Gays and lesbians are included for the first time in "Healthy People 2010," the U.S. government's blueprint for health services over the next decade. Donna Shalala, Secretary of Health and Human Services ( HHS ) , officially released it Jan. 25.
But inclusion wasn't a foregone conclusion.
Gays and lesbians were virtually ignored in the initial draft of the massive 800-plus-page document when it came out in December 1998. The word "gay" was used twice, while "lesbian" and "transgender" did not appear at all, according to an analysis by the Gay and Lesbian Medical Association ( GLMA ) .
Fred Fox, then GLMA's policy director, was "shocked" that "we have virtually no place at the table" in a document whose goal is "eliminating health disparities, primarily among racial and ethnic minorities."
GLBT health advocates flooded the Department with more than 400 suggestions on the draft document during the period for public comment. That prompted a unit of HHS, the Health Resources and Services Administration ( HRSA ) , to commission a report from GLMA and Columbia University. "Lesbian, Gay, Bisexual and Transgender Health: Findings and Concerns" also was released Jan. 25.
The report is a superb state-of-the-art summary of LGBT health issues, clearly organized into 50 pages of lucid writing and references to a massive bibliography for more detailed information.
It notes, "Because of negative attitudes prevalent in the U.S. public as well as among physicians and other medical staff, LGBT individuals are subject to discrimination and bias in medical encounters."
"Even well-meaning physicians may make assumptions about gays or lesbians that make them reluctant to return for treatment," said Darren Carter, MD, who chairs the GLMA policy board. "Or those assumptions may actually be dangerous."
"For example, we know that many doctors treating lesbians believe that a pap smear test is not necessary because lesbians are not engaged in heterosexual intercourse," he said, adding that this report "provides needed evidence that this practice can be dangerous to lesbians' health."
Other major problems include the very limited amount of research that has been conducted into LGBT issues, and methodological problems of identifying who is LGBT.
Both contribute to an unclear picture of the nature and scope of problem, let alone remedies for them.
Patricia Dunn, the current policy director for GLMA, says that HHS "added more references to LGBT health issues in the next draft" of Healthy People 2010. She hopes that the final version, scheduled for publication this summer, will be even better.
"We should be way beyond where we are in terms of our issues getting discussed in these various reports," she says. "It's a little frightening to think what might be next" with another administration.
She linked it to a broader context where too many people "don't even think that we should be able to have committed, sanctioned relationships."
Dunn calls "Findings and Concerns" "a way to point out what research there is" on GLBT health issues, and "to help make the case that more research needs to be done." She is optimistic that HRSA will fund creation of "a companion document" to Healthy People 2010 "that lays out specific objectives for LGBT health" research and service programs.
That was supposed to be the purpose of a report on lesbian health issues issued last January by the prestigious Institute of Medicine. But the floodgates of funding on lesbian health issues have not exactly sprung open. Instead, there will be a conference in March of this year to identify which federal agencies need to conduct what lesbian-specific studies and which broader studies need to include questions that identify lesbians.
"Hopefully [ federal agencies ] will take the recommendations seriously," says Dunn.
But she acknowledges that GLMA and other advocates are going to have to "start advocating for their funding. It's a sad state, there is a lot of work that needs to be done."
That is one reason why the organization, which is based in San Francisco, plans to increase its Washington presence.
"Lesbian, Gay, Bisexual and Transgender Health: Findings and Concerns" is available from the Gay and Lesbian Medical Association at www.glma.org or by calling ( 415 ) 255— 4547
