By Nazeefah Laher & Anjum Sultana
Today, Statistics Canada released the 2016 census data on language showing an increasingly diverse linguistic landscape. Ontario receives over 50 percent of all immigrants to Canada so it is no surprise that nearly half of Canadians with a mother tongue other than English live in this province. More than 25 percent of Ontarians and 40 percent of Torontonians have a mother tongue in a language other than English or French. Almost 15 percent of Ontarians and 25 percent of Torontonians speak a non-official language at home. In addition, of all the Ontarians with no knowledge of English or French, over 80 percent live in Toronto.
Because of this, plans for building equity into health care must consider linguistic diversity.
Language barriers influence access to health care and are a major challenge for Ontarians with limited English proficiency. Language barriers have been noted to have negative impacts on the quality of health care services and patient outcomes.
Language Interpretation Services (LIS) are one intervention used to address language barriers within the health care context. During health care encounters, LIS provide professional interpreters that are responsible for providing ongoing interpretation to facilitate conversations between patients and their health care providers. Without such services present, patients will often rely on family and friends who are not trained to provide interpretation. There is no guarantee that these untrained interpreters will be accurate and impartial, whereas professional interpreters receive comprehensive training.
LIS can be delivered through various modes such as in-person interpreters, telephone interpreters, and video interpreters. However, regardless of the mode of interpretation, access to trained interpreters led to improvements in clinical and health outcomes, when compared to informal interpreters and no interpreters. This was particularly evident with respect to two important areas in health care: preventive health care screenings and hospital readmission rates.
Preventive health care is an important component of comprehensive health care services because they enable early detection of risk factors, prevent illnesses from worsening, and can lead to rapid treatment. Preventive health services, like screenings for breast, cervical, and colorectal cancers, are a key priority for Ontario’s health care system. Within the context of Ontario, where there are disparities in the uptake of cancer screenings by racialized women from diverse linguistic communities, the potential impact of language interpretation services in reducing inequities is significant.
In general, access to language interpretation services led to an increased uptake of preventive services. For example, one study from the United States found that when people had access to professional interpreters, they were two to three times more likely to participate in mammograms, clinical breast exams, and pap smears. Another study found that when patients had access to professional interpreters, they had improved access to other preventive services such as rectal exams.
A key area of interest for many health professionals and policy makers in Ontario’s health care system is hospital readmission rates. Readmissions cannot always be avoided, but they can be indicative of the quality of care patients are receiving. Current 30-day readmission rates in Ontario range from about 7 percent for surgical patients to about 21 percent for heart failure patients. Research suggests that professional interpretation decreases hospital readmission rates. The positive impacts of interpretation throughout the care continuum contributes to this reduction in readmission rates. With improved health outcomes, better communication with health providers, and increased referrals to specialists, it makes sense that patients receive improved care and are therefore less likely to experience adverse health implications that require admission and readmission to the hospital.
The feasibility of this has been shown by the ground-breaking work of the TC LHIN and hospitals like CAMH, Sick Kids and William Osler Health System, which have been pioneering this work in the GTA. As our province becomes more linguistically diverse, advancing equity in access to health care becomes increasingly important to ensure no one falls through the cracks. The Patients First strategy provides an exciting opportunity to ensure not only that patients have the right care at the right time, but also that they have the necessary supports to make informed decisions about their health care. As linguistic diversity in Ontario grows, interventions that support language accessibility, like language interpretation services, are promising ways forward of advancing equity in health care for all of Ontario’s linguistically diverse communities.