Making Preventative Health Work For LGBT Americans

Our guest bloggers are Kellan Baker, LGBT health care analyst, and Mark Hines, LGBT communications project intern, at the Center for American Progress.

The Obama Administration recently released the National Prevention Strategy: American’s Plan for Better Health and Wellness. The Prevention Strategy is the first strategic health plan to focus specifically on prevention and wellness for all Americans.

According to Sen. Tom Harkin (D-IA), a long-time champion of health and prevention issues, the strategy is an important step in changing America’s healthcare system from one that focuses on care for the sick to one that encourages Americans to actively work to stay healthy throughout their lives. The strategy specifically references the lesbian, gay, bisexual, and transgender (LGBT) population, and makes recommendations for making prevention services and community-oriented prevention efforts responsive to the needs of LGBT people and their families.

The strategy was developed by the National Prevention Council, which includes 17 Cabinet secretaries from across the federal government. The council’s charge is to address the social determinants of health by ensuring that every agency that might impact overall health is also actively involved in improving health. The makeup of the council reflects the fact that education, employment, the justice system, transportation systems, and other areas of major government activity all affect the health of Americans and their families.


Building on the example of Healthy People 2020, the strategy includes the LGBT population alongside other groups that have experienced discrimination based on race and ethnicity, socioeconomic status, gender, age, mental health, or disability. The strategy also repeatedly recognizes the lack of federally collected population-level data that includes survey respondents’ sexual orientation and gender identity, and it calls on the federal government to collect these data in a routine and standardized way. These data would fundamentally transform our understanding of the health issues facing LGBT people and their families and improve our ability to tackle these issues.

The health statistics that we do know about the LGBT community speak to the importance of prevention and wellness for LGBT people. Harassment and discrimination against LGBT people in access to health care services and insurance coverage, relationship recognition, and employment contribute to health concerns, such as disproportionate rates of depression, tobacco use, and HIV/AIDS in LGBT communities. The strategy’s emphasis on issues such as smoking cessation, promoting mental health, preventing drug and alcohol abuse, and improving sexual and reproductive health are all key areas where interventions focused on the specific needs of LGBT people and their families could help significantly improve the health and wellbeing of LGBT Americans.

Despite these strengths, the strategy could have been more inclusive of LGBT people. For example, the strategy fails to recognize important work that has already been done on researching LGBT health issues, particularly the recent Institute of Medicine Report documenting LGBT health disparities. This report, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding, documents the importance of prevention for LGBT people from all backgrounds and at all stages of their lives.

The strategy should also have been more specific in its recommendations on LGBT data collection. For example, the National Institutes of Health and the Agency for Healthcare Research and Quality should formally list the LGBT population as a health disparity population, and national health surveys such as the National Health Interview Survey and the Behavioral Risk Factor Surveillance System must include questions on sexual orientation and gender identity if the prevention needs of the LGBT population are to be effectively met.

Dr. Jeff Levi, chair of the Advisory Group to the National Prevention Council, emphasized that the advisory group will focus on implementing the strategy and holding the council accountable to the plan that the strategy lays out. LGBT advocacy organizations should also engage in this process to ensure that the allocation of resources, such as those through the Community Transformation Grant (CTG) program that offers community-based organizations the ability to comprehensively tackle disparities in their communities, are inclusive of the needs of LGBT people. A focus on prevention holds tremendous transformative potential for the American health care system, and inclusive implementation of the strategy will help make sure that a fundamental part of LGBT equality — access to high-quality and culturally competent health services — is firmly established across America.