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America's Health Care System is Failing LGBT Citizens: Learning from Reagan's Mistakes

Posted: 12/21/09 09:40 AM ET

America's health system is failing its LGBT citizens. President Obama should establish a federal Office of LGBT Health to tackle the unique dangers that threaten this community.

President Ronald Reagan jeopardized the lives of millions of lesbian, gay, bisexual, and transgender Americans by failing to commit federal attention to the HIV/AIDS crisis in the 1980s. President Barack Obama should learn from Reagan's mistakes and attack the health problems LGBT people face today.

Our health system is failing miserably to address LGBT health disparities and needs across the United States. The limited data that does exist has proven valuable in identifying the most troublesome health disparities. A recent study of this data by the Center for American Progress found some staggering trends in the rates at which LGBT populations experience mental and physical health problems.

Lesbian, gay, and bisexual adults are twice as likely to experience psychological distress as their straight counterparts. They are more than twice as likely to need medication to treat emotional health issues, many of which are induced by those stresses.

Their transgender counterparts are in more acute danger from mental illnesses. They are 25 times more likely to have suicidal ideations than heterosexuals and 10 times more likely than lesbian, gay, or bisexual adults -- who already suffer from elevated risk levels -- to endure this suffering. And only one-third of African-American lesbians have received a mammogram in the past two years--the lowest screening rate of all demographic groups.

The dangers that affect LGBT youth are equally concerning. Lesbian, gay, and bisexual youth are three-and-a-half times more likely to attempt suicide, and many health experts would argue that the rate for transgender youth is probably much higher -- as it is for their adult counterparts.

Even if these youths are able to overcome their internal challenges, external threats can pose equally harmful dangers: LGBT youth are nearly four times as likely to be threatened or injured with a weapon in school and three times more likely to be in physical fights that require medical treatment.

Another challenge is that doctors, nurses, and other health care providers often don't know how best to treat LGBT people. Most medical schools and educational health programs don't include training on LGBT health needs, even though this type of preparation can dramatically improve the quality of care they can provide.

But medical schools and other training programs don't share all of the blame. The lack of information on LGBT health needs makes it extremely difficult to design effective education and training programs.

CAP found that the negative health outcomes that uniquely and disproportionately affect LGBT people are due to the cumulative and intersecting impact of three different factors, all of which played a major role in the HIV/AIDS epidemic that ravaged the LGBT community during the 1980s and 1990s.

First, LGBT Americans experience substantially reduced access to employer-provided health insurance. Second, for those who have coverage, many face a health care system that still lacks a cultural competence to treat their unique needs. And finally, all LGBT Americans, covered or not, still face the incessant, harmful social stigma that exists against LGBT people in our society.

There is also a lack of knowledge about the LGBT community's health needs, and influential policymakers and advocates aren't properly armed with information to implement effective policies and allocate the necessary resources to solve them. The main reason for this is that no national government surveys include questions related to sexual orientation or gender identity.

At the state level, only a handful of states regularly ask questions about sexual orientation. And to date only Massachusetts includes a question on gender identity in any government health survey.

To start reducing LGBT health disparities 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 disparities and needs.

Data collection should be a priority for this office. It must ensure that any federally funded health study that collects demographic information on categories such as age, sex, race, ethnicity, primary language, or socioeconomic status must also include questions about sexual orientation and gender identity. The Office of LGBT Health should also support efforts to design educational and training curricula that directly address LGBT health needs.

Finally, current efforts in Congress to expand coverage to more Americans would help reduce some of the disparities LGBT people face. The House-passed bill also included provisions related to LGBT health -- for example, expanding the definition of "disparities populations" to include LGBT people and inclusive nondiscrimination protections in health care treatment. House and Senate leadership should work to maintain these provisions in the final bill.

As the rest of society moves toward a more comprehensive and supportive understanding of the LGBT population, the nation's health care system needs to do the same. Decisive action and bold leadership now will help protect -- and save -- millions of lives.


Jeff Krehely is the Director of the LGBT Research and Communications Project at the Center for American Progress. This project builds on American Progress's early commitment to lesbian, gay, bisexual and transgender equality with a strategic policy and communications agenda including marriage equality, military service, youth homelessness, retirement security, and more. Jason Rahlan is a Press Aide at the Center for American Progress.