There is a large and frequently overlooked population experiencing barriers to good health. Consider the following scenarios:
- A white man approximately 55 years of age is visiting a doctor in a spine clinic. He is in chronic pain and is unable to speak to a doctor to find out what his options are. Prior to fully understanding what his treatment options are, he will most likely undergo spinal surgery. The clinic asks him to sign waivers regarding treatment in a foreign language.
- A Hispanic woman suffering from high blood pressure and chronic pain is admitted to the hospital and released with medications to treat her symptoms. She follows what she thinks is the correct regimen. She is later readmitted with kidney failure from improper long-term use of medications. A dialysis port is installed in her chest. She believes it is a filter to cleanse her blood. She does not realize that this is a device designed to allow for dialysis and that she must regularly show up for treatment or she will die.
- An 88-year-old Vietnamese man finds out from Medicare that he was supposed to have a prescription plan along with his regular insurance. He is facing fines that his limited income will not afford. When authorities are asked if they notified him of this requirement, they tell the agent that they sent a letter, but it was written in a language this person doesn’t read.
All of these people have one thing in common: they are deaf or hard of hearing individuals who understand English at a 3rd or 4th grade reading level or below, similar to 50% of Americans in this population group.
American Sign Language (ASL), a visual language with no written equivalent, is the primary language of the deaf community, who identify themselves as a linguistic minority living in a country where English is the dominant language. Handing a written document to a deaf individual who is not fluent in English is equivalent to presenting an English speaker with a document in a foreign language. Kevin Bowles, a Medicare insurance broker who works with deaf individuals, says that “lack of understanding of health care options can be deadly for the deaf.”
Although stakeholders are aware of the legal and ethical need to provide health care information in the language of the consumer, the realization that a large percentage of deaf individuals do not use written English as their primary language is often a surprise to agencies and providers. There is a need to educate the health care industry about delivering information concerning health care options and treatment to deaf and hard of hearing populations in the alternative format of sign language.
In addition to translating written documents into American Sign Language, health care providers must verify consumer understanding and consent or agreement with the information. As a member of the Pacific & Southwest Regional Health Equity Council, I am committed to expanding linguistically competent health care services to the deaf and hard of hearing communities. I believe that the issue of proper presentation of health care information to the deaf and hard of hearing will be one of the most important issues facing providers in the next few years.
