Language Interpretation as a Factor for Health Equity

By Muna Osman

Immigrants and refugees are among the fastest growing population in Ottawa. The percentage of Ottawa’s population increased from 21% to 22.5% from 2011 to 2016 to a total of approximately 200,000 individuals (Statistics Canada, 2016). While most these individuals are proficient in Canada’s two official languages as well as another non-official language (Statistics Canada, 2014); about 14,000 immigrants and refugees in Ottawa have limited or no proficiency in English or French (Statistics Canada, 2016), and as a result experience unique challenges when accessing services.

Immigrants and refugees with reduced language proficiency are, at times, in need of community interpreters to access public services. Community interpreters refer to professional interpreters that are guided by ethical principles and standards of practice and trained to facilitate access to community services (Healthcare Interpretation Network, 2007). The right to a language and community interpreter is a fundamental right grounded in both national and international human rights conventions. In Canada, the Charter of Rights and Freedoms recognizes that individuals who do not understand or speak the two official languages have the right to be assisted by an interpreter when accessing public services (Section 14). Both the health care and judicial system most often require language and community interpreters.

In Canada, reasonable access to high quality health care for all residents is the foundation of our publicly-funded health care system (Canada Health Act, 1985). However, some individuals might have reduced access to quality health services because of their limited proficiency in both official language. Research has evidenced the negative effects of language barriers in health care service delivery, treatment compliance, and compromised or prolonged recovery. Providing interpretation services, for such individuals, is key to ensuring health equity in Canada.

While access to interpretation services is a basic human right and the responsibility of public institutions, at times, the onus of an interpreter falls on the vulnerable client. In such cases, family members and friends act as untrained interpreters. While untrained interpreters are associated with some risks, having no interpreter can increase the likelihood of errors, reduced comprehension, and compromise a client’s right to informed consent. As such, it is the right of an individual to have access to community interpreters, as they are trained to be efficient, accurate, impartial, and help ensure quality and safe care and mitigate any harm to clients.

In the absence of a community interpreter, untrained interpreters, including family members and friends, are often used in an adhoc manner and out of an immediate necessity. However, this is not recommended. Such an approach can also disadvantage some newcomers and refugees who might lack the social networks and, thus, not have access to interpretation. The use of untrained interpreters can also lead to lack of impracticality, breach of confidentiality, and the reliability of information conveyed being compromised. Overall, the availability and quality of interpretation services have direct implications on the care and safety of clients and, at times, can perpetuate health inequities because of the language barrier.

The Information, Awareness, Language and Interpretation Action Team of the OLIP Health and Wellbeing Sector Table conducted a survey of service providers to examine the state of language interpretation use by agencies across the Champlain region and specifically the impact of COVID-19 on the provision of these services.

The survey suggests that, in the Champlain region, most service providers (60%) know where and how to access community interpretation services when needed by a client. Furthermore, from the service providers surveyed, most (74%) do not use community interpretation services regularly, and this pattern of limited use has proven consistent before and during COVID-19. The various reasons for the underuse of interpretation services by agencies will need to be further examined.

Remarkably, the survey suggests service providers consider community interpretation services only in cases where other untrained interpreters are not available. This overreliance on family, friends, and employees is concerning given that research has consistently shown the risks associated with the use of such interpreters.

While health providers were mixed (Yes:58%; No:42%) in whether they felt COVID-19 would impact services, the survey shows COVID-19 presented both changes and challenges to interpretation service provision. Prior to COVID-19, most interpretation services (79%) were provided face-to-face or over the telephone. As expected after COVID-19, there was a decrease in face-to-face interactions. However, there was no increase in the use of over the telephone interpretation. This finding implies that while face to face interactions were reduced, this change did not reflect an increase in alternate means of interpretation service delivery. This gap in services provision and its related implications will need further research.

Through the qualitative responses, service providers mentioned several issues related to or exacerbated by COVID-19. More specifically, service providers suggested COVID-19 preventative measures made it difficult to accommodate clients with interpretation needs while maintaining these safety measures. One service provider mentioned that at times maintaining physical distancing risked client confidentiality as distancing was required specifically for community interpreter and not necessarily family members. Another service provider mentioned there were added demands on health facilities when clients required an interpreter as an additional person needed to be screened before entering the facility. Additionally, to keep the numbers of individuals in a room low, clients were at times not allowed to be accompanied by family member, who could provide community interpretation in the absence of a community interpreter.

This survey was the first of its kind to address the pertinent issue of interpretation use in the COVID-19 context. The findings suggest interpretation services are not used regularly by service providers, and that COVID-19 presented some changes to and new challenges for the provision of interpretation services. Finally, the survey also points to several issues that require further exploration, such as reasons for the underuse of interpretation services, gap in service provision due to COVID-19, and the decision-making process of service providers in the absence of community interpreters.

Muna Osman is Researcher and Impact Analyst at OLIP.