Fighting words: for millions of U.S. residents still learning English, language access is sometimes a matter of life and death--and increasingly, a fight for civil rights.

ON A COLD NEW YORK CITY NIGHT years ago, Josefa Marin rushed her daughter to the hospital. The baby girl had fallen out of a defective high chair. A recent immigrant from Mexico, Marin was still learning and could not yet understand English. When she got to the hospital, she faced suspicious questioning about how her daughter was injured. In Spanish, Marin explained what had happened. The monolingual hospital employees didn't understand her, but they wouldn't call an interpreter. Instead, they called the city's Administration for Children's Services, who took custody of the baby under the assumption that Marin had abused her child. After a month without seeing her child, Marin got her day in court. As soon as a family court judge got to the bottom of the matter, at a translated hearing, Marin was reunited with her baby.

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This type of horror story is par for the course for people who don't speak English in America. According to Glenn Flores, a professor at the Medical College of Wisconsin, Milwaukee, less than 23 percent of teaching colleges train doctors in how to work with an interpreter. Almost half of emergency room visits with patients who speak limited English are not conducted in a language these patients can understand. As a result, they suffer "impaired health status, less likelihood of being given a follow-up appointment, greater risk of hospital admissions and more drug complications," according to Flores.

Every time a person still in the process of learning English is mistreated in a hospital or cannot access public services because of language barriers, it chips away at hard-won civil rights protections. The legacy of the civil rights movement is embedded in our laws. Decades of struggle, sit-ins, marches, organizing and political work won the passage of the Civil Rights Act of 1964. In addition to protecting the rights of the African Americans who led the movement, the Civil Rights Act also protects a wide array of newer populations within the United States.

While we all know that it is illegal to discriminate of the basis on race, religion or national origin, we often forget the breadth of our civil rights protections. For example, failure to provide needed translation or interpretation services has consistently been understood by the courts to be tantamount to national origin discrimination.

The number of people in the United States who are still learning English is rapidly increasing. Since 1990, immigration has reshaped our nation, and these demographic shifts have created an imperative for our government to adapt.

In the 1990s alone, almost seven and a half million people came to the United States. Immigrants have flocked to major cities like New York, Chicago and Los Angeles, but increasingly they are settling in smaller cities like Denver or suburbs like Long Island. In 1990, 30 percent of Latino and Asian populations lived in New York and Los Angeles. By 2000, that percentage had decreased to 23 percent, according to a recent study from the Brookings Institution.

Many of these new arrivals have not yet mastered English. Also, many U.S.citizens do not speak English. In New York City, for example, there are close to one million U.S. citizens from Puerto Rico, and many of them arrive in the United States before they learn English.

In Los Angeles, one out every three people over 5 years old is estimated to be "limited English proficient." In New York City, it's one out of every four people--that's two million people. In 2000, in the United States as a whole, there were more than 21 million people who were still learning English, an increase of 50 percent since 1990.

Language access problems affect everyone. How can the police respond to a 911 call reporting a crime-in-progress if the operator can't find anyone who can speak the language of the caller? How can the Department of Labor enforce labor laws if it is unable even to interview over 20 million of the country's most vulnerable workers who don't speak English? How can public hospitals diagnose, treat and contain contagious diseases when doctors and nurses can't even communicate with millions of patients?

The recent wave of immigration has been accompanied by an ugly backlash of nativism and cultural panic. Not only is the government failing to provide necessary translation and interpretation services, in many places it's actually prohibiting the provision of these vital services by passing laws that mandate the use of English and only English at government offices. Even the Senate's "compromise" immigration reform bill included a prohibition on requiring language assistance services.

For immigrants who are still learning English, translation or interpretation services can be a matter of life and death. In New York City in the late 1990s, Juana Alvarez lost her child because she couldn't explain to doctors in a crowded Brooklyn emergency room that she had gone into labor. Years later, the hospital signed a corrective action agreement with the New York State Attorney General's office to improve language assistance services for their patients. Unfortunately, the reforms came too late for Alvarez and other immigrant patients.

Whether it is a pregnant woman who can't describe complications with her pregnancy, or a family that can't make a complaint to municipal authorities about a lack of heat or running water in their apartment, language assistance services are fundamental to promoting public health and immigrant dignity.

Immigrant community organizations have been fighting for equal access to government services for many years. In many places, they've won significant public policy improvements.

A powerful example of these policy improvements is evident in New York, where, in the past 10 years, community organizations, labor unions and policy advocacy organizations have come together to both enforce and expand the civil rights of immigrants. Led by democratically-structured grassroots organizations of immigrants, the coalition of groups working on this issue has won over $50 million in new public investment in language assistance services to ensure equal access to government services.

In 1998, a group of Spanish-speaking welfare recipients organizing with the community group Make the Road by Walking, where I am co-director, released a report entitled System Failure that detailed widespread violations of the Civil Rights Act at local welfare centers. These mothers began a campaign of direct action to draw attention to the problem. New York City's fast-growing Spanish-language media paid an enormous amount of attention to the story. Their customers were affected. The city's established Puerto Rican and emergent Dominican politicians got the message, and soon aspirants to citywide elected office of all races followed suit. The New York Immigration Coalition brought other immigrant populations into the struggle.

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Nonetheless, the coalition didn't have quite enough juice to pass city legislation. The women from Make the Road by Walking had worked with attorneys to draft local legislation that required expanded translation and interpretation services at Medicaid, food stamps and welfare centers that serve over one million New Yorkers. The bill was stalled in the City Council without the support of the powerful city council speaker.

When the Immigrant Workers Freedom Ride rolled into New York City in October 2003, organizers and allies in immigrant-heavy local unions like SEIU Local 32BJ were able to make politicians' participation in the event conditional on working to pass the legislationt. Within months, it became law.

Two years later, the same coalition of groups worked with the city council and the mayor's office to create a new local law that requires expanded language assistance services at all New York City public schools to promote parent involvement and immigrant student achievement. Providing language assistance services costs money, but not that much. Agencies in New York City have done it for a fraction of a percent of their overall budget, which is impressive considering the number of people who benefit from these services. Also, effective communication can lead to savings by preventing unnecessary errors and repeat appointments.

In September 2006, the coalition pushed the New York State Department of Health to issue new regulations that require expanded translation and interpretation services at over 150 hospitals.

These are major political victories. Nonetheless, they are limited to particular government agencies. The majority of government services, even in New York, and even in the face of this organized movement to expand civil rights, are still provided only in English.

Similar gains have been won in Washington, DC, California and Hawaii. In general, these new laws require government agencies only to "accommodate" limited-English-proficient people and stop short of mandating the comprehensive translation and interpretation services that people really need. In contrast, Pennsylvania and Michigan have passed English-only legislation, mandating the use of only English in many government offices and agencies. At the federal level, Republicans in both the House and Senate have been working to roll back decades of civil rights protections for immigrants.

In cities and towns with emergent immigrant populations, the anti-immigrant backlash has been most extreme. English-only initiatives have often been accompanied by violence against immigrant day laborers and other immigrants. Similar violence and lawlessness confronted African Americans and civil rights activists when they began to assert political strength in the '50s and '60s. Demographics continue to shift, and immigrants, their families and their communities are gaining political power. Over the long haul, politicians embrace xenophobia at their own peril.

In New York, we have seen that aggressive grassroots organizing and direct action, coupled with innovative policy work and broad coalition-building can seize the initiative and win real civil rights gains that benefit millions of people. Once immigrants have political power, everyone will want to speak their languages.

Andrew Friedman is a fellow at the Drum Major Institute for Public Policy and co-director of Make the Road by Walking.