People often change in response to a perceived problem or temporary threat. Sometimes they make changes when they sense a new reality that offers both challenges and opportunities. The first type of change is reactive or defensive, while the latter is proactive and positive.

We believe you will be more likely to commit to the other steps in this guide, and ultimately succeed in improving communication with individuals who understand little or no English, if you truly believe that change is essential and act proactively rather than ignore the fact that the face of America has changed.

To begin with, we encourage you to consider the pervasive need for increased linguistic competency throughout the United States, not just in health care settings, but also in the education, business, entertainment and defense sectors. The trend that you are responding to in your organization (perhaps the reason you have read at least this far) is that you already feel the need to change your situation. But the need that you feel is only a part of a much larger movement currently underway in the country to improve language competencies. Although health care is surprisingly behind the curve in many aspects of language and communication (e.g., American Translators Association, the professional society that attests to translators’ competencies offers testing in the domains of science, technology, medicine, law, business and finance, and is just now working to recognize health care), you are now part of the necessary and decades-long effort underway to develop national competencies to succeed in our increasingly multilingual society.

Next we believe that you shouldstimulate and participate in national, state and local discussions about the role of language and culture and encourage conscious and principled language planning.  Ignoring the widespread implications of a quickly-growing multicultural and multilingual society is not in our collective, long-term best interest, nor is offering band-aid responses to this chronic need. Discussions about these issues can be difficult, but they must take place. When you do, consider that there is no such thing as a totally monolingual country. The idea that the U.S. is an exception, an island amid the increasingly blurred global linguistic lines, is a myth. But until now, the myth has largely delayed a proper response to the new reality. Politics, religion, immigration, culture, education, the economy and natural disasters have all played a role in creating multilingual societies, including our own (Crystal, 2005). These changes that are now so glaringly apparent in clinics and hospitals across the country are not likely to reverse course but will simply become more pronounced.

How do societies deal with populations who speak diverse languages? At a minimum, they can cope with attempts at interpreting and translation. This response, generally the approach taken in the U.S., is a reactive holding strategy with the idea things will return to normal. As the irreversible nature of this change takes hold, societies cope by supplementing the population’s language skills, either encouraging everyone to learn a common language (lingua franca) in addition to their mother tongue or to learn as many languages as possible. In fact, speaking two or more languages is a way of life for three-quarters of the world’s population.

Finally, forward-looking societies tend to cope by planning, that is, by engaging in conscious, principled language planning and linguistic engineering. This involves creating policies about how languages and linguistic varieties are to be used, supporting existing foreign language programs, implementing new language teaching programs (e.g., bilingual programs, language immersion), developing coherent standards for language use and maintenance, and defining the role of the media and purpose-driven policies that guide public health communication in a multilingual society.