Many of us know all too well that the lesbian, gay, bisexual, and transgender (LGBT) population experiences significant health disparities. Discrimination, violence, and prejudice on the basis of sexual orientation or gender identity routinely prevent LGBT people from accessing jobs, relationship recognition, housing, insurance coverage, and health care, making it difficult for LGBT people and their families to achieve their highest attainable standard of health.
In its 2011 National Healthcare Disparities Report, the Agency for Healthcare Research and Quality (AHRQ) at the Department of Health and Human Services has finally called out these disparities. AHRQ publishes this report every year to help policymakers understand and address the impact of racial, socioeconomic, and other differences on various populations.
The report focuses on priority populations such as racial and ethnic minorities, lower-income people, and people with disabilities — and, for the first time, it also includes the LGBT population as a priority population.
While the report discusses the disproportionate impact of HIV and AIDS on gay and bisexual men and other men who have sex with men, its strongest focus is on the disparities in health status and health care access that transgender people experience.
Drawing on data from Injustice at Every Turn: A Report of the National Transgender Discrimination Survey conducted by the National Center for Transgender Equality and the National Gay and Lesbian Task Force, the report emphasizes the enormous burden of discrimination, prejudice, and poor health that the transgender population bears.
According to the report, “transgender and gender non-conforming people bear the brunt of social and economic marginalization due to their gender identity…. Too often, policymakers, service providers, the media, and society at large have dismissed or discounted the needs of transgender and gender non-conforming people in their communities, and a paucity of hard data on the scope of antitransgender discrimination has hampered the struggle for basic fairness.”The disparities cited in the report include low rates of insurance coverage among transgender people, obstructed access to urgent and routine medical care, and refusals of treatment from providers. The report notes that almost 50 percent of transgender respondents have postponed medically necessary care for financial reasons or because they were afraid of encountering discrimination from providers.
And all of these disparities were higher for transgender people of color: for example, 31 percent of Black transgender respondents were uninsured, compared with 17 percent of white respondents.
The inclusion of LGBT health disparities in the National Healthcare Disparities Report reflects ongoing efforts by the Department of Health and Human Services to develop LGBT health care metrics and to build a body of data on LGBT population health. In particular, the department is developing sexual orientation and gender identity measures that will be included on federally supported surveys such as the National Health Interview Survey starting in 2013.
Data are crucial to identifying, tracking, and addressing the health disparities that prevent LGBT people, particularly transgender people, from accessing the health insurance and health care services they need to keep themselves and their families healthy. It is vital that the department continue to make progress on these sexual orientation and gender identity data collection efforts.
It is also critical that research bodies such as the National Institutes of Health (NIH) support further investigation into LGBT health disparities. The 2011 Institute of Medicine report on LGBT health recommended that NIH develop a research agenda designed to advance knowledge and understanding of LGBT health. A year later, NIH has yet to respond to that recommendation with a plan for next steps on building this research agenda. It also remains unclear whether NIH will consider the LGBT population in the methodology for designating health disparity populations that it is currently revising.
Under the Obama Administration, much progress in identifying LGBT health disparities has been made. But much work remains to be done, particularly when it comes to taking action to address these disparities. And ultimately, the National Healthcare Disparities Report finds that efforts to address the disparities affecting other priority populations are also making little headway — further underlining the importance of a sustained focus on health equity and an investment in reducing health disparities across the board.
The Agency for Healthcare Research and Quality has taken an enormous step forward in prioritizing LGBT disparities and drawing attention to the burden of poor-quality care and obstructed access to treatment that so many disadvantaged communities face. Others should not hesitate to follow.