Language access is healthcare access: Why translation alone is failing Pennsylvanians

By George Fernandez
In healthcare, we often talk about access as if it begins and ends with insurance coverage or the availability of providers. But for hundreds of thousands of Pennsylvanians, access starts earlier than that, with language. And too often, it stops there too.
Language access is healthcare access. Not as a slogan. As a fact. I know this not only as a professional who has spent decades working at the intersection of culture, systems, and community, but as a child who was forced into the role of interpreter far too early.
When I was 8 years old, my family immigrated from the Dominican Republic to Harrisburg, Pennsylvania. My mother was a single parent and spoke no English. That meant I became the translator for everything, including doctors’ appointments. I remember sitting in exam rooms, trying to translate words I barely understood myself. I did my best to explain symptoms and instructions between a doctor who did not speak Spanish and a mother who did not speak English. I carried that responsibility because there was no other option.
That weight should never fall on a child. And it certainly did not result in the best care for my mother or my family. What troubles me most, years later, is how familiar this story still is. More than one million Pennsylvanians speak a language other than English at home, with Spanish being the most common. In cities like Harrisburg, Reading, Allentown, and Lancaster, as well as many rural communities, multilingual households are not the exception. They are the reality. Yet too many healthcare systems still treat language access as a box to check rather than a foundation of quality care.
Forms get translated. A Spanish button gets added to a website. A bilingual staff member gets cited, even if that person has no formal training in medical interpretation or cultural competency. Then institutions move on and count that as success. This is where reach gets confused with impact.
Reach is how many materials were translated or how many people an organization believes it touched. Impact is whether patients actually understood their care, trusted their providers, and were able to act on medical guidance in ways that improved their health. Translation alone does not create understanding. Healthcare is not transactional. It is relational. It depends on trust, cultural context, and clear communication, especially for patients navigating chronic illness, mental health care, maternal health, or complex treatment plans.
When those elements are missing, the consequences are predictable. Latino patients are more likely to delay care, less likely to access preventive services, and more likely to rely on emergency rooms for conditions that could have been treated earlier. These outcomes are often mislabeled as noncompliance, when in reality they reflect systems that were never designed with linguistic and cultural realities in mind.
Too often, this conversation gets pulled into politics. Language access and cultural competency are lumped into ideological debates about diversity, equity, and inclusion. But in healthcare, this is not a political issue. It is a patient safety issue.
Federal law already requires meaningful access for individuals with limited English proficiency. But meaningful does not mean minimal. It does not mean relying on children to interpret for their parents. It does not mean phone lines that no one explains how to use. And it does not mean surface level solutions that look good on paper but fail in practice.
Real language access requires cultural intelligence. It requires training staff, not just translating materials. It requires understanding how culture, family dynamics, immigration experiences, and historical mistrust shape how patients engage with care. And in many cases, it requires collaboration and innovation beyond what a single institution can build on its own.
This is not nice to have. It is not a branding opportunity. And it is not something to promote without accountability.
If Pennsylvania is serious about improving healthcare outcomes, especially in underserved and rural communities, we must stop settling for band aid solutions. We must stop measuring effort and start measuring impact. No child should have to shoulder the responsibility I carried at 8 years old. No family should have to navigate illness through confusion and fear because systems failed to communicate. And no healthcare institution should be surprised when outcomes do not improve if access was never truly there to begin with. Language is not an add-on to healthcare. It is the gateway.
Until we treat it that way, access will remain an illusion, and families across the Commonwealth will continue to pay the price.
George Fernandez is the Founder & CEO of Color & Culture, a national multicultural marketing agency based in Pennsylvania that builds bridges between organizations and the diverse communities they serve. Through his work, Fernandez has become a leading voice in health equity, inclusive communications, and authentic community engagement across the United States.