Presented by M. Chris Gibbons, MD, MPH, on September 7, 2012 at the third annual Center for Health Literacy Conference: Plain Talk in Complex Times.

1. Can You Hear Me Now?
“The coming Communications
Crisis in US Healthcare ”
Plain Talk Conference 2012
Chris Gibbons, MD MPH
JOHNS HOPKINS URBAN HEALTH INSTITUTE

2. “BIG” Problems in US Healthcare
 Cost of Healthcare
 Access to Healthcare
 Prevalence in Chronic Disease
 Increase numbers of Seniors
 Increase in numbers of immigrants and minorities
 Intractable Disparities
 Provider Shortage
 Others????

3. Which one is the BIGGEST Problem?
 Cost of Healthcare
 Access to Healthcare
 Prevalence in Chronic Disease
 Increase numbers of Seniors
 Increase in numbers of immigrants and minorities
 Intractable Disparities
 Provider Shortage
 ????

4. The BIGGEST Problem?
Inability to Communicate with
the Healthcare system
 Definition
– Inability to understand or be
understood.

5. The largest drivers of the Problem?
Poor Health Literacy
Poor English Language Fluency

6. How big is the Problem?
 2007 Census/ACS
 Does this person speak a language other than
English at home?
 What is this language?
 How well does this person speak English
(very well, well, not well, not at all)
 Peoplespeaking below the “very well” category are
thought to need English assistance in some situations

7. How big is the Problem?
 The Voting Rights Act of 1965 uses these criteria to
determine the need for bilingual election materials.
 Self-reported data on English-speaking ability have
demonstrated the measure to be highly reliable and usable.
 “How Good Is How Well? An Examination of the Census English-Speaking Ability Question,”
<http://www.census.gov/population/www/socdemo/lang_use.html>.

8. How big is the Problem?
 In 2007 55 million people (20% US pop) spoke a language
other than English at home.
 What are they Speaking?
 Spanish including Spanish, Spanish Creole, and Ladino. (62%)
 Other Indo-European languages including most languages of Europe and the Indic languages of
India. These include the Germanic languages, such as German, Yiddish, and Dutch; the Scandinavian
languages, such as Swedish and Norwegian; the Romance languages, such as French, Italian, and
Portuguese; the Slavic languages, such as Russian, Polish, and Serbo-Croatian; the Indic languages,
such as Hindi, Gujarati, Punjabi, and Urdu; Celtic languages; Greek; Baltic languages; and Iranian
languages. (19%)
 Asian and Pacific Island languages include Chinese; Korean; Japanese; Vietnamese; Hmong;
Khmer; Lao; Thai; Tagalog or Pilipino; the Dravidian languages of India, such as Telugu, Tamil, and
Malayalam; and other languages of Asia and the Pacific, including the Philippine, Polynesian, and
Micronesian languages. (15%)
 All Other languages include Uralic languages, such as Hungarian; the Semitic languages, such as
Arabic and Hebrew; languages of Africa; native North American languages, including the American
Indian and Alaska native languages; and indigenous languages of Central and South America (4%)

9. How big is the Problem?
 50% (25 million) of non English Speakers reported that
they did not speak English “Very Well”
 Proportions were higher among older Spanish speakers
 57% of those aged 41-64
 65% of those over the age of 65
 7 of 17 languages had more than 1 million speakers
 Spanish – 34 million
 Chinese – 2 million
 French, Tagalog, Vietnamese, German, Korean – 1 million

10. How fast is the Problem changing?
 From 1980-2007
 Vietnamese saw 511% increase
 > 200% increase
 Spanish, Russian, Persian, Chinese, Korean, Tagalog
 Substantial variability across states
 W Virginia (2%), California (43%)
 Southwest and East Coast States had substantial rates
 All 50 states had some increase

11. Bottom Line
 In 2007
 25 million people were not able to speak
English Very well
 Their numbers are rapidly increasing
 They are not just in New York, California,
Florida and Texas
 Most speak Spanish, but also many other
languages involved

12. The full Story
 Dialects, slangs, vernaculars, Jargons
 Gullah
 Southern Drawl
 Urban - Phat, Cold, Mad, Badonkadonk
 In 2012 ~ 30 million people with LEP
 Healthcare Reform – 30 million more in
2014
 Health Literacy?
 40% of Americans can not understand health information
 115 million people

13. Impact on Healthcare System
 Sites of “care”
 Hospital
 Clinic
 Emergency Room
 Doctor’s Office
 Pharmacy
 School
 Work

14. Impact on Healthcare System
 Patient
 Trust
 Engagement
 Satisfaction with care
 Healthcare decision making
 Adherence
 Provider
 Patient centeredness
 Readmissions
 Reimbursements
 Outcomes
 System/Population
 Costs
 Waiting times
 Disparities

15. Impact on Healthcare System
 Add in
 Aging Provider workforce
 Nursing shortage
 Inability to manage “care in the community”
Recipe for a
“Communication Crisis in Healthcare”

16. What can we do about it?
 Wait for the Healthcare system
 Explore powerful emerging resources
 More U.S. adults used the Internet than doctors to obtain
health and medical information
 The Internet has considerably more influence over consumer
health decisions and actions than traditional channels like
print, TV and radio
 Thousands of Translator Apps (Google, Android and Apple)
 WordLens, Google Translate, many others
 Refuse to accept the status quo

17. What can we do about it?
 Refuse the status quo in health communication
 Now – one time, paper based, word dense communication
 Future - Paper +
 Electronic information – thumb drives etc
 Take anywhere
 On Demand health information – 1-800 xxx xxxx
 Obtain anytime
 Video based vs. Graphic Based information
 Culturally appropriate
 Cloud based web services information
 Access by any device
 PN & CHW based services

18. Bottom Line
 Refuse Status quo
 Utilize available emerging tools & technologies
 Request/Inform
 Advocate
 City, state and government Reps
 Organize
 Information support groups
 “Patients like me”
 “Cure together”
 Let your voice be heard
 Editorials, Blogs, Petitions

19. Be Part of the Solution
 Prepare to be the advisors and expert
consultants they will need.
 Design our own new innovative solutions.
 Prepare to be tomorrows designers and
developers.

20. Thank You
Together, we will find the “cure” for
the coming “communications crisis”.