The Language of Good Health: Pharmacy Access in New York

By Michelle Chen Aug 26, 2009

Patients are expected to follow the doctor’s orders, but for many immigrants who can’t read or speak English easily, taking your daily medicine means finding a friend or family member to translate a prescription, or just making an educated guess. In New York City, a landmark law seeks to dismantle the language barrier at the pharmacy counter. The new measure, just approved by the City Council, requires that pharmacies provide full language services to meet the needs of the city’s myriad ethnic neighborhoods. That means counseling and translations of prescription labels in Spanish, Chinese, Creole, Polish… you get the picture. The law builds on existing civil rights laws, as well as recent legal settlements that advocacy groups have brokered with large chain pharmacies like CVS. Compared to the convoluted Beltway sausage-fest that is the national healthcare debate, the city’s bill (which targets major pharmacy chains) seems pretty simple. But it speaks to the need for truly inclusive medical care, not only in terms of who is covered, but who is empowered to make informed decisions about their health. Although civil rights statutes technically require New York City hospitals and agencies to provide equal language access, pharmacies have been largely unregulated. Lawmakers cite a New York Academy of Medicine study showing that while nearly 90 percent of pharmacies regularly serve customers with limited English ability, most do not translate medicine labels on a daily basis. The Gotham Gazette described how a task that many English speakers take for granted presents a dangerous challenge for one immigrant mother:

Catalina Martinez… suffers from gastritis and has a 14-year-old son prone to allergies, forcing her to visit the pharmacy often. A native of Mexico who has lived in Ridgewood for a decade, Martinez sometimes stops strangers on the street, hoping to get her prescriptions translated since the pharmacies she frequents do not provide language assistance. Sometimes, she said, she will not give her son medication for fear of administering it incorrectly. "Maybe I have to give him this much medicine, sometimes I have to give less," said the 49-year-old. "Sometimes I won’t even give it to my son because I won’t know how to do it."

The problem inspired a grassroots campaign led by Make the Road New York and New York Lawyer’s for the Public Interest last year. They pushed for legislation to obligate pharmacies to not only provide translation but also to inform patients about the availability of language services, with penalties for non-compliance. Pharmacies that lack bilingual personnel can use phone-based translation services. In an announcement of the City Council vote, Nisha Agarwal, director of the Health Justice Program at NYLPI, said,

Many pharmacies in New York have been systematically depriving non-English speakers equal access to prescription medication… This law—the first of its kind in the country—provides an enforcement mechanism that will adequately punish violating pharmacies for their neglect.

As we’ve noted before, healthcare equity not simply about insurance, but about making the system conscious of the diverse needs of the communities it serves. The need for the government to take proactive steps to ensure quality, culturally competent care is all the more crucial given the socioeconomic disparities that erode the health of communities of color. Translating the label of a pill bottle takes just a few minutes, but it could mean the difference between staying sick and going to work or school the next morning, or it could save a family a trip to the emergency room, or worse—all possibilities that cumulatively have a major impact on the economy and the community fabric. But perhaps most importantly, a small thing like translation gives people who have long been shut out of healthcare institutions a sense of mutual trust and confidence. That’s not just good health care; it’s a form of citizenship. Image: NYC Chinatown pharmacy (via flickr)