nized. It provided the impetus for an Executive Order on improving access to services for persons with LEP3 and a subsequent report to Congress. The effect of primary language on health remains a central concern of the federal Office of Minority Health Center for Linguistic and Cultural Competence in Health Care, established in 1995 to address the health needs of populations who speak limited English

Individuals with LEP have widely varying levels of literacy and health literacy in their primary language. When LEP individuals are health literate in their primary language, the key is providing language assistance either in the form of care in their primary language or interpreter services and translated materials. When LEP individuals are not health literate in their own language, additional efforts are needed ensure adequate communication. Some languages do not have a written form or individuals may not be able to read, and so translation services are of no use in such cases. These individuals may be unfamiliar with medical terminology in their primary language and, therefore, linguistically competent services alone will be insufficient to ensure adequate communication. Alternatively, individuals may be health literate in their own culture, but not in Western medicine’s health system and style of health care.

Cultural Languages

Cultural context gets transformed into cultural language that influences three critical determinants of health literacy: comprehension, understanding, and decision-making. Different cultural groups mobilize creative forces to formulate unique cultural languages that must be considered in culturally competent approaches for implementing interventions to promote health literacy. Two examples of these innovative cultural languages can be found in the language of Aboriginal people and in the dreams of Native American cultures.

In contrast to Westernized people whose language use is dominated by nouns, Aboriginal people use a language dominated by verbs in deference to their worldly vision of all existence as energy or spirit that is in constant transformation (Ross, 1996:116). A consequence is that there is attention to the “relationship between things” and less focus on the “characteristic of things” (in a noun-driven language such as English). This feature of using “fluidity of verb-phrases” is functional in healing relationships. Thus, a rethinking and re-framing of the standard inquiries that drive health assess-


Executive Order No. 13166. Benefit-Cost Report of Executive Order No. 13166: Improving Access to Services for Persons with Limited English Proficiency. August 2000.

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