How to Close the LGBT Health Disparities Gap
December 21, 2009
By Jeff Krehley
In the past decade lesbian, gay, bisexual, and transgender, or LGBT, people have made rapid progress in winning and securing equal rights. Fifteen states and Washington, D.C. now give same sex couples at least some of the same rights afforded to heterosexual married couples. Even more states offer nondiscrimination protections based on sexual orientation, gender identity, or both. Polling data show that the general public has increasingly positive views of LGBT people and are becoming more supportive of their civil and political rights. In short, heterosexual Americans are finally recognizing LGBT people as a legitimate social minority that should have equal access to our society’s basic rights, opportunities, and responsibilities.
Despite this progress, however, members of the LGBT population continue to experience worse health outcomes than their heterosexual counterparts. Due to factors like low rates of health insurance coverage, high rates of stress due to systematic harassment and discrimination, and a lack of cultural competency in the health care system, LGBT people are at a higher risk for cancer, mental illnesses, and other diseases, and are more likely to smoke, drink alcohol, use drugs, and engage in other risky behaviors.
People who are both LGBT and members of a racial or ethnic minority will often face the highest level of health disparities. For example, as the National Coalition for LGBT Health notes, a black gay man faces disparities common to the African American community as well as those suffered by the LGBT community, and a transgender Spanish speaking woman, regardless of her sexual orientation, must navigate multiple instances of discrimination based on language, ethnicity, and gender. A companion CAP brief, ''How to Close the LGBT Health Disparities Gap: Disparities by Race and Ethnicity,'' explores these in more detail.
Health surveys cannot continue to treat populations in isolation: Members of the LGBT community who are members of other populations that are recognized as suffering from health disparities must be allowed to identify themselves fully on surveys, including their sexual orientation and gender identity.
We can only estimate the full extent of LGBT disparities due to a consistent lack of data collection on sexual orientation and gender identity. No federal health survey includes a question on sexual orientation or gender identity, and only a few states ask respondents their sexual orientation or gender identity, severely limiting researchers' ability to fully understand the LGBT population's needs and hindering the development of public policies and programs that seek to improve the LGBT population's health and well being.
To overcome this lack of data and make it easier for researchers and advocates to get a full and accurate accounting of LGBT health outcomes and needs and ultimately to close the gap between the health and well being of LGBT people and the heterosexual population the U.S. Department of Health and Human Services should establish a dedicated Office of LGBT Health. This office would take the lead in coordinating a consistent and scientifically driven response across HHS to LGBT health issues. A top priority of this office should be to ensure that any federally funded health study that collects demographic information be it age, sex, race, ethnicity, primary language, or socioeconomic status must also include questions about sexual orientation and gender identity.
This memo will outline the health disparities LGBT populations face, look at why these disparities occur, and examine why we need better data on these populations and what we can do to solve this problem.
Source of health disparities
The companion piece to this brief shows that the cumulative and intersecting impact of three main factors contributes to significant negative health outcomes for LGBT people: their reduced access to employer provided health insurance, the social stigma that exists against LGBT people, and a lack of cultural competency in the health care system. For people of color, a lack of affordable health care and insurance and culturally competent service providers along with persistent racism in society are some of the largest causes of health disparities. An LGBT person of color faces the combined impact of these barriers, increasing the likelihood of negative health outcomes.
Health disparities among transgender people of color While there is almost no data about the health disparities faced by transgender people of color, the combined impacts of racism and transphobia undoubtedly lead to worse health outcomes. The few statistics that do exist around the health disparities faced by transgender people focus almost exclusively on transgender women and incidence of HIV/AIDS.
These statistics show drastically high rates of HIV/AIDS among transgender women. In California, for example, publicly funded counseling and testing sites report that transgender women have higher rates of HIV diagnosis (6 percent) than all other risk categories, including men who have sex with men (4 percent) and partners of people living with HIV (5 percent). African-American transgender women have a substantially higher rate of HIV diagnosis (29 percent) than all other racial or ethnic groups. In addition, according to a 2008 Minority Council report on AIDS, nearly 57 percent of all HIV-positive transgender women are African American. For both transgender and LGB people of color, data collection is a matter of life and death: It is impossible to improve the health and well being of LGBT people of color without the understanding and prioritization that comes with enhanced data collection.
We need more comprehensive data on LGBT health disparities The CHIS statistics above are based on one of the few government public health surveys in the United States that regularly asks questions about sexual orientation. Much of the research to date on LGBT health issues has focused on sexually transmitted diseases including HIV/ AIDS and has neglected to study other health concerns, such as the importance of mammograms for lesbians and bisexual women or how high rates of harassment affect the mental health of LGBT youth.
For example, a review of 3.8 million citations of articles in the National Library of Medicine published between 1980 and 1999 found that just 3,800 (0.1 percent) related to LGBT issues. Of these articles 2,300 (61 percent) were disease specific, with a focus on sexually transmitted diseases, mostly HIV/AIDS. Moreover, 85 percent of the articles failed to include any mention of the racial or ethnic background of the individuals studied.
Recommendations
As proposed in the original ''How to Close the LGBT Health Disparities Gap,'' the U.S. Department of Health and Human Services should establish an Office of LGBT Health. This office would take the lead in coordinating a consistent and scientifically driven response across HHS to LGBT health disparities and overall health care for people in these populations.
The office should first act to ensure that any federally funded health study that collects demographic information on age, sex, race, ethnicity, primary language, or socioeconomic status must also include questions about sexual orientation and gender identity.
Analysis of this data should include a specific examination of the health outcomes and conditions of people based on sexual orientation, gender identity, race, and ethnicity. As the above data shows, health outcomes vary greatly by these demographic factors. To improve overall public health and to use public dollars most effectively and efficiently, the government must consider these factors when crafting public health programs and policies.