Understanding linguistic inequities in healthcare: moving from the technical to the social

When patients and clinicians do not speak the same language, the quality and safety concerns that can arise seem evident. However, the literature on the association between language and a host of health outcomes is vast and varied. In this issue of BMJQS , Chu et al share the results of their well-conducted systematic review and meta-analysis of the relationship between a patient’s spoken language and hospital readmissions and emergency department (ED) revisits.1 They report that adult inpatients who prefer a non-dominant language are more likely to experience an unplanned hospital readmission or ED revisit after discharge. Moreover, they found that children whose parents spoke a non-dominant language had more ED revisits. The authors’ work is a thoughtful synthesis of a somewhat disparate literature and offers a starting point to consider key challenges in the broader area of research on linguistic inequities in healthcare. There are several challenges that arise when language is used as a quantitative variable in research. The first challenge is one of definition. Chu et al describe the heterogeneous approach to the measurement of language in the studies they reviewed as a limitation of their results. Some studies used dominant language proficiency, while others used preferred language, and yet others used primary language. Each measure assesses a different construct. And so, it becomes difficult to aggregate outcomes across studies when fundamentally different concepts are measured and compared. Another challenge is that the borders around spoken language are assumed to be fixed and well defined. Thus, language is often made into a binary variable to facilitate comparisons between dominant language speakers and non-dominant language speakers. Yet, speakers of a non-dominant language may have some proficiency in the dominant language. Furthermore, the use of language is contextual. For example, a patient’s primary language may be Arabic, but …