Introduction

The right to health is a fundamental human right, first affirmed in the World Health Organization (WHO) Constitution as the right to the “highest attainable standard of health” (1946). This right became enshrined as a binding obligation on signatory states of the United Nations’ International Covenant on Economic, Social and Cultural Rights (1966). It has been further endorsed in numerous regional and international human rights instruments and incorporated into the United Nations’ sustainable development goal (SDG) no. 3 on good health and wellbeing, as part of the 2030 Agenda for Sustainable Development.

In practice, and particularly in a time of growing privatization and commodification of healthcare, the application and enforcement of this right are unequal. Racial and other forms of structural discrimination also weaken its application. In the United Kingdom, ethnic minorities “have poorer access to health care and experience higher rates of infant mortality” (Office of the United Nations High Commissioner for Human Rights [OHCHR], 2019, p. 17) and asylum seekers “also face major barriers to health care” (OHCHR, 2019, p. 18). Gypsy, Roma, and traveller communities who face communication barriers also have difficulties accessing healthcare (Wilkinson & Thomas, 2024).

Existing health and socioeconomic inequalities were highlighted and exacerbated by the global Coronavirus (Covid-19) pandemic declared in March 20201 and continue to disproportionately hit disadvantaged groups in society. Figures for the United Kingdom show higher fatalities among ethnic minorities, all groups other than white British (Public Health England [PHE], 2020, p. 20). Language access and modes of public health risk communication have been identified as potential contributing factors (PHE, 2020, p. 31). Language access issues and communication barriers also affect the Deaf2 and people with low literacy levels, learning difficulties, and those experiencing digital exclusion.

From the outset of the pandemic, “The World Health Organisation (WHO) guided national governments in communicating COVID-19 risks and safety precautions” (Ekezie et al., 2022, para. 1). It recommended the “creation of a national migrant targeted risk communication to slow and contain the spread of COVID-19” (Nezafat Maldonado et al., 2020, para. 30). Instead, “with [only] a minority of governments in Europe having produced these, or migrant focused health promotion material, many non-government organizations have been fulfilling this recommendation” (Nezafat Maldonado et al., 2020, para. 30). In the United Kingdom, the inadequate response of public authorities resulted in the voluntary or third sector stepping in to fill the translation gap.

This paper examines the work of the main non-governmental organization Doctors of the World UK (DoTW) and its partners to translate pandemic health guidance at a national level in England, the largest country in the United Kingdom, with a population of over fifty million. DoTW provided translations of official guidance for England in over sixty languages and in multimedia formats. Except for some initial translations, paid professional translators were used for this purpose. This unique and sustained initiative is potentially the largest voluntary sector project to communicate public health risks through translation anywhere in the world, particularly in an emergency situation.

Based on a written interview conducted with DoTW consisting of eleven questions communicated via email, the paper examines the strategy adopted by the organization from the beginning of the pandemic, focusing on the period between 2020 and mid-2021. DoTW’s approach is then analyzed through the lens of Taibi’s (2018a) community translation quality assurance model, which considers community (public service) translation as a form of empowerment. The paper identifies good practices and factors for successful public risk communication through translation and considers the sustainability and future scope of voluntary sector intervention at the national level to fill the gap in public service translation.

England’s language response to Covid-19

Official response

The United Kingdom recorded its first known Covid-19 cases in January 2020. Soon after the WHO declared the novel coronavirus a pandemic on 11 March 2020, the Department of Health and Social Care stated in parliament that translations of health and safety information on Covid-19 were not available in common community languages: Urdu, Bengali, Polish, and Romanian (UK Parliament, 2020a).

By the time the UK announced lockdown restrictions to fight the virus on 23 March 2020, the government had still not produced translations of its guidance. By the end of March 2020, “the government provided guidance on social distancing in 11 languages, including Welsh, Urdu, Arabic and Bengali” (Evans, 2020), but this was withdrawn on 1 May 2020 as the guidance changed, and was not replaced until July 2020. Other guidance on the “NHS [National Health Service] Test and Trace programme and the rules on wearing face coverings” (Evans, 2020) had not been translated by then either. When produced, official translations were typically available in around a dozen community languages.

Cheung’s (2022) case study found that Chinese translations of the British government’s Covid-19 guidance were provided on a selective basis (30 out of 117 documents categorized as guidance and regulations) and made no distinction between “Traditional Chinese and Simplified Chinese before the year 2022” (p. 64). There were time lags and inconsistencies in updating translations to the latest guidance and the translations more closely followed source language norms. The study concluded that while “fit-for-purpose” translation may be acceptable, “a high quality of writing in the target language does not only ensure effective communication but also shows respect for the ethnic minorities in a multicultural country in this unprecedented pandemic!” (Cheug, 2022, p. 61).

A parliamentary report into the British government’s handling of the pandemic, published in October 2021, received written evidence that was “critical of the Government’s efforts to engage and communicate with people from minority ethnic groups” and that “the large majority of the Government’s covid-19 public health messaging was delivered in English” (House of Commons Health and Social Care, and Science and Technology Committees, 2021, para. 311).

One study into health communication during the pandemic in the London Borough of Hackney found that “One of the most important observations to emerge from the data […] was the lack of information displayed in community/foreign languages” (Kalocsányiová et al., 2021, p. 1087) in an area where over twenty percent of adults in households do not have English as a main language. Another study, which focused on the London Borough of Haringey (Healthwatch Haringey, 2020), found that “Many Turkish and Kurdish people who do not speak English have been sourcing information about Covid-19 from Turkish television and media channels, reporting on the pandemic in Turkey” but that “This information has not always been in line with government and NHS guidance in the UK” (p. 7). The novelty of the pandemic and the rapidly changing behaviour and lifestyle changes it involved meant that inconsistent and sometimes inaccurate and out-of-date official translations added to the confusion and mistrust around the handling and response to the pandemic situation.

Digital exclusion and literacy posed other barriers for both speakers of English and foreign languages. Research into Covid-19 information on British government websites by Khan et al. (2020) found that most official information had been written at a reading level higher than that of the average British person, with few graphics and non-print media. Even in English, much of the information was not easily accessible or comprehensible to the public, nor was the format intuitive. Simplified English versions of the official guidelines would be included with foreign language translations.

Third sector response

With information, guidance, and rules changing often, the gap in the translation of this guidance was filled by voluntary organizations and charities for their service users online and in print, some local authorities through bilingual staff, and local volunteers in both online written and video format. Individual voluntary initiatives were also set up to translate government guidance such as doctor-led Covid-19 Infographics due to “real frustration at the lack of translated guidance out there from discussions with healthcare professionals, public health officials and community organisations” (Majeed, 2020). Such endeavours used volunteers and untrained professional translators or interpreters, and given how rapidly the guidance changed, they were often not updated or sustained.

Conversely, on 19 March 2020 the medical charity DoTW produced resources in twenty-five languages. This was followed by a week-long Rapid Needs Assessment carried out in April and May 2020 with forty-two participants. It was “undertaken to fill a critical evidence gap and rapidly identify the needs of socially vulnerable groups arising from the COVID-19 pandemic in England” (Stevens et al., 2021, para. 4). Among the findings were “that it was difficult for people without English language or literacy skills to access the latest guidance due to delays and omissions in publishing guidance in other languages and easy-read, audio or video versions” (Stevens et al., 2021, subsection 4.1.2).

In partnership with the British Red Cross, Covid-19 Infographics and others, DoTW translated and updated NHS guidance into sixty languages, including simplified English, on its website, initially providing videos for those with low literacy skills in some languages as well, and animations later on. Paid professional translators were used for this purpose. On 27 July 2020, the organization, along with various local authorities, voluntary organizations and charities, wrote to the government stating that the translations it had produced

are in a limited range of languages and are frequently withdrawn as guidance changes and translated versions are not maintained. We call on the government to commit to producing and maintaining national COVID-19 guidance in languages that reflect England’s multilingual communities. The UK is a multilingual society; in England and Wales over four million people speak a main language other than English with 864,000 speaking little to no English. (Doctors of the World et al., 2020)

In November 2020, the government’s response to a parliamentary question was that it had “no plans to update social media with COVID-19 guidance in languages other than English and Welsh” (UK Parliament, 2020b) and instead referred the questioner to the resources produced by DoTW.

Non-verbal languages

Poor communication also affected Deaf people in England, for many of whom British Sign Language (BSL) is their main or only language and who may not be able to read English well or at all. Again, charities stepped in to bridge the information gap. While sign language interpreters came to prominence in many parts of the world through their presence at government briefings, in England, they were conspicuous through their absence. This was heightened by their clear on-set presence in all other parts of the United Kingdom; Northern Ireland included interpreters for both British Sign Language (BSL) and Irish Sign Language simultaneously.

The lack of BSL interpreters during government briefings, which were held daily at the beginning of the pandemic, led to a #Whereistheinterpreter social media campaign in March 2020 to demand such provision. Although English subtitles were available, it cannot be assumed that Deaf people could read them, as English and BSL are distinct languages; as a language, BSL “is not dependant nor is it strongly related to spoken English” (British Sign, n.d.). From 16 March 2020, an on-screen BSL interpreter was introduced to briefings shown on certain channels of the BBC, the national public broadcaster. However, this assumed access to these channels and placed the burden to provide an interpreter on the broadcaster.

The Equality and Human Rights Commission (2020) wrote to the government in April 2020 to ask it to include a BSL interpreter on-set, stating “Including a BSL interpreter live at your daily briefings would allow you to demonstrate your commitment to equality for all, meeting your obligations to make reasonable adjustments under the Equality Act 2010” (p. 2). Following complaints by Deaf people and a judicial review launched in December 2020, the government was found to have breached the Equality Act 2010 on two occasions by not providing an on-set BSL interpreter during medical briefings and having discriminated against the Deaf claimant by failing to make reasonable adjustments (R (On the Application Of Rowley) v Minister for the Cabinet Office, 2021). This judgment, however, did not place a duty on the government to provide on-set interpreters thereafter, nor did it lead to such an outcome. BSL summaries of briefings were instead regularly produced by the deaf health charity SignHealth, using professional BSL interpreters.

Translation, Translation Quality, and Public Health Communication

Translation and public health communication

In spite of the existence of sanctions and legal instruments, and some consensus on the principles it covers, the scope and content of the broad right to health remain vague. Although it may be argued that human rights-based approaches focus on “the outcome of a right-to-health principle rather than a health outcome” and that these “indicators measure the principles of quality and accessibility, including non-discriminatory access and the right to receive health information” (Montel et al., 2022, para. 27), they are nonetheless essential to achieve any health outcome. This includes health communication, taking into consideration the varying levels of health and digital literacy within any community, as well as translation and interpreting services for minority and foreign language speakers. Both language (Fogarty et al., 2023, para. 2) and health communication (Goulbourne & Yanovitzky, 2021) can be considered social determinants of health, non-medical factors that condition health outcomes, and a part of the right to health.

The right to health principles and indicators relevant to this study are non-discrimination, participation, and the accessibility and quality aspects of the “AAAQ” (Availability, Accessibility, Acceptability and Quality) framework. It should be noted that in the United Kingdom context, while the Deaf community benefits from the legally protected characteristic of disability,

language is not explicitly protected, or referenced, under the Equality Act (UK Government, 2010), although there is potential scope for the prevention of discrimination on the grounds of language due to its definition of ‘race’: This particular characteristic is stated to include ethnic and national origins. (McKelvey, 2021, p. 47)

The most recent United Kingdom census, carried out in 2021 during the pandemic, and the second one to include self-reported language data, shows that in England and Wales, 4.1 million people “of the overall population were proficient in English (English or Welsh in Wales) but did not speak it as their main language” and 161,000 people reported that they could not speak English at all (Office of National Statistics, 2022).

The crisis in the National Health Service in the United Kingdom and in the provision and availability of public service translators and interpreters due to public sector cuts and austerity measures predated the pandemic. Claiming that “Translation undermines community cohesion by encouraging segregation” (Pickles, 2013) and to save money, the previous Coalition government (2010–2015) called on public authorities to reduce the number of documents translated into foreign languages.

As a result of these austerity policies, the responsibility was placed on interpreters or multilingual staff to facilitate verbal communication. One report found that people with limited or no English “faced problems at all points of their healthcare journey” (Healthwatch, 2022, p. 3). Combined with the increasing use of remote healthcare, numerous hurdles arise, for example, when individuals try to make appointments online and over the telephone, to register for primary care services where no language support is available, or if an interpreter is provided for a medical appointment but the appointment letter inviting the patient to attend is only available in English.

The impact of the lack of priority given to language and culture in considering the right to health is not without precedent. For example, in recent years and prior to the Covid-19 pandemic some regions of England experienced outbreaks of measles, and in 2017 measles was declared a national incident (Mulchandani et al., 2021). Affecting the Romanian and Roma communities in particular, the lack of support services for and engagement and communication with these communities reduced the impact of the response. The situation highlighted

the importance of access to timely GP in and out-of-hours community translation services to facilitate the provision of time-sensitive advice on exclusion and contact tracing of cases. [… And] the importance of public sector organisations maintaining good engagement with minority community groups in the area, and recognition of the differences between nationality (Romanian) and ethnicity (Roma), to promote inclusion, understand cultural behaviours and support outbreak control activities in the future. (Mulchandani et al., 2021, para. 30)

The ongoing prevalence of measles among young children, in spite of the existence of official translated information on the illness and vaccines in various community languages, suggests that the broader recommendations, covering both written and oral communication, and understanding of cultural differences as concerns health literacy and health culture, have not been adopted.

Translation in a public health emergency

The type of translation involved in the translation of public health guidance is community or public service translation (PST), which suffers from inequality in view of the lower levels of remuneration and training available for practitioners. The British Chartered Institute of Linguists’ (CIoL) Certificate in Translation (CertTrans) includes a public service translation component but there is no official qualification or specific training in public service translation. On the other hand, the Diploma in Public Service Interpreting (DPSI), to qualify as a public service interpreter, contains a translation component. Both public service translation and interpreting are poorly remunerated and in view of public policy that discourages translation into multiple languages, there are few opportunities to practice in this area of translation.

This affects the overall quality and availability of PST. In practice, volunteer, ad hoc (friends and family) and other non-professional translators and interpreters are not uncommon in the field. In addition, the increasing use of artificial intelligence, purportedly to save money, raises its own ethical and quality issues (Andalo, 2024).

Translation within a public health emergency setting will frequently go beyond the transfer of words and meaning in one language to “removing communication barriers” (Maaß & Hansen-Schirra, 2022, p. 38) in print and other forms of non-print communication. During the Covid-19 pandemic, “the availability of timely, high-quality information becomes even more vital, not only for the general public but also health professionals and decision makers at all levels” (Piller et al., 2020, p. 505). With WHO information directed at states, they were “tasked with localizing relevant information for their populations through their national health authorities. This means that states have been key actors—including information providers—in this crisis” (Piller et al., 2020, p. 505).

A bottom-up approach is necessary to cover the broad scope of health literacies within a community and thus PST is relevant in such contexts. According to Taibi (2018a), it “is intended to empower disempowered social groups by enabling them to have equitable access to public service information and to participation in their society” (p. 8). It is all the more relevant since “empowerment constitutes one of the major goals of health communication” (Ishikawa and Kiuchi, 2010, para. 17).

Yet, in spite of this key role for the state and its agencies, translation in crisis and emergency situations continues to rely on volunteer and untrained translators, especially for minority languages “due to the lack of translators” (Luo, 2021, p. 2) and faces “a lot of challenges such as time limits, lack of background knowledge and specialized translators” (Luo, 2021, p. 3). One study from China found that although “student volunteers possessed basic multilingual abilities, they were not equipped with adequate public health knowledge. All of them mentioned the lack of medical knowledge as one great obstacle” (Zheng, 2020, p. 591). In spite of these various constraints, “translation in such an emergency must consider the varied needs of audiences, particularly the undereducated, language minorities, and the hearing impaired” (Luo, 2021, p. 3). Given that, in fact, such constraints and needs exist even outside of emergency situations, factoring them into the general training of professional translators could offer a step to addressing these gaps which become more visible in emergency situations.

Translation quality and quality assessment

Translation quality is a longstanding concern, yet what constitutes quality in a translation remains undefined (al-Qinai, 2000), and varies depending on text and translation type, and between theoretical and more pragmatic approaches (see in particular Drugan, 2013). There is also little consensus on how quality is to be assessed, and what aspects of the translation at a textual and extratextual level are to be considered of importance. A “plethora of TQA [translation quality assurance] models and critical ideas on translation quality” (Cheung, 2022, p. 72) exist with different focuses, relying on norms and literal or functional approaches. These are dependent on the definition of a text and whether the source or target text is of greater importance which can also depend on the power balance between languages and for whom the translation is produced—both the commissioner and the end user.

In medical translation, it is often considered that the “accuracy and reliability of the information contained in the texts […] are paramount” (Montalt Resurrecció, 2010, p. 79). Karwacka (2021) argues that “Although the quality of medical translation is frequently conceptualised by researchers and specialists in the field as a requirement for literal accuracy and precision, it is conceptual accuracy (i.e., retaining the same meaning) that is actually desirable, as opposed to word-for-word rendition” (p. 81).

Emergency situations, such as the Covid-19 pandemic challenge “long-established notions and premises in translation theory and practice regarding visibility, equivalence, comprehensibility, source and target contexts, the scope of translation” (Montalt Resurrecció 2010, p. 110). In the case of the Covid-19 pandemic and migrant communities living in the diaspora, the context is one in which source and target language groups occupy the same geographic space and are both having to deal with a novel situation engendering lifestyle changes and thus new linguistic and cultural terms and concepts in all languages.

The issue here is ensuring non-discrimination and equal access to public health messages through translation. The need for equality, accessibility, and quality in public health guidance and messages for all communities dealing with the Covid-19 pandemic makes Taibi’s (2018a) pragmatic functional quality assurance model particularly relevant for examining the process through which DoTW and its partners managed to translate and communicate British government Covid-19 health guidance across England during the pandemic. The translation approach taken in this model is functionalist, focusing on the purpose of the translation to guide the process.

Similar to Taibi’s model, Karwacka (2021) also takes up the idea that translation quality is a process that precedes the actual translation:

[Q]uality assurance starts (or should ideally start) before a translation assignment is commissioned, i.e. when the source text is drafted. This stage includes predicting potential culture-specific problems and assuring compliance with the conventions and requirements of specific text genres or functions, such as readability and clarity in expert-lay communication (p. 81).

Although translator selection takes place prior to translation, and the role and competence of the translator are key to the outcome, it should be borne in mind that while medical translator competence “is significant in translation quality, specifying a method of testing a medical translator’s language skills and other translation competences is yet to be determined in translation research” (Karwacka, 2021, p. 82).

Furthermore, medical translation is often conceptualized as taking place in contexts such as medical research journals and medical trials. A distinction should thus be made in defining the competences of a medical translator versus the competences of a translator working in public healthcare where the end user is more likely to be a lay member of the public than an expert who does not speak the source language fluently. Such a distinction and the tools required to deal with the different target audiences and text purpose should fall under the remit of the training of public service translators in public healthcare.

No consensus exists on the definition of a professional or expert translator. However, in their definition of translation as enabling access, Maaß & Hansen-Schirra (2022) define translators as “experts who identify and remove communication barriers” in order to create “equivalent target texts across languages on the basis of a source text, […] as expert activity to match communication products with users and target situations” (p. 44). In this study, professional translators are taken to be such experts. They are professional qualified translators working for the agencies involved in this project.

Sustainability

In view of the emergency nature of the communication considered here, the sustainability of the translation provided in a rapidly evolving context involving new terms and behaviour in all languages must also be considered as a translation quality issue, albeit not one considered specifically elsewhere. The lack of updated official translations meant that some foreign language speakers looked for guidance from foreign countries where their native language is spoken, even though that guidance was not applicable.

Both financial and human resources come into this factor. Taibi (2018a) states that “Community translation requires public funding, and without favourable policymaking, such financial support cannot be guaranteed. In turn, without sufficient funding, translations are more likely to be assigned—if commissioned at all—to non-qualified volunteers” (p. 14). Voluntary initiatives cannot be sustained without funding to support the work of translators, management and coordination.

The July 2020 letter (Doctors of the World and their partner organizations) sent to the government stated:

[I]t is not sustainable or practical for local authorities and civil society to meet this need. The production of accessible and translated public health information for the public during a public health emergency is a central part of the Secretary of State for Health and Social Care’s statutory duty to protect the nation’s health and wellbeing, and to address health inequalities in England.

These points were reiterated by Covid-19 Infographics: “While it has been lovely to have our work be so well received, it has become clear that we are filling a gap that should be filled by the state” (Majeed, 2020). Another NGO report found that

the government’s rapidly changing and shifting guidance has presented huge challenges for those trying to disseminate this information to migrant communities. These organisations are not resourced to regularly translate information, given the time it takes and the difficulty in disseminating this information while social distancing. (Medact et al., 2020, p. 21)

Sustainability also complies with various elements of the WHO’s Framework for Effective Communication (2017), ensuring the principles that communication is accessible, actionable, credible and trusted, relevant, timely and understandable, as well as identifying the best channels and platforms to disseminate information. In the long-term, such an endeavour cannot be maintained either quantitatively or qualitatively without the financial and other assistance and cooperation of a body with such capabilities: national government and public health authorities, who have a human rights obligation to provide and facilitate public health communication.

DoTW Questionnaire Survey

Methodology

Having reviewed the existing literature and primary documentation in detail above, the findings of my questionnaire survey are presented here.

As previously discussed, given the absence and limitation of state efforts in the United Kingdom, numerous individual, community, charity, local authority, and non-governmental organization initiatives took it on themselves to translate and/or produce foreign language videos of government guidance and Covid-19 information, particularly during the early months of the pandemic in 2020.

The efforts of the medical charity DoTW became particularly prominent through the use of its translations by medical professionals, local and central governmental authorities, and civil society organizations working with vulnerable and migrant communities. Since March 2020, DoTW produced materials in print, and in some cases video and animation format, in sixty languages on its website. How DoTW was able to do this at a national scale without governmental assistance and maintain quality coupled with sustained, rapid production is detailed in the interview exchange attached as an appendix.

Although DoTW also produced materials for the rest of the United Kingdom, this study is limited to England. It should also be noted that from the outset, the work has been a collaborative effort with other organizations and translation agencies mentioned on its website, including the British Red Cross, Covid-19 Infographics, Medact, and Migrants Organise. This collaboration helped to disseminate the translated materials.

Qualitative data was collected through a written survey consisting of eleven open-ended questions put to DoTW’s Policy and Advocacy Manager in an email in July 2021. During this time, lockdowns, restrictions, and changing guidance were still very much the norm. The questions sought descriptive and qualitative information concerning the translation model used, translation quality assurance, and the future sustainability of their service. The email explained the purpose and use of the data collected. Questions were not put to any of its partner organizations or agencies, or any end users. The questions and answers are provided in full in the appendix to this study, and relevant portions of the answers are presented in quotation marks in the “Findings and discussion” section below without citation. Further clarification was sought with respect to some answers. Secondary data were obtained through publicly available materials on the websites of some of the organizations involved, specific reports, such as DoTW’s Rapid needs assessment (2020), and other public reports and documents.

In seeking a suitable translation quality assurance model to analyse the data collected, Taibi’s (2018a) flexible public service translation quality assurance model was found to be relevant and timely. This model

involves the participation of different stakeholders at different stages: before translation (e.g. policymaking, training, selection and briefing of translators), during translation (e.g. appropriate functionalist approach, language appropriateness, consultation with community members) and after translation (e.g. translation checking, seeking community feedback, etc.). Running through these stages is an overarching or transversal value that stems from the nature of community translation: the fact that it aims to empower certain social groups by facilitating access to public service information (Taibi, 2018b, pp. 175–176).

In addition to this model, recommendations made in other relevant reports such as DoTW’s Rapid Needs Assessment, concerning previous measles outbreaks (Mulchandani et al., 2021) and guidelines cited previously, such as the WHO Framework (2017), will also be considered to gain a more comprehensive overview in order to identify good practices that may be applied or adapted to deal with PST needs in future health and other emergency situations.

Findings and discussion

DoTW is the UK branch of a global humanitarian movement working “to empower excluded people to access healthcare” (Doctors of the World, 2024) since 1979. In the UK, DoTW runs “clinic and advocacy programmes in London that provide medical care, information and practical support to excluded people such as destitute migrants, sex workers and people with no fixed address” (Doctors of the World, 2018). Although DoTW’s website provides translations of health information and guides in multiple languages, its translation and updating of British government Covid-19 guidance nationwide for England in sixty languages and multiple formats is perhaps the largest such translation project ever carried out in the United Kingdom, or indeed further afield, by the voluntary sector.

Taibi (2018a) proposes his community translation quality assessment model as a framework or a set of guidelines, with various stages. Some are inapplicable to this particular project. For example, policy-making, he suggests, is

the first step towards offering community translation services and ensuring they meet quality standards [which] is recognition of a societal problem, that there are social groups that do not have (an appropriate level of) access to information, participation and services due to language barriers. (Taibi, 2018a, p. 13)

In the context of the Covid-19 pandemic, the voluntary sector-led initiative was undertaken precisely due to the government’s failure to reach this first step.

There are some other major differences between Taibi’s model and the practice herein, as there were no commercial interests involved in DoTW’s project and there was no public sector/voluntary sector partnership. Indeed, DoTW reported a lack of “engagement” by the government (Evans, 2020). There must also be recognition that certain issues can only be adequately addressed by public authorities, for example translator training. Training in PST, and knowledge of its specific requirements and ethics, is also necessary. However, it is “rarely taught” even as part of translator training (Taibi, 2018a, p. 24), as there is often no training or accreditation available for many minority languages. To compensate for this lack, DoTW used professional certified translators and one of the agencies it worked with stated in this regard: “our translators are not just professional translators, but they are also qualified in a related technical discipline and have also worked within the healthcare industry, in medicine, medical technology or pharmaceuticals” (Gauld, 2020).

Another significant difference between Taibi’s model and DoTW’s approach is that Taibi’s model rightly takes the commissioner of a public service translation to be a public authority. The difference in the power and resources of public bodies and a charity are immense. However, this suggests that if such a project can be implemented successfully at such a scale with far fewer resources, it is also perfectly feasible for public health authorities and national governments, including with respect to the remuneration of the translators, to get involved. Most of DoTW’s translation projects usually involved five to ten languages. The Covid-19 guidance translation project, involving sixty languages and a far broader audience than the marginalized communities DoTW usually targets, was its largest ever. The project “included language requests from the community and asylum and migration sector too. The reason was, because there was a lack of effort from public organisations to translate the health information, we stepped in to fill in this gap”.

Taibi’s inter-professional, translation, and post-translation stages, covering translator selection, briefing, and community involvement, among others, were more than adequately covered. Early on in the pandemic, in March and April 2020, DoTW used “both professional agencies or individuals and unpaid volunteer professionals.” As translation costs were not budgeted in its core work, there were no funds available for such a large project: “We paid for ten languages in the first version of the guidance in mid-March, and the professional agency provided ten further languages pro bono.” One agency, Transbless Translations, provided assistance in thirty different languages and ensured professionalism in the translations it contributed. For example, “A team of four professional translators created the Simplified Chinese translation with oversight by a Chinese colleague in South Africa and double proofread by a dermatologist in China.” Furthermore:

The Coronavirus (Covid-19) Guidelines also contains very important legal information for refugees. This particular paragraph was looked [sic] closely by our legal expert and translated in a simple and understandable way in order for refugees to understand the important instructions from the government. (Nelson, 2020)

For other languages, DoTW put out a call for volunteers on social media and “got a few more languages pro bono from unpaid volunteers.” In this way, translation from English into sixty languages was achieved: “Since May 2020, we never used unpaid volunteers, and have always used agencies when translating all guidance.”

To support and facilitate the sustainability of its translation work, DoTW received a three-month funding grant of GBP 45,000 from the Greater London Authority (GLA) in May 2020 (Kierans, 2020, p. 15). This helped it to move to completely professional paid translation and also led to more partnerships and different formats, “for example animations which are more engaging”. Although the official guidance was produced as text, with few graphics, DoTW was able to produce audio and video resources too before settling for more engaging animations “which are shorter and to the point.”

Regardless of the format, translation quality was a “crucial aspect of our project”: translations were checked by a proofreader who is a native speaker of the target language and a certified translator. In addition, the translations were checked during the final formatting: “when creating image documents, there were often different fonts used in different software programmes so we had to double check the translations after graphics design was applied.”

Cultural terms and novel terms and concepts relating to the pandemic were dealt with in collaboration with agencies and translators: the main agency involved checked the English source texts to ensure that all terms and content were understood correctly before they were translated. Culturally assisted translations were used to deal with terms that were difficult to translate, such as “immigration bail condition/reporting requirement”, in addition to covering specific cultural and religious needs:

This was also done in Yiddish, where a rule about attending funerals was not culturally appropriate, so we agreed with translators on a culturally appropriate translation, even though this means a slightly different English version when translated word for word.

Through proof checks and “informal sense-checking with community members who speak the language”, some errors were picked up, such as “when the advice was to use paracetamol, in the Vietnamese version, we had ‘painkillers’, which was incorrect as the medical advice was not to use ibuprofen at that time.” In addition: “We also heard from certain communities that formal language and street-level language varies so there was conflicting feedback especially in Polish and Romany” which was considered and incorporated.

DoTW’s approach and practice broadly satisfies the quality assurance requirements of Taibi’s model at its various levels, including translation checking at various stages, as well as community consultation and feedback. The approach also involves communication between DoTW as the translation commissioner, the target communities and the translation agencies to ensure the effectiveness of the communication and thus the empowerment of the community to deal effectively with the public health risk posed by Covid-19.

DoTW’s approach also broadly endorses and applies the findings of the 2017 measles outbreak (Mulchandani et al., 2021), particularly as concerns attention to the needs of the target community, and the language and repertoire actually used by it. Particularly through its partnership with other organizations to disseminate materials, and its use of various formats, such as videos and infographics, it broadly meets the WHO’s (2017) own communication framework goals. Furthermore, although trust, an important and qualitative aspect of PST is not considered here, through its partnership model with organizations who are trusted by communities, medical practitioners and local authorities, the translation project was not only disseminated but also widely trusted.

DoTW stated that “It was also promising to see public organisations like the NHS and Home Office using our resources to ensure better outreach, so hoping that our service has made a difference in the knowledge levels about Covid19”. To improve knowledge levels in dealing with health emergencies and migrant communities since the pandemic, it is essential that:

The effectiveness of urgent public health messaging strategies in linguistic minority communities should be further studied in order to plan future efforts to reduce the spread and burden of disease, to increase appropriate access to care (including telehealth and language services, when indicated), and to address specific community needs (e.g., living conditions, job loss, and immigration concerns). Public health messaging to these groups cannot simply be literal translations of dominant-language messages but must address the social determinants of health that affect access to care and health outcomes, the force of which increases under pandemic conditions. (Ortega et al., 2020, p. 1533)

The success of such voluntary projects, however, does not dismiss the role public authorities can and must play in various ways. For example, through the dissemination of the translated materials,

language services are only useful if they are able to reach the people who are in need of them. Developing online platforms for the spread of information is certainly a valuable strategy, but it risks being ineffective if people who need this information are unable to access them. (Civico, 2021, p. 16)

Sustainability and duplication of efforts are other challenges DoTW faced that the government should ideally be placed to address through funding and coordination: “there were other charities or government doing translation of the same information too, and the lack of coordination yields duplication of resources and is a waste of time and effort”. Public funding could expand on formats and the number of languages covered.

In spite of some public funding via the GLA, greater participation and coordination between both local and central government and the non-governmental organizations involved, as well as funding, is necessary. Nezafat Maldonado et al. (2020) state that “Governments should urgently partner with non-governmental organizations who already play a key role in addressing unmet health needs” in order to highlight the important role played by civil society alongside public authorities, to “provide appropriate information on COVID-19 and deliver acceptable, appropriate, accessible health services to migrant groups” (Nezafat Maldonado et al., 2020). The fatal consequences of discriminatory and exclusionary practices witnessed prior to and during the pandemic mean that it is essential that “Given the real-life interests at stake and the human lives affected by its availability and quality, community translation cannot be left to ad hoc approaches and measures” (Taibi, 2018b, p. 176).

DoTW’s approach offers a promising collaborative model for public health authorities to adopt and follow to ensure translations, and the format they are provided in, are suitable for target communities.

Conclusion

In January 2021, “the UK had the highest number of recorded deaths per capita in the world” from Covid-19 (Stevens et al., 2021, para. 1). Black and minority ethnic communities were “disproportionately represented in more deprived areas and high-risk occupations; these risk factors are the result of longstanding inequalities and structural racism” (Marmot et al., 2020, p. 14). Among these contributing inequalities is the unequal access to the right to health and the determinants of health.

Language access is just one component of this. The failure to provide and update translations in community languages spoken in England cannot be viewed independently of other discriminatory and exclusionary policies against migrant communities in English healthcare, such as the “NHS charging and data sharing with the Home Office” (Medact et al., 2020, p. 2) which acts as a deterrent to accessing healthcare. It is nonetheless an important aspect that has been raised in numerous reports and studies both in the United Kingdom and elsewhere. Public health guidance was just one area where a lack of translated resources negatively affected migrant communities: the lack of translation of benefits and support schemes for individuals and companies having to work from home, unable to work or newly unemployed meant that many foreign language speakers were unaware of their rights or entitlements, and some became victims of fraud (Lopez Zarzosa, 2021, p. 5).

The findings of this study show that it is feasible to provide suitable translations by paid professionals in multiple community languages that ensure that not only is a translation provided but that the content is accessible and comprehensible to the target communities.

But while DoTW has demonstrated an effective model of how to do this, in the long term, government bodies are best placed in terms of existing resources and infrastructure to perform and manage such a task.

Although this project may not have translated into government action at the national level, its positive impact has been acknowledged and translated into action by the Greater London Authority (GLA, 2021) who, after their initial funding of this project, approved a further GBP 55,000 to “the provision of translated information related to the COVID-19 response and recovery, and to improve the reach and accessibility of resources to London’s multilingual communities” (Executive Summary). Both the provision of translated materials and their accessibility were recognized as being important to the recovery of a major multilingual and multicultural city.

Furthermore, while DoTW reported in the interview that “the guidance documents were downloaded more than 75K [75,000] times from our website, showing the interest from the community”, the GLA (2021) reported:

These resources have proved to be effective with positive feedback from communities and have resulted in over 45,000 visits to the GLA translations hub page where there are valuable translated resources, and a social media campaign receiving over 2.7 million impressions. (Part 1, para. 1.4)

The report acknowledges that the format and accessibility of the platforms on which are resources are shared do matter, though “there remain gaps in the rapid translation of information, which can have an immediate impact on Londoners’ health and wellbeing.” (GLA, 2021, Part 1, para. 1.7).

The good practices identified and implemented in this project must be translated by public authorities on a larger scale. Governments have a human rights obligation “to act on the needs of migrants in the pandemic including but not limited to translation of public health communications” (Nezafat Maldonado et al., 2020, para. 31). Unequal access to the right to health in all its components exacerbate public health emergencies. The past few years have indeed seen a rapid expansion in health inequalities for many and particularly vulnerable and disadvantaged communities in the United Kingdom.

Although Taibi (2018b) states that “Budgetary constraints are often cited to justify lack of optimal translation services or a low volume of multilingual resources available to speakers of non-mainstream languages” (p. 174), a successful model of how this can be achieved on a low budget to provide accessible and meaningful communication has been established.

Further study is necessary to scale such translation up qualitatively within general and emergency public health communication without compromising on translation quality as a step towards addressing and reducing discriminatory practices that undermine the human right of all to health. This should include how to overcome and address financial, institutional and dominant cultural barriers. Further study of the functionalist approach to the actual translations produced, which was not considered in this study, would help to do this, particularly by assessing the texts produced by both the government and DoTW, as well as building on Cheung’s (2022) study by comparing the quality of the documents produced by government authorities and DoTW and its partners.