OCTOBER 21, 2013 I S S U E F O C U S Entry Points to Elevate LGBT Health CARA CHERVIN PEARSALL, M.P.H., Grantmakers In Health L esbian, gay, bisexual, and transgender (LGBT) health is Force of Health Care for All New York to provide information a critical health equity issue. According to Healthy to LGBT individuals about the more affordable health plans People 2020, LGBT individuals experience a range of that will be offered by the New York State Health Benefit health disparities, including behavioral health challenges and Exchange. lack of access to care, as a result of discrimination, victimiza- tion, and stigma. Recognizing these disparities, the Agency for Other strategies for health grantmakers: Healthcare Research and Quality included LGBT individuals among its priority populations in the 2011 and 2012 National • Partner with LGBT media to create and disseminate Healthcare Disparities reports. relevant information regarding the ACA and its impact Health funders have provided limited direct philanthropic on LGBT communities. support for LGBT health. Many question whether LGBT • Support federally qualified health centers to enroll issues should be integrated into mainstream systems and orga- LGBT individuals in care. nizations or if they should be supported through targeted strategies. Since few health grantmakers are prepared to carve • Collaborate with civil society funders reaching out to out a separate programmatic area focused on this issue, a grow- LGBT individuals to promote simultaneous voter ing opportunity exists for health funders to provide more registration and health care enrollment. purposeful support for LGBT health within existing grantmak- ing strategies to address health disparities and promote health equity. Potential entry points for addressing LGBT health dis- SUPPORTING CULTURAL COMPETENCY cussed here include: implementing the Affordable Care Act INITIATIVES AND POLICY (ACA), supporting cultural competency initiatives and policy, Cultural competency programs seek to develop the knowledge and reducing tobacco use. and skills of individuals and organizations to more effectively provide high-quality health care to diverse communities. Often IMPLEMENTING THE ACA these programs focus on issues of culture related to race and The passage of the ACA presents an unprecedented opportu- ethnicity, given that communities of color experience more nity to provide health care coverage and access to a large limited access to high-quality health care and poorer health number of uninsured communities, many of whom identify as outcomes than white communities. Including sexual orienta- LGBT. For example, LGBT individuals and families will bene- tion as a dimension within cultural competency trainings and fit from greater access to comprehensive coverage as a result of programs is a crucial area to consider since LGBT individuals guaranteed availability of coverage, fairness standards for pre- also experience barriers to care or substandard care (Lambda miums, and guaranteed coverage for Essential Health Benefits Legal 2010). (Cray and Baker 2013). Additionally, provisions to prevent Harvard Pilgrim Health Care Foundation’s Culture InSight unfair discrimination by health insurers offer new protections program tailors its cultural competency trainings for health to LGBT consumers, and Medicaid eligibility expansions will and human service organizations to include an LGBT compo- help many more low-income LGBT families obtain coverage. nent when requested. Recognizing that sexual orientation is As part of its “Health Happens with Equality” campaign, not a visible characteristic, the program seeks to help providers The California Endowment is providing funding to Equality avoid making potentially harmful assumptions about patients. California to educate and enroll at-risk and marginalized Culture InSight’s trainings include techniques such as case LGBT Californians in ACA-approved health care plans. The studies and story examples that illustrate the diversity of campaign will focus on educating LGBT people and the gen- LGBT communities, acknowledging that people who identify eral public about issues that affect the LGBT community. as LGBT can also be immigrants, have a disability, or be a per- Additionally, the New York State Health Foundation spon- son of color. Similarly, The California Endowment has sored a briefing to publicize a campaign by the LGBT Task supported advocacy efforts to push for policy changes related I S S U E F O C U S GIH BULLETIN to cultural competency and LGBT issues. Through partner- ships with community foundations and statewide advocacy Other strategies for health grantmakers: coalitions, the endowment helped advance policy that • Support interventions focused on changing establishes LGBT cultural competency training requirements perspectives and perceptions of tobacco use among for senior care facilities, requires state agencies to include sexual LGBT communities. orientation in data collection, and includes LGBT in cultural and linguistic competency requirements of physicians and • Collect surveillance-level data on sexual orientation dentists. and tobacco use. • Partner with the National LGBT Tobacco Control Network to support the national action plan to Other strategies for health grantmakers: address the disproportionately high rates of tobacco • Fund cultural competency trainings with an LGBT use among LGBT communities. health component for Marketplace navigators associated with implementation of the ACA. • Promote the implementation of culturally competent CONCLUSION health care services supportive of LGBT health that Given the disparities affecting LGBT communities, the issue of satisfy the National Culturally and Linguistically Appropriate Standards in Health and Health Care for LGBT health stands to benefit from more strategic philan- health care organizations. thropic attention. Because LGBT individuals are present in all communities, funders are already serving LGBT populations, • Support usage of the Healthcare Equality Index for though there is an opportunity to elevate LGBT health within health care organizations seeking to provide existing approaches to advance health equity. Addressing equitable, inclusive care to LGBT communities. LGBT health through philanthropic efforts to implement the ACA, support cultural competency initiatives, and reduce tobacco use are three examples among many for health funders REDUCING TOBACCO USE to create more integrated strategies so that the vision for achieving health equity truly does include all people. The devastating health consequences of tobacco use are widely known. In fact, tobacco is the leading cause of mortality in the United States. According to the National Coalition for LGBT Health, LGBT individuals are 40 to 70 percent more likely to smoke than non-LGBT individuals, and more than 30,000 LGBT individuals die each year of tobacco-related illnesses (National Coalition for LGBT Health 2005). Higher levels of social stress, higher rates of alcohol and drug use, and direct targeting of LGBT consumers by the tobacco industry con- tribute to disproportionately high smoking rates among LGBT communities. To address inequities facing the LGBT community, Blue SOURCES Cross and Blue Shield of Minnesota Foundation integrated Cray, A., and K. Baker, How the Affordable Care Act Helps the efforts to support tobacco cessation specific to LGBT LGBT Community, (Washington, DC: Center for American individuals as part of its broad Health Equity in Prevention Progress, 2013). portfolio. This program includes working at the state level to advance awareness of LGBT health inequities related to smok- Healthy People 2020, “Lesbian, Gay, Bisexual, and ing, promoting anti-tobacco policies that change smoking Transgender Health,” <http://www.healthypeople.gov/ norms at the environmental level, and creating a directory of 2020/topicsobjectives2020/overview.aspx?topicid=25>, 2013. LGBT-friendly providers for those seeking tobacco cessation Lambda Legal, When Health Care Isn’t Caring: Lambda Legal’s support. Additionally, through its Tobacco Policy Changes Survey on Discrimination Against LGBT People and People program, the Robert Wood Johnson Foundation funded Living with HIV, <http://data.lambdalegal.org/publications/ organizations in 33 states to cultivate grassroots efforts to downloads/whcic-report_when-health-care-isnt-caring.pdf>, promote policy changes among communities disproportion- 2010. ately affected by tobacco use, including the LGBT community. National Coalition for LGBT Health, LGBT People & Smoking, <http://lgbttobacco.org/files/LGBT%20People% 20and%20Smoking_Coalition%20for%20LGBT%20health. pdf>, 2005.