1Getting care in a second language is hard

In a national 2023 survey, 31% of immigrant adults with limited English said language made it hard to get care. Among those who took the survey in a language other than English, 17% said an interpreter wasn’t available or didn’t come in time. KFF 2023

2Fear and immigration stress

In the same survey, about 1 in 4 likely-undocumented immigrants avoided applying for food, housing, or health assistance because of immigration-related fears. Many immigrants were unsure about “public charge” rules. KFF 2023

3Feeling unheard

About 3 in 10 immigrant adults reported at least one problem getting respectful, culturally competent care, such as a provider not listening (17%) or not explaining things understandably (15%). KFF 2023

4Family at the bedside

In a study of hospitalized Spanish-speaking patients, families were a source of comfort. But when a family member interpreted, they sometimes also ended up as the decision-maker, and family interpreting raised accuracy worries. Patients preferred in-person interpreters. Nguyen et al. 2024

✦History

Winston-Salem formed in 1913 when the towns of Winston (1849) and Salem (1766) joined. Moravians founded Salem, a name drawn from “Shalom” (peace). By 1880, Hanes (textiles) and R.J. Reynolds (tobacco) had factories in Winston. NCpedia-WS

North Carolina Baptist Hospital opened in 1923 with 88 beds. The Wake Forest medical school moved to Winston-Salem in 1941. WFB history

✦Communities and languages Forsyth County

• 16.2% of residents age 5+ speak a language other than English at home. Spanish: 12.2% (about 44,800 people). C16001
• 5.9% (about 21,800) speak English less than “very well.” Among Spanish speakers, the figure is 39%. C16001
• After Spanish, the next language groups are much smaller: Chinese (~2,000), French/Haitian/Cajun (~1,400), and Arabic (~1,100). C16001
• 9.7% of residents were born abroad. Most common birthplaces: Mexico (34% of foreign-born), El Salvador (8.5%), China, Colombia, India, the Philippines, the Dominican Republic, and Honduras. B05006/B05002
• Wider Winston-Salem metro: 12.8% speak a language other than English; 9.8% speak Spanish. C16001 metro

✦What patients face

See what patients often go through. Here, Spanish dominates, and many Central American–born patients come with their families.

✦Local pride

• Old Salem, a living-history museum preserving 60+ Moravian buildings NCpedia-WS
• Krispy Kreme, founded in Winston-Salem in 1937 NCpedia-KK
• Winston-Salem State University, which opened in 1892 as Slater Industrial Academy NCpedia-WS

✦History

The area was home to the Catawba people before European settlers arrived around 1750. Charlotte was established in 1768 and named for Queen Charlotte of Mecklenburg-Strelitz. Gold found nearby after the Revolution led to mints and banks, the roots of its “banking capital of the South” reputation. NCpedia-CLT

Atrium’s story starts in 1876 with Charlotte Home and Hospital, the state’s first civilian hospital, opened by the women of St. Peter’s Episcopal Church. Charlotte Memorial Hospital followed in 1940 and became Carolinas Medical Center in 1990. Atrium CMC

✦Communities and languages Mecklenburg County

• 22.3% of residents age 5+ speak a language other than English at home. Spanish: 13.3% (about 144,000). C16001
• 10.3% (about 112,000) speak English less than “very well.” Among Spanish speakers, the figure is 53%, the highest of any region here. C16001
• After Spanish come other Indo-European languages (~24,000; this census group includes Hindi, Gujarati, Urdu, Bengali, and others Census lang groups), other Asian and Pacific Island languages (~20,000), French/Haitian/Cajun (~10,000), Vietnamese (~7,400), Chinese (~6,900), Russian/Polish/other Slavic (~6,700), and Arabic (~5,000). C16001
• 17.3% of residents were born abroad. Most common birthplaces: Mexico (14%), India (11%), Honduras (10%), El Salvador, Vietnam, Colombia, Guatemala, and China. B05006/B05002
• Charlotte metro (NC–SC): 16.1% speak a language other than English; 6.7% have limited English. C16001 metro

✦What patients face

See what patients often go through. A large share of Spanish speakers here have limited English, so interpreters often carry whole conversations: consent, discharge, family meetings.

✦Local pride

• The “Queen City” name, the gold-rush roots, and a strong NASCAR presence NCpedia-CLT
• The Tree of Life logo that has hung at CMC since 1982 Atrium CMC

✦History

Milwaukee’s name is most often translated as “the good land.” Three rival settlements (Juneautown, Kilbourntown, Walker’s Point) merged into one city in 1846. By 1890, 86% of residents were immigrants or their children: Germans above all, with Polish families on the South Side. EMKE-City

Mexican workers arrived in the 1920s. EMKE-Mex Hmong refugees from Laos began arriving in the mid-1970s. EMKE-Hmong Aurora took shape in 1984 when St. Luke’s and Good Samaritan joined, and took the Aurora name in 1987. AAH library

✦Communities and languages Milwaukee County

• 18.6% of residents age 5+ speak a language other than English at home. Spanish: 12.0% (about 104,000). Limited English: 7.0%. C16001
• The second-largest group is “other Asian and Pacific Island languages” (~17,600). This census category includes Hmong, Burmese, and Karen, among others. Census lang groups The county has about 14,600 Hmong and 5,500 Burmese residents (Asian alone; a population count, not a count of speakers). B02015
• 9.9% of residents were born abroad. Most common birthplaces: Mexico (38%), India, Burma/Myanmar, Thailand, Laos, and China. B05006/B05002
• Other Aurora markets (share speaking a language other than English / Spanish share): Kenosha 13.1% / 8.8%; Racine 9.1% / 7.0%; Waukesha 7.7% / 2.8%; Brown (Green Bay) 10.2% / 6.6%; Sheboygan 9.6% / 4.2%. Brown and Sheboygan each have about 4,600–4,700 Hmong residents, and Winnebago (Oshkosh) about 3,200. C16001 B02015

✦What patients face

See what patients often go through. In a Wisconsin study, Hmong adults with limited English said they often turn to bilingual adult children or spouses for serious decisions. The authors describe this as a shift away from relying on clan leaders and elders. WMJ 2023

✦Local pride

• Brewing (Schlitz and Pabst were once the world’s two largest brewers) and Harley-Davidson EMKE-City
• Mexican Fiesta, held since 1973 EMKE-Mex
• Hmong New Year celebrations EMKE-Hmong

✦History

Chicago’s first permanent non-Indigenous resident was Jean Baptiste Point du Sable, a free Black man from Haiti, in the 1770s. Chicago became a city in 1837 and rebuilt after the Great Fire of 1871. After the fire, waves of immigrants came for factory and meatpacking jobs, and many found help at Jane Addams’s Hull House. Chicago.gov

Advocate grew out of faith communities: a German Evangelical deaconess hospital, and an 1897 Norwegian Lutheran deaconess hospital in Humboldt Park. The two systems merged into Advocate Health Care in 1995. AAH library-Adv

✦Communities and languages Cook County

• 35.8% of residents age 5+ speak a language other than English at home, the highest of any region here. Spanish: 21.1% (about 1.03 million). Limited English: 14.0% (about 689,000). C16001
• The second-largest group is Russian, Polish, or other Slavic languages (~207,000), followed by other Indo-European (~165,000), Chinese (~69,000), Arabic (~51,000), Tagalog (~49,000), and Korean (~27,000). C16001
• 21.7% of residents were born abroad. Most common birthplaces: Mexico (35%), Poland (7.6%), India (7.0%), the Philippines, China, Ukraine, Korea, and Ecuador. B05006/B05002
• Suburbs (share speaking a language other than English / Spanish share): DuPage 29.6% / 11.5%, where India (19%) nearly ties Mexico (20%) as the top birthplace; Lake 31.4% / 19.0%; Kane (Elgin) 31.8% / 26.1%. C16001 B05006

✦What patients face

See what patients often go through. One example from the Chicago area: Chinese immigrant women in Chicago’s Chinatown described holding back questions so their doctor could “save face,” and blaming their own English for misunderstandings. Tan et al., citing Simon et al. 2021

✦Local pride

• Reversing the Chicago River in 1900 for public health Chicago.gov
• Route 66 starts in Grant Park Chicago.gov
• Willis Tower was the world’s tallest building from 1974 to 1998 Chicago.gov

✦History

Macon was founded on Muscogee (Creek) land ceded in 1821 and incorporated in 1823. The Ocmulgee Mounds there reflect thousands of years of Native American life. NGE-Macon The Macon Hospital opened in 1895 and is now Atrium Health Navicent The Medical Center. Navicent

Rome was founded in 1834 on the site of a major Cherokee settlement, Head of Coosa, before the Cherokee removal in the late 1830s. NGE-Rome

✦Communities and languages

• Bibb County: 5.9% speak a language other than English; Spanish 3.1%; limited English 2.2%. Only 3.8% were born abroad. Most common birthplaces: Mexico, India, Korea, Pakistan, El Salvador, and Venezuela. These are small counts. C16001 B05006
• Floyd County: 11.4% speak a language other than English; Spanish 9.3%; limited English 4.8%. 6.6% were born abroad. Most common birthplaces: Mexico (42%) and Guatemala (28%). C16001 B05006

✦What patients face

See what patients often go through; it applies here too.

✦Local pride

• Macon: the Cherry Blossom Festival, the music heritage of Little Richard and Otis Redding (“Soul Lives Here”), and Mercer University NGE-Macon
• Rome: the 1871 Clocktower, the Capitoline Wolf statue gifted by Italy in 1929, and the Chieftains Museum, the former home of Cherokee leader Major Ridge NGE-Rome