Access to Health Among Patients with Limited English Proficiency in the United States

In 1990, roughly 14.0 million people in the United Sates were considered to be limited in their ability to speak, read, or write in English, and about 31.8 million spoke a language other than English at home. The largest Limited English Proficiency (LEP) population lived in New York City, where 20% of the population was non-English proficient, followed by Los Angeles, Miami, and Houston, Texas. (Census Bureau, 1990).

Individuals who communicate most effectively in a language other than English face many linguistic and cultural barriers to accessing efficient and effective health care. Language and cultural barriers can result in reduced access to services, reduced ability for patients to communicate with their providers, increased potential for misdiagnoses, and reduced patient and provider satisfaction with health care interactions. These barriers can ultimately lead to poor quality of care and diminished health outcomes in LEP persons. Additionally, such barriers may result in discrimination on the basis of national origin, in violation of Title VI of the Civil Rights Act of 1964.

On August 30, 2000, the Federal Office for Civil Rights (OCR), within the U.S. Department of Health and Human Services (HHS), issued a policy guidance document entitled, "Policy Guidance on the Prohibition Against National Origin Discrimination as it Affects Persons with Limited English Proficiency." The document sets forth guidance for implementation of Title VI of the Civil Rights Act of 1964 regarding assistance for persons with Limited English Proficiency. Title VI bars discrimination based on race, color, or national origin under any program that receives Federal financial assistance.

In its efforts to facilitate a dialogue for the development and improvement of existing practices regarding language access for limited English proficient patients, the CIH established a language advisory group. Administrators, advocates, directors of interpreter services, and others convene on a regular basis and discuss issues ranging from accreditation of medical interpreters to training and monitoring.

National Council on Interpretation in Health Care (NCIHC)

The CIH is an active member of the NCIHC.