LGBT Policy

LGBT Inclusion in Federal Leading Health Indicators

By Scout

Network for LGBT Health Equity

New Institute of Medicine Report on Healthy People 2020 Has LGBT Inclusion

So HHS asked the prestigious Institute of Medicine to come up with leading health indicators for Healthy People 2020 and their report just came out today. We’re poring over all 87 or so pages now but wanted to give you the heads up LGBT people figure prominently in the document.

First, the Institute of Medicine recommends 12 Leading Health Indicators, or measures of the overall nations health be used. These include things like “Proportion of the population with access to healthcare services” and of course our favorite “Proportion of the population using tobacco”.

Then they suggested 24 objectives from all of the many in Healthy People 2020 that are very related to the Leading Health Indicators. Now this is where it gets interesting to us, they noted that 12 of those objectives were particularly relevant to LGBT health disparities.

The 12 Most Important Health Objectives for LGBT People

(The garble at the beginning refers to what HP2020 chapter they are in.)

  • AH 5L: Increase the educational achievement of lesbians, gay men, and bisexual and transgender adolescents and young adults.
  • AHS 1L: Increase the proportion of lesbians, gay men, and bisexual and transgender persons with health insurance.
  • AHS 5L: Increase the proportion of lesbians and transgender persons with a usual primary care provider.
  • HIV 17L: Increase the proportion of condom use among gay or bisexual males aged 15 and above who are sexually active with other men or women.
  • MHMD 4L.1: Reduce the proportion of gay, bisexual or questioning males and females aged 12 to 17 years who experience major depressive episodes (MDEs).
  • MHMD 4L.2: Reduce the proportion of lesbian, gay men, bisexual, and transgender persons aged 18 years and older who experience major depressive episodes (MDEs).
  • NWS 10L: Reduce the proportion of lesbian and bisexual female adolescents who are considered obese.
  • SA 13L: Reduce the proportion of lesbians’, gay males’, bisexuals’, and transgender persons’ past-month use of illicit drugs.
  • SA 14L: Reduce the proportion of lesbian, gay males, and bisexual persons engaging in binge drinking of alcoholic beverages.
  • TU 1L: Reduce tobacco use by lesbian, gay men, and transgender adults.

It’s great that they have identified priority objectives for LGBT people, but they even went further, they talked about data!

The Call for LGBT Inclusion in Health Surveys!

“A major difficulty in examining LGBT health relates to the availability of data for analysis. According to the Healthy People website,11 “Sexual orientation and gender identity questions are not asked on most national or state surveys, making it difficult to estimate the number of LGBT individuals and their health needs.” Therefore, the committee believes HHS should focus on improving and developing datasets that will facilitate analysis of disparities in LGBT health, thereby leading to action that can improve the quality of life and well-being of LGBT populations.” p. 43.

Hear hear, we agree heartily. And face it, if one more government policy doc comes out suggesting LGBT data inclusion, it’s going to be pretty hard to keep excluding us!

Read the whole report on the Institute of Medicine website.


Implementing Affordable Care Act, Section 4302: An Overview of Federal Efforts and Implications for Data Collection

by Emilia Dunham

Reporting on “The Affordable Care Act (Part II): Section 4302 and Implications for Data Collection” call earlier this afternoon

(Webinar was sponsored by the Aetna Foundation and AcademyHealth)

On the call today David Meyers of the Center for Primary Care, Agency for Healthcare Research and Quality discussed how Section 4302 of the ACA lists requirements for data collection of disparity populations affecting prevention, public health, expansion of coverage and access to care. Here were some take-aways:

  • Data from national surveillance will be available for public research, but privacy will be maintained.
  • Department of Health and Human Services Secretary Kathleen Sebelius will establish data collection standards, calling for specific language for funding.
  • Five specific standards for data collection at a minimum: Race, Ethnicity, Primary Language, Disability Status and Sex.
    • All surveys and all agencies supported by DHHS would be required to collect for these standards.
    • Secretary Sebelius has authority to require additional standards and is considering additional categories.
    • There will be listening sessions for the public to include comments on adding additional categories such as sexual orientation and gender identity. They are asking for comments on burden versus value of adding categories.
    • Next steps: Input will be incorporated, and the DHHS Secretary will either add, reject, ask for more information or more time on new categories to include.

 What to ask in listening sessions and what feedback we should provide to the DHHS?

DHHS is looking for answers on the following questions

  • What characteristic(s) do you think should be added to the current list of race, ethnicity, sex, primary language and disability status to further address health disparities?
  • How many individuals would be affected if data addressing this topic is collected?
  • Is there evidence that a health disparity exists for this characteristic?
  • Have any instruments been developed and tested to measure this demographic characteristic? If so, please provide a brief summary of the measures and evaluation results.  If not, do you have recommendations as to the questions that should be asked or how the measures should be developed?
  • Has information on this characteristic ever been collected, presented, published, or televised? If so, where has this been done?
  • Recognizing that demographic data, especially data related to disparities, may be sensitive, elicit prejudices, and affect individual’s willingness to provide information, do you have information about how collecting information on this category may affect overall data collection activities and how to maximize data quality?
  • Do you have any recommendations as to how the Secretary should decide (i.e., what criteria should be used) whether the potential for burden of adding your proposed characteristics would outweigh the need to gather additional information to address health disparities?
  • Do you have any other recommendations with respect to any other demographic data regarding health disparities that you would like the Secretary to consider?

Feedback relating to our community

One person on the call asked whether additional populations will be captured under the current 5 categories like transgender populations. Presenters stated that sex is without a doubt not just “male” or “female”, but it’s possible that options can expanded to include “other”, “transgender” or another option. HHS is needing answers on how to expand the category of sex/gender to include transgender categories.

Next Steps:

There will be additional listening sessions though many were sent by invitation only.

The Network is having a BrownBag Webinar on Monday, November 22, 2010 at 4pm to discuss what information to submit and how to respond about adding LGBT measures for federal surveillance. Please email us with thoughts or information at or register for the call here.  See our blog post for more information.