healthcare interpretation network (hin) annual general meeting - october 25, 2016: interpretation as...
TRANSCRIPT
WELCOME
Annual General Meeting
Healthcare Interpretation NetworkOctober 25, 2016
The 519
Branka Agic, MD, PhD
Interpretation as a Means to Enable
Health Equity
Foreign-born population, as a proportion of the total
population
3
Diversity of Canada’s population
Immigration plays a
critical role in Canada’s
economic and population
growth.
4(MHCC, 2016)
(Ontario Ministry of Finance, 2012)
Proportion of foreign-born individuals is highest in
Ontario
5
(Ontario Ministry of Finance, 2011)
Population by knowledge of official languages; Ontario,
2011
6
(Statistics Canada, 2012)
5% of Torontonians had no knowledge of either official language
(City of Toronto, 2014)
Healthy immigrant effect
Share of immigrants and Canadian-born self-reporting as healthy
(CIC, 2010)
Healthy immigrant effect
Current explanations: selection,
acculturation, or exposures to
harmful post-migration
environments
Health inequities are differences
in health outcomes that are
avoidable, unfair and rooted in
social determinants of health.
9
What are the impacts of
Health Determinants on
population health?
• 15% is determined by
biology and genetics
• 10% by the physical
environment
• 25% by the actions of the
health care system
• 50% determined by social
and economic policies
and environment
(Keon, W.J., Lucie, P (2008)
Social determinants of health
Socialsupport
Income
Social
inclusionLanguage
Health
services
Housing
EmploymentEducation
Official language
proficiency may
interact with other
determinants of health.
(Bowen, 2001)
Language barrier
Limited language proficiency influences health by:
• creating economic difficulties
• reducing social participation
• impairing access to health services.
37% of new immigrants who came to Canada between 2001
and 2006 reported limited official language proficiency 6
months after they arrived.
11
(Ng, Pottie & Spitzer, 2011)
Language & health
People with limited official language proficiency experience
disparities in their health status, access to services and the
quality of care received
Language barrier impacts:
• service utilization
• health outcomes
• patient satisfaction
• overall costs to the health system.
12
Language & health
Language barriers:
• pose limitations to informed consent
• delay needed services
• lead to unnecessary testing
• lengthen hospital stays
• increase emergency room use
• interfere with follow-up care
• increase readmission rates.
Inequitable access and outcomes are highly inefficient from a
system perspective.
13
Language barrier
Service providers commonly overestimate their patients' ability
to comprehend and communicate in English or French.
Due to a lack of funding, health care providers often rely on ad
hoc interpreters.
Inadequate interpretation often results in the violation of patient
confidentiality and inadequate informed consent, misdiagnosis
and/or unnecessary tests.
14
Health equity a strategic priority
MOHLTC, HQO, TC LHIN
have identified equity as a
key component of quality
care.
Health equity will be
achieved when all people
living in Ontario are able to
reach their full health
potential (HQO, 2016).
15
What is health equity?
16
Health Equity is the principle underlying a commitment to
reduce—and, ultimately, eliminate—disparities in health
between population groups.
This means all people in Ontario are able to receive
high quality care that is fair and appropriate to them
and their needs, regardless of region, economic or social
status, language, culture, gender or religion (HQO,
2016).
Equality vs. Equity
17
Why consider health equity issues?
Ethical reasons• The enjoyment of the highest attainable standard of health is one
of the fundamental human rights (WHO, 1946).
Legal reasons• Excellent Care for All Act, 2010.
• Local Heath System Integration Act, 2006.
• The Ontario Human Rights Code (1962).
Economic reasons• Estimated cost of health inequities in BC = $2.6 billion annually.
18
Reducing inequities in health care
Focusing service interventions and resources to reduce
institutional barriers will improve equitable access to care (TC
LHIN, 2008).
In July 2008, the TC LHIN identified language as a systematic
and avoidable barrier to the equitable provision of health care
services in Toronto.
The fundamental principle is to have trained interpretation
services available to all consumers who need it, where they
need it (TC LHIN, 2008.)
19
All hospitals and community health centres in the central
Toronto area collect demographic information. The purpose of
this information is to understand who our patients and clients
are and what unique needs they may have.
20
1. What language would you feel most comfortable
speaking in with your health care provider?
Language Services Toronto (LST)
Improved access to language supports
was identified as a priority in the Hospital
Health Equity Plans, in consultations for
the 2010-2013 Integrated Health Services.
In October 2012, the TC LHIN launched
the LST program to provide over-the-
phone interpretation services to hospitals
and community agencies within its
network.
21
The LST program
has a strong impact
on service
accessibility and
patient autonomy
for patients with
limited or no
English skills.
Key messages
Language is a key determinant of health.
People with limited official language proficiency experience
health disparities.
Free access to qualified interpreters is crucial to ensuring
that people not fluent in English or French have equitable
access to high-quality health care services.
22
Thank you!
23
Meegwitch!
The 519
• Since 1975, The 519 has worked for inclusion, acceptance and awareness of LGBTQ rights in Toronto and beyond. It is a City of Toronto agency with a unique approach to community building that allows them to deliver direct service, accessible space and ongoing leadership that makes a real difference in people’s lives while promoting broader understanding and respect
Mario Raúl López1965-2001
.
Why HOLA?
• It was important for Latino gay men to know what HIV was all about. Language was a key barrier to access information. Therefore, more difficult to educate ourselves about HIV.
• My hope was that one day, people would be able to read pamphlets in their own language and eventually it did happen. Nevertheless, these were literal translations from pamphlets that were translated from one of the official languages. This was better than nothing but in reality, we were not professional translators either. It was easy to tell.
CSSP
• Members of HOLA joined the Centre for Spanish Speaking Peoples and started the HIV prevention Program in Spanish.
HIV PREVENTION en español por favor
• HIV in more than 30 years has created different needs in our community and the Spanish Speaking Community of Toronto has never created an AIDS Service Organization, despite the support granted by other ethno racial groups.
Aids2006
• In 2006, several Delegates from Latin America applied for refugee status in Canada during the International AIDS Conference in Toronto
• Significant research has been conducted on the impact of language barriers on health and healthcare, now imagine advocating on your own, living with HIV in a new country and doing an immigration process in another language without any idea of what that means
Latin@s Positiv@s Toronto
• Let me tell you, what I witnessed was devastating.
• The rights of limited English proficient patients to informed consent and confidentiality are often not protected.
• I decided to become an interpreter and joined the cause of the Spanish speaking people living with HIV seeking services at the Toronto People With AIDS Foundation. With the support of the TPWAF, the newcomers founded Latinos Positivos
Status quo?
• As reported in 2015 by Sarah Bowen: research has outlined the complexity of pathways by which language, culture, race/ethnicity and health literacy may affect patient care
• For example: MCIS provides interpreters face to face to a client who needs to speak to his or her case manager. However, if that person needs to visit a doctor, the agency may not have an agreement to accompany the client to a medical appointment outside the premises
TORONTO PEOPLE WITH AIDS FOUNDATION
Telling it like it is
Muchísimas gracias
Samuel E. López
+1.647.898.4652
http://vimeo.com/channels/samuellopezdirector