Why cultural mediation is essential for access to healthcare
Too often, people on the move, coming from different countries and seeking better living conditions, find themselves facing barriers in Italy that are as trivial as they are insurmountable when it comes to accessing the services that every citizen normally benefits from. Unfortunately, this is due to different languages and cultures and, above all, to the absence of key figures in intercultural mediation. Healthcare is one of the sectors where linguistic and cultural mediation is essential.
When words are lacking, care is lacking too
In an increasingly multicultural Italy, access to healthcare services can no longer be separated from a real ability to listen, understand and relate to people from different cultures and languages. The right to health – enshrined in the Constitution and recognised internationally – can only be realised when communication between patients and healthcare professionals is effective, understandable and respectful. For this reason, cultural mediation is now an essential service.
Cultural mediators are not simply translators. They are professionals who facilitate dialogue between migrants and healthcare personnel, connecting not only different languages, but also different cultures and different views of the body, health, illness and care. They work in places where vulnerability is at its highest: in informal settlements, reception centres, clinics, outpatient clinics, emergency rooms and hospitals. They listen, explain, understand and convey essential information. They help build bridges and trust.
‘I was ill, I had severe chest pain. I tried to figure out how to get a medical examination quickly, but I couldn’t understand where I should go and who should examine me. At the hospital, they got angry because I started to get agitated out of fear, but I couldn’t explain myself, so I left. I thought I was going to die because I didn’t know where to go and, not knowing Italian, I didn’t know what to do or who to talk to. A few days later, near the station, I saw a vehicle belonging to INTERSOS. It was a mobile clinic with a doctor and a mediator. They explained to me in my own language that I had a simple stomach ache, probably caused by not eating properly. Now I feel better, and the mediator, who is from my country, also explained what I can eat to feel better, without giving up our traditions’.
INTERSOS has been working for years in Sicily, Puglia and Rome to ensure fair and dignified access to medical care, with a particular focus on migrants, asylum seekers and refugees. In every healthcare intervention – from medical or psychological counselling to health promotion and accompaniment to local services – our cultural mediators are an integral part of the team. Their contribution makes possible what would otherwise remain partial, ineffective or incommunicable.
In our experience, when cultural mediation is present, there is greater adherence to treatment pathways, understanding of symptoms and therapies, fewer dropouts and misdiagnoses, and greater trust in the healthcare system. In short: better health and higher quality interventions for all. Yet, despite the evidence, institutional recognition of cultural mediation in healthcare remains fragile, uneven and, in many areas, insufficient.
In 2023, Sicily established a regional list of linguistic and cultural mediators and facilitators. This is certainly an important step, but there is still a lack of public data on the actual presence of these professionals in healthcare services.
At the national level, the profile of the mediator is not yet firmly included in the essential levels of care. Furthermore, too often, their employment depends on temporary, precarious and fragmented projects.
Health is not just about treatment. It is about relationships, trust and communication. It is about mutual recognition. For this reason, there is no such thing as a healthcare system that is fair and accessible to all, treating people without cultural mediation.
What is needed in Italy
INTERSOS urgently calls on the relevant institutions – at all levels – to make a concrete commitment to ensuring equitable and universal access to healthcare through the structural integration of cultural mediation into public healthcare systems. In particular, we call for:
- The formal and stable recognition of the professional role of cultural mediator at national and regional level within public healthcare services;
- The stable recognition of the role of mediator within public healthcare services and its inclusion in the Essential Levels of Care (LEA);
- The adoption of common training standards and professional qualification pathways that enhance linguistic, cultural and interpersonal skills;
- Structural and non-occasional funding of cultural mediation services, with dedicated funds and operational continuity;
- Monitoring and systematic collection of data on the presence, activities and impact of cultural mediation in healthcare contexts;
- The active participation of cultural mediators in the definition of healthcare policies that affect them, as professionals and bearers of experience.
Mediation is not just translation. I see a person and immediately understand what difficulties they are facing. I come from the same background, I know how they think, I know why they have certain fears and why certain things are more difficult for them.
Souleye Wague, mediator with INTERSOS