Upon concluding the review process for our Mid-Missouri and Southeast Missouri hospitals, health advocates were faced with the challenge of sparking interest among rural hospital officials on a review of their LGBT welcoming policies. Knowing the formula for sparking interest among urban hospitals, we knew that rural outreach would be considerably different. Putting on our strategy caps, advocates came up with a road map to engage these hospitals.
One issue that we felt needed to be overcome was the assumption that LGBT health is not an issue in rural Missouri – quite the contrary. We know that LGBT folks exist and live in every county in Missouri and across the Nation and we know that they utilize health and social service facilities – just like any citizen. But, disproportionately sexual minorities experience poorer health outcomes than our heterosexual peers according to the Missouri Foundation for Health. Often times this is because of the invisibility LGBT rural folks feel within health and social service policies – it was our task to break our invisibility.
With this, advocates set out by utilizing the community, and the tools we learned from our outreach with urban hospitals. Through a series of strategic mailers that included a report of the hospitals LGBT welcoming policies as well as copies of local news articles that focused on LGBT health, advocates began to engage these officials.
In our outreach to rural hospital officials, advocates developed four points:
1. Create a sense of urgency – by highlighting local news articles that focus on LGBT health we were able to break our invisibility and create a sense of urgency. In developing these pieces, we also helped to start a community dialogue on LGBT health and the issues associated, including the lack of regional LGBT welcoming policies.
2. Highlight successes to create credibility– knowing this was the first time that these hospital officials would have likely been engaged by LGBT advocates, we wanted to create credibility from the begin by highlighting our past successes with urban hospitals.
3. Report along with methodology – to let officials know how we came to our conclusion on their LGBT welcoming policies, further establishing credibility.
4. Clear ask from the officials.
To review the packet of information sent to rural hospitals, please click here.
In the next case study, we will outline the work of the LGBT health advocates in outreaching to these officials along with lessons learned in moving forward with rural outreach on LGBT health.
At the beginning of February 2015, LGBT advocates in Missouri began reviewing our second list of hospitals on their LGBT welcoming policies. Having successfully accomplished several LGBT policy victories during our first round of outreach, we began to tackle a new beast — rural Missouri.
Choosing 10 hospitals throughout the Mid-Missouri and Southeast Missouri region, we began our review. Reviewing rural hospital policies as an outsider can be difficult. Our researchers, however, presented themselves as regular patients that really only had one connection publicly* with these hospitals — their website. Herein lies several challenges to this research. Difficulties in the regular maintenance of a hospital’s website, problems with the lack of hospital organizational structure to allow for maintenance, and the years of slowly decreasing revenue adding to the lack of structure; could lead to possible inaccuracies from the data collected during the reviewing process. We, however, have not experienced any hospitals who have challenged our review.
How did we begin to review a rural hospital’s website?
Identify hospital’s main website – for most rural hospitals this could be the website that their System had set-up, make sure to check both. If the hospital’s website links to the System network, then make sure to check the System website for their LGBT welcoming policies.
Use search engine to identify key terms used by LGBT patients – this includes searching for terms such as “discrimination”, “sexual orientation”, “gender identity”, “visitation”, “patient rights”.
Document and log policy research – in order to create the individualized reports, while also maintaining for your records whether policies do or do not exist before beginning our outreach.
Upon reviewing each hospital website, we concluded our findings and began to work on outreaching to those hospitals in hopes of sparking their interest in reviewing their policies. Next Missouri case study, find out the strategy used in outreaching to rural hospitals to spark their interest in LGBT welcoming policies.
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Reporting from Creating Change
January 2012 Baltimore, MD
The National Gay and Lesbian Task Force: Creating Change Conference in Baltimore has attracted 3,000 LGBT rights advocates from all over the US. Housing and Urban Development Sec. Shaun Donovan announces new policies to protect LGBT people.
“I’m here this afternoon because our President and his administration believe the LGBT community deserve a place at the table and a place to call home. Each of us here knows that rights that most folks take for granted are routinely violated against LGBT people. That’s why I am proud to stand before you this afternoon and say HUD has been a leader in the fight – your fight and my fight – for equality. Over the last three years we have worked to ensure that our housing programs are open. Not to some. Not to most. But open to all.”
These policies include protecting LGBT people from discrimination under the Fair Housing Act and same-sex data collection.
“Today I am proud to announce a new Equal Access to Housing Rule that says clearly and unequivocally that LGBT individuals and couples have the right to live where they choose. This is an idea whose time has come.”
It’s an exciting time for LGBT people in the US. Creating Change is working for LGBT people!
by 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.
by 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 firstname.lastname@example.org 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?
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.
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.
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.
by Scout, Ph.D.
Director, Network for LGBT Health Equity
At The Fenway Institute
Asking Officials How We Get Inclusion in Local CTG Awards
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.
By Scout, Ph.D.
Director, Network for LGBT Health Equity
A project of The Fenway Institute in Boston
Weeha! Sometimes life comes too fast, I’m just now reading the next generation of the Draft National Prevention Plan, that one created by the new uber healthcare reform group that includes half the U.S. Cabinet (meaning health isn’t just about U.S. Dept of Health and Human Services, or HHS, any more, and it’s about time).
We also submitted a few different rounds of testimony ourselves to this group, and we also submitted a few different candidates for their advisory body, and we urged White House folk behind the scenes to please make sure an LGBT person got on the advisory group. While they didn’t pick our candidates, they did add the supremely able Jeff Levi, who has now even been named chair of the group! So, let’s just say, we’re trying to make sure they don’t forget us. Anyhow…
It’s my very great pleasure to announce that with this new draft plan, one of the main things we pushed to fix has been fixed, gender identity has been added alongside sexual orientation as a marker for disparities!!!
To quote the new draft prevention strategy, pillar four is…
4. Eliminate Health Disparities: Eliminate disparities in traditionally underserved populations to improve the quality of life for all Americans. Some groups are disproportionately affected by health risks including major disorders such as heart disease, obesity, diabetes, HIV/AIDS, or viral hepatitis; high rates of infant mortality; and high rates of violence. Disparities often occur under conditions of social, economic, and environmental disadvantage. All Americans should have access to opportunities for healthy living and be supported in their efforts to make choices that promote long, healthy, and productive lives, regardless of race or ethnicity; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics.
Alas tho, it’s not all roses, the other big thing we asked for, to explicitly commit to enhanced LGBT data collection, not so much. Oh well, if life was all roses, we’d probably faint from shock, right?
Great job y’all! And let’s keep up the good work. If you aren’t on our direct mail lists for lgbt health policy advocacy opportunities email us now at email@example.com to make sure you get all the news first! (or subscribe to this blog)