Bridging the language divide in health

"A close relative had been diagnosed with a rare disease. We searched for information on it in Arabic and found websites that were unstructured or were essentially chat forums," recalls Dr Majid Altuwaijri. "But when we searched in English we found a wealth of good quality information." As co-founder of the Saudi Association for Health Informatics, Altuwaijri was well placed to help his relative, given his expertise in information technology and fluency in English. However, globally only an estimated 600 to 700 million people have English as a second language, like Altuwaijri, in addition to some 335 million native English speakers, with varying degrees of fluency. That leaves most of the world's population--some six billion people with little or no access to a large body of public health information because it is in English. Language can be a barrier to accessing relevant and high quality health information and delivering appropriate health care--an unmet need that is amplified on a global scale. [ILLUSTRATION OMITTED] "The trend towards monolingualism is far from decreasing, with the hegemonic use of one language, English, over the other five United Nations (UN) languages," the UN Joint Inspection Unit concluded in a 2011 report on implementation of multilingualism in UN organizations. As part of the UN system, the World Health Organizations (WHO) six official languages--Arabic (242 million native speakers), Chinese (1197 million), English (335 million), French (76 million), Russian (16 million), and Spanish (399 million)--are the first languages of only 2.4 billion people, according to Ethnologue: Languages of the World, 18th edition--less than half the world's population. In addition, German (78 million native speakers) is an official language in WHO's European Region and Portuguese (203 million) in WHO's African, European and Americas Regions. For native speakers of other languages, such as Hindi (260 million native speakers) and Bengali (198 million), the unmet need for health information may be great. English has long been the lingua franca of scientists--including those working in public health--and while more WHO publications and web pages are produced in English than in any other language, WHO publications appear in more than 70 languages. All WHO's official documents, such as World Health Assembly reports and resolutions, are translated into the six official languages, but this is not the case for the rest of WHO's publishing output, including technical reports and clinical guidelines. Moreover, WHO launched its six-language multilingual website in 2005, but most of its web content is still in English. While Portuguese is the world's sixth most spoken language (after Chinese, English, Hindi, Spanish and Arabic), most Portuguese-speaking scientists seek to publish their work in English to gain wider circulation, according to a study published in a report for the European Molecular Biology Organization in 2007 by Rogerio Meneghini. In public health, the linguistic disconnect between those providing health information and those who need that information affects everyone from clinicians and patients to public health managers and policy-makers. One of the most popular health information websites, Wikipedia, collaborates with Translators Without Borders to bridge that divide. With the help of the global network of translators, Wikipedia Medicine has built a large collection of articles in more than 100 languages and has at least some medical content in more than 250 languages. "We did a lot of work for the Ebola outbreak with Translators without Borders and others because most information on Ebola was in English, which is only spoken by 15-20% of the population in West Africa," says Wikipedia editor Dr James Heilman, adding: "Now we have content on Ebola in around 115 languages. …