Assessment 4 - Essay _ Barriers to access to health care amongst migrants
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Assessment 4 - Essay : Barriers to access to health care amongst migrants
People from many cultures and nations are migrating at an increasing rate as the
globalization
process
progresses,
and
prominent
factors
contributing
to this trend
include improved access to healthcare, higher education, and escape from war ( Rasi,
2020). Over 7 million Australians, or 27.6% of the total population in 2021 (up from
26.3% in 2016), were born outside of the country ( Australian Bureau of Statistics,
2020). According to a WHO (2022) report, poor health outcomes are not caused by
refugees and migrants being inherently less healthy than the host population, but rather
by the interaction of several suboptimal health determinants over the course of a
person's life, including linguistic, cultural, legal, and other barriers, as well as factors like
education, income, housing, and access to services. As a result this leads to immigrant
groups
incurring
disproportionate
disease
burden
based
on
their
ethnicity
and
pre-migration
health
condition,
yet
they
are
severely
underrepresented
in
health
research and public health initiatives ( Hussain, Atkin, Leese, 2004).
Identify the key barriers to health care
Refugees and migrants continue to be some of the most vulnerable people in society
and frequently deal with xenophobia, discrimination, poor living, housing, and working
situations, as well as insufficient or limited access to mainstream health services (
WHO,2022). For migrant populations to be socially integrated and maintain good health,
access to high-quality healthcare is crucial ( Rosano, 2018). As most immigrants come
from
backgrounds
where
they do not speak English and have little grasp of the
language, linguistic barriers are a major impediment. According to data from the Adult
Migrant English Program (AMEP), about 60% of participants in the Family Migration
Program and over 70% of applicants for the humanitarian visa have little to no English
proficiency upon arrival in Australia ( Skull, & Murray,2005). Studies have shown that
misinterpretation
of
immigrant
patients' needs and wishes or the information they
received from healthcare professionals can hinder their access to healthcare services (
Lindkvist, Johansson & Hylander,2015). It is also reported that language barriers can
affect and delay access to healthcare services, even in the absence of symptoms. The
Australian Bureau of Statistics data released in February provides the best illustration of
how poor access to healthcare affects migrants, showing that foreign-born Australian
residents have died from COVID-19 at a rate that is three times higher than that of
Australian citizens who were born there.( ABS,2022). When Covid was at its most
prevalent, the health messaging that was delivered in languages other than English
contained
translation
problems
and
outdated
vaccination
advice
(
SBS,
2021).
Communities were bombarded with information, but there was little understanding of
how different communities could access it. People were also expected to navigate
complicated online systems to find the right information, which was unrealistic for some
communities, especially those who did not have access to technology or digital literacy (
SBS, 2022).
Discuss the ethical and legal issues raised by these barriers to health care
Health inequalities including unequal treatment due to language problems are linked to
unequal access to healthcare and poor health outcomes (Messias, McDowell & Estrada,
2009).Key
ethical
issues,
such
as
clinical
judgment
and
decision-making,
client
confidentiality, and informed consent are impacted by language barriers (Blake, 2003).
Under the ethical principle of Autonomy, it states the right of people to determine their
own health care and treatment individually and collectively, to the extent that is practical,
is the other primary ethical principle that is relevant to how health care resources are
distributed.
According to these principles, healthcare professionals have a fiduciary and
ethical obligation to treat all patients equally, which includes making recommendations
that are clear and helpful and, to the best of their abilities, ascertaining and respecting
the health care preferences of adult patients who are capable of making independent
decisions.However, communication difficulties due to language or cultural differences
can
harm
the
doctor-patient
relationship
and
may
lead
to
inadequate
access
to
healthcare ( Scharf , Vardhana, Matsoukas, Wall, Arevalo & Diamond, 2021). According
to ABS (2016), only 72.7% of people only speak English.From a regulatory, clinical, and
ethical perspective, it is essential that hospitals and other health care settings make
accommodations for patients with limited English proficiency, whose rights are protected
by a number of laws, including the Australian charter of healthcare rights. The legal
need to ensure informed consent may be impeded by the presence of a language
barrier. To mention a few, the failure to get informed consent and/or warning, as well as
the
failure
to
demonstrate
that
a
patient
understood
the
medical
information
or
consented to the medical procedure, may result in aggravated battery damages and
serve as grounds for a finding of negligence (Kowalik, 2018).
Propose an ethical position, with related strategies, to address these difficulties
The Australian Charter of Healthcare Rights ( ACSQHC, 2022) states that everyone has
a right to healthcare services and treatments that are individualized to their needs.
Additionally, everyone has a right to clear information about their condition, as well as
the potential advantages and disadvantages of various tests and treatments, to enable
them to make an informed decision. There are 193,000 people who do not speak
English well and 820,000 Australian citizens who described their English as "poor." In
Sydney, Melbourne, and Adelaide, this percentage is closer to 18%. Throughout the
country, 16% of the population does not speak English at all or very well ( Salt, 2017).
The use of an interpreter is an apparent solution to the issues caused by language
boundaries. Sadly, it is wrong to assume that all interpreters are equally skilled and that
by using an interpreter, informed consent may be assumed ( Kowalik, 2018).
An
interpreter
must
be
a
"competent
interpreter"
who has earned the necessary
accreditation from relevant regulatory agencies. Even though it's a requirement for a
skilled interpreter, being highly multilingual does not guarantee interpretation skills(
NCIHC, 2022). A competent interpreter has proficiency in both the English language
and the non-English language, as well as knowledge of specialized medical terminology
in both languages, and is knowledgeable about matters relating to ethics, standards of
practice, confidentiality, and the role of the interpreter ( National Health Law program,
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2010). When using an interpreter, it is also important to keep in mind the cultural
sensitivity of differences between genders and between rival ethnic groups. A patient
may not feel comfortable using an interpreter from a particular region or background, in
which
case
the
effectiveness
of
the
information
being relayed will be diminished
(Kowalik, 2018).
Include in your discussion the reasons why you believe that previous strategies may
have failed
The adult migrant english programme (AMEP), a free service available to migrants with
poor English proficiency levels, is one method in place for overcoming the language
barrier issue. Only 510 hours of free lessons are offered under the AMEP programme to
achieve functional abilities, raising the question of whether this is enough to acquire
functional English. According to the most recent data, which dates from 2015, just 7% of
immigrants and refugees who participated in the AMEP each year were able to speak
functional English as a result (Button, 2019). Functional English is difficult to obtain due
to the legislative limit of 5 years and just 510 hours of AMEP, but failing to do so could
have detrimental implications. It allows migrants to fill out forms,
consult doctors and
carry out everyday tasks. It is essential to have a reliable interpreter when providing
interpreter services, but many hospitals and GPS allow family members to do so, which
may constitute negligence because they are incompetent interpreters who frequently
make errors in their interpretations and are prone to omissions, additions, substitutions,
and
volunteer
responses
(
Kowalik,
2018).
Health
Care
interpreter
service is an
interpretation service that offers 120 languages and claims to be available 24 hours;
however, on the contrary many migrant users have trouble accessing the services with
long waiting time periods. Particularly with Covid, interpretive services (are) dependent
on its accessibility, and given how it is currently resourced, it is almost designed to be
completely inaccessible. To be able to wait on hold for lengthy periods of time only to
reach
your
interpreter,
you
must
have
endurance and patience in general ( The
guardian, 2022).
Address current government’s health initiatives and comment on the ethics and
practicality of these ‘reforms’ and any bearing they may have on your selected group
Even though it is a legal requirement for healthcare professionals to offer language
assistance
when
necessary,
there
are
still
issues
with
language
barriers
in
the
Australian healthcare system. As written in previous pages, only 7% of participants in
Australia's AMEP in 2015 believed they could speak functional English as a result,
failing to reach the "functional English" level for many ( Button, 2019). Drawing on from
the language and interpreter services in Australia, I believe that healthcare providers
have a duty to provide language services. The legal duty to offer language services is
obvious, but in practice neither is it followed nor are providers penalized for not doing
so. Patients are consequently required to offer their own language services through
family members or friends, transferring the obligation of providing language services
from the hospital to the patient.
Australian Charter of HealthCare rights,
‘everyone has
the right to be able to access healthcare and the charter acknowledges and respects
people of different cultures and way of life’. As a result, in order to ensure that everyone
has access to healthcare, patients must be able to ask for it in a language that they feel
certain they will be able to comprehend and from which they will be able to make
educated decisions that are not constrained by a language barrier. The intrinsic value of
patients' personhood is not acknowledged when appropriate language services are not
given for them, which shows a lack of respect for them and reduces their ability to make
rational
decisions.
The
hospital's
probable
difficulty
in
supplying
an
interpreter
is
outweighed by the patient's need for medical attention. Instead of concentrating on the
individual, attention must be given to institutional accountability.
In your discussion you should refer to at least two theoretical perspectives on ethics
The moral implications of the policy of providing immigrants with equal access to
healthcare are justice, deontology and utilitarianism.Conforming to the justice principle,
every person has an equal right to fundamental liberties and should be given the same
opportunities
and
chances.
Consequently,
neglecting
to offer language assistance
violates the categorical requirement of respecting and protecting people's rights. The
utilitarian approach bases judgements on which course of action will result in the
greatest amount of benefit for the largest number of people. However, a utilitarian
approach may degrade the standard of care by stifling the voices of patients and
interpreters, objectifying the emotional labor of interpreters, and taking advantage of
patients' needs. Providers must understand that a utilitarian view of the interpreter's job
and duties could lead to ethical and interpersonal problems that lower the standard of
care.Through a deontological approach, both healthcare practitioners and interpreters
can learn from and co-evolve with one another, enabling them to preserve control over
their specialities and work as partners in providing quality care.
Conclusion
Healthcare professionals must not undervalue the significance of bridging language
obstacles.
A
successful
relationship between a patient and a medical practitioner
depends on open communication, which also serves as the foundation for providing
competent medical care and treatment.
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References
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