Action Alerts · Creating Change 2013

Action Alert – Creating Change 2013 – National Governors Initiative

 
 
Gustavo Torrez
Program Manager
The Network for LGBT Health Equity
 
 
 

Good afternoon from Creating Change 2013 in Atlanta, GA.  The Network is pleased to participate in another Creating Change Conference. This year we will be joined by some amazing folks doing great work from across the country. In our previous post: INTRODUCING OUR 2013 CREATING CHANGE BLOGGERS, we gave you a little insight about each of our blogging scholarship recipients but now that the conference is upon us you will start to hear from them all all of the exciting opportunities taking place at Creating Change this year. Each blog will be tagged with Creating Change 2013 so you can follow all the excitement.

In addition to the blogs that you will all be able to read here, we are conducting an activity this year through a postcard campaign on the ground titled the National Governors Initiative.  Our goal to to engage Governors to ensure that best practice guidelines are being implemented in an effort to eliminate LGBT health disparities. Based on our guide we have outlined four questions which each relate back to a best practice that should be implemented:

  1. Do we collect LGBT data as a routine part of all health surveys? (such as BRFSS & YRBS)
  2. Are health department and grantee staff trained in LGBT cultural competency and health disparities?
  3. Are LGBT people included in community advisory bodies?
  4. Are LGBT images routinely reflected in public health promotional materials?

photo copy

After the conference we will mail out the postcards and monitor opportunities and discussions that might take place from the campaign. If you are at creating change and interested in filling out a postcard or helping to pass them out to your friends we would love to have your support…. Our goal is to reach at least half of the participants at this years conference and with your help we can make that happen.

So please let us know if you are here…

Also if you are interested in being a guest blogger and sharing your experience with the Network base while you are at creating change please let us know. We are always welcome to having new voices represented on our blog. Fill out the form below if you would like to meet up with us to get postcards, chat about the network, or if you are interested in contributing to the blog and we will get connected while here:

Action Alerts · Data · LGBT Policy · MPOWERED

Action Alert ***Support Data Collection of Sexual Orientation and Gender Identity in Clinical Settings***

 
 
Gustavo Torrez
Program Manager
The Network for LGBT Health Equity

 

Hello Everyone,

Long story short we are all pushing for and/or understand the importance of comprehensive inclusion of LGBT communities in all surveillance instruments through sexual orientation and gender identity measures. Currently the Health Information Technology Policy Committee is seeking comments on supporting the sexual orientation and gender identity data collection in Stage 3 Meaningful Use Guidelines.

By the Close of Business day we are hoping to get as many CEO’s and Directors of Organizations, Foundations etc. to sign on to a letter developed by the Fenway Institute and the Center for American Progress.

Can we count on your support….?!?!?!?!?!?!?! Plese Support Today

Click Here To Directly Sign Onto The Letter

Click Here To View The Full Blog & Letter

Action Alerts · Data · LGBT Policy

ACTION ALERT – We need your organizations support – Ensure Collection of Sexual Orientation and Gender Identity in clinical settings

Dear colleagues,

Please consider signing on to this community public comment to the Health Information Technology Policy Committee supporting the inclusion of sexual orientation and gender identity data collection in Stage 3 Meaningful Use Guidelines.

You can sign your organization on at:

http://tfisecure.fenwayhealth.org/limesurvey/index.php?sid=82375&lang=en

Please do so by close of business Thursday January 10th. We will submit this Friday January 11th.

The critical importance of this issue is explained in the letter below and attached (footnote citations are in the attached version). This is a moment of opportunity that we don’t want to miss to increase our knowledge of LGBT health and disparities, as a key step toward reducing and eliminating these disparities. During the Stage 2 process there was considerable opposition to asking these questions; we need to push strongly for asking these questions now–just as we have had to do so in the context of adding questions to health and demographic surveys–if this is to become a reality.

Thank you for considering this request. Please forward to any other groups you think might be interested. If you have any questions please call Sean at 617-927-6016.

Best wishes,

Sean Cahill                   Kellan Baker

Fenway Institute           Center for American Progress

******

Department of Health and Human Services

Office of the National Coordinator for Health Information Technology

Farzad Mostashari, M.D., Sc.M., National Coordinator

RE: HIT Policy Committee Request for Comment Regarding the Stage 3 Definition of Meaningful Use of Electronic Health Records

Submitted online at www.regulations.gov on January 14, 2013.

Dear Dr. Mostashari,

We are a coalition of community health centers, public health organizations, groups working on lesbian, gay, bisexual, and transgender (LGBT) health, and HIV/AIDS organizations. We write to comment on the HIT Policy Committee Request for Comment Regarding the Stage 3 Definition of Meaningful Use of Electronic Health Records issued November 7, 2012.

We strongly support the inclusion of sexual orientation and gender identity data collection in Stage 3 Meaningful Use Guidelines. Gathering such demographic information in Electronic Health Records (EHR) is supported by:

  • The 2011 Institute of Medicine (IOM) report on LGBT health;
  • The 2012 IOM workshop summary report on collecting sexual orientation and gender identity data in EHR;
  • Healthy People 2020;
  • Section 4302 of the Affordable Care Act; and
  • The Joint Commission’s 2010 report, Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals.

We applaud the draft Stage 3 requirement that there be sexual orientation and gender identity functionality in EHR that is “certified” by the Office of the National Coordinator of Health Information Technology. We are, however, disappointed that the draft Stage 3 Meaningful Use Guidelines propose to retire the existing demographics objective. The collection of a range of demographic data is critical to the success of the Meaningful Use effort, and it is unfeasible to imagine that this vital objective can be considered complete in Stage 2.

Moreover, we are concerned that the draft Stage 3 guidelines do not include sexual orientation and gender identity data collection as requirements for eligible hospitals and professionals. We strongly urge you to reconsider this omission in the interest of improving health care for LGBT people and reducing disparities. Specifically, we recommend that the demographics objective be retained as a core objective in Stage 3, with a slightly higher threshold (e.g., 85 percent) to promote progress past the Stage 2 level, and that it incorporate sexual orientation and gender identity data collection. Doing so acknowledges that demographic information, including sexual orientation and gender identity, is an important part of high-quality, patient-centered care. It will also encourage eligible professionals and hospitals to utilize the LGBT data collection functionality in their EHR systems that the draft Stage 3 guidelines require.

Training and data collection must go hand-in-hand.

As many speakers at the October 2012 IOM workshop on LGBT data collection in EHR systems noted, health professionals and administrative staff need training in LGBT cultural competence to appropriately gather this information from patients. Such training should occur in a broader context of training health professionals and administrative staff in fully incorporating the requirements of Meaningful Use into their daily work. Beginning the process of gathering these data as part of the implementation of Meaningful Use is crucial to the ability of researchers and clinicians to learn more about LGBT health needs and inform training in the future. As part of this effort, we also support a study of the most effective ways to gather sexual orientation and gender identity information in order to optimize the data collection using ways that are most acceptable to consumers.

LGBT data is important in clinical settings.

The importance of sexual orientation and gender identity in clinical settings is significant. The 2011 Institute of Medicine report on LGBT health highlighted substantial health disparities among LGBT people, such as: the prevalence of STIs and HIV (with 64% of new cases of HIV occurring in gay or bisexual men in 2009), and the high rates of behavioral health issues and suicidality, often related to stigma, discrimination, and bullying and hate crimes. Lesbians are more likely than heterosexual and bisexual women to be overweight and obese, increasing their risk for cardiovascular disease, lipid abnormalities, glucose intolerance, and morbidity related to inactivity.[1]

The Massachusetts Behavioral Risk Factor Surveillance Survey found poorer health among bisexual respondents compared with gay, lesbian, and heterosexual respondents, as well as higher rates of mental health issues and smoking.[2]Moreover, there are few providers well versed in the health care needs of transgender patients, creating a barrier to accessing quality care.

Reflecting these disparities, the Institute of Medicine recommends that sexual orientation and gender identity questions be asked in clinical settings and be standardized to allow for the comparison and pooling of data to analyze the unique needs of LGBT people.[3]  Healthy People 2020, which calls for the elimination of LGBT health disparities, also calls for gathering such data by clinicians.[4]Gathering LGBT data in clinical settings is consistent with efforts of the U.S. Department of Health and Human Services to gather health data on LGBT populations as authorized under Section 4302 of the Affordable Care Act.[5]

The recent IOM workshop also noted the benefits of collecting sexual orientation and gender identity data in EHR systems. A provider’s knowledge of a patient’s sexual orientation and gender identity is essential to providing appropriate prevention screening and care.[6]Patients who disclose their sexual orientation identity to health care providers may feel safer discussing their health and risk behaviors as well.[7] Gathering sexual orientation and gender identity data will increase our understanding of LGBT health disparities and how to prevent, screen and detect early health conditions that disproportionately affect LGBT people. Finally, gathering such data in clinical settings will allow providers to better understand and treat their patients, and to compare their patients’ health outcomes with national samples of LGB or LGBT people from national health surveys.[8]

Collecting these data also helps address the fact that LGBT people have long been highly invisible to the health care system, even as they experience disparities in health outcomes and care. Few health providers are trained in LGBT health issues. A recent survey of deans of medical education at medical schools in the US and Canada found that the median time dedicated to teaching LGBT-related content in the entire medical school curriculum was five hours. One third of medical schools reported that zero hours of LGBT content were taught. Only 24% of the medical school deans considered their school’s overall coverage of LGBT material as “good” or “very good” on a 5-category Likert scale.[9]

Collecting sexual orientation and gender identity data in clinical settings is feasible and appropriate.

As documented by the IOM report, many health care organizations are moving forward with gathering sexual orientation and gender identity data in clinical settings to better address the needs of their LGBT patients. We believe that health providers should routinely gather LGBT data just as they gather data on race, ethnicity, and other aspects of identity associated with health and health care access disparities.

For example, Fenway Health in Boston recently evaluated the best way to ask about sexual orientation on its patient registration form. Based on this evaluation, the following question has been added:

Do you think of yourself as:

__ Lesbian, gay or homosexual

__ Straight or heterosexual

__ Bisexual

__ Something else

__ Don’t know

Fenway Health also conducted research on how best to ask a gender identity question on registration forms. Based on research with transgender patients, Fenway Health is now using the following question:

What is your gender?             

  • Female
  • Male
  • Genderqueer or not exclusively male or female

What was your sex at birth?

  •  Female
  •  Male

Do you identify as transgender or transsexual?

  • Yes
  • No
  • Don’t know

Opponents of asking these questions in clinical settings will raise potential barriers, just as opponents of gathering such data on national health surveys have. Any potential barriers or concerns are surmountable and addressable. One such concern is privacy and confidentiality. Sections 1411(g), 1411(c) (2), and 1414(a) (1) of the 2010 Patient Protection and Affordable Care Act provide privacy and security protections for information used by Health Insurance Exchanges.[10]A rule proposed in July 2011 would mandate “appropriate security and privacy protections” for any “personally identifiable information,” including sensitive health information that is collected and used in the provision of health care.[11]

ONC’s leadership through the Meaningful Use process is a critical component of closing the LGBT health disparities gap.

We urge the Office of the National Coordinator for Health Information Technology to demonstrate the visionary leadership required to institutionalize the routine gathering of sexual orientation and gender identity data in clinical settings. We know how to ask these questions and how to ensure that most patients answer them honestly and without fear or stigma. We are happy to answer any questions you may have, and we look forward to working with you to improve health care data management in the United States as a key step toward reducing and eventually eliminating LGBT health disparities. (Contact: Sean Cahill at the Fenway Institute, scahill@fenwayhealth.org, or Kellan Baker at the Center for American Progress, kbaker@americanprogress.org.)

Sincerely,

Fenway Health

Center for American Progress

List in formation


[1] Boehmer U, Bowen DJ, Bauer GR. Overweight and obesity in sexual minority women: evidence from population-based data. Am J Public Health. 2007; 97: 1134-1140. Cited in Mayer KH, Bradford JB, Makadon HJ, Stall R, Goldhammer H, Landers S. Sexual and gender minority health: What we know and what needs to be done. Am J Public Health. 2008: 98: 989-995.
[2] Conron, KJ, Mimiaga, MJ, Landers, SJ. A population-based study of sexual orientation identity and gender differences in adult health. Am J Public Health. 2010; 100(10); 1953-1960.

[3] Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities; Board on the Health of Select Populations; Institute of Medicine, The Health of Lesbian, Gay, Bisexual, and Transgender (LGBT) People: Building a Foundation for Better Understanding, Washington, DC: National Academies Press, 2011. http://www.nap.edu/catalog.php?record_id=13128.

[4] Health care providers should “appropriately inquire about and be…supportive of a patient’s sexual orientation to enhance the patient-provider interaction and regular use of care.”

[5] U.S. Department of Health and Human Services. Affordable Care Act to improve data collection, reduce health disparities. News release. June 29, 2011. www.hhs.gov/news/press/2011pres/06/20110629a.html

[6] Ibid.

[7] Klitzman, RL, Greenberg, JD. Patterns of communication between gay and lesbian patients and their health care providers. J Homosex. 2002; 42(4); 65-75.

[8] These include the National Survey of Family Growth and the National Survey of Sexual Health and Behavior, which ask about sexual orientation. Gates, G. How many people are lesbian, gay, bisexual, and transgender? Los Angeles: UCLA Williams Institute. 2011.

[9] Obedin-Maliver, J, Goldsmith, ES, Stewart, L, White, W, Tran, E, Brenman, S, Wells, M, Fetterman, DM, Garcia, G, Lunn, MR. Lesbian, gay, bisexual and transgender-related content in undergraduate medical education. JAMA. 2011: 306: 971-977.
 
 
[10] Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans. A Proposed Rule by the Health and Human Services Department on 07/15/2011. Federal Register. http://www.federalregister.gov/articles/2011/07/15/2011-17610/patient-protection-and-affordable-care-act-establishment-of-exchanges-and-qualified-health-plans#p-252
 
[11] Ibid.
Action Alerts · Quit Tips

National Media Collaboration, A Gay Editor’s Journey to Become Smoke-Free…

 
 
Gustavo Torrez
Program Manager
The Network for LGBT Health Equity
Deglamorizing Tobacco in the Media

We are in an era where there is too little LGBT Media coverage of tobacco control efforts, a definite lack of LGBT Educational opportunities about our disparity, and a clear need of education around smart cessation options to help our communities break the nicotine addiction. In Pictures Worth a Thousand Words: Noncommercial Tobacco Content in the Lesbian, Gay, and Bisexual Press (Smith EA, Offen N, Malone RE, 2006) we understand that “The predominant message about tobacco use in the LGB press is positive or neutral; tobacco is often glamorized”. History has shown us that tobacco use is not only glamorized but normalized within our community. LGBT people smoke cigarettes at rates 68% higher than the general population, and editors still continue to support pro tobacco imagery.

This week the Network has embarked on one of the largest media collaborations to date. We are pleased to announce our newest partnership with Bill Browing, in his quest to break the nicotine addiction. If you don’t know, Bil Browing is the Founder & Editor in Chief for the Bilerico Project, the 4th largest LGBT blog in the country. Bill has decided that for his 40th birthday he is going to celebrate by quitting smoking. As an Editor in Chief of an LGBT Blog he is going public changing the social norms of tobacco glamorization in the media, and has reached out to the Network for support.

Click here to read the introductory blog by Scout, and leave comments for Bil to show your support. Pass this on to your Network, share his updates through your social media channels, encourage others to follow and make comments as well. We have an amazing opportunity to follow a gay mans journey, in a very public way, and we hope his story inspires others to follow suit. United we can show him there is a community rallying around him, and together we can encourage the LGBT communities to break the nicotine addiction. Please take a moment to comment and share the blog today, the time is now to take a stand and combat the glorification of tobacco in LGBT media, while supporting a gay editor in his journey to become tobacco free.

Action Alerts · FDA

ACTION ALERT**PLEASE** email FDA now and ask for consistent LGBT inclusion.

ACTION ALERT RESPOND NOW

Please email: workshop.ctpos@fda.hhs.gov and say – “Please create minimal dataset that includes measures for all vulnerable populations, including LGBT people, across ALL your funded research. Please make sure coming Centers of Excellence include a vulnerable population focus that also includes LGBT people.”

The backstory:

  • Many of you know I’m at the FDA meeting today and we’re hearing about buckets of tobacco research work unfolding via their hands.
  • Happy to say we’ve got one WIN – They confirmed that LGB (not yet T) data will now be collected on their new tobacco megastudy!
  • BUT — they are rolling out research all over the place, including new Tobacco Centers of Excellence, LGBT could be masked in all that work!

Can you please take just a few seconds and email them asking to please consistently include LGBT and all their target vulnerable population data collection in all of their funded research projects, including those new tobacco centers of excellence!

Again: workshop.ctpos@fda.hhs.gov – say something like “Please ensure all your funded research collects LGBT data and that the coming Centers for Excellence include research on LGBT tobacco disparities.”

Please, we know these make a difference!

Or just enter your information and comments below and they will automatically be sent to workshop.ctpos@fda.hhs.gov.

Action Alerts · LGBT Policy · Presentations

White House LGBT Conference on Health – Feb 16th in Philadelphia

 
 
By Gustavo Torrez
Program Manager
White House LGBT Conference on Health 
 

The Network is pleased to inform you all of the White House LGBT Conference on Health.

The Event will take place in Philadelphia February 16, 2012. We encourage you to attend if you are able. Scout will be attending on behalf of the Network so if you are planning on attending let us know so we can link you all together. Make sure you RSVP early as space is limited.

 

White House LGBT Conference on Health

Hosted by the White House and the U.S. Department of Health & Human Services

in partnership with Mazzoni Center

Thursday, February 16, 2012

8:30 AM – 5:30 PM

Thomas Jefferson University

Dorrance H. Hamilton Building

1001 Locust Street

Philadelphia, PA

 

Featuring

Kathleen Sebelius

Secretary, U.S. Department of Health & Human Services

 

SPACE IS LIMITED. REGISTER ONLINE: http://go.usa.gov/nxj

Click here for full details on the event. 


Action Alerts · APHA · Community Transformation Grants · Funding · LGBT Policy

Thoughts on Tobacco, Evolution, Sustainability & Strategic Planning

Scoutby Scout, Ph.D.
Director, Network for LGBT Health Equity
At The Fenway Institute

Healthcare Reform Has Started to Change Our World

It seems I’ve been a public health professional for almost a quarter of a century. (really? wow) I’ve gotta say, in those 24 years, one of the things that gives me the most optimism is the advent of health care reform. Cutting through the details, health care reform is fundamentally shifting to being more logical about our health, particularly finally investing more in avoiding problems, instead of just fixing them. When I was in school, we used to describe public health like this; if you’re next to a river and people keep coming down drowning, the doctors will pull them out and resuscitate them, but the public health officials will head upstream to help stop them from falling in. Finally now, our health care system is moving towards that upstream intervention. It took spiraling healthcare costs to spur the shift, a burden that our kids will probably have to keep paying, but at least it’s happening.

85% Is Good News for Us

A while ago folk at CDC started to throw out a startling stat, seems the analysts crunched the numbers and came up with the fact that if we do a better job of avoiding smoking, eating better, and exercising more as a country, we can cut our healthcare costs by a whopping 85%. Eighty five percent, that’s just shocking. Yes, it’ll take a boatload of changes to really shift these 3 health behaviors, but it’s numbers like this that are spurring the 3/4 of a billion dollars the government recently invested in Community Transformation Grants aimed at these three issues. This is all good news for anyone working in tobacco, or in healthy eating or exercise. As the ex-head of CDC’s Office of Smoking and Health said, “We kept saying smoking was important, finally they realized we were even more important than anyone guessed.”

Fewer Silos, More Grain

Hold on, hold on, there’s even more logic coming out of the government. (I know, we try not to expect that). Along with the shift towards more wellness/prevention work, there’s also a lot of reorganization afoot, to combine funding streams to allow more integrated work on the three areas: tobacco, exercise, and healthy eating. Yah, not only does this probably reduce paperwork for someone (not that you could tell from any of the proposals I’ve written recently), but it also just makes sense. If we’re trying to help people be healthier, do we really want several sets of people locally trying to change things, one for tobacco, another for healthy eating, and another urging folk to exercise. Of course not, the concept of pushing Wellness as an integrated focus makes the most sense.

Evolution and Pain

As most of you know, it was this shift that spurred our move about a year ago to change our name from the National LGBT Tobacco Control Network, to the less issue-specific Network for LGBT Health Equity. We knew future funding would come out with a tobacco/eating/exercise combined focus and we wanted to ensure the Network would be ready to compete in the evolving world. Unfortunately, for a group that’s always been community driven, we dropped the ball on the name change, not announcing the opportunities for input widely enough to our membership. While most everyone was very supportive of the name change, some vocal and longtime members were upset. Worrying that we would lose our tobacco focus in the shift. I hope the ensuing time has proven our continued focus on tobacco. It is after all, the only thing we’re funded to address. But I also hope we’ve showed we can be relevant to the other health issues as well, because we really do understand much of our work in tobacco can be useful to other arenas.

Sustainability & Strategic Planning

The Network for LGBT Health Equity has about 1.5 years left on our CDC contract. After that point, there’s no guarantee CDC will continue the tobacco network funding. Of course, we’re working very hard to clarify the value in having networks like ours who can keep pointing out gaps, keep tabs on what’s happening around the country, and keep the people in touch with the policymakers. Considering the new emphasis on changing health policies I believe the value of networked LGBT communities is higher than ever, because if there’s one thing our communities have built skills in, it’s policy change. But the truth remains, this Network has to become sustainable in a shifting health environment.

As always, our strength is in our people. I’m particularly grateful to the Network Steering Committee members. This group has agonized over the name change, created a media plan, is currently creating a new level of detailed best practices document, and in 2011 spent about half a year creating a draft strategic plan to help guide us through the turbulent years ahead.

Community Review & Our Network

Very soon now, this draft strategic plan will be circulated to our constituency for review and input. I hope each of you can take a few minutes to look at it and think about whether this reflects the Network you want to see. I know how hard the Steering Committee worked on this draft, every single word was agonized over. Our history, our core of tobacco work, the evolution of the arena, what we want, all these things and more were put in the hopper and fashioned into a (deceptively) short set of goals for us to use as our compass in coming years.

Some of you were there in 2003, when 60 people gathered from all around the LGBT communities to create our first tobacco action plan. That document provided the foundation for the Network development and innumerable local programs for years. I feel the development of this strategic plan is a direct outgrowth of that work. I know our world has changed since 2003, but I hope every single person out there concerned with LGBT health, tobacco, and wellness still feels the drive we did back then, to make and keep this Network as one we have built, that represents our joint goals.

So look for that strategic plan to come out for review in a few days, and I hope you’ll take at least a few moments to check it out, and help us make it the best possible guide for the Network that community members built.

 

 

 

 

Action Alerts · APHA · Community Transformation Grants · Funding · LGBT Policy

ACTION ALERT: One Month to Demand Partnership in Local Community Transformation Grants

Scoutby Scout, Ph.D.
Director, Network for LGBT Health Equity
At The Fenway Institute

Local CTG Grantees Have One Month To Modify Action Plans

Remember how (just minutes ago) we posted that leaders are urging local disparity leaders to demand partnership in the newly awarded $100M of Community Transformation Grants (CTGs)?

Well good news is, many of the new grantees are right now modifying their action plans! CDC has asked for the new plans to be submitted to them by end of January. This means right now is a perfect time to contact the people who got the award locally and urge this partnership. Clock is ticking!

Who to Contact and How

The entities below are the CTG grantees who have to submit modified action plans by end of January. We have contact information for each of them, or you can just google it and call the top person. Please email us at lgbthealthequity@gmail.com if you want the direct contact information.

Broward Regional Health Planning Council (Florida)
City of Austin Health & Human Services Department (Texas)
County of San Diego Health and Human Services Agency (California)
Denver Health and Hospital Authority (Colorado)
Douglas County Health Department (Nebraska)
Hennepin County Human Services and Public Health Department (Minnesota)
Illinois Department of Public Health
Iowa Department of Public Health
Los Angeles County Department of Public Health (California)
Louisville Metro Department of Public Health and Wellness (Kentucky)
Maine Department of Health and Human Services/Maine CDC
Maryland Department of Health and Mental Hygiene
Massachusetts Department of Public Health (to serve state minus large counties)
Massachusetts Department of Public Health (to serve Middlesex County)
Mid-America Regional Council Community Services Corporation (Missouri)
Minnesota Department of Health
Montana Department of Public Health and Human Services
New Mexico Department of Health
North Carolina Division of Public Health
Oklahoma City-County Health Department (Oklahoma)
Philadelphia Department of Public Health (Pennsylvania)
Public Health Institute (to serve the state of California minus large counties)
San Francisco Department of Public Health (California)
Sault Ste Marie Tribe of Chippewa Indians (Michigan)
South Carolina Department of Health and Environmental Control
South Dakota Department of Health
Southeast Alaska Regional Health Consortium (Alaska)
Tacoma-Pierce County Health Department (Washington)
Texas Department of State Health Services
The Fund for Public Health in New York (New York)
University Health Services, University of Wisconsin-Madison (Wisconsin)
University of Rochester Medical Center (New York)
Vermont Department of Health
Washington State Department of Health
West Virginia Bureau for Public Health

What to Ask

  • CDC urges you to address health disparities with this award. Do you have LGBT communities identified as a disparity population this CTG award will target in your Action Plan?
  • CDC requires that you have a “Leadership Team” that includes reps from disparity popuations. Do you have LGBT people on your Leadership Team for the grant?
  • CDC requires you to do extensive data collection for evaluation. Are you collecting LGBT status as part of your demographics?
  • CDC requires 50% of these funds to be regranted locally. Are you planning on funding disparity community based organizations with these regranted monies? (versus just health departments)
  • Are you integrating a full range of disparity populations in the Action Plan, Leadership Team, and regranting plans?
  • If no to any of the above – Why not? We can help you fix this, provide data, people, groups, etc. What will it take to make this change?

Talking Points

  • LGBT people smoke at rates from 35% to almost 200% more than the local population
  • If we haven’t collected local data on this disparity – why do you think the national LGBT disparity data don’t apply to us?
  • Remember, even for the exercise/nutrition components of this award, if we change the main population, but don’t integrate disparity populations into that work, this could build a new disparity.
  • LGBT people, and all of the overlapping disparity populations have the ground forces, and policy change organizing skills you need to change local health policies. AKA If you’re trying to change local policy without us, it’s like leaving some of your best racehorses in the stable.

Successful Strategies

  • If LGBT people and/or other disparity groups are not being included — shine a spotlight on this fact, get press, post a blog about it, share with your membership. If a policy gap is widely known, it’s more likely to be fixed.
  • Identify what allies you might have above the grantees, like the Commissioner of the local health department, or allies in the Governors office, etc. Telling them about this gap can also help fix it.
  • Reach out to and partner with allied disparity population leadership to approach the grantee together, remember that parable about one stick and a bundle of sticks!
  • Remember you’re trying to partner with the local grantee, ask the hard questions, ask them loudly if need be, but offer solutions, you want to be the people who can fix a problem for them. You’re trying to build a working relationship here.

When?

ASAP, the groups above to turn in their new plans by end of January! It’ll be much harder to get inclusion once those plans are turned in.

Action Alerts · APHA · Community Transformation Grants · Funding · LGBT Policy

Leaders Urge Us To Demand Partnership in Local Community Transformation Awards

Scoutby Scout, Ph.D.
Director, Network for LGBT Health Equity
At The Fenway Institute

Asking Officials How We Get Inclusion in Local CTG Awards

Excerpts from the live video of the event

Flashback to American Public Health Association (APHA) conference a few months back. This event pulls together 13,000 public healthians from every walk of life. They had a session there where they were announcing the Leading Health Indicators for HP2020. Assistant Secretary for Health Dr. Howard Koh was there, as were several other leaders in the health and racial and ethnic minority communities. Moderating the session was Dr. Benjamin, the well respected President of the APHA.

You know what we do, when they open it for questions, we’re early in the line, asking about disparities and LGBT inclusion particularly.

This time I asked about this $100M of new Community Transformation Grant (CTG) money that’s just been awarded locally. As you know, we’ve been working on this lots and LGBT inclusion in these new awards wasn’t just optional, the way the CDC guidance was written, it was downright difficult for states to justify. To put out $100M of new local funds for tobacco, exercise, nutrition and not even target our communities is a huge loss. Even more worrisome are signs some states aren’t even reaching out to their existing racial and ethnic disparity infrastructure.

How? Demand Partnership

So, that was what my question was about this time, see full transcript below. Importantly, Dr. Benjamin was really clear and almost strident; local advocates need to demand partnering with local CTG grantees. We will too often be left out until we speak up and demand to be included.

So the question is, will we?

In Their Own Words; The Transcript

APHA PRESIDENT BENJAMIN:  Thank you. Next question? 

SCOUT:  Hi. My name is Dr. Scout and I’m from the Network for Lesbian, Gay, Bisexual, Transgender Health Equity. I love that we’re using social media so much as I’m trying to livetweet this event, which definitely bends your brain.

I did my dissertation on social determinants of transgender health. I love that social determinants are in there.

But my question would be you know something? I do a lot of work with community groups. I’ve been working for many years with a set of health disparity networks in Minnesota that are doing health and wellness disparity work around the Southeast Asian populations, Latino populations, African American and African populations, and lesbian/gay/bisexual/transgender population. 

It was dispiriting to see millions of dollars come into Minnesota under Communities Putting Prevention to Work and not see overlap with those existing health disparity networks.

We worked hard that the Community Transformation Grants. Had an RFA that said please do more work with your existing disparity populations and your disparity action plans. And it was even more dispiriting to see that they got almost $5 million in the state of Minnesota and they still haven’t even reached out to the existing disparity networks.

So my question I guess and it’s probably for you, Dr. Koh, what are we thinking around plans not just to ask for disparity inclusion for all populations, but to actually monitor and ensure that it happens as we run these huge sets of new funds out across the country? Thank you.

ASSISTANT SECRETARY KOH:  Well, Scout, it’s good to see you again. You always ask me the good questions. [LAUGHTER] We have a commitment to ending disparities that I think is greater now than ever before.

And when we talk about disparities we discuss them not just with respect to race and ethnicity, but also sexual orientation and gender identity and geography and level of disability and many, many other dimensions.

We do have a dedicated action plan on reducing disparities that was unveiled some six months ago. In fact, the next session I’m speaking at in an hour is on achieving health equity.

That is perhaps the most comprehensive plan to reduce disparity that ever unveiled by the department. And also reflects the growing commitment across the country to truly make the vision of health equity come alive.

So we also have committed to monitoring progress very, very carefully. And our assistant secretary for planning and evaluation, Sherry Glied, is a valuable co-partner and leader. And her whole office is helping monitor outcomes.

This is where using the healthy people data, the leading health indicator data, implementing the national prevention strategy, and using the power of Dr. Glied’s office is going to help us track these outcomes over the future.

Your challenges that you described about the disconnects in various states is reality speaking, so thank you. Please do not give up because I think we are in a new dimension right now with public health, a true paradigm shift with respect to social determinants. And this is our opportunity to make it happen.

APHA PRESIDENT BENJAMIN:  And let me add. I think that’s a perpetual problem and we really, and that’s on us. I’m not sure it’s on them. I think it’s on us and the community to demand that we partner.

We talk about partnerships and collaborations all the time. And then we fail to collaborate and partner. So I think we’ve got to go back to our communities and demand that we do it. Just like in the early days of the HIV/AIDS epidemic.

We’ve got to demand it. We’ve got to require it. We’ve got to talk to our local policy makers. You know, beat up on us local officials. You know, I always hated that when I was a health officer.

But the truth of the matter is unless us and those of us at APHA and others demand that that happen, it’s not going to happen locally. All that kind of control is local at the end of the day.

So let’s certainly try to do that. I know that we’re obviously eager to work in all the communities and make that happen.