35.1898, Review: The Handbook of Language in Public Health and Healthcare: Martinez, Ortega, Lor and Ramirez (eds.) (2024)

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Subject: 35.1898, Review: The Handbook of Language in Public Health and Healthcare: Martinez, Ortega, Lor and Ramirez (eds.) (2024)

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Date: 30-Jun-2024
From: Laura Callahan [lcallahan at scu.edu]
Subject: Applied Linguistics: Martinez, Ortega, Lor and Ramirez (eds.) (2024)


Book announced at https://linguistlist.org/issues/35.1457

EDITOR: Glenn Martinez
EDITOR: Pilar Ortega
EDITOR: Maichou Lor
EDITOR: A. Susana Ramirez
TITLE: The Handbook of Language in Public Health and Healthcare
SERIES TITLE: Blackwell Handbooks in Linguistics
PUBLISHER: Wiley
YEAR: 2024

REVIEWER: Laura Callahan

SUMMARY

The Handbook of Language in Public Health and Healthcare brings
together four editors and 49 contributors from various research,
educational, and medical settings. The volume is divided into five
sections, each with a brief introduction. Each of the 26 chapters has
its own list of references. There is also a preface, glossary, and
index.

Part I.  Theory, History, and Context: Language in Public Health and
Healthcare

In Chapter 1, “Are We Overlooking Language? An Applied Linguistics
Perspective on the Role of Language as a Social Determinant of
Health”, Stephanie Harsch and Maricel G. Santos advocate for an
approach to health literacy that integrates consideration of social
practice. They dissect six myths around language in healthcare, and
criticize an over-reliance on English reading ability as a measure of
people’s skills in navigating medical systems. Health literacy is
socially situated and cannot be measured with simple print language
assessments, which tend to be based on a monolingual norm.

In Chapter 2, “Sociolinguistics, Public Health, and Healthcare”, Dalia
Magaña emphasizes the importance of using local language varieties and
choosing communication styles and even metaphors that are consonant
with cultural preferences and community values. Magaña contrasts the
sociolinguistics of mobility—which privilege standard, translocal
varieties—with “‘scaling down’ and prioritizing the local” (p. 31).

In Chapter 3, “A Critical Overview of Language Narratives:
Sociolinguistic, Literary, and Graphic Perspectives”, Roxana Delbene
introduces us to illness narratives, in particular “graphic
pathographies” (Green & Myers 2010). Delbene traces the existence of
medical narratives from their origins, noting a movement away from
narratives focused on patient-as-subject to their current form focused
on patient-as-agent.

In Chapter 4, “Anthropological Linguistics, Health, and Healthcare”,
Milena A. Melo, Carla Pezzia, William J. Robertson, and K. Jill
Fleuriet center the theory of bordering to examine three case studies.
The case studies focus on undocumented immigrant patients in Texas in
dire need of dialysis, indigenous Maya in Guatemala suffering from
alcoholism, “and LGBTQI+ patients at an anal cancer research clinic in
Chicago” (p. 59). The authors find that attitudes toward which
patients deserve care can influence the quality of that care.

In Chapter 5, “Applied Linguistics, Public Health, and Healthcare”,
Holly E. Jacobson offers a review of studies from various disciplines
that aim to eliminate patient/provider communication barriers. Earlier
research comes from the fields of Communication, Public Health, and
Psychology, and focuses on improving patients’ health literacy. Only
later does Applied Linguistics enter the scene. One finding that might
be expected but is nevertheless startling concerns resuscitation
decisions.

Part II. Language Interpretation and Translation in Public Health and
Healthcare

In Chapter 6, “Recognizing and Addressing Language Discordance”
Allison Squires begins with a scenario of what it means to be unable
to communicate directly with healthcare providers in one’s preferred
language. A historical overview of language access legislation
follows. Squires maintains that the lack of a common measure of
translation quality affects the rigor and reliability of research
studies in which survey instruments had to be translated.

In Chapter 7, “The Role of Healthcare Interpreters”, Elaine Hsieh
traces the healthcare interpreter’s transformation from neutral
conduit to active participant in patient-provider interactions (Loach
2019). Hsieh details the typologies and challenges of interpreter
roles, including those of dual-role interpreters, e.g., a nurse who
speaks the patient’s language (Chang et al. 2021). Hsieh also reviews
the problems of using nonprofessional interpreters, including clinical
consequences, but nevertheless finds that family member interpreters
may have more value than previously believed.

In Chapter 8, “Healthcare Translation for Patients”, Wioleta Karwacka
outlines various modes and criteria for judging translations. Karwacka
notes that drug information often emphasizes risks rather than
benefits; this is a problem even without language discordance. In a
similar vein, confusing informed consent forms can lead to under
enrollment of less represented populations in drug research trials,
and this lack of representation exacerbates health disparities.

In Chapter 9, “Health Literacy and Plain Language”, Suad Ghaddar
reviews health literacy initiatives, the role of plain language, and
the relationship between health literacy and health outcomes. Ghaddar
also addresses the issue of how to assess health literacy; a major
impediment is the sheer number of models and measures of health
literacy.

Part III. Language Concordance in Public Health and Healthcare

In Chapter 10, “Language Concordance in Clinical Care”, Alicia
Fernández and Francine Ríos-Fetchko review work on language
concordance as a factor in clinical outcomes and patient satisfaction.
While the number of healthcare providers who speak a non-English
language has risen, those languages are not always the same ones that
patients need. Having an interpreter is not the same as having
provider-patient concordance. Research indicates that “even
high-quality medical interpretation does not provide patients as a
group the same level of comprehension as language-concordant care
does” (p. 182; italicized in the original).

In Chapter 11, “Language Concordance as Interactional Concordance in
Multilingual Clinical Consultations”, Caroline H. Vickers and Ryan A.
Goble focus on interactional achievement. For example, do providers
orient to topics raised by patients, align to information presented by
patients, and follow patients’ cues to translanguage? This chapter
includes three transcriptions of provider-patient consultations, two
in which there is alignment and one in which there is not.
Interestingly, in the consultation lacking alignment, the provider and
patient are both native speakers of Spanish.

In Chapter 12, “Assessing Clinician Language Skills”, Ute Knoch and
Jason Fan continue with the issue of how to assess healthcare
providers’ language proficiency, and specifically how to assess their
language skills for the professional setting. This differs from the
more general assessments that might be given at the end of a typical
college language course. Language assessments for professional
purposes are most available for English.

In Chapter 13, “Setting Standards for Clinician Language Use in
Patient Care”, John D. Cowden makes the case for treating the use of
non-dominant languages by medical providers the same way that English
skills are measured and regulated as part of the professional
certification for clinicians who were educated in country in which
English is not the dominant language. Cowden argues that “[a]pplying
regulatory and professional standards only to dominant language
proficiency among healthcare professionals creates a two-tiered
system, where some patients (i.e., dominant language speakers) are
treated to a different level of communication competence than others
(i.e., speakers of nondominant languages)” (p. 233).

In Chapter 14, “Current Gaps and Future Directions in Language
Concordance Research and Policy”, George S. Corpuz, David A.
Chirikian, and Lisa C. Diamond highlight an issue raised in several of
the preceding chapters in this volume, the lack of consensus on what
it means to be proficient: “Research in language concordance must
coalesce around a common definition and measure for language
proficiency so that findings from studies across various fields can be
compared” (p. 272). The authors also emphasize the importance of
considering not just the physician but rather the entire team of
people with whom patients interact in the healthcare system, from the
person who schedules appointments to interpreters to nurses.

Part IV. Pedagogy of Medical Language Education

In Chapter 15, “Second Language Acquisition for Healthcare Purposes”,
Karol J. Hardin offers a review of second language acquisition (SLA)
theories and pedagogical practices in language instruction over the
years, followed by an exposé of the current state of teaching language
for healthcare purposes (LHP) in the United States. A key
recommendation is that “[l]anguage for healthcare courses […] target
intermediate proficiency or higher, focus on oral/aural interaction
with patients and cross-cultural communication, and emphasize
conversation over memorizing lists of vocabulary” (p. 298).

In Chapter 16, “Centering Translanguaging for Inclusive Health
Communication: Implications for Healthcare Professional Education”,
Josh Prada and Robin Woodward-Kron call for curricular innovations
that center the expertise and lived experience of heritage speakers
and local community members, as a part of Value-Added Medical
Education (VAME). Prada and Woodward-Kron state that “[f]or us, the
education of healthcare professionals must incorporate spaces for
critical reflection about the life histories, historical formations,
and linguistic and cultural practices of the populations they serve”
(pp. 313-314).

In Chapter 17, “Dedicated Medical Spanish Courses and Crosslinguistic
Healthcare Communication Skills”, Marco A. Alemán and Alejandra
Zapién-Hidalgo note the inconsistencies in medical Spanish program
evaluation. This chapter offers detailed practical suggestions for
such courses, including the use of trained actors in role-play
scenarios “to expose medical Spanish learners to cultural issues
affecting Spanish-speaking populations” (p. 338).

In Chapter 18, “Medical Language Programs to Enhance Engagement with
Diverse Communities in the United States and Around the World”, Rose
L. Molina and Jennifer Kasper present a case study of the Medical
Language Program at HMS (Harvard Medical School). Its global health
focus means that students can apply their language skills in other
countries. The authors discuss steps taken to avoid the reproduction
of colonial structures and to elevate the authority of local personnel
and perspectives, and to do so in the local language.

In Chapter 19, “Clinical Communication Skills Training in Minoritized
Languages”, Carmen Pérez-Muñoz and Tiffany M. Shinn note the place of
medical Spanish courses in Language for Specific Purposes (LSP), but
warn that it does not suffice to model medical Spanish courses after
English for Specific Purposes (ESP) (Trace et al. 2015, cited on p.
369).

In Chapter 20, “Faculty Development in Medical Language Education”,
Mónica B. Vela and Adriana C. Black Morocoima urge the training of
medical school faculty in health equity, and denounce the power
imbalances that allow the persistence of “poorer standards of care for
linguistically diverse populations” (p. 388). Vela and Black Morocoima
advocate for seeking more medical students and healthcare workers who
have intersecting, minoritized identities.

Part V. Mass Communication and Health: Theory, Research, and
Applications with and for Linguistically Diverse Populations

In Chapter 21, “Mass Media and Health Research in, with, and for
Linguistically Diverse Populations”, Katharine J. Head and Katherine
E. Ridley-Merriweather delve into research methodologies and
theoretical frameworks used to study mass media and its effects on
health behaviors. Of particular note is the shift to messages that
ordinary individuals can both create and disseminate to mass
audiences. This contrasts with just a couple of decades ago, when
authorship would have been limited to governmental or commercial
entities.

In Chapter 22, “Health Information Seeking among Linguistically
Diverse Populations in the United States”, Christine Swoboda, Priti
Singh, A. Susana Ramírez, and Naleef Fareed discuss intersecting
factors that can hinder linguistic minorities’ access to useful health
information. Such factors include general mistrust, lack of accurate
and comprehensible information in the non-English language, and
barriers to accessing online information. This latter has become
especially acute with the increase in insurance and healthcare system
information being available exclusively online.

In Chapter 23, “Entertainment-Education as Linguistic Duality in
Practice”, Suruchi Sood and Rachael HaileSelasse present numerous
examples of entertainment designed to educate, appearing in various
media. Television, posters, and social media—in local languages around
the world—are some of the channels through which campaigns have been
made to influence behaviors. These public education efforts often deal
with culturally stigmatized topics. Sood and Rachael HaileSelasse
argue that using linguistic features from local languages can increase
the effectiveness of the message.

In Chapter 24, “Graphic Medicine and Visual Communication Techniques
for Public Health and Healthcare in Linguistically Diverse Settings”,
MK Czerwiec, Q. Jane Zhao, Isa Álvarez, and Pilar Ortega trace the
history of graphic medicine and the humanization of medicine. Graphic
medicine has obvious applications for patient and public education,
especially when images may compensate where not every viewer’s
language can be included. But graphic medicine also has valuable
applications for medical students and practitioners, such as to
develop empathy and to foster self-care.

In Chapter 25, “Social Media and Health in Linguistically Diverse
Communities: An Examination of Overlooked Populations and Understudied
Platforms”, Anna Gaysynsky, Kathryn Heley, and Wen-Ying Sylvia Chou
highlight successes in communicating with hard-to-reach populations
using various social media platforms. The authors acknowledge the
social media dangers of mis- or disinformation and of hate speech and
discriminatory language, due to “inadequate moderation efforts in
languages other than English” (p. 505).

In Chapter 26, “Urgent Communication During Public Health Crises:
Reaching Linguistically Diverse Populations”, Victoria Ledford, A.
Susana Ramírez, and Xiaoli Nan focus on the COVID-19 pandemic and the
successes and failures of public health messaging during this time. In
addition, the chapter explains the application of communication and
behavior theories to public health campaigns, and how to tailor such
campaigns for specific populations.

EVALUATION

The Handbook of Language in Public Health and Healthcare is a
well-edited and comprehensive contribution to multiple disciplines. It
will be of interest to students, scholars, practitioners, and
administrators in medicine, public health, communication, and applied
linguistics.

The book’s organization adds to its effectiveness. Individual chapters
end with a list of highlights, helpful for returning readers to
refresh their memory. There is ample repetition of key information
across chapters within each of the five sections, and across the
volume as a whole. Thus, later chapters reinforce concepts from
earlier ones, which helps maintain cohesiveness in this 26-chapter
collection. This also makes each chapter comprehensive enough to read
alone.

A very minor criticism would be the occasional overuse of
abbreviations for the names of concepts, theories, or disciplines.
Using the full form might add a little to the total word count, but
would save readers the distraction of having to refer back to previous
pages in a chapter. As an alternative, a future edition could include
a list of abbreviations for the entire volume. This would help users
who may not always read pages in a strictly linear fashion.

Topics of particular interest to applied linguists and language
educators include plain language, proficiency levels and measures, and
medical language courses and curricula.

On the topic of plain language, while some authors in this volume
advocate for its use (e.g., Chapters 2, 8, 9), others view it more as
a tool whose usefulness is unproven (Chapter 5), and/or even
problematic (e.g., Chapter 1). While the use of plain language to
facilitate comprehension might seem at first to be a matter of social
justice, Harsch and Santos (Chapter 1) argue that this strategy can
have the opposite result. Plain language may help solve an immediate,
surface level problem but at the same time obscure a structural issue.
Harsch and Santos advocate instead for empowering people to develop
critical health literacy (HL), “[…] to express their healthcare needs
and desires and to advocate for themselves” (p. 15). These authors
continue, “[a]s applied linguists, we would like to see more research
and interventions that link linguistic simplifications to patient
empowerment outcomes, not only indicators of patient compliance (e.g.,
following instructions, accepting medical advice) typically reflected
[in] functional HL definitions” (p. 15).

Healthcare providers’ proficiency in the languages spoken by their
patients is an issue of great relevance, although there are varied
opinions on the level of linguistic abilities required and on what
assessment practices are adequate. Fernández & Ríos-Fetchko (Chapter
10) discuss the pros and cons of self-reporting proficiency versus
formal testing. Self-reporting can be fairly accurate for
distinguishing between providers who have little to no ability and
those who are highly proficient, but is much less reliable when it
comes to the broad range of skills that characterize the intermediate
level.

Providers may report the ability to speak another language, but their
estimations of personal fluency may be unreliable. Fernández and
Ríos-Fetchko (Chapter 10) explain why this matters:
“For example, someone who speaks fluent conversational Spanish,
learned at home or in school, may not have the medical vocabulary
required to say ‘your spleen is swollen,’ as they do not know the
words for either spleen or swelling. Conversely, someone who knows the
words for spleen or swelling because they learned a list of vocabulary
may not necessarily have the Spanish language level to spontaneously
produce an explanation about what the medical terms mean, why it is
significant to the patient’s health, and what the next steps in
treatment are” (p. 180).

A recommendation that arises more than once in this volume is that
medical Spanish courses be aimed at intermediate and advanced level
learners (e.g., Chapters 15, 16), as this level of proficiency is
needed to communicate with patients. Molina and Kasper (Chapter 18)
however, defend offering some courses at the beginner level; they cite
the proficiency gains students in these courses can achieve, as well
as the demand for courses to prepare students for an intermediate
level course. Pérez-Muñoz and Shinn (Chapter 19) suggest offering
beginning level courses for clinicians to learn greetings and informal
conversation skills, to build rapport and trust with patients. These
authors, as do others in this volume, also recommend giving training
on how to work with professional interpreters, and caution that
“students must understand that calling in an interpreter should not be
viewed as a failure” (p. 375).

A call for standardized curricula is a common refrain in education,
and the field of medical language education is no exception. While
standardization might be optimal for the purposes of conducting
research in this area, to have every program to follow the same
curriculum is not necessarily the best option for programs, students,
or patients. Rather, as Pérez-Muñoz and Shinn (Chapter 19) state
“[f]rom curriculum design to teaching tools and methods of evaluation,
LSP [Language for Specific Purposes] courses must be intentional in
content, learning objectives, teaching methodologies, and student
assessments” (p. 370). Intentional is not the same as standardized,
and as these same authors later affirm, “[t]here is not a ‘one size
fits all’ approach to medical language education; courses and programs
must be tailored to the specific level, institution, and context in
which they take place” (p. 383).

Pérez-Muñoz and Shinn (Chapter 19) give recommendations for specific
types of programs: from undergraduate programs, graduate programs in
healthcare, medical school programs, resident physician training
programs, programs for physicians-in-practice, to programs for
non-physician healthcare professionals. Each program can focus on
particular needs of its students. The first type of program, general
undergraduate, has broad ramifications. This is because many
Modern/World Language departments at U.S. universities are currently
looking to develop medical Spanish and other LSP courses to counter
dwindling enrollments. Indeed, at some institutions the very survival
of such departments is at stake (e.g., Bauer-Wolf 2023; West Virginia
University). Hardin (Chapter 15) makes the important point that since
medical students have very little time to spend on language
acquisition once they are in medical school, there should be more
emphasis on learning languages earlier in their academic careers.

Finally, another issue of perennial importance to language educators
is how to help students acquire cultural competence. The definition of
cultural competence has evolved over the years, and the term cultural
humility is becoming more and more frequent instead. Contributors to
this volume make some salient observations. For example, Alemán and
Zapién-Hidalgo (Chapter 17) state that “[s]tudents must learn that
culture is complex and dynamic, affects all people, does not determine
behavior and cannot be distilled into a body of traits that is used as
a checklist, implied by the term cultural competence (Hunt 2019)” (p.
337). Pérez-Muñoz and Shinn (Chapter 19) also recommend teaching
cultural humility, making the important point that “[i]nstructors may
have difficulties selecting cultural content while avoiding
stereotyping patients given the many cultures, traditions, and
perspectives that often reside within a single language” (p. 371).

REFERENCES

Bauer-Wolf, Jeremy. 2023. West Virginia University no longer plans to
completely eliminate world languages. Higher Ed Dive. 29 August.

Chang, Heesun, Claire Hutchinson, and Janice Gullick. 2021. Pulled
away: The experience of bilingual nurses as ad hoc interpreters in the
emergency department. Ethnicity and Health. 27(7). 1045-1064.

Green, Michael J. & Kimberly R. Meyers. 2010. Graphic medicine: Use of
comics in medical education and patient care. BMJ. 340. 574-577.
Hunt, Linda M. 2019. Beyond cultural competence: Applying humility to
clinical settings. In The Social Medicine Reader, Volume II, Third
Edition, eds. J. Oberlander, M. Buchbinder, L.R. Churchill, S.E.
Estroff, N.M.P. King, B.F. Saunders, R.P. Strauss & R.L. Walker.
127-131. Durham, North Carolina: Duke University Press.

Loach, Barbara L. 2019. A time to speak and a time to keep silent:
Professional ethics, conscience, and the medical interpreter. Ethics,
Medicine, Public Health. 11. 52-59.

Trace, Jonathan, Thom Hudson, & James Dean Brown. 2015. An overview of
Language for Specific Purposes. In Developing Courses in Language for
Specific Purposes, eds. J. Trace, T. Hudson & J.D. Brown. 1-22.
University of Hawaii at Manoa: National Foreign Language Resource
Center.

ABOUT THE REVIEWER

Laura Callahan has taught courses in Spanish language and linguistics
in California, Michigan, and New York, at Ohlone and Mission Colleges,
San José State University, Santa Clara University, the University of
California at Berkeley, Michigan State University, and the City
College and Graduate Center of the City University of New York. Her
principal area of research has been Spanish in the United States. Her
publications include work on code switching, intercultural
communication, heritage language maintenance, and linguistic
landscapes. Prior to her academic career she worked in food service
and healthcare, where she served as an ad hoc and dual role
interpreter.



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