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August 10th, 2006

The U.S. Hispanic Population -- One Market or Many?

By Scott D. Schroeder

Hispanics are the most rapidly growing ethnic group in the United States. And, because they’re also becoming increasingly affluent, their importance to marketers has never been greater.

To tap into this burgeoning consumer group, marketers need to understand the differences -- some subtle, some profound -- in consumer behaviors within the different types of Hispanic households.

Numbers You Can’t Ignore

In 2006, about 11.6 million U.S. households -- that’s one in every 10 -- are Hispanic. This translates into a Hispanic population of about 42 million. The U.S. Census estimates that by 2020, the Hispanic population will reach 60 million -- or almost 18 percent of the total U.S. population.

The economic influence of Hispanics is growing even faster than their population. Nielsen Media Research estimates that the buying power of Hispanics will exceed $1 trillion by 2008 -- a 55 percent increase over 2003 levels.

Sizeable Hispanic Markets: At a Glance

Market

Hispanic Population

Los Angeles

8.4 Million

New York

4.4 Million

Miami

2.1 Million

Houston

1.9 Million

Chicago

1.9 Million

Overall, about two-thirds of all Hispanics in the United States are of Mexican descent. Central and South America account for 14 percent, Puerto Rico 9 percent and Cuba another 4 percent.

Smaller Markets with High Hispanic Concentrations:

McAllen , Texas

94% Hispanic

El Paso , Texas

88% Hispanic

San Antonio , Texas

54% Hispanic

Fresno-Visalia , Calif.

50% Hispanic

Source: U.S. Census, Advertising Age “Hispanic Fact Pack” 2006

A Quick Cultural Overview

As a starting point for understanding the Hispanic marketplace, it’s useful to have a few basic facts.

Hispanic households tend to be larger and younger than non-Hispanic households. Hispanic households are more likely to have both multi-generational and non-related family members living together. And 53 percent have children living in the home, which is 66 percent higher than the general U.S. population.

In addition, Hispanic households vary widely in terms of how long they’ve been in the United States. In fact, 40 percent of U.S. Hispanics are foreign-born and less assimilated into the broader U.S. culture than Hispanics who were born here.

Beyond their demographics, research has shown that the Hispanic community shares at least three broad cultural characteristics of which marketers should be aware.

The U.S. Hispanic population compared to the country as a whole.

Demographics

Hispanic

Consumers

U.S.

Population

Median Adult Age

38

48

Median HH Income

$34,000

$48,000

Average HH Size

3.1

2.3

% with Children at Home

57%

36%

% High School Graduate

64%

84%

% College Graduate or Higher

12%

25%

Homeownership

48%

67%

Percent Married (HH)

57%

50%

% Catholic

67%

25%

Most Common Occupations

Technical, Sales, Administrative Support, Service Occupations

Managerial, Professional, Technical, Sales, Administrative Support

Sources: Cohorts, Neilson and Simmons Market Research Bureau (2005)

Specifically, Hispanics are more likely to:

1. Focus on Family and Home -- They often shop as a family and make purchasing decisions collectively. Because Hispanic households often span multiple generations, the effective marketer should consider using benefits statements that appeal to differing age groups.

2. Hold Traditional Values -- Hispanics tend to embrace multiple cultural traditions, including those of their country of origin (if they are fairly recent immigrants), their local community and those of the broader U.S. culture. They respect authority, so marketing that uses doctors, policemen or other recognized experts will resonate well. For many, particularly older Hispanics, conservative themes and family-oriented marketing are most effective.

3. Be Media Friendly -- Hispanics tend to trust the information they read in their local newspaper. They listen to the radio for quick news updates and rely on magazines to keep them informed. They are also receptive to television advertising, especially when it’s entertaining and gives them something to talk about -- the more interesting the better, because they tend to remember those ads when shopping.

Diverse Down to the Household

Understanding these broad cultural characteristics is important, but to effectively market to Hispanics, marketers need to understand that a wealth of diversity exists within the U.S. Hispanic community. While it can be tempting, for example, to assume that cultural heritage is a key determinant of this diversity, the vast majority of consumer behaviors are determined by current needs and wants -- not by historical cultural ties.

Therefore, marketers would do better to segment the Hispanic community by the household-specific economic and familial circumstances that drive consumer behavior, rather than by cultural heritage.

An extensive study undertaken in 2004 using market research, census data and statistical analyses identified 19 distinct household types (or segments) within the Hispanic marketplace.

Here are four examples:

Description

Median Age

Median Income

Population and %

Affluent Grandparents

Successful, dual-income couples who are financially secure and enjoy upscale activities, lots of travel and doting on their grandchildren.

Acculturation = High

62

$97,000

375M

3.2%

Young Families

Families with younger, career-minded parents whose kids affect what they buy and how they spend their free time. At home, they frequently speak Spanish.

Acculturation = Moderate

30

$34,000

1,344M

11.6%

Young Social Latinas

Young, social Latina women who are into fitness and fashion and passionate about their friends, music and hip electronic gadgets. Most are bilingual.

Acculturation = Moderate

23

$23,000

110M

1.0%

Young Latinos

Less-educated, single Latino guys who enjoy living on the edge. They’re into sports, cool cars, music and electronics. They share their home with another adult who has children. Acculturation = Low

28

$37,000

1,001M

8.6%

For example, with a median income of $34,000 and young children at home, the largest segment, Young Families, epitomizes a prime Hispanic market segment for many packaged and consumer goods—but not necessarily for high-tech and luxury goods.

Generating the Right Message

One of the biggest mistakes marketers make in trying to reach Hispanic consumers is to simply translate existing marketing messages into Spanish.

Because Hispanic households vary widely, how marketers speak to Hispanic consumers must also vary. That’s why successful marketers will make use of the wealth of Hispanic household-level information that exists to ensure that they deliver the right message to the right Hispanic household.

For example, marketers need to communicate their messages in English when trying to reach affluent grandparents -- who are highly acculturated, do not speak Spanish at home and do not read or watch Hispanic media. In addition, marketers might do well to understand that affluent grandparents feel very blessed to have reached their level of financial security and would never forget their family or their cultural heritage.

On the other hand, Spanish language and media are important to moderately acculturated young families, who speak Spanish at home. Their kids, career and conservative values are all important hot buttons that marketers can press in order to elicit a response.

What Now?

With the insights derived from the household-level Hispanic consumer segmentation tools available today, marketers can finally understand the consumer and media behavior of their key Hispanic customers and prospects. For the first time, integrated Hispanic marketing communications programs can be developed across media that target specific, relevant segments of the Hispanic marketplace.

Scott D. Schroeder is President/CEO of Cohorts in Denver. He can be reached at sschroeder@cohorts.com.

Original Source: DMNews.com



July 19, 2006

Language a Widening Barrier to Health Care
Many U.S. residents don't speak English, limiting dialogue with doctors, report says

By Amanda Gardner - HealthDay Reporter

One of the biggest barriers to high-quality health care for millions of U.S. residents has nothing to do with medicine.

It has to do with language.

"We're looking at 50 million people in the U.S., 19 percent of the population, who speak a language other than English at home and 22 million who have limited English proficiency, so that's a lot of people," said Dr. Glenn Flores, director of the Center for the Advancement of Underserved Children, and a professor of pediatrics, epidemiology and health policy at the Medical College of Wisconsin in Milwaukee.

And the number is growing, added Flores, who is author of a perspective article in the July 20 issue of the New England Journal of Medicine that outlines the issues and possible solutions.

Between 1990 and 2000, the number of Americans speaking a language other than English at home grew by15.1 million (a 47 percent increase) and the number with limited English proficiency grew by 7.3 million (a 53 percent increase).

Patients who face language barriers have difficulty accessing care, receive fewer preventive services, and are less likely to follow medication directions. For example, asthmatic children with language barriers are more likely to end up intubated in intensive care.

"Patients who do not have the opportunity to have a culturally and linguistically competent physician often don't get as good care," confirmed Dr. Robert Schwartz, chairman of family medicine and community health at the University of Miami Miller School of Medicine. "It's a critical issue to be able to speak to a patient."

Schwartz's department serves a predominantly Hispanic part of Miami. And in Miami, according to the journal article, 75 percent of residents speak a language other than English at home.

Examples cited by Flores range from the near-comic to the tragic.

There was, for instance, the interpreter who mistranslated a nurse practitioner's instructions and told a mother to put oral antibiotics into her 7-year-old daughter's ear.

In another example, the mistranslation of a single word resulted in preventable quadriplegia. The patient, an 18-year-old male, said in Spanish that he felt nauseated before collapsing. A non-Spanish speaking paramedic mistook the word to mean "intoxicated," and the patient spent more than 36 hours being worked up for a drug overdose. The delay resulted in the rupture of a brain aneurysm. The case was settled for $71 million.

And one Spanish-speaking woman told a hospital resident that her 2-year-old daughter had "hit herself" falling off her tricycle. The resident misinterpreted the statement to mean abuse and contacted the appropriate authorities, who had the mother sign over custody of both her children.

The language issues are most pronounced in the emergency room and in psychiatric settings. One study found that no interpreter was used in 46 percent of emergency-room cases involving patients with limited English proficiency.

Psychiatric patients who have language barriers are more likely to receive a diagnosis of severe
psychopathology, and are also more likely to leave the hospital against doctors' orders.

What can be done?

"We need to keep making the case based on the evidence, which is that you see a lot of adverse
consequences," Flores said. "There's a long laundry list we've accumulated and all of this is adding up to suboptimal quality of care, excessive costs, lower patient satisfaction, medical errors, and even morbidity and death. We can do a better job."

Currently, only 13 states provide third-party reimbursement for interpreter services. Unfortunately, most of the states containing the largest numbers of patients with limited English proficiency have not followed suit, sometimes citing concerns about costs.

There is legislation in the works, including a bill in California that would prohibit state-funded organizations from using children younger than 15 years of age as medical interpreters. But more needs to be done, Flores said. One government report estimated that it would only cost, on average, $4.04 more per physician visit to provide all U.S. patients who need them with language services.

In the meantime, individual institutions do what they can. Maimonides Medical Center in New York City, for example, has about 80 languages spoken there, including Gujarati, spoken on the west coast of India, and Zapotec, a native Mexican-Indian dialect.

"About five years ago, we put up our patient bill of rights in 10 different languages and that barely scratches the surface," said CEO and President Pamela Brier.

The center relies on a network of interpreters from the existing staff and volunteers, including people who were doctors in their own country and are hoping to get into a residency program. About four years ago, the hospital hired enough people to have round-the-clock coverage in Mandarin, Cantonese and Russian.

"For all we do, we have not nailed it," Brier said. "It's going to be a life's work."

More information

Some recommendations for setting up interpreter programs in hospitals can be found at Universal Health Care.

SOURCES: Glenn Flores, M.D., director, Center for the Advancement of Underserved Children, professor, pediatrics, epidemiology and health policy, Medical College of Wisconsin, and Children's Research Institute of the Children's Hospital of Wisconsin, Milwaukee; Robert Schwartz, M.D., professor and chairman, family medicine and community health, University of Miami Miller School of Medicine; Pamela S. Brier, president and CEO, Maimonides Medical Center, New York City; July 20, 2006, New England Journal of Medicine

Original Source: Forbes.com, July 17, 2006





July 11, 2006

Bilingual health workers sought
Visa plan would be open even to those illegally in U.S.

Chicago Tribune

By Oscar Avila, Tribune staff reporter. Tribune staff reporter Stephen Franklin Advertisement
contributed to this report

Cook County should sponsor foreign-born nurses, pharmacists and radiologists
for legal work visas to help fill a shortage of Spanish-speaking health
professionals, a county commissioner said Monday.

Commissioner Roberto Maldonado's proposal is unconventional enough, but he wants to take it even further: He wants the county to hire Illinois college graduates in the health field even if they don't have legal immigration status.

The idea is clearly illegal, immigration experts agree, but Maldonado said he will introduce the plan Wednesday to highlight the shortage of bilingual health providers at county facilities.

"If somebody wants to challenge that in court, they can. I want the county to break ground," he said. "Here we have a great need and a great pool of potential health professionals. Why not match the two?"

Experts estimated that less than 5 percent of the state's nurses are bilingual; county officials estimate that about one-third of their patients speak primarily Spanish.

Under the modest pilot program, the county would work with Latin American consulates in Chicago to fill about 20 professional positions.

Both components of the proposal are likely to generate criticism--from opponents of illegal immigration and from labor unions that contend the legal work visas would displace U.S.-born workers.

The H-1B visa program has become popular among employers, who quickly snapped up the 65,000 visas available for fiscal 2007. Industry groups have pushed to expand the visas, which last for up to six years and are geared to specialized fields, such as engineering and law.

The proposal would focus on students from Latin America at Chicago-area colleges who need work visas to remain in the U.S. The program also would benefit legal immigrants in Chicago with professional training.

Cook County would sign a pact to provide the consulates of at least 10 Latin American nations,
including Mexico, Ecuador and Chile, an ongoing list of vacancies at county hospitals and clinics.
County officials and the consulates would work together to select applicants.

Jill Furillo, an official with the union that represents nurses at county-operated health facilities, said her group does not oppose employing foreign-born nurses to fill vacancies. But "our position is that we need to do everything we can to solve the nursing shortage by training and educating people from our community here," said Furillo, an official with the National Nurses Organizing Committee.

Aida Giachello, director of the Midwest Latino Health Research, Training and Policy Center agrees that health authorities must do a better job of fostering a new generation of bilingual U.S.-born workers. But with the shortage so severe, health officials cannot close the door to foreign talent, she said.

Some experts question whether the H-1B visas would fill the nursing shortage because immigration authorities typically don't include nursing as a "specialized field" that qualifies for the program.

Maldonado's more radical idea is to hire undocumented immigrants with health training. Maldonado said he would try to link them with legal visas but would hire them anyway if they graduated from public state universities. Because they are living here illegally, those graduates now have no job prospects after attending college under an Illinois law that grants in-state tuition to undocumented high school graduates.

Paul Zulkie, a Chicago immigration attorney, said the county has no authority to override federal
immigration law that prohibits hiring illegal immigrants. Federal authorities could fine the county or even bring criminal charges if it knowingly hired illegal immigrants.

"The law is very clear. There is no gray area," said Zulkie, past president of the American Immigration Lawyers Association.

Maldonado acknowledged that the proposal would generate heated debate. He plans to join consular representatives at a downtown news conference Tuesday to promote the idea.

Cesar Romero, spokesman for the Mexican Consulate, said hundreds of immigrants swamped an event several years ago to publicize jobs in health care. Most were ineligible to fill the jobs because they were living here illegally, he said.

Mexican officials offered qualified support for Maldonado's plan to hire illegal immigrants.

"We support any kind of measure that can benefit the immigrant community," Romero said.

About H-1B visas

What are they? A temporary visa for workers in specialized fields such as medicine, education, law and the arts. Eligible jobs require at least a bachelor's degree or equivalent. Workers can keep H-1B status for a maximum of 6 years.

Limits: The current law allowed a maximum of 65,000 visas for fiscal 2007.

Applying: Visa recipients must be sponsored by a U.S. employer. The employer must attest to meeting certain labor conditions, such as prevailing wages.

Source: U.S. Citizenship and Immigration Services



July 9, 2006

Bridging the Language Gap
Some hospitals make non-English-speaking patients feel right at home

By Josh Fischman
U.S NEWS & World Report

There is no Room 1504 on 15 East, the new Chinese unit at St. Vincent's Hospital Manhattan." The number 4, in Chinese, sounds the same as the word for death," says Frances Wong, the hospital's director of Asian services. "Chinese people think that's really bad luck. What's worse, there was one room, 1523, which in Chinese means 'definitely not easy to live.'" For a hospital hoping to make its Chinese patients comfortable, you couldn't think of more unfortunate signage. "That was changed to 15A," says Wong.

There are other cues this is not a typical hospital floor. Visitors are greeted by a Chinese sign: "We have all the health services available to serve you." The waiting area sports a red-and-gold "longevity" sign, and Asian art adorns the corridor. Among those assigned to the unit are two physicians, a nurse, and six nursing assistants--all of Chinese background and fluent in the language. In the rooms, patients eat a lunch of congee, a traditional warm watery rice porridge. It's comfort food. Chinese don't like to eat or drink anything cold when they are sick.

Located near New York's Chinatown, St. Vincent's has a patient population that's 10 percent Chinese, and 15 East brings western medicine to them on their own terms. In Chinatown, English--and American culture--barely exist for many people. And when hospitals and patients can't communicate, the result is bad medicine. This spring, the New York Academy of Medicine released a report on healthcare among immigrant families, reporting that 55 percent complained that language barriers hampered their care. "There's pretty solid evidence of adverse consequences," says Glenn Flores, a pediatrician and director of the Center for the Advancement of Underserved Children at the Medical College of Wisconsin in Milwaukee, who has published numerous studies on language problems. "You get a lower rate of mammograms. Kids with asthma are more likely to have a crisis and get intubated." In one case reported this spring, a 10-month-old infant ended up vomiting and on an IV in a hospital because a nurse with limited Spanish at a clinic hadn't explained the proper dose of an iron supplement to the Spanish-speaking parents. The parents had given the baby a typical teaspoon of medicine--more than 12 times the intended dose.

Widespread concern. St. Vincent's cultural makeover is the most visible portion of a movement affecting hospitals across the country, as such language problems are increasing. Current population surveys show that 28 million Americans were born in another country, and 22 million of them have limited or no ability to speak or understand English.

Hospitals of all shapes and sizes are trying to keep pace. "There's been a huge increase in requests for advice during the last five years," says Shiva Bidar-Sielaff, cochair of a committee of the National Council on Interpreting in Health Care that released the first national standards on medical interpreting last year. Institutions want to know, for example, how to set up language services and train their staffs. "It's a whole new way of looking at our patients," says Elita Christiansen, who runs what's called a "cultural competency program" for Inova Fairfax Hospital in Falls Church, Va., where an estimated one third of households in the region have limited English skills.

Good intentions. But many hospitals are struggling. There are no national numbers on how many of them offer language services, but a recent survey by Flores of all hospitals in New Jersey found that 97 percent didn't have any full-time interpreters. Some 80 percent provided no formal training for staff on working with medical interpreters.

Untrained--though well-meaning--bilingual people acting as interpreters can create many problems. In a 2001 study, when researchers videotaped 21 Spanish-speaking patients at a Southern California clinic that used nurses as interpreters, they found that just over half of the interactions had bad enough miscommunications that doctors didn't completely understand the patients' symptoms. In a 2003 study, Flores found that hospital staffers used as interpreters--who had no formal training--were particularly prone to "false fluency" errors: misinterpreting words or concepts based on a limited understanding of the language. For instance, one interpreter used a Puerto Rican colloquialism for mumps when talking to a Central American mother, who didn't understand it. Other interpreters didn't know the right Spanish words for "medicine" and "results," while others didn't ask about drug allergies.

AnMed Health Medical Center is trying to do better than that. The community hospital in Anderson, S.C., population 25,000, has been part of a project funded by a Robert Wood Johnson Foundation program to improve hospital language services in the region. "Five percent of our patients now speak a language other than English," says Juana Slade, the hospital's director of diversity and language services. "Most of those are Spanish speakers, but there's also Russian, Chinese, and deaf people who use American Sign Language."

Before Slade's department was created in 2001, "things were really decentralized and a little confused," she says. Each nursing unit had its own list of bilingual interpreters on the staff and would call on them when needed. Often, Slade says, that meant patients and doctors would have to wait until a staffer was finished with his or her regular job. Or--since doctors are in a hurry--it meant doctors or nurses would charge ahead into a sea of misunderstandings.

Slade set out to avoid these problems by instituting a system that starts the moment a patient arrives. Admitting clerks ask about preferred language. "If it's not English, or they have trouble answering questions in English, that's a full stop," Slade says. "The computer screen won't let the clerk continue until a language is identified." (For emergency admissions, a triage nurse does much the same thing after a patient is stabilized.) That language preference follows the patient to every medical appointment, every clinical encounter. "If they go to radiology, we're there waiting for them," says Slade. "If a doctor comes in for rounds, we're there too." If a nurse has an unscheduled chat with a patient about pain or medicine, she is under strict instructions to page language services first; someone is there in five minutes.

And that someone is properly trained. Every one of the 20 interpreters has gone through a 40-hour course on medical interpreting. "People joke and call me a language cop, but this is really important," says Janine Ferra, the hospital's language services manager. One of the major lessons: An interpreter is there to translate word for word what the patient says to the doctor and vice versa. "You are not there to be an advocate or to add information you think is important," says Ferra.

That neutrality is perhaps the hardest part of the job, says Heather Cazarin, one of AnMed's Spanish interpreters. "You see people not getting it, and it's real tempting to add more explanation," she says. "I'm not a doctor, I'm not a radiation technician, and I should not be explaining medicine or radiation." Cazarin had to explain the difference between a bacterial and viral infection to Lucia Lau, mother of a 15-day-old girl, Britani, who was admitted with a fever. "I came to the U.S. five years ago, from Peru," says Lau, through Cazarin. "I know some English but don't understand everything the doctors say to me." Doctors had to tell Lau they had ruled out a bacterial infection but needed to keep Britani on antivirals for a while until some tests came back.

Cazarin has to deal with cultural disconnects as well. In some very traditional Hispanic cultures, for instance, a wife tends to defer to her husband in medical matters or the husband insists on interpreting for the wife. "I can hear the husband editing the wife's answers," says Cazarin, "and I have to tell him--politely--to let her speak for herself."

Medical staff needs to be sensitive, too. "A lot of times, if there are children in the room, even grown children, patients will minimize symptoms," says Wong of St. Vincent's Chinese patients. "It's part of the culture not to trouble your children." These dynamics change as the parent ages, as they will tell the doctor to let the son or daughter decide on treatment. "That makes it hard to know if you are really getting informed consent," says Wong.

Talk easily. Mon Lam, a 58-year-old man on 15 East with a bleeding gastrointestinal tract, hasn't relied on his children as much as he has on Faith Zhao, the physician assigned to the floor. "It's very good to be in a place like this," says Lam. "I can talk easily to the doctors and nurses." It turned out he had a malformed junction of an artery and vein near his stomach. In a relatively simple procedure, doctors sealed off the junction, and Zhao, speaking in Lam's native Cantonese, tells him he's OK to go home but to stay on soft foods for a while.

St. Vincent's also has patients who are Hispanics, western Europeans, Indians, or Hasidic Jews who speak Hebrew. There are bedside cards in Chinese telling patients about language services but not in many of the other languages. And while Ellen Gayama, the language coordinator, uses five full-time interpreters plus 120 members on the hospital staff who speak 30 foreign languages--from Albanian to Yiddish--only 30 of them have, so far, been through the hospital's 32-hour certification course covering medical terminology and ethics. (More classes are scheduled.) "This is a work in progress for us," says Dennis Greenbaum, chair of St. Vincent's department of medicine. "We don't have the resources to do everyone at once."

At least the hospital is aware there are cultural differences. "Some hospitals around the country say there are no disparities and they treat everyone equally," says Amy Wilson-Stronks, a health services researcher at the Joint Commission on Accreditation of Healthcare Organizations. Wilson-Stronks is in the middle of a project evaluating language and culture service at 60 hospitals. "There's definitely a learning curve, and hospitals are on different points of that curve."

The Office of Minority Health in the Department of Health and Human Services has developed 14 guidelines for culture and language services, including one that states that organizations must provide interpreter services at no cost. Though the guidelines don't have the power of law, Garth Graham, the office's director, says they do help, and "folks are moving to the standard of culturally competent care." JCAHO is also starting to ask detailed questions about language services. Since a negative survey report from the commission can ruin a hospital's ability to get insurance reimbursement as well as to attract staff, executives tend
to pay close attention.


And for those hospital executives who feel the United States, with a long history of immigration, has done just fine without special language services in the past, Bidar-Sielaff has a reply: "We also used to be a nation that had people with different skin color drink from different water fountains and going to different schools. Things have changed. We should do better now.




July 1, 2006

Silver Spring Hospital Struggles to Serve
Immigrants Swell Uninsured Ranks At Holy Cross

By Susan Levine
Washington Post Staff Writer

Some weeks it seems as if the whole world, with its many troubles, has
walked through the doors of Holy Cross Hospital.

Daily, the second-floor women's clinic fills to overflowing with patients from countries in Central America, Africa and Asia. Some have never had care during previous pregnancies -- and never had a child born alive. "We ask, 'Do you know why?' " says director Nancy Nagel. "And they say, 'I just lost the baby.' "

Elsewhere, from the emergency room to the primary medicine clinic, doctors and nurses confront conditions and diseases they did not see a decade ago -- malaria, infectious diarrhea, parasites such as tapeworm. Even many common ailments can be more challenging, because they often require translation from a panoply of foreign tongues and cultures.

Serving the underserved is integral to Holy Cross's mission, and the Silver Spring hospital has long shouldered much of the care for poor, uninsured residents of Montgomery County. But as that population has expanded rapidly with the continued arrival of immigrants, legal and illegal, it has become a much more difficult and expensive proposition.

And now a generous mission is reaching its limit. After yet another sharp increase in the prenatal program it runs for the county, Holy Cross has drawn a line. Starting today, for the first time since it opened in 1963, Maryland's biggest community hospital will restrict how many uninsured obstetrics patients it will accept.

"It has taxed the system enormously," said physician Imad Mufarrij, a native of Lebanon who can converse with patients in five languages.

Barely half an hour from the congressional chambers where the nation's immigration policies have been rancorously debated, there is little dissent over what is right to do. It is why Holy Cross opened its primary health clinic two years ago, agreeing to cover what in 2005 was a $460,000 operating deficit. And why it spends almost half a million dollars annually on interpretation services and ethnic-specific programs for patients and Spanish classes for employees.

From 2000 to 2005, the cost of the institution's yearly charity care more than doubled to $9 million; the care is significantly but not entirely for immigrants. A third of the total now goes to the low-income women, a veritable United Nations, who are seen through Holy Cross's Maternity Partnership with the county.

President and chief executive Kevin Sexton has no qualms: "As much as I am interested in public policy and public issues, I basically suspend that at the door of a health care facility and believe that everyone needs care."

The pressures on Holy Cross mirror those at other facilities in the region, though they fall far short of the intense demands that providers face in towns and cities along the U.S.-Mexican border. Washington Hospital Center regularly translates documents and physician-patient communication into nearly a dozen languages, including Turkish and Tagolog. Inova Health Systems estimates that it spends at least $10 million on such services, outreach programs and charity care for uninsured immigrants in Northern Virginia. In Fairfax County, more than one in seven births are to immigrants, according to one estimate.

Critics cite the burden they say newly arrived immigrants place on health care as one rationale for restricting their numbers. Last year, the federal government set aside $1 billion to cover emergency room care for illegal immigrants through 2009. The full medical bill to U.S. hospitals, clinics and taxpayers probably exceeds $6 billion annually, calculates Steven Camarota of the Center for Immigration Studies, a research group that seeks "fewer immigrants but a warmer welcome for those admitted."

Still, Camarota thinks proposals to deny access to treatment misdirect the debate. "Either you select immigrants who are self-sufficient and don't need help from the government, or you shut up about the cost," he said. "There's no middle ground."

The head of Holy Cross's primary care clinic agrees with the latter point. At her clinic, the uninsured patients are not asked how long they have been in the United States or whether they came lawfully.

"The fact is," director Elise Riley said, "people are here. They're going to end up on our doorstep one way or another."

A morning spent in the busy maternity clinic is an experience in multiculturalism and multilingualism -and their possible complications. Many mornings, 60 or more women are seen. The phone at the front desk rings nonstop for inquiries and appointments.

"Sir, I cannot understand you," Melina Martinez tells an Asian caller with limited English. "Did your wife have a C-section? If her C-section looks okay, she doesn't have to come back for two weeks."

There is a pause while Martinez tries to grasp the man's response. "Does she have staples in? Staples, like you use for paper." At this point, the health unit coordinator is earnestly making stapling motions in the air. "You have to check, sir. Check her incision. Check her belly."

At the front desk, a patient from Cameroon schedules her next gynecology visit. A Salvadoran woman waits. She needs to monitor her blood-sugar levels for gestational diabetes but seems confused on the instructions she has been given.

"Escribo?" a nurse asks, offering to write them down in Spanish.

Some patients have had so little education in their homelands that the staff may teach them reading along with prenatal nutrition, occasionally receiving handmade tortillas or tamales as thank-you gifts. In fact, illiteracy was a factor taken into consideration when Holy Cross redesigned the clinic as part of a facility-wide expansion and renovation. Women now have their blood drawn as they come in, rather than being sent to a lab elsewhere in the hospital. Before, bilingual signs directed them down corridors, but many Central American immigrants had gotten lost because they could read neither English nor Spanish.

The clinic's success with its patients is measurable. Despite their socioeconomics, Holy Cross's percentage of low-birth-weight infants is half the state average, contributing to healthier starts in life.

Early in the venture with the county, Holy Cross officials committed to caring annually for 1,200 uninsured obstetrical patients sent by the county health department. Within two years, that cap was reached and exceeded. By fiscal 2005, admissions were 1,802.

Then last fall, Gov. Robert L. Ehrlich Jr. (R) barred several thousand legal immigrants from receiving state Medicaid, and the clinic's numbers surged again -- to 2,131 women by this spring. Projections only indicated further increases.

Too much, hospital officials decided. They set a future limit of 1,500. The partnership had never been intended to include only one hospital, they reminded the county, yet theirs was the sole institution that had stepped up. As a consequence, Holy Cross's share of deliveries to low-income women had soared, to 65 percent of the county Medicaid total, from less than half five years earlier.

"Holy Cross has been bearing the brunt of that," agreed Montgomery Health Officer Ulder Tillman. "They've really become overwhelmed."

The stress is felt on the hospital floors where handsome art decorates the hallwaysand newborns spend their first day or so. Despite the recently completed expansion, the most significant in the facility's history, the 21 new labor and delivery rooms and 68 private maternity suites are always occupied -- and intermittently overbooked, given the nearly 8,900 births a year, 24 a day.

No distinction is made when mothers are placed in those quiet, spacious suites. A young illegal
immigrant, barely able to write her name, may be next door to a high-powered business executive. Neither would necessarily ever know.

"It is harder in every way, including financially, to choose this course, but it's the right way," stressed Sexton, the chief executive.

Even with the looming deadline, only late this spring did two other hospitals with major obstetrics services agree to join the partnership. Washington Adventist and Shady Grove Adventist will start accepting up to 700 uninsured women between them for care this summer.

How quickly they and Montgomery's other hospitals will act on a different pledge is uncertain. As a group, they agreed more than a year ago to open three additional primary care clinics to assist the Holy Cross primary clinic, which expects to double patient visits to 10,000 by 2010. "In terms of following through," Tillman conceded, "it is painfully slow." Little has moved forward to date.

"We need more people in the trenches," obstetrician Mufarrij said simply during a rare break in delivering babies one afternoon. He was a prime proponent of the maternity collaboration with the county and remains so despite the fiscal and physical demands it has meant for facility and staff alike. The previous night, his colleagues had done seven Caesarean sections in the midst of other arrivals. Mufarrij's own record is 14 deliveries in a 24-hour shift.

But as a doctor, he sees no other way. "Once these patients are here, you have only two options," he said. "Neglect them or give them quality care."


March 15, 2006

Research on Language Barriers on Health Care is Scare
Health Care and Language Barriers

By HBNS

Despite numerous studies showing that people who speak little English have less access to health care and receive poorer quality care, there is surprisingly little research on what solutions work best to overcome language barriers to care, according to a review published in The Milbank Quarterly this month.

"Most health care organizations do not provide linguistic assistance services or offer only inadequate services," according to lead researcher Elizabeth Jacobs, M.D., and colleagues.

Health care workers and hospitals that receive federal funding are required by law to find ways to make their care accessible to patients with limited English skills. Many states have similar requirements. However, providers that do offer language-aid services must cobble together programs in the face of scant information about which types of programs work best, usually without reimbursement from public or private insurers, the researchers say.

"Unfortunately, the literature provides little guidance on which interventions, and under which circumstances, best reduce language barriers," said Jacobs, of the John H. Stroger Jr. Hospital and Rush University Medical Center in Chicago.

"Consequently, many health-care purchasers, insurers, regulators and clinicians wonder how or even if they even need to address the issue of language barriers in medical care," she added.

Jacobs and colleagues reviewed 151 scholarly articles on language barriers in health care to find out where the gaps in the current research were most notable.

The two most common ways to overcome language barriers in health care are to increase the number of doctors and other health care workers who speak the same language as their patients and to use interpreters. The studies suggest that providers who speak the same language as their patients and professional interpreters can improve access to and quality of health care for those with limited English. The studies do not offer guidance on which option is best under specific circumstances, however, which can leave providers in the dark about how to proceed, Jacobs said: "Should they offer incentive pay for bilingual providers, should they hire professional interpreters, or both?"

Only one of the examined studies focused on the quality of medical interpreters, and none of the articles discussed necessary qualifications for interpreters. "This leaves health care stakeholders wondering what type of training, if any, should be required of interpreters and how an interpreter's skill can be evaluated," Jacobs said.

Yolanda Partida, Ph.D., the national program director for Hablamos Juntos, a program to improve health care language services for Latinos, agreed that "there are many challenges with training interpreters, the least of which is that there is no clarity about the role and the skills involved."

Most medical interpreters now get "more of an orientation than training, the kind of guidance you get on the job," Partida said. "Urgency has driven the field of language access. That is why the gold standard is a 40-hour training program."

Partida says well-trained interpreters are essential, "but that does not mean that all language barriers should be addressed with interpreters."

Jacobs and colleagues also found only three studies directly measuring the cost of language barriers, including lost work time, unnecessary doctor visits and medication errors. Jacobs said employers with a high percentage of immigrant workers would especially like to know if these problems are "costing them money."

Jacobs said the lack of federal funding for language barrier studies "has hurt the quantity, quality and rigor of this research." The National Institutes of Health and the Agency for Healthcare Quality and Research should include language barriers in health care as "explicit funding areas," she said.





February 9, 2006 Thursday

The Chronicle of Philanthropy

Telephone Service Links Interpreters and Doctors

Interpreters who can help doctors communicate with patients who speak Haitian Creole, Somali, Twi, and 150 other languages are just a phone call away, thanks to a nonprofit organization in Portland, Ore.

The Institute for Cultural Competency uses a sophisticated telephone routing service to join medical professionals and their patients who don't speak English with one of 2,500 interpreters through a teleconference during which they can discuss their cases. The interpreters, who work from their homes, are assisting more than 400 hospitals, clinics, and individual doctors.

Clear communication between patients seeking medical treatment and the doctors and nurses who treat them can make a difference in the quality and appropriateness of the care they receive, says Jim Manczak, president of the cultural institute.

He says that if emergency-room personnel rely on a Spanish-speaking patient's limited English or a staff member's limited Spanish, instead of using a fluent interpreter, they may be able to identify only a few of the patient's symptoms. Missing just one or two symptoms, he says, can be dangerous. For example, diabetes might be misdiagnosed as the flu, says Mr. Manczak.

He says the availability of professional interpreters also eliminates patients' need to rely on family members to pass along medical information.

The family member with the best command of English often is a child, he says, who may then be called on to relay complex or upsetting information to an elder. Mr. Manczak recalls a friend who took on the role of interpreter for her immigrant family at the age of 10 and had to explain to her aunt and uncle that her aunt had suffered a miscarriage.

Improvements in telecommunications technology have helped bring down the cost of hiring an interpreter, making it an option for many more organizations. The Institute for Cultural Competency provides its services for 75 cents to $1.25 a minute, depending on how often an organization uses the service. In the past, says Mr. Manczak, such services would have cost $2 to $7 per minute, depending on the language and time of day.

For more information: Go to http://www.i2c.cc.




February 2, 2006


TELEGRAM & GAZETTE (Massachusetts)

Video interpreting machine climbs barriers;
Device aids deaf and non-English speakers

Surgery for a deaf patient went ahead without delay, thanks to a video interpreter machine that allowed the patient to "speak" with the doctors and nurses at Heywood Hospital.

"A sign language interpreter was supposed to be at the hospital to assist this patient, but they cancelled at the last minute," explained Barbara Nealon, director of social services at the hospital.

"Without this machine, we would have had to cancel the surgery and then reschedule it. Because the machine and services were available to members of our staff, the surgery went ahead as scheduled."

Heywood Hospital recently received a $50,000 grant from the United Way of North Central Massachusetts.

Part of the grant money, $26,100, was used to purchase two video interpreter machines. The machines, totally portable, give doctors and patients who speak different languages a way to communicate.

For patients who are deaf and unable to speak, the machines use a small camera so a sign-language interpreter can remotely see the patient signing.

A microphone is also in place so the interpreter can hear the questions being asked by the registrar, doctors or nurses. The patient can see the interpreter on a video monitor. The interpreter is able to speak to the doctors and nurses, telling them the patient's responses to the questions.

The service also provides translation in 10 other languages, considerably improving communication between the doctor and the patient.

Languages that can be accessed by using this method are: Vietnamese, Cantonese, Russian, Japanese, Korean, Mandarin, Bosnian, Haitian, Spanish and Portuguese.

The hospital previously had one video interpreter machine, but it wasn't portable. The grant money from the United Way was used to purchase the two portable devices that are placed on a rolling cart and can be used in any room in the hospital that has a high-speed telephone line. Ms. Nealon, said the grant also provided money to install high-speed phone line for each nursing unit and all outpatient departments.

"Due to the lack of American Sign Language interpreters, we were not able to meet patient needs. We will no longer have to wait four to 24 hours, we can now have an interpreter within five to 10 minutes," she said.

She noted that sign-language services are the most heavily used of all the languages that fall under this program. "But Spanish and Portuguese are really coming into their own. We're seeing more and more people who speak these languages coming into the hospital seeking services, and we want to be able to communicate with them."

Ms. Nealon said the service that provides the interpreters is looking into expanding the menu of languages it provides. "It would be wonderful if they could provide us with interpreters for Hmong or Laotian people. We really have a need for interpreters who speak any of the Asian dialects. Again, people who speak these languages are coming to the hospital, seeking services."

"We're very thankful for this grant," said Daniel P. Moen, president and chief executive officer for Heywood Hospital. "It really is filling a vital need for members of our community."

"We saw an underserved population that could benefit tremendously from this grant," said Peter Bovenzi, who with his wife, Leslie, co-chaired last year's United Way of North Central Massachusetts annual campaign. Mr. Bovenzi is also a board member of the United Way.

He said the equipment improved communication for people struggling to understand what is happening to them. If those with a different language know the hospital has these machines in place, he noted, it may able encourage them to come to the hospital to seek care.

The remainder of the grant money, $23,900, will be used to reinstate the Community Health Series at the hospital. The series provides general patient education on a variety of health care topics through seminars and outreach efforts.

Topics for this year's series are: February, healthy hearts; April, diabetes; May, women's health; September, prostate cancer and November, breast cancer. The Community Health Series program is generally held in the evening at the hospital during a weeknight. Information on the program can be obtained by visiting the Web site www.heywood.org.

The grant was funded through the United Way of North Central Massachusetts Community Care Fund that serves the communities of Ashburnham, Ashby, Ayer, Barre, Devens, Fitchburg, Gardner, Groton, Harvard, Hubbardston, Leominster, Littleton, Lunenburg, Pepperell, Shirley, Templeton, Townsend,
Westminster and Winchendon.



January 29, 2006 Sunday

The Baltimore Sun

Effort targets Latinas' health care;
Video is latest tool in campaign to address rights, services and cultural issues

In a scene worthy of a Daytime Emmy, the arrogant Mrs. de la Cruz attempts to storm into the doctor's office, her baby wailing, the background music at a piercing, dramatic pitch.

It's just what you would expect from a high-drama Spanish soap opera, or telenovela, complete with extraordinarily made-up women in clingy clothes, class struggles and the never-understated, talk-to-thecamera asides.

But this video has more than guilty-pleasure entertainment value. In Spanish with English subtitles, Senora de la Cruz is the latest educational tool used by Baltimore public health advocates to guide immigrant Latinas through the convoluted U.S. health care system.

The video and accompanying booklet serve as a know-your-rights manual for immigrant women who are pregnant and explain language and cultural barriers that can keep them from seeking vital prenatal care.

The educational tools are an effort by Baltimore Health Care Access, which received a $120,000 grant from the Robert Wood Johnson Foundation.

In addition to helping hospitals improve their services to Latina patients, Baltimore Health Care Access created the video with Megaphone Project, a Baltimore production company that makes documentaries on social justice issues.

Pamela Bohrer Brown, who coordinated the Hispanic Health Care Project for Baltimore Health Care Access, planned to distribute the pamphlet to churches, groceries and hair salons. The video is available free to agencies or outreach groups, she said. Brown also uses Office of Minority Health funds through Baltimore Medical Systems to help providers care for their Latina patients.

"A lot of times these new babies can't get their health care benefits right because their parents just don't understand the process," she said. "The way we can help is by getting out simple materials that can help someone with questions. We wanted to teach them using a very creative process."

The needs couldn't be more acute. Last summer, Gov. Robert L. Ehrlich Jr. alarmed immigrant advocates when he slashed a Medicaid program serving pregnant women and children younger than 5 who are legal permanent residents. Although he later restored some of the cuts for women, attorneys for the Legal Aid Bureau filed a lawsuit in the fall on behalf of eight children, alleging that the state discriminated against them and other non-U.S. citizens by eliminating their coverage.

The lawsuit remains unresolved, and some lawmakers have vowed to pass legislation to restore the cuts.

"There has been a great deal of confusion lately," said Brown. "Some women who qualify don't think they do, and they are unlikely to fill out the paperwork or obtain the necessary resources."

And because babies born in the U.S. are automatically citizens, understanding the rights and benefits of mother and child can be particularly confounding.

Even so, advocates argue that lack of health insurance is not the only obstacle. Experts say language barriers, cultural confusion and, for undocumented women, a fear of deportation, can prevent them from going to the doctor.

Studies show that Latinas are less likely than non-Hispanic white women to receive prenatal care, increasing the risk of delivery complications and of giving birth to children with birth defects and low birth weights. Hispanic women are more than twice as likely as non-Hispanic white women to not receive prenatal care in their first trimester or at all, according to the National Center for Health Statistics at the Centers for Disease Control and Prevention.

Once they receive care, Latinas are prone to particular pitfalls. For example, in many Latino cultures children take both parents' surnames. The trouble occurs when a woman checks into a hospital under one name and the baby is given another name on a birth certificate and yet another on an insurance card.

Public health advocates say it doesn't matter which name is used, so long as it's consistent.

On the video, the know-it-all Mrs. de la Cruz finds herself in such a bind. On one set of forms she lists her maiden name, on another she's known by her married name, "de la Cruz," and her some of her baby's forms have each name and others have both.

At every encounter with health professionals, the too-good-for-the-public-clinic character makes a point to stare into the camera to proclaim she is "Mrs. de la Cruz."

Insisting from the start that her English is good enough to get by, Mrs. de la Cruz endures a string of fiascoes at the health clinic. The scenes are straightforward, with moments of hilarity.

In one, Mrs. de la Cruz, dressed in a slinky print dress and eight months' pregnant, goes out of her way to dismiss a humble woman who obtains a translator and has no problems from prenatal care to delivery. Mrs. de la Cruz later suggests to her husband that the timid woman would make the perfect domestic help.

Brown said the video, with its comic and dramatic moments, offers the right tone to reach women. The most important element is that they understand translators are not only available but are a right and that there is no shame in asking for help, she said.

"When I showed it to the first test groups, they said it's funny, but it's not that funny," Brown said. "One woman said, `Oh, that arrogant woman is my sister-in-law. She's that one. I've got to take her to see this video.'"

The video served as reminder to Maria Hunter, originally from the Dominican Republic, who now lives in Reservoir Hill with her husband and three children. Although her English is passable, she had a daunting experience when she gave birth in Baltimore to her youngest son.

"When I got to the hospital, it was fine, but I would have liked if someone spoke Spanish," she said. "I didn't get an interpreter. And sometimes when they wanted to talk to me, we never understood each other too much."

Now things are different. "I try to get an interpreter all the time," Hunter said. "I want them to
understand me and for me to understand them."



January 25, 2006

Finding Solutions to Language Barriers
Initiative Creates Universal Health Care Symbols

By Sheri Porter, American Academy of Family Physicians

Patients with limited English proficiency can feel overwhelmed in a health care setting because of communication difficulties. Enter a new multifaceted initiative, Hablamos Juntos (We Speak Together), created by the Robert Wood Johnson Foundation to find affordable solutions to language barriers in health care.

One arm of the initiative -- Signs That Work -- involves the creation and testing of symbols for use in settings such as hospitals, clinics and physician offices.

"It's impractical to think about signage in multiple languages because you never know which (language) group you're serving," said Yolanda Partida, initiative director. "Pictures are a common language."

"This program is the beginning of something that has a lot more potential," said Partida. She encourages physicians to download the images and other resource material from the Hablamos Juntos Web site and begin using the symbols in office signage, print materials and even on their medical practices' Web sites.

Created by the Society for Environmental Graphic Design with input from RWJ, the symbols are in the public domain and are available as PDF files. There is no charge for physicians to use them; however, each image is copyrighted and must not be altered.

Some of the symbols -- such as those relating to patient registration, medical records, a waiting area, pediatrics and OB/GYN -- very much apply to family medicine practices, said Partida. The symbols can "help improve people's understanding of where they are and what they're looking at," she said.

What sets this set of symbols apart from others -- such as images on some prescription medications -- is that they were given a test drive before their release, said Partida.

As part of the testing phase, 300 multilingual testers from four language groups -- English, Spanish, Indo-European and Asian -- provided input on the symbols, and at least 87 percent of the multilingual testers understood 17 of the 28 symbols. The symbols were then placed in four hospitals for more exposure and the feedback was positive.

  • More than 75 percent of people tested found the symbols more helpful than text because the symbols were easier to see and understand.
  • More than 80 percent of hospital staff interviewed thought the symbols would ease the process of giving directions to patients and visitors.
  • English speakers preferred the symbols to text.

"We'd like to see physicians experiment with the symbols in their offices, and we'd like to hear about how people are using them," said Partida. "Over time … the successes they find will tell the rest of the story."

Hablamos Juntos is also developing Spanish health care materials and working to improve interpreter services in the U.S. health care system. More information about those facets of the initiative is also available at the Web site.



January 6, 2006

Bush Push on ‘Critical’ Foreign Languages

By Rob Capriccioso and David Epstein

On Thursday, President Bush and a bevy of government officials — including the secretaries of state, education and defense — announced a wide ranging plan to enhance the foreign language skills of American students

Several college leaders applauded attention to an area that many view as underdeveloped in the United States. At the same time, others said that they needed more details about the plan — few of which were released — and some have expressed concern over the large Pentagon role in it.

Under the plan, President Bush will request $114 million in the 2007 fiscal year, with approximately 75 percent of that amount coming through the State and Education Departments, for the National Security Language Initiative, and the Department of Defense would allocate more than $750 million during the 2007 to 2011 fiscal years to groom skilled personnel in languages deemed critical.

To an audience of more than 100 college presidents invited to attend a two-day Washington summit, Bush described the National Security Language Initiative as a “broad-gauged initiative that deals with the defense of the country, the diplomacy of the country, the intelligence to defend our country, and the education of our people.”

“[T]his program is a part of a strategic goal, and that is to protect this country in the short term and protect it in the long term by spreading freedom,” said Bush. “We’re facing an ideological struggle, and we’re going to win.”

The president said that his administration’s short-term international strategy is to “stay on the offense,” providing troops, intelligence officers and diplomats with “all the tools necessary to succeed.”

“That’s what people in this country expect of our government,” said Bush. “They expect us to be wise about how we use our resources, and a good use of resources is to promote this language initiative in K through 12, in our universities.”

The president did not discuss with the college presidents the much larger language initiative, which is coming through the Defense Department.

Bush also said that “a good use of resources is to encourage foreign language speakers from important regions of the world to come here and teach us how to speak their language.”

While the president did not provide details on who these foreign teachers would be, he did win points with college presidents by saying explicitly that there have been serious problems with foreign students getting visas to enroll at American colleges.

“It’s in our national interest that we solve visa issues,” said Bush. “We have been calibrating the proper balance after September the 11th, and I fully understand some of your frustrations, particularly when you say the balance wasn’t actually calibrated well.”

Secretary of State Condoleezza Rice, to applause from many of the presidents at a State Department dinner Thursday night, said that “we as a nation must continue to improve our visa policies.”

She said that great progress has been made, though, and that “we are now moving 97 percent of our visas in just one or two days.” She added that “there are legitimate security concerns,” and stressed the need for institutions to help the government ensure they are met.

Victor C. Johnson, associate executive director of NAFSA: Association of International Educators, noted that the United States needs to make sure that its institutions are especially inviting, as foreign institutions are becoming ever more competitive for top students. Rice said she often meets people in Saudi Arabia who introduce themselves by referring to their American alma mater’s team name, representing a special bond to America that can only be created in colleges.

According to the Department of Education, fewer than 8 percent of undergraduates in the United States take foreign language courses, and fewer than 2 percent study abroad in any given year. Foreign language degrees account for approximately 1 percent of undergraduate degrees conferred in the United States. The college presidents whom Bush addressed are in Washington for meetings with federal officials, continuing today, on a range of international education issues.

Department of State officials stressed the need to have more people master “critical” languages, including Arabic, Chinese, Russian, Hindi and Farsi. Officials, noting that fewer than 2 percent of American students currently study any of the target languages, said that they are critical to national security and cultural understanding.

Rice noted that the “country made a huge intellectual investment in winning the Cold War” and said that in recent years America has not made similar investments, especially surrounding the teaching of critical languages. She added that the countries where the critical languages are spoken “will define the 21st century. Nothing is more important than being able to converse with them in their native tongue.”

In that effort, some of the Defense Department’s $750 million would go toward improving programs in languages at the military academies and for ROTC students. Under the plan, the department will also launch the pilot Civilian Language Reserve Corps. Details of the program were not clear, but State and Defense Department officials said the corps should eventually have 1,000 people, many of whom could be identified in college.

The corps will require a four-year commitment, during which time a member may be called up to accompany a mission abroad “when we need quick assistance,” said United States Air Force Lt. Col. Ellen G. Krenke, a Defense Department spokeswoman.

Three-quarters of the $114 million that President Bush will request in the fiscal 2007 budget will go to the Departments of Education and State, and the rest will go to the Department of Defense and the Director of National Intelligence. Barry Lowenkron, the assistant secretary of state for democracy, human rights and labor, said the money will go toward adding 150 Fulbright scholarships annually for students to study languages abroad.

By 2008, he said there could be as many as 200 additional Gilman scholarships for low-income undergraduates to study the target languages abroad. The Gilman International Scholarship Program, established by the International Academic Opportunity Act of 2000, offers an annual competition for awards for undergraduate study abroad.

A senior State Department official said that, within a few years, hopefully hundreds of students at all levels will spend time at “immersion centers” that would be developed as part of the initiative. Immersion centers would be located abroad and would be intended for short-term study by college students.

The new programs could also offer some opportunities for college students after their campus days. Lowenkron said that a program “like Teach for America” will be developed to pair graduating students with unique language skills up with teaching positions at schools. More than $20 million in grants may be used to set up incentive programs for the teachers.

Additionally, $27 million would go toward creating continuous language study programs, beginning in kindergarten and going through graduate school, through the Defense Department’s National Security Education Program. That initiative will require a commitment to work in a government job for at least two years. Officials did not have exact details about the continuous programs, but they said that kindergartners would not be in danger of committing to government labor

Lowenkron labeled the $114 million as “seed money,” and said that foundations and private investors are currently being solicited to provide more support.

David Ward, president of the American Council on Education, commended the initiative, even though little of the money will go directly to colleges. “The clients will be largely students at high school and college,” he said. Ward also did not take issue with the fact that so much of the money is routed through the Defense Department. “Defense might be the only place in the budget with loose change. As long as it benefits students and scholars, in the short run, it’s okay with me.”

Ward added that “if we’re going to do anything in higher education in the next 20 years, we’ll have to tap more than one source of revenue.” He said he hopes to see incentives for universities to reallocate money for languages. “We can’t just expect the government to fund it all. We’re not in the age of Sputnik anymore.”

Richard S. Meyers, president of Webster University in St. Louis, which has campuses in nine foreign countries, said that the immersion programs are a good idea because Americans really need to study language in the context of culture. With respect to the National Security Education Program, Meyers said that, generally, he would hope new programs “would be more of an education initiative, and not connected with some kind of government commitment before you get your education.” Meyers added that he hopes the initiative will take advantage of cost-effective measures. “Webster’s on 44 military bases [in the U.S.] already,” he said. “It would be a very small step for us to expand these offerings.”

Peg Lee, president of Oakton Community College, in Illinois, said that she found it “very encouraging” that President Bush was placing such an emphasis on foreign languages. Oakton offers a range of the traditional European languages — Spanish, French, German and Italian — as well as Japanese, Mandarin and Arabic. Currently it offers four-semester sequences in the languages, including Arabic, which was the most recent addition.

Lee said that a range of reasons draw community college students to language study, and that “with every local business seeing itself as an international business,” she anticipated continued growth and interest.

Lee also praised the president for focusing on the issue, and for talking about the importance of starting students at young (pre-college) ages. But she added, “I wish there had been less emphasis on defense [as a rationale] — more emphasis on building the global community would have been good and not so much the ‘we and them’ stuff.”

Upon reviewing details of the plan provided during a press briefing on the initiative, Rosemary Feal, director of the Modern Language Association, said, “I’m really pleased that these issues have come to the president’s attention and he’s outlining steps to help Americans become competent in many languages. Any attempts to teach languages early and continue through advanced training are to be applauded.”

However, Feal said that she’s disappointed that it took an event like 9/11 for government officials to focus on language teaching in the United States. She also said it is important to get students learning languages abroad, but that she would also like to see more of an emphasis on teaching them at colleges and universities in America


January 5, 2006


National Security Language Initiative

by Dina Powell, Assistant Secretary of State for Education and Cultural Affairs and
Barry Lowenkron, Assistant Secretary of State for Democracy, Human Rights and Labor

US Department of State, Office of the Spokesman

President Bush today launched the National Security Language Initiative (NSLI), a plan to further strengthen national security and prosperity in the 21st century through education, especially in developing foreign language skills. The NSLI will dramatically increase the number of Americans learning critical need foreign languages such as Arabic, Chinese, Russian, Hindi, Farsi, and others through new and expanded programs from kindergarten through university and into the workforce. The President will request $114 million in FY07 to fund this effort.

An essential component of U.S. national security in the post-9/11 world is the ability to engage foreign governments and peoples, especially in critical regions, to encourage reform, promote understanding, convey respect for other cultures and provide an opportunity to learn more about our country and its citizens. To do this, we must be able to communicate in other languages, a challenge for which we are unprepared.

Deficits in foreign language learning and teaching negatively affect our national security, diplomacy, law enforcement, intelligence communities and cultural understanding. It prevents us from effectively communicating in foreign media environments, hurts counter-terrorism efforts, and hamstrings our capacity to work with people and governments in post-conflict zones and to promote mutual understanding. Our business competitiveness is hampered in making effective contacts and adding new markets overseas.

To address these needs, under the direction of the President, the Secretaries of State, Education and Defense and the Director of National Intelligence have developed a comprehensive national plan to expand U.S. foreign language education beginning in early childhood and continuing throughout formal schooling and into the workforce, with new programs and resources.

The agencies will also seek to partner with institutions of learning, foundations and the private sector to assist in all phases of this initiative, including partnering in the K-16 language studies, and providing job opportunities and incentives for graduates of these programs.

The National Security Language Initiative has three broad goals:

Expand the number of Americans mastering critical need languages and start at a younger age by:

  • Providing $24 million to create incentives to teach and study critical need languages in K-12 by re-focusing the Department of Education’s Foreign Language Assistance Program (FLAP) grants.
  • Building continuous programs of study of critical need languages from kindergarten to university through a new $27 million program, which will start in 27 schools in the next year through DOD’s NSEP program and the Department of Education, and will likely expand to additional schools in future years.
  • Providing State Department scholarships for summer, academic year/semester study abroad, and short-term opportunities for high school students studying critical need languages to up to 3,000 high school students by summer 2009.
  • Expanding the State Department Fulbright Foreign Language Teaching Assistant Program, to allow 300 native speakers of critical need languages to come to the U.S. to teach in U.S. universities and schools in 2006-07.
  • Establishing a new component in State’s Teacher Exchange Programs to annually assist 100 U.S. teachers of critical need languages to study abroad.
  • Establishing DNI language study "feeder" programs, grants and initiatives with K-16 educational institutions to provide summer student and teacher immersion experiences, academic courses and curricula, and other resources for foreign language education in less commonly taught languages targeting 400 students and 400 teachers in 5 states in 2007 and up to 3,000 students and 3,000 teachers by 2011 in additional states.

Increase the number of advanced-level speakers of foreign languages, with an emphasis on critical needs languages by:

  • Expanding the National Flagship Language Initiative to a $13.2 million program aiming to produce 2,000 advanced speakers of Arabic, Chinese, Russian, Persian, Hindi, and Central Asian languages by 2009.
  • Increasing to up to 200 by 2008 the annual Gilman scholarships for financially-needy undergraduates to study critical need languages abroad.
  • Creating new State Department summer immersion study programs for up to 275 university level students per year in critical need languages.
  • Adding overseas language study to 150 U.S. Fulbright student scholarships annually.
  • Increasing support for immersion language study centers abroad.

Increase the number of foreign language teachers and the resources for them by:

  • Establishing a National Language Service Corps for Americans with proficiencies in critical languages to serve the nation by:

1. Working for the federal government; and/or
2. Serving in a Civilian Linguist Reserve Corps (CLRC); and/or
3. Joining a newly created Language Teacher Corps to teach languages in  our nation’s elementary, middle, and high schools.
This program will direct $14 million in FY07 with the goal of having 1,000 volunteers in the CLRC and 1,000 teachers in our schools before the end of the decade.

  • Establishing a new $1 million nation-wide distance-education E-Learning Clearinghouse through the Department of Education to deliver foreign language education resources to teachers and students across the country.
  • Expand teacher-to-teacher seminars and training through a $3 million Department of Education effort to reach thousands of foreign language teachers in 2007.