Development of a Universal Symbol for LEP Individuals

Many limited English proficient (LEP) individuals may not know how to access language services. Information and notices sent by public health programs, health care providers, and insurers are often provided primarily in English. If information in a non-English language is included, it often is the last page of a long notice and only available in a limited number of languages.

The Office of Minority Health, part of the U.S. Department of Health and Human Services, is exploring creation of a universal symbol for language access. The goal of a universal symbol is to improve awareness and use of language access services by LEP individuals. The symbol could be used on websites, in physical locations (e.g. hospitals, clinics, offices) and on paper and electronic documents.  

OMH wants your input! They want your answers to certain questions. You can answer 1 or more of them:

  • Do you believe a new graphic symbol informing people about the availability of language assistance services is important? Why?
    • For example, would it increase the rate at which people request language assistance services or increase access to information about health services, programs, and/or products?
  • What steps do you recommend for developing a new symbol for language assistance services?
    • For example, are there frameworks or standards that should be considered to support the development, testing, implementation, and dissemination?
  • Are the current ways of informing LEP individuals about language access effective? Why or why not (be as specific as possible)?
  • How can we ensure a symbol is used by LEP individuals, healthcare providers, public health departments, and other entities engaged in health care?


The right to language access in health services is derived from Title VI of the Civil Rights Act of 1964. Executive Order 13166 built on this protection, requiring that federal agencies draft and implement plans to ensure meaningful access to their federally conducted services. They must also provide guidance to their federal fund recipients regarding their obligations under Title VI and its implementing regulations to provide meaningful access to LEP persons. With respect to health care, § 1557 of the Affordable Care Act expressly extends the protections of Title VI (and other federal protections against discrimination) to “any health program or activity, any part of which is receiving Federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an Executive Agency or any entity established under this title.” The regulations implementing § 1557 of the Affordable Care Act expressly address language access, requiring all regulated entities to “take reasonable steps to ensure meaningful access to such programs or activities by limited English proficient individuals.” Yet to date, many limited English proficient people are unaware of their rights under these protections.

The need for language access in health care is significant: more than eight percent of the U.S. population, that is, more than 26 million citizens and residents, is limited English proficient (LEP). The Department of Justice defines LEP as those five years of age or older who identify as speaking English less than “very well.” The provision of language access in health care is correlated with better patient outcomes, better compliance with instructions such as prescriptions and hospital discharge orders, and greater patient satisfaction.  Given the strong desire across the federal government to address racial disparities and social determinants of health, improving awareness of the right of language access services, and how to access them, is important.