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Applied ResearchExecutive Order 13166 and Its Impact on Translation and LocalizationOverviewAs Americans begin to focus on what constitutesfair and equal access to health care, questions ariseabout how language barriers affect access to healthcare services. According to the 2005 U.S. census, nearlyone out of five Americans speak a language other thanEnglish at home; the resulting need for translationand interpretation services has given rise to legislationregulating which materials get translated and for whichpopulations. Executive Order 13166 was designedto ensure that patients with limited English-speakingability receive equal access to programs and health carethrough translation and interpretation services; it is apivotal piece of legislation that is affecting how themedical profession treats the limited English proficient(LEP) population. Technical communicators andlocalization experts have assumed key roles in the effortto make health care information accessible to diversepopulations in the United States.In this article, I explore the impact of ExecutiveOrder 13166 and its effects on technical communicationin the United States, and make recommendations forlocalizing health care information for LEP audiences,especially with regard to what technical communicatorsand localization experts can do globally to meet thisemerging health communication crisis.The Need for Health Information for LEPPopulations in the United StatesEach day, hospitals and clinics across the UnitedStates encounter limited English proficient (LEP)patients—persons defined by the U.S. Census Bureauas “speak[ing] English less than ‘very well’” (AmericanMedical Association [AMA], 2006, p. 1). Accordingto the American Community Survey (U.S. CensusBureau, 2005), more than 19% of Americans speaka language other than English at home. Many of thepeople who do not speak English at home (29% ofSpanish-speakers, 22% of Asians and Pacific Islanders,and 13% of Indo-European language speakers) speakEnglish “not well” or “not at all” (Hasnain-Wynia,Yonek, Pierce, Kang, & Hedges Greising, 2006, p. i). Asimilar survey conducted by the Health Research andEducational Trust (HRET) revealed that 12–23 millionU.S. residents (4.5%–8.6% of the population) speakEnglish less than “very well” (p. i).In addition, HRET found that 80% of hospitalsencounter LEP patients “frequently,” which wasdefined as at least monthly (Hasnain-Wynia et al.,2006, p. 2). This is a very large population of LEPpatients who need translation (written language) andinterpretation (oral language) services in a health caresetting (p. 29).Medical translation and interpretation issues are notconfined to the United States. Worldwide, there are anestimated 191 million immigrants, and immigration rateshave more than doubled around the globe in the past50 years (Shah, 2008). The United States has taken only20% of these immigrants, while Europe has absorbed33%. This situation has created what many consider tobe a global health information crisis (Shah, 2008). TheEuropean Union has unique challenges, particularly inthe regulation of documentation for medical devices.The EU makes up 30% of the medical device market,but it is having problems balancing the need forregulations to meet the needs of all users against thecost and time required to do so:Regulations controlling the manufacturing,marketing and usage of medical devicesin the EU are forcing manufacturers toincorporate language translation andlocalization into global developmentstrategies as individual Member Statesdemand product information in thelanguage of the local user. (RegulatoryLanguage Requirements and the EuropeanUnion, 2005).The need for more translation and localizationefforts in medical contexts has led to an increasedinvolvement of technical communicators as writersand localization experts in the health fields in everydeveloped country. Research indicates that manyorganizations are attempting to accommodateimmigrant populations by offering a greater number oftranslated materials for their clients. Organizations andagencies such as the American College of Obstetriciansand Gynecologists (ACOG) and the Centers for Disease252 Technical Communication l Volume 57, Number 3, August 2010