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Breaking down linguistic barriers

New Queen’s research reveals the potential impact of language on immigrant health outcomes.

[Photo of a hospital waiting room]
Patient waiting room in a healthcare facility (Unsplash)

Immigrants represent two-thirds of Canada's population growth and make up more than 20 per cent of the nation's population (Statistics Canada). As Canada’s largest age group – the baby boomers – enter their senior years, elderly immigrants along with them, many are facing several mental and physical health issues. Many aging immigrants, however, in addition to managing their health, also must contend with linguistic barriers that discourage interaction with the healthcare system.

A Sri Lankan-born, Canadian immigrant himself, researcher Don Thiwanka Wijeratne (Internal Medicine and Public Health) is aiming to uncover how immigrant health is impacted by the linguistic barriers that exist in healthcare. Along with his collaborators from Queen’s (Gerald Evans and Sudeep Gill), the University of Toronto, and McGill University, he recently published a study in Drugs and Therapy Perspectives, analyzing the different rates at which long-standing Canadian residents and immigrants undergo unplanned, emergency hospital visits.

In order to focus their research, the team looked at the use of a common blood thinner called Warfarin, used to prevent blood clots, among three groups: long-standing Canadian residents, language proficient (LP) immigrants, and non-language proficient (NP) immigrants, all over 65 years of age. The study documented how often members from each group presented at the hospital for a health emergency related to the use of Warfarin.

Dr. Wijeratne’s team found that older immigrants, both LP and NP, who immigrated to Canada in the last five years may be less likely to seek medical attention for emergency healthcare needs than their long-standing Canadian resident counterparts. Similarly, non-language proficient immigrants were less likely to present to the hospital with unplanned healthcare visits in comparison to language proficient immigrants.

[Photo of Don Thiwanka Wijeratne]
Dr. Don Thiwanka Wijeratne (Internal Medicine and Public Health)

“Language challenges can reinforce systemic and social-cultural barriers to accessing healthcare services and further, prolonged language barriers have been strongly associated with poor health outcomes,” says Dr. Wijeratne. “Hence, to optimize healthcare provision, it’s important to explore the true effects of immigrant health and healthcare utilization at a population level.”

One explanation for the discrepancy in the number of hospital visits between immigrants and long-standing residents is a phenomenon often referred to as the “healthy immigrant effect.” This effect is thought to be the result of several factors, including immigration screening, which favours healthier candidates, proactiveness among immigrants in seeking preventive and primary healthcare services, and the fact that many older immigrants coming into the country are often cared for by family members who provide physical care and help them navigate linguistic barriers. The culminating impact of these factors is that immigrants in general exhibit better health than their Canadian resident counterparts and thus, normally experience a lower number of health emergencies.

Less encouraging, however, is what the study’s findings indicate about the healthcare experiences of non-language proficient immigrants. Dr. Wijeratne’s team found that those who were not fluent in English or French were less likely to present to hospital with unplanned emergency healthcare visits than language proficient immigrants. This may indicate a serious lack of linguistic accessibility provisions in hospitals, and the team offered suggestion of how healthcare systems might look to remedy these shortcomings.

“Ready resources, including interpretation and representation of more diverse ethnicities among healthcare workers, will facilitate communication in multiple languages and offer more culturally attuned service provision, catering to cultural diversity,” says Dr. Wijeratne.

The study received funding from the Ontario Ministry of Health and Long-term care, under the Ontario Drug Policy Research Network (ODPRN), and the Canadian Patient Safety Institute. Dr. Wijeratne and his team plan to continue their research on this issue by leveraging the Canadian immigration database, which can be linked to healthcare utilization databases in Ontario. These population-level analyses will facilitate exploration of knowledge gaps and unique healthcare needs for non-language proficient immigrants.

“These findings are significant because they highlight potential shortcomings in our healthcare system that, if left unfixed, could threaten the lives of a large portion of our population," Dr. Wijeratne notes. 

For more information on Dr. Wijeratne and his research, follow him on Twitter (@Dr_DTW).