Linguistic fairness in the U.S.: The case of multilingual public health information about COVID-19

Lack of high-quality multilingual resources can contribute to disparities in the availability of medical and public health information. The COVID-19 pandemic has required rapid dissemination of essential guidance to diverse audiences and therefore provides an ideal context in which to study linguistic fairness in the U.S. Here we report a cross-sectional study of official non-English information about COVID-19 from the Centers for Disease Control and Prevention, the Food and Drug Administration, and the health departments of all 50 U.S. states. We find that multilingual information is limited in many states, such that almost half of all individuals not proficient in English or Spanish lack access to state-specific COVID-19 guidance in their primary language. Although Spanish-language information is widely available, we show using automated readability formulas that most materials do not follow standard recommendations for clear communication in medicine and public health. In combination, our results provide a snapshot of linguistic unfairness across the U.S. and highlight an urgent need for the creation of plain language, multilingual resources about COVID-19.