Are we at the tipping point in LGBT Health?

by Emilia Dunham

Reporting from the Trans Health Summit in San Francisco

We all know that in our community’s history has experienced severe health disparities compared to the general population.  Rob Garofalo of Chicago’s Howard Brown University wraps up the Summit with a summary of the LGBT IOM Health Report and what this could mean for LGBT populations.  Rob was on the committee developing this report.

With all these incredibly supportive reports and recommendations to include LGBT populations, could this mean that these amazing recommendations could still be implemented and have a tremendous ripple effect to heal the health wounds in this community with Health People 2020 and now the LGBT IOM Health Report.

So what is changing?

  • HHS is including gender identity in its non-discrimination plan, hospital visitation policy and approach to including LGBT persons in all policy decisions
  • AMA’s LGBT Advisory Panel, non-discrimination policy, support of DADT, recommendations to include LGBT healthcare
  • HRC and other organizations are holding organizations, hospitals and insurers accountable to fully include LGBT populations.
  • There are more RFAs and research including, and specific, to LGBT populations.
  • WPATH is revising its standards of transgender health care

We are coming out of a dark place in LGBT health, but with the number of organizations (government, local, private, etc) coming on board to support LGBT inclusive health policies, research and care is considerable.

But what do you think?

The Needs and Practical Implication of Transgender Healthcare Inclusion

by Emilia Dunham

Reporting from the National Transgender Health Summit in San Francisco

In the afternoon I attended a session led by Andre Wilson and Jamison Green who discussed transgender insurance inclusion.

First of, what does Trans-Inclusive Policies mean?

Insurance policies include:

  • Mental Health care
  • Hormone Replacement Therapy
  • Breast/chest reduction
  • Genital surgeries
  • Hysterectomy

Second, what needs to happen?

  • Advocating: As the metaphor goes, the squeaky wheel gets the wheel, which is the case of trans health inclusion. Here is where grassroots advocacy makes a difference as often it’s the behind-the-scenes work that accomplishes this. Here is how YOU can help, as even as an ally you may have more clout to communicate this need to your organizations, communities and state plans.
  • Community/Organizational Pressure of corporations and state plans: For instance, the Human Rights Campaign (HRC) has something called the Corporate Equality Index in which Fortune 1000 and other major companies are scored on LGBT inclusive policies and environment. Until recently, to get a score 100% in LGBT inclusion, companies had to have at least 1 trans-inclusive health policy coverage of HRT, counseling, short-term disabilities, surgical procedures and/or follow-up procedures/labs. In a game-changing move, with the consultation of Green and Wilson, in 2012, employers will need to cover ALL of these to score 100% and these factors will be weighted twice as strongly. Right now only 85 of these companies have this complete suite of trans inclusion, but this number could spike within the next few years, so the three million Americans who receive coverage from these companies could increase to even more.
  • The need of visibility through medical consensus: For instance, this is the Healthy People 2020 Report, the Institute of Medicine LGBT Health report, AMA, etc. This is how these recommendations and reports can be used for practical implications that change the very lives of trans people in our community.

As to be expected, there are several challenges that have come up

  • Some insurance providers will sometimes ask for more years living full-time in desired gender and/or more letters, even exceeding WPATH standards.
  • Sales/Vendors, call center staff all may say that these plans don’t exist
  • Reimbursement issues: few in-network providers, so people are getting screwed on reimbursements
  • Coding problems

However, despite challenges, there is incredible momentum happening at the grassroots level that will alleviate health disparities for this segment of our community that experiences the very worst of health disparities overall. It’s something that is not terribly expensive (can cost just a few cents per employee); it’s something we ALL can advocate for and it will, again, have a tremendous effect. And there is something very real that can be done!

JUST RELEASED: Announcement of Primary Care Protocols for Transgender Patients

by Emilia Dunham

Reporting from the National Transgender Health Summit in San Francisco

 

There were some amazing protocols released today at the Summit which you’ll definitely want to review and show.

What did the Project Plan involve? Literature review and gap analysis, draft protocol, review meetings, core protocol, backgrounders & FAQS and ongoing development. Thrillingly, they are have reached the 4th plan which is releasing the core protocol.

One of the major aspects they are suggesting is to intake forms for gender:

  • Male
  • Female
  • Transgender Male/Transman
  • Transgender Female/Transwoman
  • Genderqueer
  • Additional Sex or Gender: Please specifcy
  • Unknown or Question Not Asked
  • Decline to State

This protocol covers: cancer, cardiovascular, vaccinations, sexual health, pulmonary screening, diabetes, musculoskeletal health, mental health, substance use. There is also a section on hormone administration involving consent and both male-to-female and female-to-male hormone use as well as surgical options. Special considerations for children/youth and aging

There were several suggestions listed for Best Practices on:

  • Sex-Segregated systems
  • Identity documents
  • Insurance problems
  • Electronic Medicaton Records (EMR)

This Protocol is all listed on their website: http://www.transhealth.ucsf.edu/tcoe?page=protocol-00-00

Precursors of this protocol were at many LGBT Centers, including Fenway Health.

Importance of Advocacy for Implementation of Trans Inclusion in Federal Health Policies

by Emilia Dunham

Reporting from the Transgender Health Summit in San Francisco

I’m having the incredible privilege of attending the Center for Excellence for Transgender Health’s first national Transgender Health Summit. The opening remarks this morning were from Herb Schultz, MPP, Regional Director at the DHHS Region IX who spoke about trans inclusion at the federal level.

Some of the major themes he discussed were inclusion, implementation and bringing advocacy to the local, state and federal level and how we can assist government to make changes that affect our community.

He discussed his personal story, and how 20 years ago, he become involved in HIV prevention. Later became involved in LA AIDS Project, and after a meeting with trans advocates, he realized there were so few protections and services for trans people. He’s inspired by trans communities and the progress we’ve made in such a short time, despite our opposition.

Despite the struggles to enact and implement trans inclusive policies, recent advocacy to the federal level is getting inclusion.

Herb Schultz, MPP, Regional Director at the DHHS Region IX

There is a place in the government to advocate for trans inclusion in government, which we’ve seen from the recent IOM report and report from HHS of non-discrimination concerning gender identity. The changes made were because trans communities went to Kathleen Sebelius; people like us, who have advocated for trans inclusion.

In the future, what we need to consider future advocacy and implementation. For instance implementation of the Health Care Reform Act is vitally important for trans communities. There are consumer protections, there are groundbreaking changes in our health services, but when you look at where our government is, there are many people on local, state and federal government who are against HCR and trans programs. For that reason, we should prepare to defend these programs.

Governments have never included communities like ours to get our input, so it’s SO important we continue advocating!