Aimee Van Wagenen, Center for Population Research in LGBT Health at The Fenway Institute
I am guest blogging today on my trip to the Williams Institute—a think tank dedicated to the study of sexual orientation law and public policy at the University of California, Los Angeles Law School. The Williams Institute is hosting a two day conference that’s been put together to highlight recent scholarship at Williams and elsewhere on LGBT people and families. Sessions are being held over two days on a variety of topics, including LGBT parenting, LGBT activism and the gay rights movement and LGBT employment discrimination. The meeting will close with a keynote from U.S. Census Director Robert M. Groves is who will speak about what the Census is doing to improve the accuracy and validity of data collected about same-sex couples. I’m looking forward to that session, though I’ve just heard that a federal government shutdown could prevent him from coming. (Let’s hope that doesn’t happen.)
Today I want to share highlights from the first panel of the day: LGBT Health and the 2011 Institute of Medicine Report. Scout and others have blogged about the groundbreaking IOM report since its release about a week ago on March 31, 2011 (see here for example). The Williams Institute panel on the report included some leading scholars in LGBT health research and was moderated by Mark Schuster –one of the IOM LGBT health committee members. They were been brought together to reflect on the findings from the report and discuss where the research in LGBT should be headed. The panelists included:
- Susan Cochran, Professor of Epidemiology, UCLA School of Public Health
- Daniel Gould, Deputy Director, LGBT Health and Human Services Network, Equality California
- Gregory Herek, Professor of Psychology, University of California, Davis
- Nan Hunter, Professor of Law, Associate Dean, Graduate Programs, Georgetown Law
- Stephen T. Russell, Professor, Fitch Nesbitt Endowed Chair, Norton School Family and Consumer Sciences, Director, Frances McClelland Institute Family Studies and Human Development, University of Arizona
- Moderated by Mark A. Schuster, William Berenberg Professor of Pediatrics, Department of Pediatrics, Harvard Medical School
Mark Schuster introduced the panel by giving an overview of the report. He highlighted the role of the Institute of Medicine in challenging health disparities – historically with African-Americans, Latinos, and women—and put the IOM report on LGBT health in this context. He suggested that the most important or overarching finding of the report was that it was not possible to identify “gaps” in the evidence in LGBT health (as was the task for the IOM committee) because the evidence is so sparse across the board. The report thus recommended that NIH should implement a substantial research agenda designed to advance knowledge and understanding of LGBT health, with particular emphasis on 5 priority areas: demographic research, social influences, health care inequalities, intervention research and transgender-specific health needs. He continued to overview the other 6 recommendations of the committee around federal data collection, inclusion of sexual orientation and gender identity in electronic medical records, standardization of measures, support for methodological research, research training, and inclusion of sexual and gender minorities in NIH health research. He finally noted that there have been some early federal responses to the report—for example, the recent announcement of an LGBT research coordination committee charged with addressing the recommendations and a commitment from NIH to working with the Center for Health Statistics to improve methods for collecting survey data on sexual orientation and gender identity.
Susan Cochran talked about the way IOM reports matter. She argued they matter to create research opportunities, to draw new researchers to the field, to identify health targets for interventions, and identifying disparities to warrant public health attention in policy advocacy. She also highlighted the inclusion of LGBT disparities in the recent Leading Health Indicators for Healthy People 2020 report. She argued for the importance of collection of sexual orientation data in national surveys – in particular NHIS, important because it is linked to national mortality data and serves as the sampling frame for the Medical Expenditure Panel Survey, and the National Children’s Study.
Stephen Russell echoed other panelists on the importance of the report and underscored the importance of the minority stress model as a frame for understanding the causes of LGBT helath disparities. He praised the report’s emphasis on intersectionality–that is, on the multiple intersecting identities, communities, and structural inequalities that are part of LGBT identities, communities, and inequalities. Russell’s own work has focused on gay youth and he raised the example of youth suicide as clear example of the relevance of both minority stress and intersectionality. He argued for the need for greater attention to social context and a structural approach in order to truly move the field forward, beyond consideration of individual health outcomes. He pointed to policy changes that can influence contexts and to a current bill under consideration in California that might do that for youth—SB 48–the Fair, Accurate, Inclusive and Respectful (FAIR) Education Act.
Daniel Gould asserted the importance of research for policy advocacy, underscoring the value of the IOM report at putting LGBT health on the map for the LGBT rights movement. He calls the report “a big push at creating some visibility.” He meets with state agencies that provide programming in support of public health and argues for attention to LGBT people and feels that the IOM report will be “huge in transforming the discourse.” From his perspective, the report provides support for another bill under consideration in California — SB416, the Survey Data Inclusion Act, which would encourage California to include sexual orientation measures in state data collection.
Nan Hunter highlighted anti-discrimination provisions in health law and how this relates to the IOM report. She hopes that the IOM report will establish a mandate to collect and analyze data regarding disparities by sexual orientation and gender identity. That data is essential to challenge discrimination. She notes health law is increasingly relying on such data to make a case about the effect of laws on the health of populations and thinks about law as one of the important social determinants of health.
Gregory Herek underscored the report’s focus on the vast differences within LGBT populations–between the Ls, Gs, Bs, and Ts and between racial/ethnic and other subgroups within LGBTs. Herek, also one of the IOM Committee members, praised the report’s focus on the one thing these groups have in common: the experience of prejudice and stigma. Experiences of stigma and discrimination are particularly relevant to policy and policy at NIH around support for LGBT research. Herek recalled the days of the Traditional Values Coalition NIH researcher “hit list” and argued for the importance of the report at countering that.