Academic journal article Translation & Interpreting

Healthcare Interpreter Policy: Policy Determinants and Current Issues in the Australian Context

Academic journal article Translation & Interpreting

Healthcare Interpreter Policy: Policy Determinants and Current Issues in the Australian Context

Article excerpt

Interpreter Policy and the Policy Process

Policy and the policy process are highly contested terms. In the health context, Buse et al (2005) see policy as embracing

'courses of action (and inaction) that affect the set of institutions, organisations, services and funding arrangements of the health system.... including policies made in the public and private sector.....and the actions external to the health system which have an impact on health.' (Buse et al 2005 p6)

Dye argues that policy is anything that governments choose to do or not do (Dye 2001), that is, that policy may be explicit or implicit (Folz 1995), written or unwritten.

Health policy also includes actions outside of the healthcare system that impact on health or health status (Palmer & Short 2000). For instance immigration policy changes supporting the immigration of people from sub-Saharan Africa, or small village communities from south-east Asia, has significant implications for the organisation, delivery and budgets of healthcare interpreter services, as the range and demand for cross-linguistic encounters increases and diversifies.

Policy can be seen as one of the key dimensions of the health system; others are resources, organisational structure, management and support systems, and service delivery (Janovsky & Cassels 1995 p12). Fundamental to policy analysis is the way power and influence are exercised and the way societies and governments function (Buse et al 2005; Walt 1994). Thus, this model of interpreter policy highlights the important role of key stakeholders.


The Model of Interpreter Policy within Healthcare

The complex and dynamic nature of the interpreter health policy process is modelled in Figure 1. Interpreter policy operates within a context that is both defined and influenced by the broader political and social context. Thus attitudes towards immigration, immigrants, health and welfare social provision all (explicitly or implicitly) frame, mediate and influence interpreter service policy and provision. Healthcare interpreter policy is intertwined and nested within multicultural and mainstream healthcare policy. The interpreter service is a key multicultural service which promotes access to health services for people with limited English proficiency.

Many more direct factors may interactively influence or determine interpreter policy and service delivery. These include factors associated with the patients with limited English (including their language proficiency, beliefs, socio-cultural background, age, health status, family relationships), factors associated with interpreters (including their personal and sociocultural background, interpreter supply, quality, accreditation and training), factors associated with the interpreter service management (budget, structure, management culture), factors associated with healthcare providers (such as their cultural competency, attitudes and workloads), healthcare system factors (such as budgetary constraint, service capacity, workforce supply, institutional culture), the advocacy and interests of key stakeholder groups (including ethnic community groups and party political groups), and the available evidence and research.

At the operational level, interpreting in healthcare is a complex communicative interaction between provider, interpreter and patients; parties which have unequal power relations and each of which has their own socially and institutionally mediated values, demands, beliefs, expectations and goals. These factors consciously and unconsciously shape each encounter. Thus, as Angelelli notes:

'..interlocutors bring their own set of beliefs, attitudes and deeply held views on interpersonal factors, such as gender, race, ethnicity, and socioeconomic status, all of these get enacted. The interpreter.. also brings her own set of beliefs, attitudes and deeply held views that are constructed, co-constructed and re-enacted within the interaction. …

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