"How LGBT Health Disparities Intersect With Other Health Disparity Groups"
CAP is proudly taking part in the Health Equity Can’t Wait! blog carnival celebrating National Minority Health Month. Participating bloggers are health, consumer, civil rights, and provider advocates committed to promoting health equity. You can find all the posts for the carnival here.
In America today, an African-American baby is still twice as likely as a white baby to die before her first birthday. More than 30 percent of Latinos in the U.S. are uninsured, compared to 12 percent of non-Hispanic whites. Despite advances in HIV prevention and treatment, gay and bisexual men and transgender women of color are still disproportionately likely to become infected with HIV and to die from AIDS.
Clearly, race and ethnicity matter in health. So do gender, poverty, and ability. So too do sexual orientation, gender identity, and other characteristics linked to discrimination or exclusion.
And according to Senator Daniel Akaka, who introduced the Health Equity and Accountability Act yesterday in the Senate to build on the advances of the Affordable Care Act, “glaring health disparities based on racial and ethnic identity alone…are further exacerbated by factors such as socioeconomics, geography, and sexual orientation and [gender] identity.”
Areas of intersection between sexual orientation, gender identity, and other disparity factors include mental health concerns linked to minority stress, such as depression, anxiety, and suicide; higher rates of smoking and other substance use; and greater risk of contracting HIV and other sexually transmitted infections. Fear of mistreatment from health care providers who are not familiar with culturally competent care for different minority populations also prevents many people from accessing vital health services and compounds the seriousness of conditions such as heart disease, cancer, and diabetes.
These health disparities do not occur in a vacuum. Like poverty, they feed off established social and economic structures that determine the distribution of power and resources. What’s worse, inequality turns diversity into disparity. For people who belong to multiple communities that experience health disparities, these disparities do not simply add up: They multiply.
Take the case of lesbian, gay, bisexual, and transgender (LGBT) communities of color. In our supposedly “postracial” America, discrimination still shadows people whose skin color doesn’t match the white faces that dominate boardrooms, statehouses, and the halls of Congress. Similarly, while things have improved for most LGBT people in the United States since the stigma, silence, and arrests that characterized the era before the rise of the LGBT rights movement, LGBT Americans and their families still face widespread discrimination in relationship recognition, employment, housing, and access to health insurance and health care.
Discrimination limits opportunity and choice. As a result, LGBT people of color may be more likely than either white LGBT people or straight and non-transgender people of color to be less healthy and experience greater disparities in health care access. They are more likely to live in poverty, to have trouble seeing a doctor when they need to, and to live in environments where the surgeon general’s goal of making the healthy choice the easy choice remains an unfulfilled promise. For too many Americans, each additional “disparity factor,” from having a disability to being a woman to living in a rural area, magnifies the health gap.
An important step in breaking the cycle of disparities breeding disparities is changing our lens from health disparities—a focus on what has gone wrong—to health equity—a focus on where we want to be. The U.S. Office of Minority Health defines health equity as the attainment of the highest level of health for all people. Achieving it requires not only valuing everyone equally but also taking concrete steps to address inequality, close disparities, and build a healthier society.
On April 2, the Department of Health and Human Services (HHS) kicked off National Minority Health Month with a health equity town hall in Washington, DC. The event featured Assistant Secretary for Health Howard Koh, Acting Assistant Secretary for Minority Health Nadine Gracia, representatives from other HHS offices of minority health, and DC-based community health leaders.
The speakers described numerous health equity initiatives at HHS, including expanding access to insurance coverage and preventive services under the Affordable Care Act, enforcing nondiscrimination protections in the health system, developing comprehensive cultural competency resources, and implementing the National Stakeholder Strategy for Achieving Health Equity and the National Partnership for Action to End Health Disparities.
Another major HHS initiative of particular importance for LGBT communities is improving data collection on health disparities. Currently, major public health surveys collecting data that can help identify racial and other disparities do not ask respondents about their sexual orientation and gender identity, rendering LGBT people almost invisible in the national fight for health equity. In response, HHS has developed a plan to begin including sexual orientation and gender identity questions on federally supported health surveys and eventually developing standards to guide the routine collection of high-quality data on the health of LGBT communities.
As Assistant Secretary Koh reminded the audience at the National Minority Health Month town hall, using Reverend Martin Luther King, Jr.’s memorable phrase, the shadow of health disparities continues to chill those who have been left out of the sunlight of opportunity. But just as no community experiences health disparities in isolation from other disadvantaged communities, no community struggles alone in the fight for health equity. All of us battling health disparities may have arrived in different ships, but we’re all in the same boat now, pulling together.