Over the last 40 years, the number of individuals at least 5 years old in the U.S. who speak a language other than English at home has increased from 11% (23 million) in the 1980s to 21.5% (71 million) in 2018.1 Of those 71 million, almost 40% (25.7 million, ~8.5% of the U.S. population) have “Limited English Proficiency” (LEP),1 defined as a self-rated English-speaking ability of “less than very well.”2 Patients with LEP face numerous healthcare inequities and poorer health outcomes, as LEP adversely impacts multiple aspects of healthcare including access and utilization, patient–physician communication and trust, satisfaction, quality and safety, and duration of hospitalization.3,4 The majority of individuals in the U.S. with LEP speak Spanish (66%), and the Latinx population continues to grow. There are now more people who speak Spanish at home in the U.S. than in any country in Latin America, with the exception of Mexico, Colombia, and Argentina.5 Despite this, only 5.8% of U.S. physicians identify as Latinx,6 creating a major challenge for representation in healthcare.

The Civil Rights Act of 1964 and the Department of Health and Human Services (HHS) regulations mandate that institutions that receive federal financial assistance from HHS provide language services to individuals with LEP where required.7 In recent years, healthcare institutions have made significant efforts to ensure the provision of language services for patients with LEP, utilizing strategies including identification and documentation of patient preferred language in the medical record and harnessing technology to increase the availability of interpreters.8,9 However, many healthcare systems continue to struggle to provide appropriate language services,10,11,12,13 and the COVID-19 pandemic has magnified significant challenges in providing equitable healthcare to patients with LEP. In our own institution, during the initial COVID-19 surge, existing interpreter services were unable to meet the in-person language needs of the overwhelming number of patients with LEP, in particular Spanish-speaking patients, and the use of telephone language services proved challenging in full personal protective equipment.14 These challenges created an opportunity for us, as Spanish-speaking neonatologists, who normally care for newborns, to care for Spanish-speaking adult patients with LEP.

Log in or create a free account to read this content

Gain free access to this article, as well as selected content from this journal and more on nature.com

Access through your institution

or

Sign in or create an account
Continue with Google
Continue with ORCiD