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California Endowment: Language Access

In 2003 The California Endowment (TCE) and NAM partnered on a community-based campaign to remedy the fact that most California immigrants were unaware of their right to an interpreter when getting medical care--a right that could make a critical difference in quality of care.

Today, the balance has tipped the other way, thanks to a two-year paid advertising campaign that engaged communication leaders in the ethnic media to increase immigrants' awareness of that right. Now, far more Californians know that they can ask for an interpreter any time they seek medical care.

The ethnic media are not just widely consulted (they reach 84% of the state's African Americans, Hispanics and Asians)--they're also among the most trusted institutions in ethnic communities. Which is why TCE decided to work with these outlets to reach California's more than 9 million Limited English Proficient (LEP) immigrants.

From 2003 to 2005, TCE contracted with NAM to place more than $1.9 million dollars worth of advertising in 13 different languages in 140 media outlets--reaching millions of LEP Californians. To bring reporters' attention to the issue, NAM convened a series of news briefings in San Francisco, Los Angeles, Fresno and San Diego, inviting representatives from the ethnic media and the health care industry. Journalists, doctors, nurses and interpreters provided input in early brainstorming sessions on how best to frame the campaign and reach LEP Californians as effectively as possible.

Prior to the campaign, NAM commissioned Bendixen and Associates to conduct a poll of LEP Californians in 11 languages to quantify the problem. Results validated TCE's decision to work through NAM's network of ethnic media: most respondents said foreign-language media was their number one source of health care information, and medical care ranked at the top of California immigrants' list of social concerns, over education and unemployment.

The poll's findings illustrated the depth of the language barrier:

  • One-third said they felt the quality of health care they receive was typically poor or very poor.
  • One-third said it was often unclear how they should take prescription medications.
  • More than half of Hmong, Iranians and Hispanics claimed they were confused during the hospital discharge process.
  • Nearly three-fourths of Cambodians said they had trouble understanding medical situations when they were explained only in English.

And yet just 9 percent of all respondents said they exercised their right to an interpreter.

The first year's campaign message focused heavily on raising awareness of that right. "Does anyone here speak my language? Ask for an interpreter--it's your right," stated a print ad that ran in 13 languages, from Arabic to Vietnamese. Television and radio spots in 11 languages, including Armenian, Cantonese and Tagalog, aired that same message across the state.

In year two, the campaign message educated LEP Californians on practical steps to take to get a qualified interpreter.

The participating ethnic media ran news stories on the campaign in their papers, magazines and broadcasts. "Patients Have the Right to an Interpreter" stated a front-page headline in the Spanish language paper El Popular. Armenian Business Life ran a cover story titled "Healthcare: Bridging the Language Barrier." "Language a Barrier to Good Health," stated Asia, a paper serving Asian Pacific Islanders in San Diego. More than 30 print publications and several broadcast outlets reported on the poll findings, too.

During both the first and second rounds of the campaign, NAM syndicated a four-column series written by Dr. Alice Chen, a physician at Asian Health Services in Oakland. "Ask Dr. Alice" was featured in more than 30 publications and illustrated the perils of relying on an unqualified interpreter--and the benefits of using a professional.

The campaign also sponsored an essay contest, which 25 ethnic media outlets supported by running pro-bono ads soliciting personal stories on the subject of "How I Overcame the Language Barrier." NAM received more than 120 entries to the contest and compiled the six winning essays, along with close to a dozen others, into a booklet that has been distributed to ethnic and mainstream media, TCE grantees, health professionals and community-based organizations.

Goal: Improve access to health care among LEP Californians by raising awareness of the right to an interpreter.

Impact: Follow-up polling, conducted in 2005, showed that California immigrant health care consumers do, in fact, now know more about their right to a trained interpreter, whether at a scheduled appointment with a family doctor or on a sudden trip to the emergency room. By the end of the campaign, awareness of that right nearly quadrupled among Hmong respondents and doubled among Chinese. Awareness also increased among Koreans and Hispanics, the two groups most aware of their rights at the start of the campaign.

Goal: Leverage advertising investment to garner editorial coverage.

Impact: Editorial coverage of the campaign message in years one and two was valued by NAM as equivalent to $880,000 in advertising, nearly half of TCE's $1.9 million investment in paid ads; the essay contest promoting audience engagement ran quarter-page ads in 25 publications over two months, valued at nearly $100,000. Total added value contributed by the ethnic media matched TCE's advertising investment fifty cents to the dollar.