By Cheng Lam Cheang
Canadians’ Growing Linguistic Diversity
Access to healthcare and medical assistance is an intrinsic human right and an essential need within the fabric of any society. However, it can be a complex puzzle for those whose lives have taken them far from their lands of origin. Misunderstandings still exist due to patients’ different linguistic and cultural backgrounds. The process of immigrants or temporary residents seeking healthcare is often coloured by linguistic and cultural barriers that cast a shadow over their ability to access and understand vital medical services. According to Statistics Canada, in 2021, the immigrant influx saw 1,328,240 individuals arriving between 2016 and 2021, constituting 16% of the overall immigrant community. Ontario plays a pivotal role as it houses the largest population of immigrants in Canada.
Downloadable images from Statistics Canada. 2021 Census of Population.
We should realize that citizens are no longer bound to their home countries as often, embracing travel or seeking to immigrate to other countries at will. Nevertheless, the medical problem comes around and should never be underestimated. This research blog dives into the significant challenges encountered by immigrants, particularly concerning linguistic and cultural barriers when accessing healthcare services.
While not focusing on any specific country or region, I draw references and data from Canadian sources. By spotlighting immigrant hurdles, my aim is to raise awareness and push for more inclusive and accessible healthcare solutions through this blog. Statistics Canada reveals the primary languages spoken at home among immigrants, with the top three being Arabic, Mandarin, and Tagalog (Pilipino). Towards the end of 2023, Canada declared its commitment to continue welcoming immigrants in the years ahead, aiming to bolster the economy and sustain a stable workforce. Simultaneously, there is a heightened emphasis on facilitating immigrants’ access to the healthcare system. Canada aims to welcome 485,000 new permanent residents in 2024, 500,000 in 2025, and plateau at that figure in 2026, according to Immigration, Refugees and Citizenship Canada.
What are Some Language Barriers?
According to the report of ‘Language Barriers in Access to Health Care’ which released in November 2001 Prepared by Sarah Bowen, B. A., M. Sc for Health Canada, haven’t update since then. This report aims to summarize the impact of language barriers on healthcare access and quality, particularly focusing on the Canadian perspective. While it encompasses international studies, its primary goal is to analyze research evidence concerning the effects of language barriers on healthcare access and quality within Canada. This report lists four group of people who encounter in the language barriers to health care: First Nations, newcomers (immigrants/refugees), deaf individuals, and some official language speakers. Each group’s access to language services is influenced by unique historical and legal contexts.
For example, language barriers faced by immigrants are viewed as “newcomer” challenges rather than minority issues, unlike in some countries like the United States. While “minority” issues often relate to marginalized groups’ rights, “newcomer” issues are considered temporary and tied to newcomers’ adaptation, not inherent societal barriers. In many cities, interpretation services are primarily provided by settlement agencies or ethnocultural groups. However, these services often focus on settlement and are time-limited, lacking health expertise, authority, or adequate funding to address healthcare access needs. Unfortunately, these community-based interpretation services are often separate from healthcare services and lack health funding, resulting in limited collaboration, funding, training, research, and impact on policy development. Despite immigrants needing ongoing assistance communicating with healthcare providers, language access to health remains predominantly seen as a settlement rather than a health issue in Canada (Sarah, 2001).
In the quest to comprehend the linguistic challenges encountered by immigrants seeking healthcare, the study ‘Healthcare Worker’s Perceptions of Barriers to Care for Immigrant Women with Postpartum Depression: An Exploratory Qualitative Study’ (Teng et al., 2007) shows that lack of functional fluency in English emerges as a primary obstacle to accessing postpartum depression care for immigrant women. As evident in numerous interviews and consistent with existing research, language proficiency is paramount for these women. They not only need to communicate effectively but also possess the skills to navigate the healthcare system, access information, and comprehend medical instructions.
These language barriers are not unique to recent immigrant women but are significantly pronounced as they navigate through an unfamiliar healthcare system. It is imperative that we address these barriers to ensure equitable and inclusive healthcare for all.
Debbie [home visitor]: ‘you need to get to the right starting points first. . .for example, you have to know how to search the phone book, which is usually in English.’
Greta [psychologist]: ‘in my experience, trying to communicate with a woman suffering from PPD through a translator [sometimes] feels like. . .an exercise in futility.’
(Source: ‘Healthcare Worker’s Perceptions of Barriers to Care for Immigrant Women with Postpartum Depression: An Exploratory Qualitative Study’)
A 2017 news report written by Dr. Brain Goldman claims that the extent of this issue is challenging due to the lack of comprehensive data from all across Canada. An investigation featured in the Toronto Star revealed that roughly 2% of Ontario’s nearly 14 million residents do not have proficiency in English or French.
This report also addresses a 2014 study by the Centre for Research on Inner City Health, that reveals 18% of the province’s 20,000 primary-care physicians are capable of conversing in a language other than English or French. However, less than 4% can communicate in one of Ontario’s major unofficial languages, which include Mandarin, Italian, Portuguese, Punjabi, and Spanish. While most patients lacking English or French proficiency are fortunate to have physicians who share their language, the 2014 study highlighted examples like Waterloo, a small city west of Toronto, where around 1,500 people speak Portuguese, but no physicians can communicate in their language.
The Healthcare Limitations of Language Barriers
Immigrants facing language barriers face an elevated risk of diagnostic and treatment errors, such as unnecessary diagnostic tests and misinterpretation of symptoms (Jacobs et al., 2006). For instance, research indicates that migrant children with language barriers often receive intubation for asthma, while non-English speakers may not receive sufficient anasthesia (Jacobs et al., 2006). Furthermore, the same study found that immigrants with limited English proficiency may struggle to comprehend medical instructions and recommendations, which encompass areas like correct medication dosages and follow-up appointment scheduling. Other than that, these linguistic cultural barriers can also result in increased emergency room visits and hospitalizations resulting from preventable conditions. Moreover, the lack of adequate language support contributes to disparities in access to preventative care and health education, impacting the overall health outcomes and well-being of immigrant communities.
Serve Patients in their Distinct Languages
Language barriers in healthcare can lead to a misunderstanding between healthcare professionals and patients. Implementing technologies such as translation tools may improve the quality of healthcare and the satisfaction scale among both healthcare providers and patients. Embracing such technology can bridge language gaps and improve overall healthcare experiences. While there are challenges to overcome, such as the need for interpreters and multi-language services, it is clear that the benefits far outweigh the costs. By investing in a healthcare system that truly understands and caters to the diverse needs of our population, we can ensure that no one is left behind when it comes to their wellbeing.
It is time to recognize that linguistic and cultural barriers in healthcare are not just an immigrant’s problem; they are a societal concern. The next step is to work collectively to implement these solutions and break down these barriers. Due to the significant number of immigrants arriving in Canada, health care organizations can increase the number of healthcare providers who speak other languages. Conducting seminars or knowledge-sharing sessions within healthcare providers can be immensely beneficial. Hosting seminars or sharing sessions allows healthcare providers to exchange experiences, strategies, and best practices in overcoming language barriers. This collective sharing of knowledge enables them to learn from each other’s experiences and find innovative solutions. These sessions can also create networks and support systems among healthcare professionals. They can collaborate, seek advice, and develop partnerships to enhance their approach in addressing language barriers.
The government should also regularly collaborate with health or research organizations to publish information regarding patients’ proficiency in the official language and include it as part of health system data collection. Long-term observation of these variables can reveal their impact and changes, facilitating timely improvements in measures.
References:
Teng, L., Robertson Blackmore, E., & Stewart, D. E. (2007, May 14). Healthcare worker’s perceptions of barriers to care by immigrant women with postpartum depression: an exploratory qualitative study. Archives of Women’s Mental Health, 10(3), 93–101.
Statista. (2023, October 18). Immigration in Canada: Statistic & facts. Statista Research Department. https://www.statista.com/topics/2917/immigration-in-canada/#editorsPicks
Dr. Brian Goldman. (2017, October 16). Let’s talk: Why Canadian need to health care in their own language. CBC News. https://www.cbc.ca/radio/whitecoat/blog/let-s-talk-why-canadians-need-health-care-in-their-own-language-1.4356139
Jacobs, E., Chen, A. H., Karliner, L. S., Agger-Gupta, N., & Mutha, S. (2006, March 10). The Need for More Research on Language Barriers in Health Care: A Proposed Research Agenda. The Milbank Quarterly, 84(1), 111–133. https://doi.org/10.1111/j.1468-0009.2006.00440.x
Jain, P., & Krieger, J. L. (2010, June 16). Moving beyond the language barrier: The communication strategies used by international medical graduates in intercultural medical encounters. Patient Education and Counseling, 84(1), 98–104. https://doi.org/10.1016/j.pec.2010.06.022
Al Shamsi, H., Al Mashrafi, S., Al Kalbani, T., & Almutairi, A. G. (2019, May 22). Implications of Language Barriers for Healthcare: A Systematic Review. Oman Medical Journal, 35(2), 1–7. https://doi.org/10.5001/omj.2020.40
Statistics Canada. (2021). 2021 Census of Population. https://www12.statcan.gc.ca/census-recensement/2021/as-sa/fogs-spg/page.cfm?topic=9&lang=E&dguid=2021A000011124
Immigration, Refugees and Citizenships Canada. (2023, November 1). Supplementary Information for the 2024-2016 Immigration Levels Plan. Government of Canada. https://www.canada.ca/en/immigration-refugees-citizenship/news/notices/supplementary-immigration-levels-2024-2026.html
Health Canada. (2006, March 31). Language barriers in access to health care. Canada.ca. https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-accessibility/language-barriers.html#a6_4_1
Cheng Lam is a native speaker of Cantonese and Mandarin. She became a TV news reporter who worked in Television in Macau for 3 years after graduating with a Bachelor’s Degree in Journalism. During the pandemic, she wrote and reported over 1500 pieces of breaking news with politics, medical, art cultures and economic affairs. As a professional journalist who has an intense curiosity of social sciences and society, she never stops writing and reading. Nevertheless, she wants to improve her knowledge in the diversity of society while she is on her school journey majoring in a research analyst postgraduate program at Humber College in Toronto, Canada, due to her passion for market research and marketing. Cheng believes, ‘Never be endless in exploration.‘ This blog article was chosen as one of the winners of the best research bloggers contest organized in Fall 2023.
