are not English-speaking.Although there have been suggestions for machine translation tools (e.g. Google Translate), this approach must go one step further. It is important to make discharge planning a conversation that patients who are not English-speaking can participate in. Clinicians can give patients their translated discharge instructions before discharge. They can also review them verbally with an interpreter and allow patients the time and space they need to ask questions.These changes must be supported by policy reform in order to make them work on a large scale. Reinstating the language provisions regulations that were weakened by the recent HHS rule is a good place to begin. The new rule no longer requires providers to inform patients about their rights to receive language assistance. For many federally funded health care agencies, the absence of a language access program does not constitute a breach in regulatory compliance. These changes can cause health care organizations to prioritize language access and are a step backwards.How do we finance these initiatives? One, the government could direct a portion of $1.32 billion to community health centers under the CARES Act to build the infrastructure necessary to support non-English speaking people. Nonprofit hospitals could also tap into community benefit dollars, which nonprofit hospitals must provide in order to support their tax-exempt status.Our health care system is failing patients who speak limited English. It is time to act. We need to move beyond temporary solutions and make comprehensive changes that support non English speakers across the entire health care continuum.This article is an opinion/analysis article. Scientific American does not necessarily endorse the views expressed in it.
