The latest edition of the CDC’s Yellow Book, which offers health guidance for international travelers, contains a chapter on health communication with refugee, immigrant, and migrant communities for the first time. MHI authors were specifically invited to write this pioneering chapter, offering their expertise for the benefit of healthcare providers and public health professionals serving an increasingly diverse U.S. population. With 46 million people living in the United States born in another country and more than 20% speaking a language other than English at home, this chapter is more important than ever.
The Importance of Language Access
Language barriers do not just prevent patients from understanding health information, they may prevent them from seeking out healthcare services in the first place. This, combined with legal obligations like Title VI of the Civil Rights Act, make professional translation and interpretation services a legal and ethical imperative. Healthcare providers and public health professionals can:
- Avoid making assumptions about English language proficiency based on country of origin, time spent in the U.S., or other demographic factors.
- Arrange for professional interpretation services for patients who need it, rather than relying on a patient’s family members.
- Confirm language preferences for written and spoken communication, as they may differ.
- Learn key principles for working with an interpreter, such as speaking directly to the patient, using short simple sentences, and avoiding medical jargon.
- Employing only professionally trained translators for written communication.
- Involve the community in selecting or culturally validating communication materials.
Trust and Cultural Humility Matter
Patients from refugee and immigrant communities have varied experiences that can affect how they interact with health systems. For example, some may have experienced violence or unethical medical experimentation that create distrust, while others have not and are completely comfortable in healthcare settings. Strategies that create a more welcoming environment include:
- Being transparent about why you’re asking for information about medical history, demographics, or immigration status.
- Offering a chaperone during certain encounters if interacting across genders is uncomfortable for the patient.
- Taking time to understand the specific health and social needs of your patients, recognizing that each community is unique.
- Understanding nonverbal communication norms that vary by culture, such as eye contact, hand gestures, physical touch, and personal space.
Beyond Google Translate: Cultural Validation Matters
Whether creating your own health education materials or selecting them from another agency or organization, it’s important to know what makes materials high-quality:
- Use plain language principles. Plain language benefits everyone – even native English speakers – and makes translation faster and easier.
- Avoid machine translation for patient-facing materials. Translations generated by Google Translate or AI often contain errors. Even if they are error-free, these tools cannot convey tone, urgency, and cultural context the way professional translators can.
- Partner with communities to culturally validate translated materials will ensure they are not only accurate, but culturally appropriate.
- Offer multiple formats. Consider audio and video resources for patients from communities with rich oral traditions, and use QR codes to link written materials to alternative formats.
Partnerships Amplify Impact
Some RIM communities have well-founded mistrust of healthcare systems due to historical trauma and ongoing discrimination. Collaborating with trusted messengers—such as faith-based organizations, refugee resettlement agencies, community health workers, and local cultural organizations—can help deliver health information in culturally relevant ways.
Final Thoughts
MHI’s expertise helped shape this resource, but it’s up to healthcare systems and individual providers to adopt these recommendations for them to truly advance health equity. Start today by:
- Use MHI’s Cultural Validation and Translation Review Toolkit to add cultural validation to your translated materials.
- Select high-quality, translated materials from MHI’s Resource Library.
- Consider audio or video public service announcements (PSAs) to promote health behaviors
- Explore MHI’s Community Partnerships and Engagement Toolkit for more ideas on how to involve communities in your work.