An inability to understand the local language creates significant barriers to accessing healthcare, particularly for migrant and refugee communities. Visionary initiatives and evolving tech are helping surmount this linguistic hurdle.
In many countries, the pandemic exposed the language barriers within healthcare systems and served as a catalyst for change. Photo: cottonbro studio
Maria de Brito* scrolls through an endless string of messages on her phone. “You won’t believe how much time I’ve spent writing these messages,” she says.
Originally from Brazil, de Brito moved to Helsinki, Finland, eight years ago. She recently gave birth to her first child, which necessitates regular interaction with the local healthcare system. In Helsinki, health services are largely accessed through a smartphone app called Maisa, where users can book and view appointments, seek answers from professionals, and access health data.
Without knowing the local language or understanding the working of the system, de Brito, whose mother tongue is Portuguese, often has to ask for help. She is also frequently forced to repeat her questions—either due to gaps in communication or the long threads of referrals from one institution to another in search of someone equipped to answer her query.
When de Brito experienced postpartum depression, she was forced to approach the emergency room to gain timely access to an on-call therapist.
de Brito also took time to adjust to the new culture, which is quite different from what she was used to back home—socially reserved interactions with healthcare professionals, where remote messaging is favoured over the warmer in-person approach in her native Brazil. “Here, it is much more oriented towards the system and the processes. I’m missing the human touch,” she says.
de Brito’s experiences are borne out by research: language barriers delay access to early intervention and treatment, leading to a higher likelihood of emergency room visits, stress, and anxiety for the patient, as well as caregivers. Language gaps can also lead to misdiagnoses, medical errors, needless additional tests, higher hospitalisation rates, and prolonged hospital stays.
In short, language barriers put patients at risk and drive up the cost of healthcare.
Tackling pervasive language barriers
Language barriers have traditionally been tackled using interpreters, who translate consultations and interactions with healthcare professionals. But as de Brito’s experience shows, the issue is much larger, impacting the patient's entire treatment journey well before stepping inside a hospital and long after discharge.
Navigating a complex phone tree when calling for help or language barriers in interacting with a customer service agent can derail the entire endeavour. Equally, acquiring medications and following a treatment plan can be challenging when the instructions are in an unfamiliar language and the pharmacy or rehabilitation staff speak a different tongue.
Often, language is so deeply intertwined with culture that it becomes difficult to pinpoint where a language barrier ends and a cultural one begins.
For migrants and refugees, language gaps may be seen as merely a short-term challenge during the first few months of arriving in a new country, but in reality it may take years to learn a new language and the workings of a society well enough to navigate its healthcare system confidently, especially when unwell.
Discussing sensitive topics such as medical issues becomes all the more harder when using a non-native language. Often, language is so deeply intertwined with culture that it becomes difficult to pinpoint where a language barrier ends and a cultural one begins.
Any attempt to bridge the gap will require work on all levels, from policymakers to the healthcare professionals on the hospital floor. In countries such as Finland, the pandemic exposed the language barriers within healthcare systems and served as a catalyst for change.
“The [pandemic] made us see how diverse a population we are and how the old ways of offering healthcare services only in the official languages [Finnish, Swedish, Sami] simply do not work anymore,” says Dr Jenny Paananen, a researcher at the University of Turku in Turku, Finland. “Healthcare services belong to everyone equally, and during the pandemic we also saw how crucial it is for everyone’s collective safety to be able to communicate with the entire population effectively.”
Improving accessibility with video
Similar conclusions were made in Ireland. “There are over 600,000 people in Ireland who are multi-lingual, speaking a language other than Irish or English at home,” says Michelle Hayes, a project manager for intercultural health at HSE Social Inclusion.
The videos feature doctors, nurses, and other healthcare professionals providing health information in Ukrainian, Urdu, and Somali, among other languages.
“Providing accessible information in user-friendly formats to all service users is a fundamental approach to help them effectively navigate the healthcare system and derive the maximum benefit from it.”
One such initiative is ‘My Health, My Language’, which has created videos in 17 languages with information on health topics ranging from pregnancy to dental care, and the Irish healthcare system. The videos feature doctors, nurses, and other healthcare professionals providing health information in Ukrainian, Urdu, and Somali, among other languages. These professionals are immigrants from other countries who live and work in Ireland.
The video format is much more effective in reaching audiences compared to just subtitles or voice-overs, Hayes explains. QR-coded posters in healthcare facilities direct users to the video content and a written booklet with more information on each topic.
So effective is My Health, My Language that it was selected for the Equality Initiative of the Year award at the Irish Healthcare Awards 2022. Looking ahead, translations remain a major focus in HSE Social Inclusion’s five-year strategy. “There will be more videos,” Hayes says.
Community-led approach creates trust
In Australia, where immigrants make up 28% of the population, policymakers have teamed up with the Multicultural Centre for Women's Health, a community-based not-for-profit organisation of women from migrant and refugee backgrounds, to reach and engage with refugee and migrant communities.
In contrast to the top-down video format approach in Ireland, the centre has been using in-person bilingual health education programmes in its outreach efforts for more than four decades.
Its first national-level education programme, ‘Health in My Language’, was introduced during the pandemic. Led by Dr Regina Torres-Quiazon, the programme aims to raise covid-19 vaccination rates within migrant communities. It consists of non-hierarchical participatory sessions, typically in small groups, that foster woman-to-woman interactions for the sharing and exchange of health information in a respectful and non-judgemental environment.
The sessions raise awareness on covid-19 vaccines, promote healthy behaviours and attitudes, and, ultimately, help reduce negative health outcomes and healthcare expenses.
“The participants have appreciated this opportunity to have conversations in their own language, such as Arabic, Vietnamese, Dari, Karen, Mandarin and Cantonese, and, in some sessions, to practise speaking English. They have ended up discussing issues that they would not feel comfortable raising with their general practitioners,” Torres-Quiazon explains. The programme began in March 2023, and by August it had conducted 2,000 health education sessions covering nearly 33,000 participants. In August alone, bicultural health educators conducted 180 sessions, reaching 2,500 participants. The sessions raise awareness on covid-19 vaccines, promote healthy behaviours and attitudes, and, ultimately, help reduce negative health outcomes and healthcare expenses.
Torres-Quiazon and her team have built the infrastructure, including partner organisations in each state and territory in Australia, as well as teams of trained bilingual health education workers who serve as facilitators during the sessions. This is a feat in its own right and a powerful means to address inequities at the personal and systemic levels.
Moving forward, a 2023 Senate inquiry report by the Australian government recommended harnessing the model to improve access to sexual and reproductive health information. “The model can be adapted to support migrant and refugee communities across different health issues and topics,” Torres-Quiazon says.
Going digital for sexual health
German sexual health platform Zanzu is used by healthcare professionals when counselling immigrants, refugees, and people with low literacy. Photo: Sarah Chai
To fill a similar information gap, a digital initiative was introduced for health professionals in Germany, where more than 20% of the population has a migrant background. ‘Zanzu, my body in words and images’ is a platform with information on sexual health in 14 languages. It is primarily meant to be used by healthcare professionals when counselling immigrants, refugees, and people with low literacy or low health literacy.
"Information on women’s sexual health is often coloured by beliefs or power structures. We strive to be a safe source of neutral, correct, scientifically proven information."
Released in 2015 by government-affiliated organisations, it has since been adopted in Belgium, the Netherlands, and Norway. The German site alone receives close to 100,000 visits annually.
Zanzu features short, simple texts in languages such as Ukrainian, Arabic, and Tigrinia, as well as drawings to further illustrate the message. The combination has proven so popular and effective that the site has seldom needed to be updated for almost a decade.
“Information on women’s sexual health is often coloured by beliefs or power structures. We strive to be a safe source of neutral, correct, scientifically proven information,” says project manager Svenja Vergauwen.
Sexual health is often not an easy subject to discuss, and becomes all the more difficult when there is a language barrier, too. Cultural factors can add another layer of hesitancy. “In some cultures, the topic is a taboo, so the language may lack words for it entirely,” Vergauwen says.
To ensure quality, the team uses an experienced translation agency and works with groups of native speakers to test the content before release.
Closing the language gap with technology
Platforms like Zanzu, as well as more advanced digital solutions such as speech recognition, speech-to-text, chatbots and machine translation, show great potential in closing language gaps. But these are still not within the purview of national-level policymakers and remain available only to a select few.
“The revolutions that are currently happening in language technology, such as AI or ChatGPT, are exciting, but are only available in the major languages. Roughly half of the [global] population is left behind,” says Dr Andrew Bredenkamp, chair of Clear Global, a non-profit previously known as Translators without Borders that works to break down language barriers.
“It is not just a division by communities or urban and rural populations,” Bredenkamp continues, “but also by gender, age, and level of education.” Women, children, older people, and people with disabilities are often at the greatest disadvantage as they are less likely to understand international languages. For example, in north Nigeria, the lingua franca Hausa is spoken by 40-50 million people, yet it is not well supported by any of the currently used language technologies.
To accelerate change, Bredenkamp urges international donors to focus on the development of technologies that have a wider reach than is commercially viable, "so that this divide between the haves and the have-nots in terms of access to information” doesn't widen any further. He says the process needs to be driven by organisations in the global south rather than the north.
Gram Vaani, a New Delhi-based company that uses technology to create participatory media platforms, is a case in point. Its Mobile Vaani social media platform is similar to Facebook but designed specifically for rural areas of India, where more than 100 languages are spoken.
It functions via voice, where the interactive voice response (IVR) system allows users to call a number and leave a message about their community in their local language. They can also listen to messages left by others, or playlists created by governmental bodies or NGOs. These messages aim to raise awareness or share information on topics such as the health and nutrition of mothers and young children.
The system was developed specifically for people with low literacy, and no access to internet connectivity or the regular media, thereby tackling both language and technology barriers. During the pandemic, the platform was used to build awareness, counter misinformation, enable community feedback, and link those in need with support. Over a 15-month period, 870,000 individuals used the platform through 2.5 million calls, recording 24,880 voice reports, and sharing 2,327 impact stories.
It is clear that solutions that help close language gaps do exist—and they do work—but more is needed to scale them up to be truly accessible to all. “This may sound obvious, but we will want to listen at least as much as we talk, to create a dialogue that is genuinely going two ways. That will lead to more mindful language choices and language technology approaches,” Bredenkamp says.
*Name changed at interviewee’s request