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United We Stand: Achieving Health Equity for All

April 25, 2012

This blog post is jointly written by Kellan Baker, MPH, MA,  Health Policy Analyst, LGBT Research and Communications Project at the Center for American Progress; Patrick Paschall, Esq., Policy Advocate, National Gay and Lesbian Task Force; and Harper Jean Tobin, Esq., Policy Counsel, National Center for Transgender Equality. This post is part of the Blog Carnival “Health Equity Can’t Wait,” taking place April 25-27, 2012.

The Center for American Progress, the National Center for Transgender Equality and the National Gay and Lesbian Task Force are partners in the Health Equity and Accountability Act Community Working Group, a broad coalition of health equity advocates. A cornerstone of this group’s work over the last year, the Health Equity and Accountability Act, is a groundbreaking effort to promote health at the intersections of disparities related to factors such as race, ethnicity, sexual orientation, gender identity, immigrant status and disability status.

We do this important work at the intersections because, as the Institute of Medicine report on lesbian, gay, bisexual and transgender (LGBT) health emphasizes, “the experiences of LGBT individuals are not uniform and are shaped by factors of race, ethnicity, socioeconomic status, geographical location, and age, any of which can have an effect on health-related concerns and needs.”

Moreover, the effects of health disparities multiply exponentially for those who are members of more than one minority population: LGBT people of color may be more likely to experience worse health and greater health care access disparities than either their heterosexual and nontransgender counterparts within communities of color or their white counterparts within the LGBT population.

But the full extent of LGBT health disparities remains unknown. Major health surveys collecting data that can help identify disparities do not ask respondents about their sexual orientation or gender identity, meaning that researchers must often rely on anecdotal data and limited studies that cannot fully explore LGBT health disparities. This data gap particularly erases the experiences of those at the intersections of multiple disparity populations, such as LGBT communities of color.

Some Things We Do Know about LGBT People and Health Disparities

According to the American Community Survey, same-sex couples live in almost every county across the country. More than one million of these families, many of them black and Latina lesbians, are raising children. The challenges these families and other LGBT people face include discrimination in employment, housing, relationship recognition, health insurance and health care access — all of which give rise to health disparities such as greater exposure to violence, higher rates of conditions such as HIV and cancer, and a greater burden of mental health concerns such as depression.

Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, released in 2011 by the National Center for Transgender Equality and the National Gay and Lesbian Task Force, found that one in five transgender people has been refused health care outright due to anti-transgender bias. Such disparities are worst across the board for transgender people of color: For example, 31 percent of African-American transgender respondents reported being uninsured, compared to 17 percent of white respondents.

How LGBT Advocates Are Advancing Health Equity

The lack of data on LGBT health means that one of our biggest priorities is data collection. We are currently working with the Department of Health and Human Services to ensure that federally supported health surveys collect information about the health needs and experiences of LGBT people in order to give a much fuller picture of the diversity of LGBT communities. As part of its LGBT Data Progression Plan, the department is developing sexual orientation and gender identity questions for surveys such as the National Health Interview Survey.

We are also informing LGBT people about their rights under the health reform law. In particular, recent federal regulations ban discrimination on the basis of sexual orientation and gender identity by the state-based health insurance exchanges, which will connect consumers with affordable private coverage starting in 2014. The Affordable Care Act also extends nondiscrimination protections in the health system on the basis of HIV/AIDS status and sex. Such sex protections have been interpreted to include gender identity, including in a recent Equal Employment Opportunity Commission ruling that sex protections prohibit employment discrimination against transgender people.

Other recent health equity efforts include:

These and other efforts, including the Health Equity and Accountability Act, are critical steps in the direction of building a world in which complexity of identity is not reduced to multiplicity of risk. Achieving health equity for all will require collecting more data, conducting more research, and dedicating more resources to understanding and fighting the health disparities that affect disadvantaged communities. Our work is based on the conviction that together, we can end disparities and build a healthier nation.

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