Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.”
– Martin Luther King Jr.

One of the social determinants of health is healthcare access and quality, which includes having access to healthcare, health insurance, and health literacy. Health literacy is how patients understand and retain healthcare information to make informed decisions and take action. Receiving healthcare education has a direct impact on a patient’s health outcome. Part of health literacy is language preferences, which is a crucial component of a healthcare interaction.

When language preferences aren’t addressed during a clinical encounter, data shows that the quality of care can be low, unsafe, and costly. For healthcare to become more equitable, healthcare companies must provide content in the preferred languages of the current and potential customer base.

To help with inequities in healthcare, improve the quality of services, and achieve health equity, the U.S. Department of Health & Human Services created a set of standards called Culturally and Linguistically Appropriate Services (CLAS). This standard was created for health and healthcare organizations to:

Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs (CLAS Standards).

The CLAS Standards provide guidance in three main areas:

  1. Governance, leadership, and workforce
  2. Communication and language assistance
  3. Engagement, continuous improvement, and accountability

The goal is to help healthcare organizations remain respectful of diverse cultures and languages, which in turn can increase member retention and grow the member base, and ultimately, improve health equity.

At Avantpage, our goal is to improve lives and bridge worlds through language, understanding, and compassion. We help organizations ensure their content and communication is created and reviewed with CLAS standards in all areas of our language services, from interpreting to translation to accessibility. Let’s take a look at language needs and ways you can apply the CLAS Standards.

CLAS Standards: What’s the Difference Between Culturally and Linguistically Appropriate?

As much as culture and language can be tied together, they also need to be considered separately. It’s the combination of the two that provide the most appropriate and comfortable experience.

What Does Culturally Appropriate Mean?

Creating something culturally appropriate means having it make sense for a target member’s culture. Here are some examples.

  • In 2015, a store in London featured an aisle display promotion of smokey bacon flavor chips, with messaging of Ramadan, during Ramadan.
  • Nike had an ad in 2013 that showed a woman wearing clothing that appeared similar to a traditional Samoan tattoo – one which is intended for men. Nike ended up removing the product entirely. 

Since culture is highly socio-based, it can also be different in different locations, like a big city versus a rural area, and change over time. To nail what’s culturally appropriate, you should involve experienced linguists with a strong cultural understanding of your audience.

What Does Linguistically Appropriate Mean?

Having something linguistically appropriate means making the language appropriate and linguistically correct by looking at various of aspects of the language, such as the language itself, the voice used such as formal or informal, and the intent or messaging. Here are some examples.

  • A translation might require an exact translation, such as technical instructions that must be followed precisely for the correct outcome. At other times, the wording might change quite a bit due to an underlying meaning if the material is more expressive in nature. For example, the phrase “get it done” in American English may have a harsh and blunt interpretation that when missed, could have negative repercussions like not understanding the severity or time-sensitive nature of completing a task.

  • A translation might need to be expanded upon to emphasize the intent. For example, the Japanese culture places more emphasis on politeness than the American culture. This example from Hubspot explains how a translation was modified for intent. The English excerpt:

    “…and keep sending feedback to make us better. Thank you”


    “Feedback from our valued customers is the most important for HubSpot. Please keep sending feedback.Again, thank you so much for using HubSpot products as usual. Thank you very much for your kind support.”

Again, experienced linguists will review content for appropriate translations.

Examples of CLAS Standards in Practice

So, what do some of the CLAS Standards look like in healthcare applications? Here are some examples.

#1 Interpreting Services: Linguistics

Interpreting requires implementing culture and language while speaking to a member. Using professional and qualified interpreters is a must so that the interpretation is accurate and appropriate, and doesn’t leave any room for confusion or miscommunication.

For example, a doctor’s office recording states in English that they’re open Monday through Friday from 8AM – 5PM except for Tuesdays and Thursdays between 12PM-2PM. If the phone interpreter fails to mention when the office is closed, it could result in the individual showing up when the office is closed.

#2 Localization Services: Culture

As we pointed out in the example about reaching a Muslim audience, you have to fit a culture’s expectations. Marketing a flavor such as bacon to an audience that does not typically eat pork products might not resonate with your audiences – especially on religious and fasting holidays.

#3 Desktop Publishing Services: Linguistics

You have content to translate into the target language, but the formatting from the source language doesn’t work with the target language. For example, you have a table that compares healthcare plans. The text in the table is at maximum capacity, so there’s no more room. When you translate that text, it has no room to expand, so it might overlap other text, making it difficult or impossible for target audiences to fully comprehend the content.

#4 Translation Services: Culture

As we previously described in the HubSpot article, the Japanese translator added content to the Japanese translation to meet the audience’s cultural needs.

#5 Accessibility Services: Linguistics

Accessibility has to be comprehensive. If you have a website with alt text for images to help readers and the ability to enlarge text, that’s a great start. However, if the colors aren’t highly contrasted, then the website isn’t fully accessible. 


The CLAS Standards emphasize the importance of being both culturally and linguistically appropriate in your services, and while these two are separate, they need to be reviewed and function together. Since culture and language include such a diverse array of possibilities, change over time, and are highly nuanced, it’s best to partner with a language service provider (LSP) to get it right. An LSP will help you target your messaging for the audiences that best match your organization. An LSP will also have the network capabilities to fully employ people with the relevant skill set, experience, and cultural understanding to provide meaningful messages that resonate with your target audiences.

As a result, you can attract potential members and better support your current members. Bit by bit, we can all help healthcare become more equitable and improve the quality of healthcare services.

To learn more about how we can help you with the CLAS standards, contact us at [email protected] or (530) 750-2040.