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Culture & Health Literacy

Tools for Cross-Cultural Communication and Language Access Can Help Organizations Address Health Literacy and Improve Communication Effectiveness

Effective communication recognizes and bridges cultural differences.

The ideas people have about health, the languages they use, the health literacy skills they have, and the contexts in which they communicate about health reflect their cultures. Organizations can increase communication effectiveness when they recognize and bridge cultural differences that may contribute to miscommunication.

Culture Allows and Can Get in the Way of Communication

Culture can be defined by group membership, such as racial, ethnic, linguistic or geographical groups, or as a collection of beliefs, values, customs, ways of thinking, communicating, and behaving specific to a group.

As part of a cultural group, people learn communication rules, such as who communicates with whom, when and where something may be communicated, and what to communicate about. Members of a cultural group also learn one or more languages that facilitate communication within the group.

Sometimes, though, language can get in the way of successful communication. When people and organizations try to use their in-group languages, or jargon, in other contexts and with people outside the group, communication often fails and creates misunderstanding and barriers to making meaning in a situation.

Doctors, nurses, dentists, epidemiologists, and other public health and healthcare workers belong to professional cultures with their own languages that often aren’t the everyday language of most people. When these professionals want to share information, their jargon may have an even greater effect when limited literacy and cultural differences are part of the communication exchange with patients, caregivers, and other healthcare workers. Review the Find Training section of this website for courses in culture and communication.

Translation and Interpretation Are Necessary but Not Complete Solutions

Translated materials and interpreter services can help bridge language differences, but translations and interpreter services may not be fully accurate or complete. Not all languages have words for something that exists in other languages and cultures, and not all words and ideas can be easily translated into or explained in another language.

Or, people may have weak literacy and numeracy skills in their native language, and translated materials are too complex or technical for them. The interpreter may not be fully attuned to the need for everyday language, making it difficult for the client to fully comprehend the information.

The context for communication, such as the physical location or people’s shared or different experiences, may also affect the meaning of translated and interpreted words. The intended meaning may be lost, causing confusion even when everyone involved in the communication exchange believes they understand what is being said.

Organizations Can Support Cross-Cultural Communication and Language Access

The National Institute on Minority Health and Health Disparities (NIMHD)  launched a resource for people who work with health disparity populations with limited English proficiency: the Language Access Portalexternal icon (LAP). The LAP contains information, in multiple languages, for six disease areas where major health disparities have been identified in non-English speaking populations. The portal supports NIH’s comprehensive Language Access Plan by providing access to reliable cross-cultural and linguistically appropriate health information from NIH and other federal agencies.

The National Culturally and Linguistically Appropriate Services (CLAS) Standardsexternal icon can help organizations address the cultural and language differences between the people who provide information and services and the people they serve. The principal standard is to provide effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs.

Organizations can use the Guide to Providing Effective Communication and Language Assistance Servicesexternal icon to help communication between those who provide and receive care in a health care facility.

Federal agencies, and potentially organizations that receive federal funds, must create and follow plans to meet the needs of people with Limited English Proficiencyexternal icon. On November 3, 2015 the U.S. Census Bureau released a set of new tablesexternal icon reporting at least 350 languages that U.S. residents speak in their homes. These tables show the number of speakers of each language and the number who speak English less than “very well” — which is a common measure of English proficiency.

The best way to make sure of translation and interpreter quality is to select and match certified translators and interpreters with the primary audience. The American Translators Associationexternal icon has information on the certification process. A good match between translator or interpreter and primary audience happens when the translator or interpreter uses information about the language preferences, communication expectations, and health literacy skills of the audience to create appropriate messages and materials.

Health professionals and educators can use the Primer for teaching cultural competency. The Primer: Cultural Competency and Health Literacyexternal icon guide provides teaching tools to improve cross-cultural communications skills, deliver culturally and linguistically appropriate healthcare services to diverse populations, and develop programs and policies to improve health outcomes and reduce health disparities.

The CDC webinar, Cultural Competence in Preparedness Planning, can help your organization enhance its commitment to cultural competence during emergencies and reduce the disparities among people of different cultural backgrounds that can sometimes arise during disasters. Our Emergency Partners Information Connection and Office of Minority Health and Health Equity came together for this webinar to discuss:

• Why responding organizations should demonstrate cultural competence during emergencies


• What can happen if a responding organization is culturally incompetent


• Where you can find resources to help build your organization’s understanding of cultural competence