2021 HEALTHCARE WORLD LANGUAGE INDEX - A National and State-by-State Listing of the Most Frequently Spoken Languages Other Than English in ...
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2021 HEALTHCARE WORLD LANGUAGE INDEX A National and State-by-State Listing of the Most Frequently Spoken Languages Other Than English in Hospital, Medical Group and Community Health Center-Based Patient Encounters
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Executive Summary
AMN Healthcare Language Services (formerly Stratus Video) is a leading provider of healthcare language
interpretation services and is a division of AMN Healthcare (NYSE: AMN), the largest healthcare staffing
organization in the U.S. and the innovator of healthcare workforce solutions.
AMN Healthcare and its divisions produce a continuous series of surveys, white papers, educational
presentations and reports that examine a wide range of healthcare staffing issues. Topics addressed by
AMN Healthcare include healthcare professional supply and demand trends, health care professional practice
patterns, morale levels, compensation metrics, recruiting and retention methods and a variety of others.
An additional topic covered by AMN Healthcare is the delivery of medical interpretation services. AMN
Healthcare Language Services partners with thousands of hospitals, medical groups, community health centers
and other healthcare facilities nationwide to provide on-site and remote medical interpretation. These
services help ensure patients and healthcare providers can fully and effectively communicate with one another
regarding patient symptoms, diagnoses and treatment plans.
In this, the inaugural edition of the Healthcare World Language Index, AMN Healthcare Language Services
reports on the world languages other than English most commonly spoken in patient/provider encounters
nationally and by state.
The Index references data on 50 different languages other than English spoken throughout the U.S. in
healthcare encounters based in a variety of settings. It lists the top ten languages other than English spoken in
healthcare encounters nationally and by state. It also includes an analysis how increasing language diversity in
the U.S. and the availability of interpretation services is affecting access to care and quality of care.
The intent of the Index is to track the extent to which world languages are spoken in healthcare encounters,
as well as the specific languages being used, and how these usage patterns may vary over time. Data included
in the Index may be of use to health care providers, administrators and policy makers seeking to ensure that
appropriate healthcare services are available to a linguistically and culturally diverse population. The Index
may also be of interest to journalists, researchers and members of the public who follow trends in
cultural diversity, particularly as they apply to the delivery of healthcare services.
© Copyright AMN Healthcare 2021 2021 Healthcare World Language Index
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Methodology
The Healthcare World Language Index uses internal data compiled by AMN Healthcare Language Services to
determine which languages other than spoken English are used in patient encounters with physicians, nurses
and other healthcare professionals at hospitals, medical groups, community health centers and other settings.
The 2021 Healthcare World Language Index is based on 110,540,751 minutes (76,764 days) of interpretation
services that AMN Healthcare Language Services provided to 3,239 healthcare facilities during the 12 months from
January 1 of 2020 to January 1 of 2021. During these more than 110 million minutes, an on-site or remote AMN
Healthcare Language Services interpreter provided interpretation services allowing healthcare professionals and
patients to communicate with each other using a language other than spoken English, including American Sign
Language (ASL).
Approximately 80 percent of these encounters took place in acute care settings, 10 percent in community
health centers, and the remaining ten percent in medical group or other non-acute care settings.
Because this is the first time AMN Healthcare Language Services has compiled this information, no comparisons
to previous years are provided. Data will be tracked over time and data comparisons will be included in future
Healthcare World Language Indexes prepared by AMN Healthcare Language Services.
© Copyright AMN Healthcare 2021 2021 Healthcare World Language Index
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Key Findings
Following are some of the key findings revealed by the data.
• The top ten languages other than English used in • Vietnamese is the second most spoken world
patient/healthcare provider encounters nationally language other than English used in healthcare
as tracked by minutes of medical interpretation encounters nationally, and is used in 3.8% of
services include: encounters.
• American Sign Language ranks third when
Language Percent used
considered as non-spoken English, used in 3.6% of
1. Spanish 74% patient encounters.
2. Vietnamese 3.8% • Arabic ranks fourth, and is used in 3.5% patient
encounters.
3. American Sign Language 3.6%
4. Arabic 3.5% • Mandarin is the 5th most spoken world language
other than English used in patient encounters
5. Mandarin 3.0% and Cantonese is 7th. When combined, however,
6. Russian 1.8% languages commonly spoken in China represent
the second most spoken world language other
7. Cantonese 1.7% than English, used in 4.7% of patient encounters.
8. Portuguese 1.2%
• 50 different languages are included in the top ten
9. Haitian Creole 1.0% languages used in patient encounters by state.
10. Korean 0.9% • Mandarin is included in the top ten world
languages other than English used in patient
• Spanish is by far the most frequently used world
encounters in 47 states, the most among Far
language other than English in patient/healthcare
Eastern languages, followed by Vietnamese in
provider encounters nationally. Spanish is spoke in
38 states, Korean in 24 states and
74% of such encounters nationwide, and in 47 out
Cantonese in 15 states.
of 50 states.
• Hawaii (Mandarin), Vermont (Nepali) and Maine
(Arabic) are the only three states in which Spanish
is not the most spoken world language other than
English in patient/provider encounters.
© Copyright AMN Healthcare 2021 2021 Healthcare World Language Index
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• 47 states include Arabic among their top ten most • There are only 7 states where European languages
spoken languages. make up two of the top three world languages
other than English used in patient/provider
• 26 states include Sub-Saharan languages among encounters.
their top ten. Swahili is the most common and is
featured in the top ten in 17 states. • One state (New Mexico) includes a Native
American language (Navajo) among its top ten.
• 26 states include Russian among their top ten
most spoken foreign languages. Russian makes the • The language with the fewest native speakers to
top three in one state (Oregon). make any state’s top ten is Chuukese (also known
as Trukese), a language spoken by about 45,000
• 20 states include languages spoken in India (Hindi, people in Micronesia, and among the top ten in
Bengali, Punjabi, Gujarati) among their top ten. North Dakota.
Top Ten World Languages Other Than English Used in Provider/Patient
Encounters By State Based on Minutes of Medical Interpretation Services
The Top Ten Languages Used Nationally Coded in Color. All Others in White.
Language
State 1 2 3 4 5 6 7 8 9 10
AK Spanish Korean Hmong ASL Tagalog Somali Russian Mandarin Swahili Lao
Portuguese
AL Spanish ASL Arabic Vietnamese Mandarin Quiche Swahili Cantonese Korean
(BRA)
AR Spanish ASL Arabic Vietnamese Mandarin Marshallese Korean Hindi Hmong Burmese
AZ Spanish ASL Arabic Vietnamese Mandarin Swahili Cantonese Russian Somali Kinyarwanda
CA Spanish Mandarin Cantonese Vietnamese ASL Arabic Russian Korean Farsi Punjabi
CO Spanish Vietnamese ASL Russian Mandarin Rohingya Somali Arabic Cantonese Korean
Portuguese Haitian Portuguese
CT Spanish Arabic ASL Mandarin Pashto Polish Vietnamese
(BRA) Creole (EU)
DC Spanish ASL Amharic French Arabic Mandarin Vietnamese Bengali Russian Farsi
Haitian Portuguese
DE Spanish ASL Arabic Mandarin Vietnamese Korean Bengali Turkish
Creole (BRA)
Haitian Portuguese
FL Spanish ASL Vietnamese Russian Mandarin Arabic Korean Farsi
Creole (BRA)
Portuguese
GA Spanish Vietnamese ASL Mandarin Korean Russian Arabic French Cantonese
(BRA)
HI Mandarin Spanish Cantonese Vietnamese Korean Japanese Tagalog ASL Russian Arabic
IA Spanish French Burmese Swahili Karen Vietnamese Arabic Nepali ASL Hakha Chin
ID Spanish Arabic Swahili Nepali Russian ASL Vietnamese Farsi Mandarin Kinyarwanda
IL Spanish ASL French Arabic Polish Mandarin Vietnamese Russian Cantonese Korean
Haitian
IN Spanish Burmese Arabic Hakha Chin French ASL Yoruba Swahili Kinyarwanda
Creole
KS Spanish Vietnamese ASL Burmese Swahili Mandarin Kinyarwanda Arabic Russian Korean
KY Spanish Swahili Burmese Zomi ASL Bosnian Arabic Karenni Karen Somali
Portuguese Haitian
LA Spanish ASL Vietnamese Arabic Mandarin Korean Cantonese Hindi
(BRA) Creole
Portuguese Portuguese Haitian
MA Spanish Vietnamese Arabic ASL Russian Mandarin Cantonese
(BRA) (EU) Creole
MD Spanish ASL Arabic Burmese Vietnamese Korean Mandarin Nepali Russian French
Portuguese
ME Arabic Spanish ASL French Somali Kinyarwanda Vietnamese Lingala Mandarin
(BRA)
MI Spanish Kinyarwanda Vietnamese ASL Arabic Nepali Burmese Swahili Hakha Chin Mandarin
Khmer
MN Spanish Somali Vietnamese Hmong ASL Mandarin Karen Oromo Amharic
(Cambodian)
MO Spanish Vietnamese ASL Arabic Swahili Burmese Somali Bosnian Karen Mandarin
Kanjobal
MS Spanish Arabic Vietnamese ASL Mandarin Chuj Gujarati Punjabi Akateko
(Q'an jo'bal)
MT Spanish ASL Mandarin Russian Swahili Vietnamese Armenian Japanese Arabic Tagalog
© Copyright AMN Healthcare 2021 2021 Healthcare World Language Index
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Language
State 1 2 3 4 5 6 7 8 9 10
NC Spanish Vietnamese ASL Arabic Russian Mandarin Burmese French Nepali Swahili
Haitian Chuukese
ND Spanish Arabic French ASL Swahili Vietnamese Mandarin Kurdish
Creole (Trukese)
Kurdish-
NE Spanish Arabic Karen Kunama ASL Somali Quiche Burmese Nepali
Kurmanji
Portuguese
NH Spanish Nepali Arabic Kinyarwanda Swahili Vietnamese ASL Mandarin Bosnian
(BRA)
Portuguese
NJ Spanish Cantonese Mandarin Russian ASL Arabic Bengali Korean Polish
(BRA)
NM Spanish ASL Arabic Vietnamese Mandarin Rohingya Karenni Burmese Tagalog Navajo
Portuguese
NV Spanish ASL Korean Mandarin Vietnamese Arabic Cantonese Serbian CDI
(BRA)
Haitian
NY Spanish Mandarin Arabic Russian Nepali Cantonese Bengali ASL Karen
Creole
OH Spanish Nepali Arabic Somali ASL French Mandarin Russian Karen Vietnamese
OK Spanish Vietnamese ASL Mandarin Burmese Korean Arabic Zomi French Cantonese
OR Spanish Vietnamese Russian Cantonese ASL Arabic Mandarin Korean Somali Burmese
Haitian Portuguese
PA Spanish Arabic ASL Vietnamese Mandarin Russian Nepali Korean
Creole (BRA)
Portuguese Portuguese
RI Spanish ASL Cantonese Mandarin Korean Arabic Russian Tagalog
(BRA) (EU)
Portuguese
SC Spanish Vietnamese ASL Arabic Russian Mandarin Karen Swahili Chuj
(BRA)
SD Spanish Arabic ASL Nepali Karen Kunama Ukrainian Mandarin Tigrinya Amharic
TN Spanish Arabic ASL Vietnamese Mandarin Swahili Kinyarwanda Kurdish Burmese Farsi
TX Spanish Vietnamese Arabic ASL Mandarin French Burmese Nepali Korean Swahili
Portuguese
UT Spanish ASL Vietnamese Mandarin Arabic Cantonese Russian Bosnian Korean
(BRA)
VA Spanish Vietnamese Arabic Korean ASL Mandarin Farsi Russian Amharic French
VT Nepali Spanish Swahili ASL Somali Vietnamese French Arabic Mandarin Burmese
WA Spanish Vietnamese Cantonese Russian Mandarin Arabic Somali Korean ASL Amharic
WI Spanish Hmong ASL Somali Vietnamese Mandarin Karen Lao Arabic Russian
Haitian
WV Spanish ASL Vietnamese Mandarin Arabic Russian French CDI Korean
Creole
WY Spanish Japanese Vietnamese Mandarin
Languages Included in the Top Ten for All 50 States
Spanish Burmese Bosnian
Korean Kinyarwanda Karrenni
Hmong Farsi Lingala
American Sign Language Punjabi Oromo
Tagalog Rohingya Khmer
Somali Haitian Creole Chuj
Russian Pashto Gujarati
Mandarin Polish Kanjobal
Swahili Amharic Akateko
Lao French Chuukese
Arabic Bengali Kurdish
Vietnamese Turkish Kunama
Quiche Japanese Navajo
Portuguese Karen Certified Deaf Interpreting
Cantonese Hakha Chin Urkranian
Marshallese Yoruba Tigrinya
Hindi Zomi
© Copyright AMN Healthcare 2021 2021 Healthcare World Language Index
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Overview
One Nation, Many Languages
The United States is a nation of immigrants, many of whom do not speak English as their first language. Using
Census Bureau data, the Center for Immigration Studies reports:1 2
• 67.3 million residents in the United States, or 22 percent of the population, now speak a language other
than English at home, a number equal to the entire population of France. The number has nearly tripled
since 1980, and more than doubled since 1990. It includes native-born Americans, legal immigrants and
undocumented immigrants.
• Since 1980, the number five-year-olds or above who speak a language other than English at home grew
nearly seven times faster than the number who speak only English at home. Even since 2010, when the
number speaking a language other than English at home was already very large, the number of non-English
speakers increased more than twice as fast as that of English speakers.
• In nine states, more than one in four residents now speaks a language other than English at home. These
nine states account for two-thirds of all non-English language speakers. In contrast, in 1980 non-English
speakers comprised one in four residents in just two states (New Mexico and Hawaii) and these two states
accounted for just 3 percent of all non-English language speakers.
• The states with the largest share of their populations speaking a language other than English at home in
2018 were California (45 percent), Texas (36 percent), New Mexico (34 percent), New Jersey (32 percent),
New York and Nevada (each 31 percent), Florida (30 percent), Arizona and Hawaii (each 28 percent), and
Massachusetts (24 percent).
• In America’s five largest cities, just under half (48 percent) of residents now speak a language other than
English at home. In New York City it is 49 percent; in Los Angeles it is 59 percent; in Chicago it is 36 percent;
in Houston it is 50 percent; and in Phoenix it is 38 percent.
• There are now more people who speak Spanish at home in the United States than in any country in
Latin America with the exceptions of Mexico, Colombia, and Argentina.
• Of those who speak a language other than English at home, 25.6 million (38 percent) told the
Census Bureau that they speak English less than very well.
In an increasingly diverse country, access to healthcare is not just determined by economic
factors, geographic location, or health insurance coverage, it may also be determined
by the ability of patients to communicate with their care givers.
© Copyright AMN Healthcare 2021 2021 Healthcare World Language Index
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Language Barriers and Quality of Care
Productive patient/provider encounters depend on how well providers and patients understand each other.
Providers must follow patients closely enough to accurately diagnosis their complaints and communicate
treatment plans. Patients must understand providers well enough to follow the care plans they are given.
Language barriers, particularly those facing Limited English Proficiency (LEP) patients, can significantly erode
patient/provider communication.
LEP is an increasingly widespread healthcare challenge nationwide. Eight percent of Medicare beneficiaries are
LEP, according to a 2017 brief from the Center for Medicare and Medicaid Services’ (CMS) Office of Minority
Health.3
Medicare beneficiaries in urban areas are four times as likely to face language barriers as beneficiaries living
rural regions, with two percent of rural-dwelling patients having LEP compared to eight percent of urban
beneficiaries.
LEP is also pervasive outside of the Medicare population. As was referenced above, more than one-fifth of the
population speaks a language other than English at home.
Language barriers put about nine percent of the US population at risk for an adverse patient safety event,
according to the Agency for Healthcare Research and Quality (AHRQ) report Improving Patient Safety Systems
for Patients With Limited English Proficiency.
Patients see language barriers as a significant hurdle to managing their health. The Robert Wood Johnson
Foundation reports that half of Spanish-speaking patients cite language limitations as their biggest barrier to
healthcare. Language barriers keep these patients from both engaging in seamless conversations with their
doctors and interacting with the healthcare industry at large.4
Health disparities such as unequal treatment related to language barriers are associated with unequal access to
healthcare and unequal health outcomes.5
Similarly, several studies have shown that patients who face language barriers have poorer health outcomes
compared with patients who speak the local language.6 7
Cultural Misunderstanding
It is not just the ability to understand providers that can inhibit the healthcare experience for those who are not
proficient in English. Patients who cannot understand billing forms may be inappropriately charged for services.
In addition, patients given information about additional healthcare resources at their disposal may not use
those resources if they do not understand the information.
Cultural misunderstanding regarding gender roles, generational roles, body etiquette and other factors that are
caused by language barriers also can erode quality of care and the patient/provider experience.
Similarly, language barriers can adversely affect how providers deliver healthcare. Providers may abandon
typical relationship building techniques they employ with English speakers and adopt a more paternalistic
approach to those who are not proficient in English.
Family members sometimes act as interpreters but may carry with them an implicit bias, potentially to guard the
patient’s feelings or protect the patient from bad news. Family members, most notably children, also may not
have a full understanding of the healthcare industry and healthcare terminology, leaving some concepts lost in
translation.
© Copyright AMN Healthcare 2021 2021 Healthcare World Language Index9
Healthcare Language Mandates
For these reasons, the Joint Commission requires healthcare organizations to offer interpretive services at the
point of care.
In addition, various federal laws and policies require that LEP patients have a means to address language
barriers in healthcare settings. These include:
• Title VI of the 1964 Civil Rights Act, which establishes that language access be provided to those with LEP in
organizations that benefit from federal funding and other resources.
• Title III of the Americans with Disabilities Act provides for equal treatment for those with disabilities,
including the Deaf community.
• Section 1557 of the Affordable Care Act which prohibits discrimination in certain health programs and
requires qualified interpreters for LEP patients.
© Copyright AMN Healthcare 2021 2021 Healthcare World Language Index10
Trends And Observations
The 2021 Healthcare World Language Index offers a variety of insights into the use of languages other than
English in patient/provider encounters within the context of an increasingly diverse society.
Not surprisingly, Spanish is the dominant non-English language spoken in patient/provider encounters
nationwide, and is used in 74 percent of encounters tracked by the Index. People of Hispanic/Latinx origin now
represent 18 percent of the total U.S. population (approximately 60 million people) and have accounted for
more than 50 percent of total U.S. population growth since 2010.8
As of 2018, there were 44.8 million people in the U.S. who were born in another country, representing 14
percent of the population. Spanish-speaking Mexico is the country of origin of 25 percent of all U.S. immigrants
(see chart below):
Country of Origin of U.S. Immigrants
In millions % of All Immigrants
Mexico 11.2 25
China 2.9 6
India 2.6 6
Philippines 2.0 5
El Salvador 1.4 4
Source: Key Findings About U.S. Immigrants. Pew Research Center. August 20, 2020.
As the chart above indicates, China is second behind Mexico as the country of origin of the most U.S.
immigrants, and Chinese languages (Mandarin and Cantonese) when combined, are ranked as the second
most spoken in patient/provider encounters by the Index.
Though India ranks third as the country of origin of the most U.S. immigrants, languages
commonly spoken in India are not ranked in the top ten by the Index. This is because a wide
variety of languages are spoken in India, including Hindi, Punjabi, Gujarati and others, and
also because English is widely spoken in India.
© Copyright AMN Healthcare 2021 2021 Healthcare World Language Index11
Similarly, though the Philippines ranks fourth as the country of origin of the most U.S. immigrants, no
languages native to the Philippines are ranked in the top ten by the Index. Approximately 170 languages are
spoken in the Philippines and English also is widely spoken, limiting the number Filipino immigrants likely to
require language services.
Niche Languages
All the world languages ranked in the top ten nationally by the Index are spoken widely throughout the world,
with the exception of Haitian Creole. The list of the most spoken languages in the world includes:
Most Spoken Languages Worldwide by Total Speakers
Language Number of Speakers
English 1.132 billion
Mandarin 1.117 billion
Hindi 635 million
Spanish 534 million
French 280 million
Arabic 280 million
Bengali 265 million
Russian 258 million
Portuguese 234 million
Indonesian 199 million
Source: The Ten Most Spoken Languages in the World. Babbel Magazine. June 2, 2021.
In contrast to the large numbers above, only 10 million people speak Haitian Creole. Healthcare professionals
can be particularly challenged when treating patients conversant with only one of a variety of niche languages
that are included among the top ten used in patient encounters in various states as ranked by the Index.
These niche languages include:
• Oromo – spoken in Northeast Africa by 30 million people
• Amharic – spoken in Ethiopia by 21 million people
• Yoruba – spoken in Southwest Nigeria by 20 million
• Lingala – spoken in the Congo by 10 million people
• Tigrinya – spoken in Eritrea by 7 million people
• Quiche (also known a K’iche) – spoken in the Central Highland of Guatemala by 1 million people
• Akateko – a in certain regions of Guatemala by 65,000 people
• Chuukese, (also known as Trukese) – spoken in Micronesia by 45,000 people
A Linguistic Diaspora
The Index suggests that niche languages now are among the most commonly spoken world
languages in patient/provider encounters in a variety of states.
For example, Hmong, Somali and Swahili are among the top ten world languages other than
English spoken in patient/provider encounters in Alaska. Haitian Creole is the number two
most spoken world language other than English in patient/provider
© Copyright AMN Healthcare 2021 2021 Healthcare World Language Index12
encounters in Florida and Indiana. Arabic, Swahili and Nepali and two, three and four respectively in Idaho,
while Nepali is second in New Hampshire and Ohio.
Though not a niche language, Vietnamese is second after Spanish as the most commonly used language other
than English used in patient/provider encounters in Colorado, Georgia, Kansas, Missouri North Carolina ,
Oklahoma, Oregon, South Carolina, Texas, Virginia and Washington.
Similarly, Arabic is either the second or third most commonly used language other than English after Spanish
in patient/provider encounters in Alabama, Arkansas, Arizona, Connecticut, Idaho, Mississippi, North Dakota,
Nebraska, New York, Ohio, Pennsylvania, South Dakota, Tennessee and Texas, and is ranked first in Maine.
In total, 50 different languages are cited by the Index as being among the top ten spoken in patient/provider
encounters throughout the 50 states and Washington, D.C.
A Land of Asylum
Several of the languages listed in the top ten in various states are spoken in countries which have experienced
violence and other turmoil in recent years. These countries include Vietnam, Somalia, Myanmar, Democratic
Republic of Congo, Eritrea, Ethiopia, Guatemala, El Salvador, Haiti, and others. Some of the citizens of these
countries have come to the U.S. seeking asylum and may require translation services when they seek healthcare.
The chart below lists the countries of origin of U.S. asylum seekers in 2019:
Top 5 Countries of Origin/U.S. Asylum Seekers/2019
Democratic Republic of Congo 43%
Myanmar (Burma) 16%
Ukraine 15%
Eritrea 6%
Afghanistan 4%
Source: Key Findings About U.S. Immigrants. Pew Research Center. August 20, 2020.
Continued international unrest is likely to add to the number of immigrants in the U.S. who will require
translation services in healthcare settings.
Few European Languages in the Top Ten
Only two European languages other than Spanish (Russian and Portuguese) are ranked in the top ten languages
other than English spoken in patient/provider encounters nationally, representing 3 percent of all encounters
(It should be considered that the great majority of Spanish and Portuguese speakers in the U.S. are from Latin
America, not Europe). By contrast, 9.6 percent of languages listed in the national top ten by the Index are
spoken in the Far East, including Mandarin, Cantonese, Vietnamese and Korean.
These numbers underscore the relative decline of immigration to the U.S. from Europe. From 1960 to 2016, only
13 percent of U.S. immigrants came from Europe or Canada (see chart below).
Regions of Origin of U.S. Immigrants
Mexico, Central and South America 40%
Asia 28%
Europe/Canada 13%
Caribbean 10%
Sub-Saharan Africa 5%
Middle East and North Africa 4%
Source: Key Findings About U.S. Immigrants. Pew Research Center. August 20, 2020.
© Copyright AMN Healthcare 2021 2021 Healthcare World Language Index13
The fastest growing number of immigrants to the U.S. are from Asia. The number of immigrants from China, for
example, has increased seven-fold since 1980. In 2018, China surpassed Mexico as the country sending the most
immigrants to the U.S., though China was not in the top ten in 1980.9 A growing number of patients requiring
medical interpretation services in the future are likely to be from China and other Asian countries.
A Sign of the Times
Because it is non-spoken English and users may require medical interpretation, American Sign Language (ASL) is
included in the Index among foreign languages used in patient/provider encounters.
The Index suggests that the use of ASL in patient/provider encounters is relatively common. ASL ranked second
behind Spanish as the most commonly used language other than English used in patient/provider encounters
in 13 states and the District of Columbia. According to the Communication Services for the Deaf (CSD),
approximately one million people in the U.S. now use ASL as their main way to communicate. It is used by the
Deaf and Hard of Hearing as well as those with communications disorders.
© Copyright AMN Healthcare 2021 2021 Healthcare World Language Index14
Conclusion
With its longstanding tradition of immigration, the United States continues to be an ethnically, culturally
and linguistically diverse nation. AMN Healthcare’s 2021 Healthcare World Language Index provides insights
into how linguistical diversity manifests in patient/provider healthcare encounters both nationally and
by state. While Spanish is the primary language other than English spoken in such encounters, 50 other
languages are among the most commonly spoken, depending on the state. These languages include those
generally spoken in Asia by hundreds of millions of people, but also may include niche languages spoken by
fewer than 50,000 people. Because the quality of healthcare encounters depends on clear patient/provider
communication, medical interpretation will be a continued key to healthcare access for a growing segment
of the population.
© Copyright AMN Healthcare 2021 2021 Healthcare World Language Index15
References
1 American Community Survey. U.S. Census Bureau. September, 2019.
2 67.3 Million People in the U.S. Spoke a Foreign Language at Home in 2018. Center for Immigration Studies. Cis.
org/Report/67-million-united-states-spoke-foreign-language-2018
3 Understanding National Patient Language Proficiency, Barriers. Patient Engagement HIT. May 4, 2017
4 Addressing Language Barriers in Patient/Provider Communication. Patient Engagement HIT. September 26, 2017
5 Hilfinger Messias DK, McDowell L, Estrada RD. Language interpreting as social justice work: perspectives
of formal and informal healthcare interpreters. ANS Adv Nurs Sci 2009. Apr-Jun;32(2):128-143. 10.1097/
ANS.0b013e3181a3af97.
6 Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. Int
J Qual Health Care 2007. Apr;19(2):60-67. 10.1093/intqhc/mzl069
7 Squires A. Evidence-based approaches to breaking down language barriers. Nursing2019 2017;47(9):34-40.
8 Hispanics Have accounted for More Than Half of Total U.S. Population Growth since 2010. Pew Research Center.
July 10, 2020
9 Chinese Immigration to the U.S. Migration Policy Institute. January 15, 2020
© Copyright AMN Healthcare 2021 2021 Healthcare World Language IndexFor additional information
about medical language
interpretation, contact:
AMN Healthcare Language Services
855.865.8778
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