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Limited English Proficiency



Although English is the predominant language of Colorado, over 15 percent of residents speak a primary language other than English, and the 2000 Colorado Census indicates that Colorado is now home to over 41 different languages. The most common documented language spoken among non-English speakers is Spanish, followed at a distance of German, French and Vietnamese. The percent of linguistically isolated Spanish speaking households rose 171% statewide between 1990 and 2000, and this number continues to rise.


Research indicates that people with Limited English Proficiency are less likely to utilize preventive health care and public health services such as regular medical check-ups, immunizations, and cancer screenings. In addition to language, cultural barriers might also contribute to poorer health outcomes. For example, the 2005 Colorado Health Disparities Surveillance Report reveals that diabetes is disproportionately high among Hispanics. Ultimately, these disparities are costly in terms of quality of life, health care dollars and lost productivity.


On August 8, 2003, a revised policy guidance was published in the Federal Register,1 to clarify the responsibilities of health and social service providers (and their contractors) that serve Limited English Proficiency persons and receive financial assistance from the U.S. Department of Health and Human Services. The Colorado Department of Public Health and Environment is such an agency. The Guidance is based on Title VI of the Civil Rights Act of 1964, and its implementing regulation 45 CFR Part 80, which provides that:


No person in the United States shall be subjected to discrimination on the basis of race, color or national origin under any program or activity that receives Federal financial assistance.


The Guidance does not impose any new requirements, but reiterates longstanding Title VI principles that the Office for Civil Rights has been enforcing for over 30 years. Consequences for noncompliance with the Federal Guidance include termination of Federal assistance, referral to the Department of Justice for injunctive relief or other enforcement proceedings, or any other means authorized by law. A Guidance summary is provided as Appendix B.


In October 2001, Colorado Department of Public Health and Environment senior management gave the newly formed Limited English Proficiency Services Work Group the authority to design and conduct an assessment of the Department's need for language services, and to make system wide recommendations. Responsibilities of the Work Group include the following:


1. Develop a methodology for conducting a department-wide language needs assessment
2. Conduct the assessment
3. Analyze and interpret the data
4. Prepare a report to Senior Management with recommendations
5. Assist with implementation of changes as directed by Senior Management
6. Conduct regular evaluations of the Department's language assistance services


The Work Group partnered with the Office for Civil Rights, U.S. Deptartment of Health and Human Services, Region VIII, which provided consultation throughout the process.


The Office of Health Disparities along with the Limited English Proficiency Steering Committee, will develop training and technical assistance modules for improving state and local health program's capacity to meaningfully serve Limited English Proficiency clients. The group will work with the Colorado Department of Public Health and Environment's Office of Communications to develop policies and standards for materials published by the Department in Spanish.


1.  The policy guidance was initially published in August 2001.




  • National Standards on Culturally and Linguistically Appropriate Services                                                                            (Their standards are primarily directed at health care organizations; however, individual providers are also encouraged to use the standards to make their practices more culturally and linguistically accessible. The principles and activities of culturally and linguistically appropriate services should be integrated throughout an organization and undertaken in partnership with the communities being served.)





  • National Council on Interpreting in Health Care                                                                                                                            (A multidisciplinary organization based in the United States whose mission is to promote culturally competent professional health care interpreting as a means to support equal access to health care for individuals with Limited English proficiency.)




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