“When I’m sick, I’m not bilingual” – Language Support is Health Equity
February 7, 2025
By Marco Campana, Knowledge Mobilization and Social Action Coordinator, Access Alliance
Language can be a significant barrier to accessing healthcare and achieving desired health outcomes. Reframing language access as part of health equity can help ensure that newcomers, and others, have better healthcare experiences and improved health outcomes.
What we know
Our recent article Healthcare Service Needs for Refugees, Asylum Seekers and Residents with Precarious Immigration Status in Canada: A Scoping Review outlines that barriers to health care have many sources, such as a lack of awareness about opportunities, cultural stigma, and language.
The report Medical Interpreting Services for Refugees in Canada: Current State of Practice and Considerations in Promoting this Essential Human Right for All outlines how limited English or French language proficiency can create significant barriers to healthcare access and quality for refugees in Canada.
We know what the solutions are, and we know how to make them work. In our 2021 literature review Investing in Language Access to Optimize Health System Performance we outlined how investments in language access in general, and professional interpreting in particular, contribute to a higher performing health system. It’s part of a health equity approach that ensures access for everyone.
Language access is health equity
Health equity is achieved when everyone has the opportunity to achieve their individual health potential. Language access initiatives can ensure that all individuals have equitable access to high-quality care, information, and services regardless of the language they speak or sign. Equitable access is at the core of achieving a state of health equity where everyone has the opportunity to reach their individual health potential.
In the context of reaching health potential, what if instead of just thinking about individuals as having a degree of limited English proficiency, we repositioned our perspective to focus on a language of comfort?
Comfort in healthcare is not trivial. Hippocrates wrote that our goal in health care is ‘To cure sometimes, to relieve often, to comfort always.’ When we are asking someone to speak in an acquired language such as English or French that is not their language of comfort, we risk making them feel uncomfortable or excluded. Speaking in their acquired language might be something they associate with schools, teachers, with being graded or evaluated. For some it can be associated with being judged and oppressed.
While comfort may be difficult to define, a 2020 study of culturally diverse patients in hospital undergoing heart surgery found that “Comfort is transient and multidimensional and, as defined by patients, incorporates more than the absence of pain.” The authors’ Comfort ALways Matters (CALM) framework describes four senses of comfort:
- Relief from pain, emotional and physical distress.
- Feeling positive, safe and stronger.
- Feeling confident, in control, having a degree of choice, agency.
- Feeling cared for, valued, connected.
A simple question can reduce discomfort and exclusion. What if at the point of serving people with limited English proficiency we asked: “What language would you feel most comfortable speaking with your healthcare provider?” and then we met their language needs?
Communicating in your language of comfort increases information retention and engagement. In a health care context, better information retention and engagement are associated with:
- increased patient safety
- Improved outcomes
- improved provider satisfaction
- improved patient experience
Creating comfort also creates safety
When we talk about health equity it’s important for us to place access to language in the mix. It’s not simply a good idea, but one that ensures better healthcare experiences, improved health outcomes and patient safety.
As this 2015 report from the Office of the Languages Commissioner of Nunavut “If you cannot communicate with your patient, your patient is not safe” wrote: “Being able to speak in one’s mother tongue when it concerns health is not asking a favour of health care professionals or organizations. On the contrary, it is a basic issue of accessibility, safety, quality and equality of services.”
It can also be a legal requirement when it comes to Ontario’s French Language Services Act as well as for access to sign language interpreters in healthcare settings across the country.
Learn More
Healthcare Service Needs for Refugees, Asylum Seekers and Residents with Precarious Immigration Status in Canada: A Scoping Review
This article examines the trends of influx, healthcare service needs and challenges of refugees, refugee claimants, and residents with precarious immigration status in Canada. Researchers wanted to understand trends and identify unique refugee healthcare and wellbeing needs.
Medical Interpreting Services for Refugees in Canada: Current State of Practice and Considerations in Promoting this Essential Human Right for All
This research examines the current state of medical interpreting services for refugees in Canada. Limited English or French language proficiency can create significant barriers to healthcare access and quality. The authors make the case that these services are an essential human right while analyzing implementation challenges and opportunities across different jurisdictions.
Investing in Language Access to Optimize Health System Performance – A Review of the Literature (2021)
This literature review explores findings from over 120 sources, examining research done in Canada and around the world. It organizes the literature in alignment with the four goals of the Quadruple Aim Framework: Better Health Outcomes, Improved Patient Experience, Improved Staff Experience, and Lower Cost of Care. The report makes the argument that language interpreting services can lead to a higher performing Canadian healthcare system. The report provides an update on previous research from 2009, making a business case for investing in professional interpreting services.
RIOMIX Multilingual Information Library
A collaborative, centralized and accessible repository of translated materials and multilingual websites relating to health and community care and support. The library can be searched by language, topic, category and keyword. Items in the library include the English source and information about the publication (e.g., author, date, translation methodology).
Access Alliance Language Services
Established in 1990, Access Alliance Language Services (AALS) delivers high-quality language access services to Access Alliance and a diverse range of health, social, and public sector organizations. We provide a wide range of services including interpreting (on-site and remote), translation, audio/video language recordings, interpreter professional development training, and consulting and training services to support organizations to achieve their language access goals and meet the language needs of the individuals, families, and communities they serve.
Community Interpreting in Canada: An Information Session for Afghan Interpreters and Language Assistants
Presentation slides from 2021 providing information about interpreter accreditation and certification organizations, interpreting initiatives happening across Canada, and an overview of college language interpreter training programs.