The SDG Agenda intends to create a greater sustainable future for all, however, when examining the SDGs, it is apparent that there is one key variable that is missing, namely multilingualism. Here, multilingualism refers to the growth of linguistic and cultural diversity in society. There are several places where multilingualism could be included, most clearly in goals related to education and participation. However, the lack of mention under Goal 3: Good Health and Wellbeing, was very concerning.
Good health and wellbeing underpin vital areas such as workforce participation, quality of life, and education. For those who live in vulnerable conditions, the health of an individual is a key determinant in investing in higher education to escape poverty traps. Arguably, multilingualism may be excluded since it is a universal mechanism in achieving these Goals. Yet even under the newly created communication-centred Goal 17, whilst financing (another ‘mechanism’) was mentioned again, multilingualism was not. Beyond Goals 3 and 4, it could be argued that Goals 5, 8, 10, 11 and 16 could also include notions of multilingualism.
Language and communication are intrinsically linked. Both are intertwined into healthcare, however, obstacles in effective communication such as language, medicinal cultural practices, and knowledge of health terms are relevant barriers towards sustainable healthcare.
Miscommunication in healthcare is widespread, with its consequences leading to an increase in errors between medical personnel and the patient. This may occur amongst migrant patients and immigrant staff, where neither of them may share the same first language. These errors can in turn lead to fatalities.
The growth of multiculturalism and globalisation has led to the increase of language diversity in cities across the globe, especially in the United States. Yet these individuals who are both cultural and ethnic minorities are affected the most. It is also important to recognise that language as a barrier to healthcare is a part of the wider systemic issue surrounding inequalities of minority groups in achieving equitable standards of living. Whilst language is associated with culture, there is a large difference between biomedicine and other variants. Merely understanding language doesn’t equate to an immediate understanding of culture. The dominance of western medical standards in biomedicine has often marginalised medicinal practices from other cultures.
This current problem directly undermines equitable access of information, expression, and equality in communication. On a broader scale, it could therefore be interpreted that such inaction towards multilingualism and health, could be seen as a form of implicit discrimination, which directly contradicts against the core principles of human rights. The WHO explores this beyond ‘language discrimination’ under the ‘right to health‘, which features both ‘non-discriminatory’ and ‘information accessibility’ as key principles.
Whilst there has been a complete disregard of languages and multilingualism in the SDG Agenda, some national policies have materialised, particularly in the USA, where it is a legal condition in all federal areas and activities to provide accessible language facilities. States, such as New Jersey, require breast cancer brochures to be in Spanish as well as English, however, excludes other conditions. Despite providing language access as a legal requirement, application of this has been uneven across institutions and organisations. This neglectful attitude has also created a lack of urgency and recognition of languages in healthcare from a researcher’s perspective. The American Hospital Association in 2016 surveyed 4586 hospitals about translation services, discovering that only 56% housed such services.
The problematic nature of multilingualism, especially related to health as a means of access, is only one key area where the inclusion of multilingualism would make a difference. For Health and Wellbeing, target 3.8 and 3.C present themselves as examples of where an existing target could be reworked, or how multilingualism could be added as an additional target. Target 3.8 mentions achieving universal health coverage (UHC) and access to quality health services without financial hardship, and target 3.C promotes the increase of health financing and workforce recruitment. There is a fundamental need to explicitly recognise that access to healthcare transcends language and is a fundamental human right. Therefore, a proposition may include:
1. An amendment to one of the current target 3.8; to adjust it so that not only are individuals protected from ‘financial hardship’, but also ‘linguistic barriers’.
2. To substantiate this further by highlighting ‘access to healthcare’ as a Human Right, as stated by the WHO
This is a continuation of our argument presented earlier – that it is also important to achieve an appropriate level of ‘ease’ of access to the correct healthcare services.
Most indicators are quantified in their nature. For multilingualism, this could be achieved by expressing the usage of translators as an indicator to measure against, as certain countries are already using such services, thus forming an identifiable bridge between language and healthcare. Here, familiarity is necessary in successfully introducing the issues of multilingualism into the international arena of Sustainable Development. This could be completed by creating an indicator under 3.8 which measures the percentage of correct materials and language services offered to individuals who attended a primary healthcare facility in a year, whose primary language was not that of the country they were seeking medical assistance in. This would therefore measure how diverse healthcare practices are in being able to appropriately cater to a multilingual society.
Alternatively, we could seek to explore the proportion of the population whose first language is not the same as the country they are residing in and assess their usage of such healthcare services. We would expect a difference to the rest of the population whose first language is the same as their country of residence. However, a lack of usage in terms of healthcare service and access may thus be attributed to language, and in turn culture, as the main reason for this difference.
Addressing issues surrounding multilingualism and healthcare access is integral in achieving sustainable, healthy populations. This issue will only cause greater problems in the future. Whilst biomedicine is predominantly focused on disease-specific interventions, as seen by most indicators under Goal 3, the influences of a horizontal approach to medicine, where interventions are not merely disease-specific, can also in turn help us paint a more contextualised picture of healthcare access more broadly, as well as usher multilingualism into the arena of Sustainable Development.
This target proposition will hopefully provide a stepping stone towards recognising the wide range of cultural differences related to health and medicine, forming part of a broader agenda in slowly entrenching multilingualism into the SDGs. In turn, this could materialise into either more targets and indicators related to health and language under Goal 3 e.g. recognising cultural differences in medicine or even allow greater depth of exploration, allowing multilingualism to be applied in other SDG Goals, such as Goal 4: Education and Lifelong Learning, where health literacy could be integrated next.
By Andrew Wang