Language Bias and Self-Rated Health

From PHS 795 Student Edward Vargas:

I wanted to share this paper we published on language bias among Spanish speaking Latinos when examining health status.  Long story short, all major survey’s using the Self-Rated Health Measure…“How would you rate your overall physical health — excellent, very good, good, fair, or poor?”  translate the “fair” category to be “regular” in Spanish. This however is not the way native Spanish speakers interpret “fair” health. In this paper, we do a wording experiment showing that using “regular” instead of “mas o menos” (which we argue gets closer to what “fair” health means), over inflates poor health status.  Why does this matter?  Read the paper and holla at me! 

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823170/

OK — now, this is awesome. First student-suggested blog post, and it involves their own research — and it’s right in line with the material we’re covering in course this week. For example, the Hruschka reading mentions the importance of research looking at culture as an explanatory factor for why we observe differences in health or health outcomes associated with health interventions. Hruschka admonishes us to look at specific mechanisms and not just reflexively appeal to a vague concept of culture, and that is exactly what Edward and his co-author Gabriel Sanchez have done here.

Language and culture go hand in hand — language often forming a basis for culture, and also encoding some of the shared norms of the culture. In this case, Edward finds that “regular” encodes a different concept than what the designers intended for the Self-Rated Health Measure response of “fair” to mean. I am guessing that among native Spanish speakers, this effect may vary according to a number of factors, including whether the individual speaks English as a second language, their specific region — perhaps even neighborhood or social network.

Practically speaking, this reminds us that the tools we use for measurement in health have to be culturally accurate.

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4 thoughts on “Language Bias and Self-Rated Health

  1. Hey Ed,
    This article was particularly interesting to me because of my volunteer efforts at local Free Clinics. I studied Spanish for four years in high school and three years in undegrad, so I felt fairly comfortable when communicating with and treating Latino patients at the clinic. However, this article made me think about the cultural aspect of Latino heritage and how language doesn’t necessarily translate or take into account the deeper cultural meanings. Your research found convincing evidence that respondents who reported regular as an option reported poorer health as compared to those who were given the alternative translation of mas o menos. This is fascinating and illustrates a real need for additional research like yours. It also makes me curious about the potential advantage Latino medical doctors would have over others because of their cultural link and connection with the patients. What is your take on that aspect? Do you see any associations with this and if articles like these could help spike an even greater interest in the Latino community to pursue medical careers?

    Additionally, I wanted your opinion on the term así así as opposed to mas o menos and regular when describing health. I know that así así translates to so so in English, but are there deeper meanings and connections to mas o menos or regular when trying to describe overall health? Thanks for your insight.

    Joe Bates

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  2. Joe: Thanks for your response and for your service. It’s great that you spent some time working in the Latina/o community. Latina/o populations are growing exponentially as you may know 1/4 of all children in the US are Latina/o and 1/3 of all Latina/o children live in poverty. We have some major obstacles ahead of us and so thanks for joining in on the struggle.

    Regarding your question about the number of Latina/o physicians. A study conducted by folks at UCLA find that, “in 1980, there were 135 Latino physicians for every 100,000 Latinos in the U.S.; by 2010, that figure had dropped to just 105 per 100,000. Meanwhile, the national rate of non-Hispanic white physicians increased from 211 for every 100,000 non-Hispanic whites to 315 per 100,000.” (http://newsroom.ucla.edu/releases/rate-of-latino-physicians-shrinks-even-as-latino-population-swells).

    This is figure is alarming in that while the Latino population increased over 243 percent since 1980, Latino physicians decreased 20 percent over this time period. I must also preface and say just because you are Latina/o does not mean you speak Spanish nor have a linked fate with other Latina/os. The U.S. Latino/Hispanic population is immensely diverse, with members originating from twenty-one countries. Latino/Hispanic sub-groups tend to reside in different areas of the United States, have different cultural practices/norms, different immigration experiences, and varying levels of economic attainment.

    In fact, in my own work, I find that there is a White advantage of health among Latinos….So, Latinos who think others view them as white, report better health than Latinos who think that others view them as Latino. This is called socially-assigned or ascribed race….which is the idea of how others view you might matter more than how you see your own race/ethnicity. Here is the citation: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439394/

    Long story short….just because your Latina/o doesn’t mean you can connect with other Latina/os. Regarding your question about, “Asi Asi” versus “mas o menos,” as the translation for “Fair” health…..I think that’s a great empirical question and should be tested among various outcomes when using ordinal likert scales. I know for me personally…I never say “asi asi” and if I do….say it in the context of “like this…like this” in other words, this is how you do it. I’m about to go into the field with a new survey instrument and will be asking adults to self-rate their child’s health…and doing a similar experiment as the one first tested….I’ll get back to you about the results…mid December.

    Again…thanks for engaging.

    Edward D. Vargas

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  3. Thanks for your response, Ed. It is alarming to see the actual numbers of Latina and Latino physicians drop from 1980 to 2010. This figure was not something I anticipated, but it is great to see this research being conducted in hopes of changing this trend. Do you have any insight on the reasons for this decline among Latinos entering the medical field? As you cite the 243 percent increase in the Latino and Latina population, this decrease in physicians is particularly stunning.

    You make a good point about the assumed connection between patients and doctors who identify as Latino and Latina. It is interesting when looking at a White advantage where reported health is actually better when viewed as White as compared to Latino/a. This type of phenomenon really highlights the social aspect and other factors that contribute to health status, which are sometimes hidden from plain sight. I look forward to the research you are conducting on children’s health with a new survey. Keep me posted with the results.

    – Joe

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  4. Ed,

    I appreciated your research and your interpretations of your findings. To give a frame of reference for my perspective, I was born and raised in Miami, which has a large Latina/o community, and I have taken Spanish classes in 1st grade-11th grade, and also in college.

    I believe that there is a general problem with direct translations. Because of contextual and cultural considerations tied to word usage, I don’t think meanings can be fully translated across languages. That being said, I would pick mas o menos over regular if I were creating a survey, because it has the most similar results to the English survey, and could therefore maximize comparability between different language versions of the survey.

    I found the comments on cultural competency relevant. I believe that doctors who have a cultural connection to their patients are able to put patients at ease, and potentially communicate important information to patients with greater ease due to shared language or mannerisms. As for Ed’s comment on how Latina/o’s who identify as white have better health outcomes, I think that this could be an example of internalized bias. However, if they actually appear different from other Latina/o’s perhaps their appearance causes them to receive different treatment from people in their social networks and from health professionals.

    Lastly, when reading Ed’s report, I felt that perhaps regular may have less negative connotations than mas o menos because I believe that regular implies normalcy, while mas o menos includes the term menos which I believe implies some sort of loss.

    -Omar

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