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PALGRAVE STUDIES IN TRANSLATING AND INTERPRETING
SERIES EDITOR: MARGARET ROGERS

Language as a
Social
Determinant of
Health
Translating and Interpreting
the COVID-19 Pandemic

Edited by
Federico Marco Federici
Palgrave Studies in Translating and Interpreting

Series Editor
Margaret Rogers
School of Literature and Languages
University of Surrey
Guildford, UK
This series examines the crucial role which translation and interpreting in
their myriad forms play at all levels of communication in today’s world,
from the local to the global. Whilst this role is being increasingly
recognised in some quarters (for example, through European Union
legislation), in others it remains controversial for economic, political and
social reasons. The rapidly changing landscape of translation and
interpreting practice is accompanied by equally challenging developments
in their academic study, often in an interdisciplinary framework and
increasingly reflecting commonalities between what were once considered
to be separate disciplines. The books in this series address specific issues
in both translation and interpreting with the aim not only of charting but
also of shaping the discipline with respect to contemporary practice and
research.

More information about this series at

http://www.palgrave.com/gp/series/14574
 Federico Marco Federici
Editor

Language as a Social
Determinant of
Health
Translating and Interpreting
the COVID-19 Pandemic
Editor
Federico Marco Federici
Centre for Translation Studies
University College London
London, UK

Palgrave Studies in Translating and Interpreting

ISBN 978-3-030-87816-0    ISBN 978-3-030-87817-7 (eBook)
https://doi.org/10.1007/978-3-030-87817-7

© The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature
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 Foreword

Health and wellbeing count among the most precious gifts we can enjoy.
Sometimes, a crisis or an emergency threatens them. This volume sheds
light on the key issue of access to information or services during a time of
crisis such as COVID-19. Access on the part of people who do not com-
municate in the main societal language is gained through language provi-
sion (i.e. provision of translation and/or interpreting services). Translation
and interpreting services, at times provided with limitations or requested
from volunteers without checking quality, other times avoided under the
guise of being costly, or simply ignored, or overlooked, have raised their
profile during the COVID-19 pandemic. Users of spoken languages
became more aware of sign-language as some governments (e.g. Scottish,
Welsh, or Northern Irish government) always had a sign-language inter-
preter in their daily briefings, although others did not (e.g. English gov-
ernment). We read translated news or watched news broadcasted from
every corner of the world and understood it through interpreters.
Translation and interpreting are essential to navigating crises and
emergencies because, through language services, information can be dis-
seminated equally and equitably to linguistically diverse communities
that do not access the societal language. When a crisis or an emergency
occurs, translation and interpreting provide all people the opportunity to
ask questions as well as to express their concerns or fears. Language provi-
sion is key to providing equitable access to institutional, national, and
v
vi Foreword

international resources. At the same time, language provision is an insti-

tutional resource to be shared in a fair and equitable way.
While translation and interpreting have existed for as long as there has
been contact among users of different languages, we continue to encoun-
ter justifications for the challenges of providing language support, or the
inability to overcome language barriers. This volume offers us the oppor-
tunity to deconstruct these two statements. Languages are not barriers
and language support does exist. While, like any other service, translation
and interpreting carry a cost, the cost is minimal compared to the cost of
non-social integration and/or the cost of human life.
Languages, much like identity or diversity, are part and parcel of being
human. Languages, like identities, are diverse, but not barriers, even if
when one may perceive a different language as a problem or a barrier
simply because one cannot use it. Because we are diverse, we do not all
speak one language. This fact does not constitute a barrier to communi-
cation. The expectation that we should all be able to use a lingua franca
during a crisis would be as absurd as the expectation that all human
beings should be of the same race or gender.
As illustrated in this volume, language diversity is addressed through
language provision. In our interconnected world, we communicate with
the help of humans and technology. We resort to language professionals
who, like other professionals, vary in their degree of expertise and experi-
ence as well as in their use of technology. These professionals are transla-
tors, interpreters, language mediators, and language brokers—different
local legislative frameworks and traditions create a continuum of possi-
bilities and professional profiles. By definition, these professionals are
bilinguals, but the relationship between language proficiency and
translation/interpreting ability is not symbiotic, instead it is hyponymic.
Translators and interpreters are freelancers, members of staff in organi-
zations, they own or work for translation/interpreting agencies. They
work for profit and non-profit organizations. They work for government.
At times they also volunteer, like other professional groups. They work
with written, spoken, and sign languages, deploying their knowledge and
skills; they work across two languages or more, they work from a distance
or face to face, they work around the clock, individually or in teams.
Languages are brokered and there is a continuum of needs in which users
 Foreword vii

of non-societal languages seek language provision and some organiza-

tions provide it (World Bank organization, 2003).
Global crises, like a pandemic, affect us all, however, they affect us all
differently. Globalization put these differences on the table. These differ-
ences are many. They may be related to geography; to the healthcare sys-
tems in place in different areas; to governments’ roles or decisions; to
culture, language, ethnicity, socio-economic status, and race. While we
are all connected through our human fabric, this fabric is diverse. Some
differences may be quite evident and constitute facts to account for as we
connect with each other. For example, we live in different geographic
locations with different time zones, we have different needs. Consequently,
we work out our differences, we take into account these facts to connect
with each other. With the self comes the language we use to communi-
cate, to describe, and to interpret our own communities as well as those
of others.
While globalization in areas such as business, education, entertain-
ment, health, marketing may have made us aware of how interconnected
our world is (Pan et al., 2002), globalization has also raised our awareness
on how different our perceptions and beliefs can be and how we see the
world though our own cultural lenses. It is precisely because we express
ourselves through language (whether spoken or signed) that language is
central to working out these differences; language is central to integrate
others rather than to isolate them.
Globalization has been enabled by technological developments which
allow interconnectivity. These developments are accessible, feasible, and
affordable to many but not to all people. Many international organiza-
tions, as well as government and NGOs at national, regional, or local
level continue to help bridge the technological divide, to bring people
closer. However, at the core of being interconnected lies the ability to
access and understand information, to communicate with others. As this
volume demonstrates, countries which did well are those that provide
translation and interpreting services. These services are available and
affordable. There is honestly no justification or excuse for not offering
these services when they do in fact exist.
This volume successfully explores the COVID-19 pandemic through
the lens of access to communication by bringing together studies on
viii Foreword

responses from different areas of the world. Contributors to this volume

present much needed research in healthcare communication during a
pandemic. Consequently, this volume is a valuable contribution to cur-
rent debates on social cohesion and social justice. My hope is that the
new knowledge presented here informs evidence-based policy making.
This will help us ascertain if current policy and practice from different
areas in the world converge or diverge when it comes to protecting the
right to access healthcare, to give informed consent, to hospitalization
and treatment as well as to vaccination during a major crisis like
COVID-19.

Edinburgh, UK Claudia V. Angelelli



References
Angelelli, C. (2018). Cross-border healthcare for all EU Residents? Linguistic
access in the European Union. The Journal of Applied Linguistics and
Professional Practice, 11(2), 113–134.
O’Brien, S., Federici, F. M., Cadwell, P., Marlowe, J., & Gerber, B. (2018).
Language translation during disaster: A comparative analysis of five national
approaches. International Journal of Disaster Risk Reduction (31), 627–636.
Pan, Y., Wong- Scollon, S. & Scollon, R. (2002). Professional communication in
international settings. Blackwell Publishers.
WHO. (2008). World health organization outbreak communication planning
guide. World Health Organization. Retrieved August 6, 2021, from https://
www.who.int/ihr/elibrary/WHOOutbreakCommsPlanngGuide.pdf
World Bank Organization. (2003). A document translation framework for the
World Bank Group. Retrieved August 6, 2021, from https://documents1.
worldbank.org/curated/en/535491468782383662/text/261450
TranslationFramework.txt
 Preface

A crisis is a disruption of ordinary ways of life, caused by an event, calling

for an urgent response, and a strategy to reduce the risks emerging in the
short term and long term with their cascading consequences (Alexander,
2016; O’Brien & Federici, 2019; Seeger, 2006; Sellnow & Seeger, 2013).
The COVID-19 pandemic is an international crisis. Not all risks are
unpredictable; pandemics are expected but not foreseeable. Hence, emer-
gency health relies on training, planning, protocol, and past experience to
deal with the unforeseen. Emergency planning makes dealing with the
unexpected more bearable and effective, as it mitigates and reduces risks.
Striking a balance between unexpected and sudden events and risk reduc-
tion is a central concern of public health planning. Risk communication
is an integral part of mitigating the impact of a crisis (Reynolds & Lutfy,
2018); large-scale events such as pandemics have been studied in order to
create protocols and plans to reduce their potential impact (Crouse
Quinn, 2008; Hewitt et al., 2008; Petts et al., 2010). However, multilin-
gual risk communication is rarely well-integrated in emergency plan-
ning—even the influential ‘Crisis and Emergency Risk Communication
(CERC)’ manual (Reynolds & Lutfy, 2018) mentions linguistic diversity
only in passing.
This is a problem. Translators and interpreters (T&Is), if mentioned in
emergency plans and risk communication strategies, figured as a service
to be commissioned as part of logistic arrangements to be completed at
ix
x Preface

the onset of a response, until recently. The Project Sphere (2018) consid-
ered their role as essential in planning humanitarian operations focused
on real community engagement. Why did most countries face poor levels
of preparedness regarding multilingual communication at the start of
COVID-19? Why did emergency plans underestimate the need for inter-
preting, signing, and translation in public campaigns of this magnitude?
Of course, eventually translations appeared and have continued to appear.
Yet, at the onset, limited translation and interpreting capacity was a logis-
tic, health and safety, and organizational problem (Li et al., 2020; Wang,
2020; Zhang & Wu, 2020); during the pandemic some governments
gradually became organized (e.g. see detailed analysis of Ireland in
O’Brien et al., 2021). In most countries, speakers of non-main languages
have relied on multiple sources of information to understand the mitigat-
ing measures and restrictions in place.
Professional T&Is, bilingual staff members, volunteer bilingual nurs-
ing teams, and local staff helped the International Federation of the Red
Cross and Red Crescent Societies (IFRC) to disseminate information via
their capillary local networks from January 2020. Many have drawn on
their linguistic expertise to contribute to communicating risks associated
with the spread of and infection by COVID-19, including massively
open and international crowdsourcing activities (Zhang & Wu, 2020),
migrants’ support (Ahmad & Hillman, 2021), grassroots organizations,
charities, NGOs (Respond Crisis Translation, Translators without
Borders, and others), foundations (Engage Africa Foundation,
Endangered Language Project), social media (see Hu’s Chap. 7 in this
collection), professionals volunteering (see the example discussed in
Al-Sharafi’s Chap. 6), community volunteers (see an example discussed
in Teng’s Chap. 11), healthcare NGOs (e.g. Doctors of the World,
EMERGENCY, Médecins Sans Frontières, etc.), and many others.
In The Lancet, Horton (2020) encourages scientists to reframe the pan-
demic in relation to its unequal impact on members of society. Not only
a viral outbreak, COVID-19 is in fact a syndemic event. For Singer and
Clair (2003: 428), ‘syndemic points to the determinant importance of
social conditions in the health of individuals and populations’ (emphasis
in the original). The disproportionately unjust impact on socially and
economically vulnerable groups makes the epidemiological event a
 Preface xi

syndemic (see discussion of its translation, in Spoturno’s Chap. 4).

COVID-19 has paraded all the destructive powers of endemic health
inequality locally (e.g. private vs public healthcare, North Italy/South
Italy), continentally (e.g. response success rates China/India), or interna-
tionally (with the UK, Brazil, and the USA performing terribly on con-
taining the virus spread, and on letting it have an impact directly
correlated with the health inequality embedded in their societies; see
Lawrence, 2020; Paremoer et al., 2021). Additionally, at the time of writ-
ing, inequities in the vaccination roll out make some countries vulnerable
to new waves (e.g. Peru), while others are recovering more quickly by
accessing more types and quantities of vaccines (e.g. the USA, the UK).
Contributors to this volume discuss these issues engaging with the
relationship between risk communication and T&I.

Risk in Public Health

Successful communication in crisis contexts is extremely complex to
achieve and extraordinarily significant in mitigating the impact of risks
and their cascading effects. Defining the significance of effective multilin-
gual communication in public health entails contributing to saving lives
and reducing morbidity. Risk communication is well-studied; it is worth
narrowing the focus here to consider only risk communication connected
with mitigating the impact of epidemiological hazards, such as SARS
coronaviruses or those of flu pandemic. Before Trump’s administration
reduced federal funds, disempowered, and regularly discredited or under-
mined the activities of the Centers for Diseases Control and Prevention
(CDC), this US body had been extremely influential in establishing prac-
tical, actionable, and successful protocols supporting disaster manage-
ment and public health. Its practices include communication strategies,
explained in its Crisis and Emergency Risk Communication (CERC)
manual (Reynolds & Lutfy, 2018). CERC is founded on six principles:
‘(1) be first; (2) be right; (3) be credible; (4) express empathy; (5) pro-
mote action; (6) show respect’ (Reynolds & Lutfy, 2018: 3). In the cur-
rent collection, Al-Sharafi (Chap. 6) analyses credibility in relation to
encouraging action and gaining respect among multilingual
xii Preface

communities, who are excluded from the most widely used channel of
communication. During the response phase of any disaster or emergency
cycle, these principles are all essential and difficult to respect, which is
why preparedness and planning are crucial especially in terms of com-
munication. The principles are valid beyond the response phase, as they
also pertain to public health campaigns (e.g. against smoking, in favour
of healthy lifestyles, etc.); in fact, ‘Risk communication provides the
community with information about the specific type (good or bad) and
magnitude (strong or weak) of an outcome from an exposure or behavior’
(ibid.: 4). To engender action and positive outcomes, risk communica-
tion depends on becoming credible and showing respect; creating obsta-
cles, such as limiting provision of information in other languages by not
including live signers, interpreters, and distribution of translated infor-
mation in multiple formats, fails to establish a respectful relationship of
trust. In Communicating Risk in Public Health Emergencies. A WHO
Guideline for Emergency Risk Communication (ERC) policy and practice
(WHO, 2017), the glossary entry for ‘Emergency risk communication
(ERC)’ describes this type of communication as:

an intervention performed not just during but also before (as part of pre-
paredness activities) and after (to support recovery) the emergency phase,
to enable everyone at risk to take informed decisions to protect themselves,
their families and communities against threats to their survival, health and
well-being. (WHO, 2017, p. vii)

Even countries once able to deploy professionals from extensive T&I

networks were short of all combinations; the problem was anticipated in
evidence emerging after the 2009 H1N1 (Swine flu) pandemic, as this
passage assessing the UK pandemic preparedness clearly stated in 2010,

We can expect differential ability to access information amongst those

from lower socioeconomic groups. Yet, these will be the very people poten-
tially most at risk during a pandemic and least able to take personal protec-
tive measures (including time for recuperation from illness). Careful
attention will be needed to communication in different forms and lan-
guages as well as opportunities for people to listen to messages, not just
read them. (Petts et al., 2010, p. 157)
 Preface xiii

In England, sign language interpreting was not even provided during

the COVID-19 daily conferences, defying legal requirements set out by
the UK’s 2010 Equality Act. Analysing poor communication strategies
through the lens of definitions of health risk in order to understand their
full consequences makes for grim thoughts. The probability of that part
of the population with limited English proficiency needing extra infor-
mation in their own language in stressful situations increases risks in a
multiplicative way:

Risk is commonly defined as a multiplicative combination of the probabil-

ity of a hazardous event occurring (e.g., smoking) and the severity of the
resulting negative consequences (e.g., lung cancer). This definition of risk,
as ‘probability × severity,’ implies that greater probability and greater sever-
ity result in greater overall risk (Slovic, 2000). (Renner et al., 2015, p. 702)

Health risks, especially those arising from biological hazards, are magni-
fied when social factors (e.g. limited language proficiency) intertwine
with a hazard. This was the situation, for example, when mitigating mea-
sures were (belatedly) taken to protect the UK population.
Table 1 uses data provided by the John Hopkins’s Coronavirus Research
Centre, ordered from the highest to the lowest number of deaths per
100,000 people. Many factors determined high COVID-19 casualties.
The figures in Table 1 indicate that there is a correlation in the 20 nations
with the highest death toll between their shaky communication strategies
and the impact of social determinants of health—in the main language
and even worse in other languages used locally—and lack of compliance
with mitigating measures, which caused second, more deadly waves (see
Lee et al., 2021; Vardavas et al., 2021; Varghese et al., 2021). The impact
on these countries’ linguistically diverse populations, often concentrated
around densely populated urban areas, also correlates with healthcare sys-
tems weakened over years of neoliberal approaches that cut costs in pub-
licly funded and managed health systems through austerity (northern
Italy, the UK), despite these health systems being known for their effec-
tiveness and efficiency in the long run (van Barneveld et al., 2020). Dense
and populous areas have shown the vulnerabilities of cities (Sharifi &
Khavarian-Garmsir, 2020); and neighbourhoods with the largest
xiv Preface

Table 1 Mortality rates by country (Coronavirus Research Centre, 2021)

Confirmed Case/ Deaths/100 K
Country cases Deaths fatality POP.
10 Brazil 16,471,600 461,057 2.80% 218.46
14 Italy 4,213,055 126,002 3.00% 208.97
16 Poland 2,871,371 73,682 2.60% 194.05
17 United 4,496,823 128,037 2.80% 191.57
Kingdom
18 United States 33,251,939 594,306 1.80% 181.06
21 Argentina 3,732,263 77,108 2.10% 171.58
22 Spain 3,668,658 79,905 2.20% 169.73
46 Tunisia 343,374 12,574 3.70% 107.52
62 Israel 839,453 6407 0.80% 70.77
63 Canada 1,384,373 25,451 1.80% 67.71
74 Oman 213,784 2303 1.10% 46.29
94 India 27,894,800 325,972 1.20% 23.86
95 Saudi Arabia 448,284 7334 1.60% 21.4
96 Qatar 217,041 554 0.30% 19.56
99 Indonesia 1,809,926 50,262 2.80% 18.57
139 Australia 30,096 910 3.00% 3.59
140 Guinea-Bissau 3761 68 1.80% 3.54
171 New Zealand 2672 26 1.00% 0.53
174 China 102,960 4846 4.70% 0.35

culturally, ethnically, and linguistically diverse communities within the

cities saw disproportionate incidence of cases (see Lawrence, 2020).
Out of the 180 countries considered by the John Hopkins Coronavirus
Research Centre, Table 1 offers only an overview of the countries men-
tioned in this volume. The figures clearly show how countries that
adopted more reliable, credible, empathetic, and trustworthy risk com-
munication strategies also reduced the health risks for the whole popula-
tion. China, for example, adopted extremely strict and successful
protocols early on to stop the spread and control waves arising from
incoming flights. New Zealand had proportionally one of the most effec-
tive pandemic plans, and it was accompanied by an extensively multilin-
gual messaging (Brandon & Maang, 2022). The figures are strongly
indicative of a relationship between language and the other factors pro-
ducing cascading effects on number of cases and mortality rates.
 Preface xv

The Contributors’ Aims

This volume engages with examples of health communication during the
COVID-19 pandemic from across the world. Whereas interpreting needs
may be sudden and unforeseen, this volume shows how exploiting exist-
ing data and expertise could make translation into a significant risk
reduction, or risk mitigation tool (Federici & O’Brien, 2020). The con-
tributors use different data collection methods and various theoretical
ways of interpreting the data. All chapters share a common denominator:
T&I needs to be better integrated in healthcare communication and in
risk communication to mitigate or reduce the impact of hazards on pub-
lic health. The lack or approximation of T&I services, engendering wide-
spread needs for more or better translations, remains a leitmotif
throughout the volume.
The book is subdivided into four parts entitled ‘Terminologies and
Narratives’, ‘Translating COVID-19 Credibility, Trust, Reliability’,
‘Health and Safety in Risk Communication’, and ‘Communities and
Translation’. In these parts, the contributors engage with case studies
emerging from national and cross-national examples of issues in dissemi-
nating information in a timely, useful, and trustworthy manner during
COVID-19’s first and second waves (2020–2021), and the linguistic pat-
terns that influence discourse, narratives, credibility, and trust. To open
the volume, Federici in Chap. 1 makes the case for considering transla-
tion and interpreting as integral components to achieve higher levels of
health equity by discussing multilingual communication strategies in
relation to the notion of social determinants of health.
In the first part, Chatti in Chap. 2 looks at metaphors in public health
communication, with particular attention to Tunisia. Chatti argues that
the global outbreak of COVID-19 continued the existing approach to
the use of figurative language in medical contexts, namely war metaphors.
Building on Conceptual Metaphor Theory, the chapter explores the mul-
tiple correspondences between war and COVID-19 as an illustration of
the war/fight/battle framing often adopted in healthcare communication.
The chapter engages the reader to consider whether a reframe is needed
to evoke hope and optimism that affordable and effective vaccines can
bring an end to the pandemic. Dawood in Chap. 3 focuses on Australia.
xvi Preface

This chapter analyses translations into Arabic of several English Covid-19

awareness posters, issued by the Government of New South Wales.
Analysing the posters, through the lenses of Postcolonial Theory of
Translation, Dawood puts forward provocative and grounded reflections
on the ways in which English as the dominant language of scientific com-
munication negatively influences translations. From layouts to sentence
structure, the Arabic translations analysed manifest a degree of linguistic
hegemony that increases the risk of confusion and uncertainty in the
target readers, when the leaflets should be informative, clear, accessible,
and trustworthy. Spoturno in Chap. 4 contributes to discussing the role
of translation in the communication of health risks in relation to the
circulation of health narratives from abroad that coexist with local, spe-
cific narratives of risk mitigation. Focusing on Argentina, Sportuno
assesses the different trajectories of journalistic debates straddling on the
one hand presentations of advancements, risk protocols, and recommen-
dations made in Argentina for its residents, and COVID-19 findings and
debates imported from abroad through translations from English on the
other hand. The chapter investigates the specific role of translation in
communicating risks locally and contextualizing the pandemic globally.
Using a corpus of news articles published online in Clarín, La Nación,
Infobae, Página 12, and Perfil in Spanish, and English articles from The
New York Times, The Washington Post, BBC News, and The Guardian,
Spoturno highlights how narratives emerged and continue to develop in
the journalistic discourse around COVID-19.
In the second part, Nugroho, Prananta, Septemuryantoro, and Basari
in Chap. 5 show the urgency of carrying out translations to access crucial
information in Indonesia. In March 2020, the Indonesian government
commissioned translations of guidelines detailing hospital treatments
and mitigation of the contagion. This chapter reports on a project focused
on assessing the translation, and its reception, of the Guidance for Corona
Virus Disease 2019 (Liang, Feng, and Li, 2020). Written in Chinese, this
text was translated into English and published in February 2020; the
English version was then translated into Indonesian. The chapter reports
the results of the mixed-method approach used to evaluate via a question-
naire the accuracy of the Indonesian translation (involving professional
translators as evaluators) and its reception. Surveying specialist readers
 Preface xvii

(doctors) and members of the public, the author’s reception study aims to
ascertain their understanding of the Indonesian version. The findings of
the project are discussed in relation to mistranslation and maltranslation,
which are important concepts in medical translation. Al-Sharafi in Chap.
6 focuses on the strategies adopted by the Omani government in estab-
lishing credibility in its dissemination of information, so that trust in the
messages would endanger compliance with the restrictions and mitigat-
ing measures. The chapter uses a corpus of 183 official statements and 23
press conferences issued in Arabic by the Omani Covid-19 Supreme
Committee over a period of nine months from January 2020 to February
2021 and their official translations into English, explaining the recruit-
ment of translators, and development of a strategy to complete the trans-
lations into English. The discussion is then contextualized by taking into
account the linguistic diversity of Oman beyond English, putting forward
considerations regarding the effectiveness of adopting this bilingual strat-
egy for trust-building which still excluded many residents, that is, those
foreign nationals who do not speak Arabic or English. Hu in Chap. 7
looks at the relationship between official sources of information in trans-
lation and additional sources of information in Chinese among Australian
Chinese-speaking communities. Focusing on the abundance of (mis)
information during the COVID-19 pandemic, the chapter considers
how multilingual communities were more exposed to poor or unreliable
information, as linguistic and cultural difficulties interfere with distin-
guishing truth from falsity. The chapter investigates the communicative
effects of the Australian government’s translated COVID-19 information
in relation to three types of trust (interpersonal, institutional, and cul-
tural). The findings encourage Hu to suggest that translators could act as
ethical filters in the context of the COVID-19 infodemic, choosing what
and how to translate, and what translation norms to obey to avoid mis-
representing risks, even when they were operating in unofficial channels
of communication.
In the third part, the relationship between phraseologies, terminolo-
gies, and expectations dictated by health and safety regulations are anal-
ysed from two different perspectives. Kodura in Chap. 8 focuses on safety
instructions, related to COVID-19 mitigation measures, by comparing
English versions with their Polish renderings. Drawing on her study of
xviii Preface

the pragmalinguistic shifts introduced in Polish when translating from

English, through a detailed analysis, Kodura observes possible correla-
tions between pragmalinguistic dimensions of health and safety discourse
and the public’s compliance with the dissemination of information
regarding the mitigating measures adopted by the Polish government.
Rossato and Nocella in Chap. 9 consider the efforts made in translating
health and safety regulations for cruises to support the tourism industry
in its recovery from the impact of COVID-19. Issues of safety concern-
ing the promotion of COVID-19 measures are analysed by engaging
with the websites of four different cruise lines (MSC, Costa Crociere,
Royal Caribbean, and P&O Cruises). As cruises can be overcrowded
spaces, heightening the risk of spreading viruses, health and safety dis-
course became paramount for the industry during the pandemic. Drawing
on investigations of the language of tourism and cruises, the chapter
examines how cruise lines’ websites talk about risk, safety, and preven-
tion. Rossato and Nocella use multimodal and discourse analysis to com-
pare examples of both written texts and non-verbal content (images,
videos, colours). The analysis focuses on cross-cultural elements and the
role of images in localizing the message across the different languages.
In the fourth part, Pena-Díaz in Chap. 10 reports on a study con-
ducted in La Paz hospital in Madrid after the end of the main lockdown
in Spain. The chapter provides an analysis of intercultural communica-
tion in health settings as perceived by users of interpreting and transla-
tion services. In particular, it focuses on migrants as users of public service
interpreting services, and through qualitative data collection (surveys and
interviews) the chapter seeks to understand whether there is any correla-
tion between T&I services and the users’ perception of risks. Participants’
responses are used to assess the participants’ perception of risks associated
with COVID-19 and to identify risk communication strategies and their
effectiveness. Pena-Díaz’s findings indicate that for many participants the
perceived quality of access to healthcare services is proportional to their
satisfaction with the interpreting and translation services available. This
relationship in turn influences trust in institutions and the participants’
perception of risk.
Teng in Chap. 11 assesses the involvement of citizen translators in
crowdsourcing projects through the conceptual framework of ‘imagined
 Preface xix

community’. Focusing on communities of citizen translators who pro-

vided translations into Chinese during the COVID-19 pandemic, Teng
discusses three levels of imagined community engagement: weak,
medium, and high. In relation to these levels, the chapter assesses the citi-
zen translators’ familiarity with the targeted community and their ability
to produce translations of appropriate quality for their target audience.
Reflecting on its findings, the chapter considers the training of citizen
translators and the role of community engagement in risk communica-
tion. Specifically, it focuses on (1) remote community engagement in
contrast to onsite interactions; (2) recruitment of citizen translators
among multilingual communities in relation to trust-building and soli-
darity; and (3) the relationship between language needs and channels that
grant access to information in the languages preferred by the affected
communities.

The Volume’s Aims

All contributors and the volume as a whole suggest that there needs to be
political willingness to ensure that T&I services contribute to making
information about risks accessible to all members of multilingual com-
munities. Many chapters also identify a recurrent issue: lack of prepared-
ness and planning for inclusion of T&I services in the public health
campaigns. For instance, guidelines to respond to a SARS-based disease
were published in English in 2004 and revised twice (WHO, 2014); the
scramble to translate new guidance in February 2020 could have benefit-
ted from having translated the existing information on SARS-type dis-
eases before. Translation of these materials could have informed practices
in countries that faced the COVID-19 outbreaks early on. It is difficult
to understand why guidelines of this type anticipating the impact of cer-
tain hazards are not routinely translated into widely used regional lan-
guages, prioritizing regions with under-resourced healthcare systems.
Taking time to produce, assess, and validate high quality translations of
these documents means being better prepared. Translations of guidelines
for known and expected epidemics and pandemics could create language
assets that would help to inform translators, interpreters, and sign
xx Preface

language T&Is when rendering mitigating measures during the response

phase of an outbreak, when information flows are constant and
overwhelming.
It is not surprising that Showstack et al. (2019), basing their experi-
ence on the US contexts, encouraged applied linguists and Translation
and interpreting researcher to collaborate more than is currently the case
in conducting studies that focus on the inclusion of language among the
social determinants of health. Even though fairer healthcare systems free
at the point of access are always better (van Barneveld et al., 2020),
healthcare cannot address all inequality in health. Inequality is dependent
on social factors and healthcare on its own can only treat the symptoms
but not the causes. Translation and interpreting provision for multilin-
gual countries as well as for culturally and linguistically diverse commu-
nities in predominantly monolingual countries could serve as a powerful
risk reduction tool in the context of public health, contributing to the
reduction of such inequalities.

London, UK Federico Marco Federici

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 Acknowledgements

Language is one of the socio-economic factors that have an impact on

health. I thank the contributors of this volume for engaging with the
challenge of taking an active stance from the title of this volume. All the
preoccupations in translation, interpreting, sign language, and multi-
modal ways of communicating risk in multilingual contexts that enrich
our disciplines may be perceived as niche, outside our main areas of activ-
ity. By focusing on language(s), we speak of a concept that may be more
tangible than referring to translation and interpreting for researchers and
experts who may not frequently engage with research in work in our dis-
ciplines. While titling the volume we made a conscious and committed
decision: it forces us to connect languages to health inequalities.
Researchers in translation and interpreting studies, sociolinguistics, risk
communication, and crisis communication have in different ways taken
a stance on language diversity. Now, we hope that considering language
in relation to health inequality can be a currency beyond disciplinary bar-
riers for a debate that must attract the attention, criticism, and interac-
tion of experts from different backgrounds.
As it is customary, acknowledgements express thanks and gratitude. I
have to say the contributors deserve my most sincere thanks for accepting
my feedback, observations, and in-depth criticism of their chapters. I
learnt a lot from their openness to engaging with my questions and tex-
tual interventions. I value their generosity in sharing with me the
xxv
xxvi Acknowledgements

findings of their projects, which not only did they carry out in the middle
of the pandemic, but they were also affected directly, through hospitaliza-
tions, symptoms, test scares, and ill health. I have never underestimated
the editor’s perks of partnering with colleagues from afar, yet the editing
process never ceases to surprise me for how rewarding it is. The contribu-
tors’ chapters made me look in different directions and consider new
methodological approaches.
Working on this project with Shaun Pickering, who is embarking on a
research project in multilingual communication in a health context, gave
me the opportunity of collaborating with a fine proofreader and promis-
ing researcher. His questions, comments, and revisions helped this proj-
ect develop and evolve in eight intense weeks of editing.
Figures 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, and 3.10 are repro-
duced with thanks to the State of New South Wales NSW Ministry of
Health that provided the translations for foreign nationals living in
Australia. Through the NSW Ministry of Health, under the aegis of the
Australian Governments Open Access and Licensing Framework
(AusGOAL), the state supports and encourages the reuse of its publicly
funded information as CC-BY open licences.
I am also thankful to the series editor, Prof. Margaret Rogers, for her
support on this editorial project, which was not a poised, pondered
research endeavour, but a sprinting event so that the volume could be
published in 2021. My gratitude goes to Prof. Claudia V. Angelelli, for
finding opportunities to talk about our shared passions about multilin-
gual communication, as well as for her willingness to engage with this
project. Her influential work in the field of healthcare interpreting has
kept me busy and away from major mistakes. All the mistakes that remain
are my sole fault.
At Macmillan Palgrave, Alice Green has championed the proposal
from the very beginning and made the editing process run very smoothly.
As I gradually re-learnt that holidays and weekends are not for working,
I thank Theresa, Rhys, and Iwan for accepting my absence over two
weekends, when I had to make sure this volume would be published—
my love to them is unconditional.
 Contents

1 Translating Health Risks: Language as a Social

Determinant of Health  1
Federico Marco Federici

Part I Terminologies and Narratives  37

2 Military Framing of Health Threats: The COVID-19

Pandemic as a Case Study 39
Sami Chatti

3 Implications of Linguistic Hegemony in Translating

Health Materials: COVID-­19 Information in Arabic in
Australia 63
Sama Dawood

4 Translating the COVID-19 Pandemic Across Languages

and Cultures: The Case of Argentina 93
María Laura Spoturno

xxvii
xxviii Contents

Part II Translating COVID-19 Credibility, Trust, Reliability 119

5 Translation Accuracy in the Indonesian Translation of the

COVID-19 Guidebook: Understanding the Relation
Between Medical Translation, Reception, and Risk121
Raden Arief Nugroho , Alfian Yoga Prananta, Syaiful Ade
Septemuryantoro, and Achmad Basari

6 Credibility in Risk Communication: Oman’s Official

Arabic COVID-19 Risk Communication and Its English
Translation147
Abdul Gabbar Al-Sharafi

7 Translation as an Ethical Intervention? Building Trust in

Healthcare Crisis Communication179
Bei Hu

Part III Health and Safety in Risk Communication 209

8 Health and Safety Discourse in Polish and English: A

Pragmalinguistic Perspective of COVID-19
Communication211
Małgorzata Kodura

9 Risk and Safety on Cruise Ships: Communicative

Strategies for COVID-19237
Linda Rossato and Jessica Jane Nocella

Part IV Communities and Translation 265

10 Managing Communication in Public Health: Risk

Perception in Crisis Settings267
Carmen Pena-Díaz
 Contents xxix

11 Citizen Translators’ ‘Imagined Community’ Engagement

in Crisis Communication293
Yanjiang Teng

I ndex317
 Notes on Contributors

Abdul Gabbar Al-Sharafi is Assistant Professor of Translation and Head

of Department of English Language and Literature at Sultan Qaboos
University, Oman. There he teaches on, and coordinates, the MA in
Translation programme. He holds an MA in Translation Studies and a
PhD in Text Linguistics both from Durham University, UK. Previously
he worked at Qatar University (2000–2003). He has authored a book
entitled Textual Metonymy: a semiotic approach (Palgrave Macmillan,
2004) and several research articles in the area of translation, discourse,
rhetoric, and related fields.
Claudia V. Angelelli is Chair in Multilingualism and Communication
at Heriot-Watt University, Edinburgh campus, UK, Emeritus Professor
of Spanish Linguistics at San Diego State University, USA, and Visiting
Professor of Foreign Studies at Beijing University, China. Her research
lies at the intersection of sociolinguistics, applied linguistics, and transla-
tion and interpreting studies. She is the sole author of Medical Interpreting
and Cross-cultural Communication (2004), Revisiting the Interpreter’s Role
(2004), and Healthcare Interpreting Explained (2019). She was the world
project leader for ISO 13611 Standards on Community Interpreting (PSI),
approved as the first ISO Standard on community interpreting/PSI. She
co-authored The California Standards for Healthcare Interpreters (2002).

xxxi
xxxii Notes on Contributors

Achmad Basari is a lecturer in the Department of English Language

Studies, Faculty of Humanities at Universitas Dian Nuswantoro in
Semarang, Indonesia. He holds his MA in Translation (2007) from
Universitas Negeri Semarang, Indonesia. Translation studies is his pri-
mary area of research; his projects focus on subtitling.
Sami Chatti is Assistant Professor of Linguistics at the University of
Manouba, Tunisia, Assistant Professor in the Department of English at
King Abdulaziz University, Jeddah, Saudi Arabia, and a certified transla-
tor. He holds a doctorate and a master’s in English Linguistics from the
Université Sorbonne Nouvelle, Paris 3, France, and obtained a second
master’s in translation from the School of Interpreters and Translators
(ESIT) in Paris. His research interests include cognitive semantics, trans-
lation studies and corpus linguistics. He has authored a book on the
Semantics of English Causative Verbs (Paf, 2012), and contributed several
articles to specialised journals in linguistics and translation.
Sama Dawood is Associate Professor of Translation and Interpreting at
the Faculty of Al-Alsun (Languages and Translation), Misr International
University, Egypt. She holds her PhD (2013) from Ain Shams University,
Egypt, and her MA from Al-Mustansiriya University, Iraq. Her research
interests span across translation and interpreting and so do her publica-
tions. She contributed chapters to the Routledge Handbook of Arabic
Translation and the Routledge Handbook of Translation, Feminism and
Gender. She has co-authored a paper on computer-aided interpreting.
Her projects focus on the role of translation in multilingual communities
and computer-aided translation.
Federico Marco Federici is Professor of Intercultural Crisis
Communication at the Centre for Translation Studies, University College
London (UCL). He holds a PhD in Translation from the University of
Leeds, UK. Before joining UCL, he designed the curriculum, founded,
and directed the EMT MA in Translation Studies at Durham University,
UK (2008–2014). His peer-reviewed articles have been published in
journals across different disciplines, from Translation Spaces to Disaster
Prevention and Management. His research focuses on translators and
interpreters as intercultural mediators, online news translation, and the
study of translation in crises.
 Notes on Contributors xxxiii

Bei Hu is Assistant Professor of Translation Studies at the National

University of Singapore. She holds her PhD in Translation and Interpreting
Studies from the University of Melbourne, Australia. Her research inter-
ests lie in high-stakes intercultural communication, intuitional transla-
tion, and reception studies with a focus on empirical/experimental
methods. Her recent work has been published in Target and Asia Pacific
Translation and Intercultural Studies.
Małgorzata Kodura is an assistant professor at the Pedagogical
University of Krakow, Poland. She holds a PhD in Linguistics. She is a
certified translator for English and a translator trainer. She is a staff mem-
ber of the Department of Translation Education that runs the translation
programme affiliated to the European Master’s in Translation Network,
initiated by the European Commission. She teaches practical courses in
specialised translation and translation technologies. Her research inter-
ests focus on translator training in the digital age and translator trainer’s
competence. She co-edited Negotiating Translation and Transcreation of
Children’s Literature (2020).
Jessica Jane Nocella is a PhD candidate at the University of Modena
and Reggio Emilia, Italy. She is working on the diachronic analysis of the
semantic changes of the word ‘slow’ over the last fifty years both in Italian
and in English, with a special focus on the implications of its new values
in the investigation of slow art discourse. Jessica holds a master’s degree in
Cultures and Difference from Durham University, UK, and a BA in
Portuguese and Russian language and literature from the University of
Bologna, Italy. Her main interests concern corpus linguistics, evaluative
language, and promotional discourse.
Raden Arief Nugroho is a lecturer in the Department of English
Language Studies, Faculty of Humanities, Universitas Dian Nuswantoro,
Semarang, Indonesia. He holds his PhD from the Universitas Sebelas
Maret, Indonesia (2017). His main research interests include translation
studies and applied linguistics. His research focuses on the development
of a translation model for visually impaired translators.
Carmen Pena-Díaz is Professor of Translation at the Department of
Modern Philology at Alcalá University, Madrid, Spain. There, she is the
xxxiv Notes on Contributors

director of the European Public Service Intercultural Communication,

Translating and Interpreting master’s degree. She is a member of the
research group FITISPos-UAH in Spain, which investigates pedagogical
issues in Public Service Translation and Interpreting training. She was
the principal investigator of InterMed, a project investigating interlin-
gual and intercultural mediation in health settings. Her research areas
are bilingualism, translation, and English for Specific Purposes. Her
articles have appeared in international journals such as MonTI,
Intercultural Education, Babel, and the International Journal of Bilingual
Education and Bilingualism.
Alfian Yoga Prananta is a doctoral researcher in Translation Studies at
the Department of Linguistics of Postgraduate Program at the Universitas
Sebelas Maret, Indonesia. His research interests cover topics in linguis-
tics, translation studies, and literary studies. He also lectures in transla-
tion studies and linguistics at several private universities in Semarang,
Central Java, Indonesia.
Linda Rossato is Assistant Professor of English Language and Translation
at Ca′ Foscari, University of Venice, Italy. She holds a BA in Translation
(Bologna-Forlì, Italy), MA in Screen Translation (Bologna-Forlì), and a
PhD in English for Special Purposes (University of Naples Federico II,
Italy). Her research interests include food and cultural translation, screen
translation, child language brokering, non-professional translation, and
translation of tourism-related texts. She co-edited the volume Non-
Professional Translation and Interpreting (2017) and the Special Issue
21(3) of The Translator: Food and Culture in Translation (2015). She is
writing a book on the translation of food discourse and the media.
Syaiful Ade Septemuryantoro is a university teacher and works in the
Department of Hospitality Management at the Universitas Dian
Nuswantoro, Indonesia. He holds his MA in Management Studies (2014)
from STIEPARI Semarang, Indonesia. Management Studies is one of his
key research areas. His projects focus on tourism growth, especially
around MICE activities (meetings, incentives, conferences, and
exhibition).
 Notes on Contributors xxxv

María Laura Spoturno is Associate Professor of Literary Translation

and US American Literature at Universidad Nacional de La Plata and a
researcher with CONICET, Argentina. She is the principal investigator
of the project entitled ‘Escrituras de minorías, ethos y (auto)traducción’.
Her research focuses on the study of subjectivity and (self )/(re)translation
practices, and the relations between translation, gender, feminisms, and
exile. Her recent contributions include a special issue of Mutatis Mutandis
co-edited with Ergun, Castro, and Flotow on transnational feminist
translation (2020) and papers on (re)translation practices and multimo-
dality (Lengua y Habla, 2019; Routledge Handbook of Translation,
Feminism and Gender, 2020; and The Translator, 2020).
Yanjiang Teng is a researcher in the International Studies Program at
Michigan State University, USA. He holds a PhD from Michigan State
University, USA. His research interests comprise language service provi-
sion, translation studies, and second language teacher education. His
contributions include chapters published by IGI Global, Springer, and
Routledge and articles appeared in Research in Language and Education:
An International Journal. His research projects focus on emergency lan-
guage services during the Covid-19 pandemic. He is the assistant editor
of the Journal of Second Language Studies (John Benjamins), and a review
board member of Chinese Language Teaching Methodology and Technology
(Cleveland State University).
 List of Figures

Fig. 1.1 Correlations between the social determinants of health

(CSDH, 2008) 5
Fig. 1.2 INTERACT crisis communication policy recommendations
(Federici et al., 2019) 19
Fig. 1.3 Tanguay’s diagram of how GPHIN works (2019) 21
Fig. 2.1 Cross-domain mapping of war onto COVID-19 in the corpus 48
Fig. 3.1 ‘COVID-19 (Coronavirus): Who to Call’. (© State of New
South Wales NSW Ministry of Health) 74
Fig. 3.2 ‘COVID-19 (Coronavirus): Who to Call’ in Arabic. (© State
of New South Wales NSW Ministry of Health) 75
Fig. 3.3 ‘Diabetes and COVID-19 (Coronavirus): Look after your
diabetes’. (© State of New South Wales NSW Ministry of
Health)78
Fig. 3.4 ‘Diabetes and COVID-19 (Coronavirus): Look after your
diabetes’ in Arabic. (© State of New South Wales NSW
Ministry of Health) 78
Fig. 3.5 ‘Cardiovascular patients and COVID-19 (Coronavirus)’.
(© State of New South Wales NSW Ministry of Health) 80
Fig. 3.6 ‘Cardiovascular patients and COVID-19 (Coronavirus)’ in
Arabic. (© State of New South Wales NSW Ministry of Health) 80
Fig. 3.7 ‘Stroke and COVID-19’. (© State of New South Wales
NSW Ministry of Health) 82

xxxvii
xxxviii List of Figures

Fig. 3.8 ‘Stroke and COVID-19’in Arabic. (© State of New South

Wales NSW Ministry of Health) 82
Fig. 3.9 ‘Arthritis and COVID-19 (Coronavirus): Look after your
diabetes’. (© State of New South Wales NSW Ministry of
Health)84
Fig. 3.10 ‘Arthritis and COVID-19 (Coronavirus): Look after your
diabetes’ in Arabic. (© State of New South Wales NSW
Ministry of Health) 84
Fig. 6.1 An integrated model of risk translation  153
Fig. 7.1 Number of WeChat Articles Addressing Nine Subthemes 197
Fig. 7.2 Information sources of the 27 WeChat articles 198
Fig. 7.3 Translators’ interventions 199
Fig. 9.1 ‘Safe Bubble’ image in the English-language MSC website.
Courtesy of MSC company 256
Fig. 9.2 Bolla Sociale image in the Italian-language MSC website.
Courtesy of MSC company 257
 List of Tables

Table 2.1 Verbal collocates of ‘Coronavirus’ 50

Table 2.2 Verbal collocates of ‘COVID-19’ 51
Table 2.3 Nominal collocates of ‘coronavirus’ 52
Table 2.4 Nominal collocates of ‘COVID-19’ 53
Table 3.1 Risk communication parameters adapted from Strategic
Communications Framework for Effective Communications
(WHO, 2017a) 70
Table 3.2 Assessing source infographic ‘COVID-19 (Coronavirus):
Who to CALL’ and its translation against WHO guidelines 77
Table 3.3 Assessing source infographic ‘Diabetes and COVID-19
(Coronavirus)’ and its translation against WHO guidelines 79
Table 3.4 Assessing source infographic ‘Cardiovascular patients and
COVID-19 (Coronavirus)’ and its translation against WHO
guidelines81
Table 3.5 Assessing source infographic ‘Stroke and COVID-19
(Coronavirus)’ and its translation against WHO guidelines 83
Table 3.6 Assessing source infographic ‘Arthritis and COVID-19
(Coronavirus)’ and its translation against WHO guidelines 86
Table 5.1 Criteria for selection of participants 127
Table 5.2 Translation accuracy quality rating scale (Nababan et al.,
2012)128
Table 5.3 Categories of accuracy used in the study 130

xxxix
xl List of Tables

Table 5.4 Homogeneity test results of the translation of the

COVID-19 guidebook 134
Table 5.5 Participants’ assessment of the translation of C19GB 135
Table 5.6 One way ANOVA for the translation of C19GB 136
Table 6.1 Distribution of foreign languages in Oman as of June 2018
(https://www.omaninfo.om/library/74/show/6143)155
Table 6.2 COVID-19 Supreme Committee press conferences 160
Table 6.3 Structure of COVID-19 press conferences 161
Table 7.1 COVID-19 Information: 14 Chinese translations and their
English source texts (DoH, 2021) 183
Table 7.2 List of WeChat articles with over 1000 reads disseminated
in Chinese 187
Table 8.1 Searle’s taxonomy of speech acts (1979) 218
Table 8.2 Options for translating an instruction from English into
Polish222
 1
Translating Health Risks: Language
as a Social Determinant of Health
Federico Marco Federici

Since 2003, the World Health Organization (WHO) has invested

resources in preparing for the threat of ‘the first severe and readily trans-
missible new disease to emerge in the twenty-first century’ (WHO, 2003,
p. 2), which was the severe acute respiratory syndrome, termed
SARS. Activities to prepare to deal with the SARS-associated coronavirus
that appeared in February 2003 led to recommendations for every coun-
try to revise or to introduce pandemic emergency plans (ibid.).
Preparations were indeed necessary as the appearance of the Middle East
respiratory syndrome–related coronavirus (MERS-CoV) in June 2012
showed that the epidemiological features of this typology of viruses neces-
sitated specific hospital protocols and information campaigns on hand-
hygiene, physical distance to avoid contagion, sanitation, aeration, and so
on (WHO, 2014). Ten years before the COVID-19 pandemic erupted,
the 2009 H1N1 pandemic, which took 17,000 lives worldwide, was
caused by the H1N1 strain of the influenza virus, a strain of 1918 flu

F. M. Federici (*)
Centre for Translation Studies, University College London, London, UK
e-mail: f.m.federici@ucl.ac.uk

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 1

F. M. Federici (ed.), Language as a Social Determinant of Health, Palgrave Studies in
Translating and Interpreting, https://doi.org/10.1007/978-3-030-87817-7_1
2 F. M. Federici

pandemic. WHO was heavily criticized for activating the pandemic pro-
tocol in 2009, as this was considered as overreaction due to an excess of
caution. This criticism may have induced complacency in politicians and
some members of the public causing an underestimation of COVID-19
and questioning the validity of the WHO’s announcement on 11 March
2020 that the disease caused by SAR-CoV-2, or COrona VIrus Disease,
was a pandemic. From 23 January, the efforts to update the WHO web-
site with accurate information about preventing people from contracting
the disease were multilingual (Chinese and English) and by 12 February,
they were multimodal (including documents, subtitled videos, and
webpages).
The need for timely crisis and emergency risk communication (CERC)
makes time an obvious, but by no means the only constraint to affect
translators and interpreters (T&I) during the COVID-19 pandemic. To
be able to produce timely translations or to recruit interpreters in the
needed languages or modality quickly and efficiently, risk communica-
tion strategies ought to consider local language needs as part of emer-
gency planning. The most significant constraint to achieve timely, trusted,
and regularly updated communication in multiple formats and multiple
languages consists of a widespread lack of recognition of the role of lan-
guage in ensuring individuals’ protection. By endorsing the call for action
laid out in Showstack et al. (2019), this chapter argues that the impact of
linguistic diversity is a threat in itself when emergency plans do not
accommodate the language needs of the population. The chapter suggests
that not only does the Western monolingual ideology (Auer & Wei,
2007) represents languages as ‘barriers’ and problems, which anti-­
immigrant, isolationist, and nationalist policies exacerbate, it also creates
the preconditions to disregard the impact of language discrimination on
health provision and healthcare for all members of society, including the
impact on medical personnel’s time. In the first section, the chapter
argues that language is a social determinant of health, as the absence of
T&I provision makes healthcare less effective for medical personnel and
patients alike. Grounded in examples of T&I activity during the pan-
demic and in existing studies of multilingual healthcare communication,
the claim is explained in relation to risk communication and its concep-
tual fit with the paradigm of social determinants of health. In the second
 1 Translating Health Risks: Language as a Social Determinant… 3

section, the chapter expounds on how rights-based approaches to sup-

porting multilingualism are a necessity dictated by the prevalence of mul-
tilingual contexts worldwide. It also critically analyses misconceptions
around obstacles to communication. The last section shows how language
issues emerging in the pandemic as well as from recent epidemics have
raised awareness on the importance of reliable T&I. In turn, this aware-
ness is growing in infrastructural, technology-focused activities, and in
actions intending to build local capacity for translating training and
information, so as to move beyond the social and economic risks of pub-
lic health campaigns designed within a ‘monolingual mindset’
(Clyne, 2008).

Multilingual Risk Communication

A 2015 systematic review of healthcare communication issues (focused
on Canada but referring to studies from the USA, the UK, and the EU)
shows the breadth of issues perceived from the point of view of medical
personnel (Bowen, 2015). Healthcare interpreting has also documented
extensively the trappings of poor resources leading to poor communica-
tion (Angelelli, 2019; Hsieh, 2016). Even in the EU where there are
statutory expectations for provision of language access, actual access to
translated materials, as much as interpreting, was flagged as an issue in
Angelelli’s Study on Public Service Translation in Cross-border Healthcare:
Final Report for the European Commission Directorate-General for
Translation (2015). By commissioning this report, the
European Commission acknowledged that the EU multilingual policies
were falling short and member states had limited plans to budget for
implementations of the policy. Angelelli’s report demonstrates infrastruc-
tural deficiencies, in established multilingual healthcare settings that
would be serious stressors in an epidemic or pandemic. Despite EU leg-
islation recognizing the right of all citizens to use their preferred language
of use, the report proved that there were enormous gaps: all later con-
firmed by the COVID-19 pandemic. Linguistic diversity shows up health
inequalities (De Moissac & Bowen, 2019). Speaking languages other
than the main or official language regularly and systematically causes
4 F. M. Federici

additional complications and a higher incidence of specific conditions

(Okrainec et al., 2015; Thorne et al., 2005); it increases the likelihood of
inappropriate treatment in emergency departments (Cox & Lázaro
Gutiérrez, 2016; Cox & Maryns, 2021; Granero-Molina et al., 2018;
Hsieh, 2016; Ryan et al., 2017; Schwei et al., 2016), and it has a negative
impact in epidemics, as foreign nationals may receive diagnoses with
extensive delays, increasing exposure to contagion in other patients
(Hines et al., 2014; Kaplan, 2020). Longer hospitalization time (John-­
Baptiste et al., 2004), slower diagnoses, and longer consultation time if
poor interpreting is offered contribute to stretching demands on medical
personnel. The case for effective translation, interpreting, and accessibil-
ity services that are supported and regularly reviewed is writ large; none-
theless, the deficits in these services are evident and extend beyond
political motivations alone.

Social Determinants of Health

The health of individuals goes beyond the mechanics of the human body,
its anatomic specificity, and DNA blueprints. Health is affected by these
but also by multiple other factors. The UCL Institute of Health Equity
explains,

Social determinants of health (SDH) is a term used to describe the social

and environmental conditions in which people are born, grow, live, work,
and age, which shape and drive health outcomes. Factors that determine
how the SDH conditions are experienced across societies include the dis-
tribution of power, money and resources. Unfair distribution creates avoid-
able health inequalities, known as ‘health inequities’. Therefore, social,
economic, and environmental factors, as well as political and cultural fac-
tors, constitute the ‘social determinants of health’. (Institute of Health
Equity, 2021)1

In 2005, the World Health Organization established the Commission

on the Social Determinants of Health ‘to marshal the evidence on what
can be done to promote health equity, and to foster a global movement
to achieve it’ (WHO, 2008, p. 1 ); the Commission released the
 1 Translating Health Risks: Language as a Social Determinant… 5

diagrammatic representation of the correlations between these factors

seen in Fig. 1.1. WHO endorsed the multi-factor notion of health that
Marmot introduced in the 1970s (Marmot et al., 1978) and demon-
strated its validity with extensive, solid, statistically valid evidence
(Marmot, 2005; Wilkinson & Marmot, 1998). The Commission on the
Social Determinants of Health recognizes that

inequities in health, avoidable health inequalities, arise because of the cir-

cumstances in which people grow, live, work, and age, and the systems put
in place to deal with illness. The conditions in which people live and die
are, in turn, shaped by political, social, and economic forces. (WHO,
2008, p. 1)

The conditions are not immutable and, remarkably, small changes to

some factors have a bigger impact on public health than large invest-
ments in medical equipment for a single hospital (Marmot, 2015). In
short, even if it is possible to avoid the high incidence of some factors,

SOCIECONOMIC
& POLITICAL
CONTEXT
Governance
Material Circumstances
Social Position
Social Cohesion
Policy DISTRIBUTION
Education Psychosocial Factors OF HEALTH
Macroeconomic
AND
Social Occupation Behaviours WELL-BEING
Health
Income
Biological Factors
Gender
Cultural and
Societal norms Ethnicity / Race
and values Health Care System

SOCIAL DETERMINANTS OF HEALTH AND HEALTH INEQUITIES

Fig. 1.1 Correlations between the social determinants of health (CSDH, 2008)
6 F. M. Federici

they have statistically evidenced and proven impact, resembling the

impact of linguistic diversity, when ignored. The socio-economic factors
are often interrelated. From a sociolinguistic perspective, we know how
linguistic identities are composite and intersectional; hence, the para-
digm of social determinants of health fits logically with T&I researchers’
fields of study. The impact of individual factors is magnified by limita-
tions on accessing information, or healthcare services, determined by the
language spoken, the speaker’s proficiency in the main language, and lim-
ited language service provision in a country’s healthcare system. The
Commission’s report influenced the evidence-based approach to consid-
ering ways of protecting health as a human right, beyond the abstract
shared notion that it is. In its report, it recognizes that ‘exclusion’ is a
health risk: ‘Being included in the society in which one lives is vital to the
material, psychosocial, and political empowerment that underpins social
well-being and equitable health’ (CSDH, 2008, p. 24).
Currently, WHO has a policy on The Right to Health, supported by the
Office of the High Commissioner for Human Rights. Factsheet 31 of the
policy explicitly reminds us that creation of ‘language barriers’ is an
infringement of human rights (OHCHR, 2020). The reference is to
migrants being left out of healthcare provisions. However, language as a
tool for inclusion is implicitly recognizable in the broader ‘human rights-­
based approach to health’ that, for WHO, ‘provides a set of clear princi-
ples for setting and evaluating health policy and service delivery, targeting
discriminatory practices and unjust power relations that are at the heart
of inequitable health outcomes’ (WHO, 2017, n.p.): excluding groups
because of their languages is a breach of this approach.

In pursuing a rights-based approach, health policy, strategies and pro-

grammes should be designed explicitly to improve the enjoyment of all
people to the right to health, with a focus on the furthest behind first.

Showstack et al. (2019) called on language-related professionals, research-

ers, and scholars of language matters for action: from sociolinguists to
applied linguists. It is necessary to gather large-scale evidence on the
impact of language as a social determinant of health, because of the
 1 Translating Health Risks: Language as a Social Determinant… 7

indissoluble relationship between linguistic diversity and (temporary)

exclusion that has an impact on the universal right to health.

The right to the conditions necessary to achieve the highest attainable stan-
dard of health is universal. The risk of these rights being violated is the
result of entrenched structural inequities. Social inequity manifests across
various intersecting social categories such as class, education, gender, age,
ethnicity, disability, and geography. It signals not simply difference but
hierarchy, and reflects deep inequities in the wealth, power, and prestige of
different people and communities. (Commission on Social Determinants
of Health, 2008, p. 24)

It is opportune to discuss the issue from the superordinate position: and

as such to focus on language, rather than T&I. Clearly, together with sign
language, T&I are inherently connected with delivering accessible infor-
mation across divides of a linguistic, cultural, intersectional, and multi-
farious nature. When addressing the impact of linguistic diversity on
social equity, awareness of language diversity is the first activist position
to ensure that multimodal healthcare communication improves in all its
very different modalities, because it is understood as a core element in
risk communication practices.
The COVID-19 pandemic irrefutably confirmed that language needs
compound other socio-economic factors to have an impact on (tempo-
rarily or long-term) marginalized groups. The inability to access informa-
tion in a language and format that patients understand mirrors and
exacerbates health inequality (Espinoza & Derrington, 2021). It can also
be argued that language is a social determinant of health per se, for all
those who may not necessarily be economically deprived but are in rea-
sonable financial positions and can be affected by limited access to infor-
mation that could have a critical impact on their health, thus debunking
arguments about personal and individual responsibility as causative
among the poor. Clearly the level of impact is different, but there is an
irrefutable element in common: linguistic preparedness to deal with haz-
ards is rarely a priority.
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