I recently wrote about how changing diets of immigrants can contribute to the decline in their health. There are many studies that explain how immigrants’ diets change with the inclusion and/or exclusion of foods. There are many other health barriers that immigrants can face when moving to the US. For example, they may live in less wealthy neighborhoods, with fewer doctors or clinics nearby. They may not have insurance and feel that is a barrier to health services. They may also face many other obstacles. One of these is language. Not being able to communicate effectively has a huge impact on health outcomes of immigrants, old and new.
This month, a study by Ariela Schachter in the Journal of Health and Social Behavior supports this idea. She found that immigrants who speak English and their native language report better health status than immigrants who speak only their native language. This is not the first time that language is explained as a barrier to health. 
In 2003, the Kaiser Family Foundation reported that language barriers were responsible for poor health outcomes in many ways. For example, language barriers can make it difficult to find a job that offers insurance benefits. They may also make it difficult to complete insurance applications. Often times, paperwork for programs like Medicaid and SCHIP are not even available in certain other languages.
So how else does not speaking English actually lead to being less healthy? It can be challenging to effectively explain health problems to physicians. It can also be difficult to convey symptoms of a problem, issues with medical history, and other important information. Although it may seem obvious that there is a need for translators, there are disagreements about who should pay for them. Joseph Heyman, chair of the Board of Trustees of the American Medical Association, believes that government is responsible for paying for translators. However, for any hospital that receives federal funding, an old civil-rights law says those hospitals are responsible for translators. Regardless of who should pay, it is clear that language can present real challenges, and can affect how immigrants try to seek out health services.
According to Schachter, while many people focus on the impact of encouraging English speaking, it is important not to “ignore the positive things that people can get from maintaining a strong ethnic culture and identity, and part of that identity is a native language.” It is possible that immigrants who speak English well are generally in a position have better jobs with better insurance benefits, and also may have enough health education and life skills knowledge to take care of themselves. Immigrants who don’t speak English well are less able to assimilate and form diverse social and support networks, and are thereby removed from mainstream medical facilities.
Some information on “best practices” has emerged, however. The major theme is the improvement of health literacy among immigrants. There are many ways this has been approached. The best of these practices is one that uses multitasked approaches and direct communication. For example, a health educator with native 
language skills of the target population and cultural sensitivity provide oral instructions of patient education materials. In addition, making use of existing social networks and other community facilitators, ensures acceptance by the target immigrant population. This type of approach relies heavily using public spaces as hubs for interaction, and include community health centers, schools, ethnic associations, and churches and temples. Other approaches of improving health literacy involve actively engaging target communities and having individuals and groups actively involved in projects. It is also possible to have interventions that apply multiple approaches to health literacy. This is being done for several different ethno-linguistic groups in both the US and Canada – huge hubs for migration.
Although the ideas to improve health literacy are emerging, there are going to be things to keep in mind.
1) There should be ways to evaluate programs and factors like health literacy, health outcomes, self-reported health, and other health indicators.
2) Funding will be a constant issue. To maintain engaged community health facilitators, to maintain outreach initiatives, and to maintain awareness of health literacy programs, funding is crucial. These programs should be subsidized, at least in part, by state or city governments. In addition, because the services directly benefit medical staff at local health facilities and are a way to support services offered by health facilities, local health care centers should try to allocate some funding towards maintaining community-based participatory projects.
3) Finally, ensuring competent and dedicated staff with working knowledge of languages and cultures will be an important component. These make targeted interventions more acceptable within the target immigrant populations, ensure sustainability and attendance, and are a part of supporting better health outcomes.
