Pre-Condition to Health Equity: Breaking
                Down Language Barriers

               Bob Gardner
  Healthcare I...
Key Messages

• free and equitable access to high quality interpretation is
   – vital to an equitable and well-performing...
Outline

• that promise – of how ensuring equitable access to high-
  quality interpretation will help create an equitable...
Crucial Pre-Condition for
                                                 Health Equity

• language is one of most crucia...
Use Existing Levers

• need to define clear equity-focussed expectations:
   – all providers will deliver sufficient high-...
Connecting the Dots and Driving
                              Change: Building Interpretation
                            ...
Connecting the Dots and
                                        Driving Change II: Equity-
                               ...
Building on Existing System
                                                        Drivers
• key things that worry EDs an...
All About Culture

• interpretation is never just about words, but culture
   – skilled high-quality interpretation is one...
Build on Front-Line
                                                                Innovation
• peer ambassadors – local ...
Building Equity-Focussed
                                            Innovation Into System
                              ...
© The Wellesley Institute   12
www.wellesleyinstitute.com
Contact Us

• these speaking notes and further resources on policy
  directions to enhance health equity, health reform an...
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Pre-Condition to Health Equity: Breaking Down Language Barriers

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This presentation provides insight on the pre-conditions required to achieve health equity.

Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI

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Pre-Condition to Health Equity: Breaking Down Language Barriers

  1. 1. Pre-Condition to Health Equity: Breaking Down Language Barriers Bob Gardner Healthcare Interpretation Network AGM September 22, 2009
  2. 2. Key Messages • free and equitable access to high quality interpretation is – vital to an equitable and well-performing health system – an indispensable pre-condition for achieving equal opportunities for good healthcare for all – especially in an increasingly diverse society – crucial to breaking down barriers to good health care for disadvantaged and marginalized populations • building high quality interpretation services is a crucial element of an overall progressive health equity strategy © The Wellesley Institute 2 www.wellesleyinstitute.com
  3. 3. Outline • that promise – of how ensuring equitable access to high- quality interpretation will help create an equitable healthcare system -- is theme of my remarks: – addressing barriers -- language and culture as among most important barriers to equitable access and quality of care – levers – how interpretation can be built into health providers’ incentives, expectations and requirement – drivers – linking interpretation to system drivers like safety, quality, managing ER, ALC and other bottlenecks, risk management – opportunities for innovation – connections – where building interpretation services intersects with – and underpins – an overall equity strategy © The Wellesley Institute 3 www.wellesleyinstitute.com
  4. 4. Crucial Pre-Condition for Health Equity • language is one of most crucial barriers to access to care • like most barriers it can be addressed through good policy and services → – need high-quality trained interpretation services available to all who need them – need continuum of responsive and consumer-centred interpretation services – where and when people need them • how to ensure services are available and accessible = crucial challenge for equitable and efficient system – high on Toronto Central LHIN agenda and on province’s © The Wellesley Institute 4 www.wellesleyinstitute.com
  5. 5. Use Existing Levers • need to define clear equity-focussed expectations: – all providers will deliver sufficient high-quality interpretation services to meet the needs of the people, communities and catchment areas they serve • then build requirements to meet these expectations – and targets and indicators to measure progress -- into performance management systems: – accreditation requirements and processes – Service Accountability Agreements between LHINs and providers – health profession Colleges and other professional regulatory mechanisms © The Wellesley Institute 5 www.wellesleyinstitute.com
  6. 6. Connecting the Dots and Driving Change: Building Interpretation Into Performance Management • for providers to meet these requirements, they will need to: – know the language needs of the communities they serve – this is far more than the languages of those who come to them for services – but do need to collect that data – also need to know who is not coming in because of language and other barriers = unmet need – and it doesn't mean just basic demographic data on languages spoken – it means what language people are most comfortable receiving care in • so demand/drive for accessible interpretation → built into performance mgmt → providers assessing community needs far better © The Wellesley Institute 6 www.wellesleyinstitute.com
  7. 7. Connecting the Dots and Driving Change II: Equity- Focussed Data • driving change through performance management will require better data on language and other needs of community – need far better social determinants type data across the health system • need to also collect data on service delivery – range of clients served and their gender, socio-economic and cultural background → contributes to building up better picture of community needs – impact of interpretation services – comparing re-admission rates, satisfaction, post-hospital recovery, infection, etc. → builds case for investing in interpretation • need to ensure interpretation practitioners and experts are at planning tables and equity-focused indicators and data collection systems are being worked out © The Wellesley Institute 7 www.wellesleyinstitute.com
  8. 8. Building on Existing System Drivers • key things that worry EDs and CEOs: – reducing risk and enhancing safety – delivering high-quality care efficiently – meeting provincial priorities – wait times, mental health or diabetes, ALCs • access to interpretation underlies all of these system drivers: – poor communication between provider and patient due to language or cultural barriers can contribute to misdiagnoses and inappropriate prescriptions – inability to read or understand instructions can lead to medication errors → safety and cost implications – support for self-management for diabetes and other chronic conditions has to be delivered in languages of communities to be effective – promising indications that good interpretation helps keep people out of hospital and gets them out sooner • aligning to such drivers and incentives = crucial to build support for interpretation strategy © The Wellesley Institute 8 www.wellesleyinstitute.com
  9. 9. All About Culture • interpretation is never just about words, but culture – skilled high-quality interpretation is one part of ensuring culturally competent care – part of inter-related changes needed to ensure inclusive health service providers and healthcare system – cultural sensitivity and competence – just as equity overall – need to be built into core fabric of daily working cultures of service providers • so cultural competence and interpretation must be central to wider equity and diversity-focussed organizational and system transformation • and need to build on the many local community-based initiatives and front-line innovations who are doing just © The Wellesley Institute 9 that www.wellesleyinstitute.com
  10. 10. Build on Front-Line Innovation • peer ambassadors – local initiatives out of CHCs: – members of specific ethno-cultural communities who help others navigate through health system or deliver health promotion programs – ambassadors often work within the language of the community/consumer – need to be well trained and supported • Edmonton Multi-Cultural Health Brokers Cooperative – provides navigation, counselling and other support to people, who because of language or cultural barriers have trouble making their way through the health system – arose from a grass-roots recognition that these barriers were increasingly important but not being addressed – jointly developed by the local regional health authority, public health and other stakeholders – many of the brokers were internationally trained providers -- doing this work allowed them to use their skills and become familiar with the provincial system as they waited for recognition of their qualifications. © The Wellesley Institute 10 www.wellesleyinstitute.com
  11. 11. Building Equity-Focussed Innovation Into System Change • these examples highlight innovative ways in which a seamless and responsive continuum of care can be filled out • another opportunity for innovation is learning from other jurisdictions – e.g. who have developed centralized interpretation resources and systems within health authorities • more generally, this kind of local community-based and front-line innovation is key to driving equity-focussed health reform • LHINs and Ministry need to support widespread experimentation and front-line service innovation • but to realize potential of innovation, also need infrastructure to: – systematically trawl for and identify interesting local innovations and experiments – evaluate and assess potential beyond the local circumstances – share info widely on lessons learned – scale up or implement widely where appropriate • all to create a permanent cycle and culture of front-line driven innovation on equity © The Wellesley Institute 11 www.wellesleyinstitute.com
  12. 12. © The Wellesley Institute 12 www.wellesleyinstitute.com
  13. 13. Contact Us • these speaking notes and further resources on policy directions to enhance health equity, health reform and the social determinants of health are available on our site at http://wellesleyinstitute.com • my email is bob@wellesleyinstitute.com • I would be interested in any comments on the ideas in this presentation and any information or analysis on initiatives or experience that address health equity © The Wellesley Institute 13 www.wellesleyinstitute.com

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