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As gay and transgender people know all too well, you can’t be healthy if you have to hide who you are. Unfortunately, the health care system often renders gay and transgender people invisible by erasing their experiences and obscuring the impact that societal discrimination and prejudice have on their health.
Colorado’s statewide gay and transgender equality group, One Colorado, examines this injustice in its new report, “Invisible: The State of LGBT Health in Colorado.” One Colorado’s executive director, Brad Clark, discusses the report’s findings and recommendations for health systems, providers, and members of the LGBT community.
Jeff Krehely: Hello, thanks for joining us today. My name is Jeff Krehely and I’m the Director of the LGBT Research and Communications Project here at the Center for American Progress. I’m joined by Kellan Baker, who is the Health Policy Analyst with the LGBT Research Project at the Center. We are going to be speaking today with Brad Clark, who is the executive director of One Colorado. Before we jump in, Brad, and talk about this health report you released recently, can you just give us a quick overview of what One Colorado is and the issues you are working on?
Brad Clark: You bet. Thanks for having me. One Colorado is a statewide LGBT advocacy organization. We were formed in 2010 with the mission to advance equality for lesbian, gay, bisexual, and transgender Coloradans and their families—a statewide organization with members throughout the state.
JK: Great. So, we were really struck by the title of the report, which is called “Invisible: The State of LGBT Health in Colorado,” and really wanted to hear a little bit of your thoughts on why you chose to title it “Invisible.”
BC: It was a very intentional decision. Too often LGBT people are invisible, and especially when it comes to health care; we are often hidden, rarely studied, and poorly characterized. We thought the title pretty much summarized the current state of LGBT health in one word.
Kellan Baker: Given the lack of information that we have in so many corners about what exactly LGBT health is and what some of the issues are, what kinds of issues did you expect to uncover with this report?
BC: We had done some preliminary work. We have traveled the state over the past two years from the western slope to the front range of Colorado, and talked to thousands of LGBT people about their experiences. Given the conversations, we knew the horrible circumstances many in the community faced when it came to health. Specifically we heard the heartbreaking experiences of transgender Coloradans being denied care, administering their own hormones, and just lacking basic housing and care. In addition, we heard from a number of older adults facing similar situations when it came to fears around entering a nursing home or making end-of-life decisions.
JK: What do you think was the most surprising finding or research nugget that you came up with?
BC: We knew that it was happening anecdotally and from people’s stories, but the revelations from the data and the survey we conducted showed that more than 20 percent of LGBT people in this state have been denied access to health care before, and more than 50 percent of transgender Coloradans have had bad experiences. I think by far that was the most surprising and the most appalling, obviously.
The other thing we found was the connection between being “out” to your doctor and having an LGBT-friendly doctor—the connection of that to people’s health and well-being. And all the indicators, from how often people went to the doctor, to whether someone is seeking preventive care—the correlation with those two things and being out with an LGBT-friendly provider was very key and very surprising.
KB: Did you find anything particular about what it means for a provider to be LGBT-friendly?
BC: Through some of the open-ended questions in the survey, a lot of people wrote in great examples, and I don’t think it takes that much for a provider to indicate subtly that they are friendly—just basic things, like having sexual orientation or gender identity on health forms or not asking marital status, but asking a more open-ended question. And also putting things in gender-neutral language, when people are in a doctor’s office.
We also realized that it [being LGBT-friendly] extends beyond the actual provider. There were a number of people who reported that they had a negative experience with a nurse, a staff person, or an intake person before they actually got to the doctor, and that prevented them from actually seeing the doctor.
KB: This report really comes at a pivotal time in the national conversation about the U.S. health care system: the way that it serves some populations better than others, the way that it’s failing a lot of us, and particularly as your report shows, how it’s failing a lot of LGBT Americans. Are there any issues in the report that resonate with changes that Colorado, or the country as a whole, are seeing under the Affordable Care Act?
BC: I think one of the things that was really clear throughout the survey and our report that relates to the Affordable Care Act is the reality that LGBT folks are much like their straight friends and neighbors, and they are struggling simply to make ends meet, afford health care, and access the system. But there is obviously this extra hurdle that LGBT folks face when it comes to employment, discrimination, housing, or any of these other issues that impact people’s health.
Obviously there are key things under the implementation of the Affordable Care Act that we want to see to improve the health of our own community—things like access for [transition]-related care or domestic-partnership recognition. Better data collection is one that relates to the actual title of the study about us rarely being counted in any sort of surveys. And obviously nondiscrimination policies to make it unlawful to deny our community access to see a doctor.
JK: The report makes several recommendations for health systems and providers, including things like better data collection on the LGBT population, expanding access to affordable and high–quality care for LGBT people, and boosting LGBT cultural competence in the health network. But you also make several recommendations directed at the LGBT community specifically. Can you talk through what some of those recommendations are and what motivated you to direct recommendations specifically at the LGBT population and community members?
BC: I think this piece of it, this study, and these recommendations really came both from our anecdotal experiences within the community and also the data that were collected. We realized that we can’t rely solely on providers and systems to fix this problem. We as a community must own that reality that we are part of this problem and for some very valid and understandable reasons. From drinking and smoking rates to the number of us that aren’t out to our providers, it’s on us to do our part to address this and fix the problem.
Specifically, we think that LGBT organizations should make health an LGBT issue. This should be on the radar of all of our organizations; we shouldn’t just rely on health organizations to make this a health issue. And we should also do a better job as a community to reduce the promotion of alcohol and tobacco through our own media and at our events.
I think the biggest thing we realized through this study is the need to come out. That’s true in all the work that we do. The power of people coming out is transforming other people’s attitudes, and without a doubt, this is one of the biggest issues facing our community with health care. If our doctors don’t know who we are, how can they actually treat us?
KB: One Colorado has been a real leader in using health as a lens for talking about what discrimination means and what inequality means, and how they are impacting the actual wellbeing of LGBT people and their families as well as their ability to keep themselves and their families healthy, happy, and safe. But why has it been so hard to make health an LGBT issue, and how has One Colorado overcome that?
BC: What we did at the very beginning was listen to our own community, and I think that that’s where this [focus on health] came from. It was a priority that people within our community told us we needed to focus on as we traveled the state, in our surveys that we’ve done of the community, and in town hall meetings. It’s not just a rural or urban issue. It’s something we heard all across the state—that health is consistently an issue people have identified as their priority. And this is true especially for the most underserved within our community, transgender folks, and those with the least means and without access to health care.
It’s taken a bit of time to talk to some other folks within our community about why health should be an LGBT issue, why they should care, and essentially how it relates to all of the other issues we work on, from school safety for LGBT youth to civil unions and relationship recognition for LGBT families. Health is really interconnected with all those issues.
JK: Can you give some advice to advocates in other states who want to focus more attention to LGBT health? What were resources that were helpful and critical to you in developing this report and getting it off the ground?
BC: My advice is just to do it, and I think people within the community will listen, people will follow—you just have to actually start the conversation, which I think in any of these issues is often the hardest part.
We relied heavily on the resources of our own community—doctors, health care experts, nurses, insurance folks. Many people were already embedded in the existing system, and they were the ones who helped guide and direct this, in addition to the Center for American Progress and other organizations that helped provide a lot of guidance and information and resources.
The one thing we noticed when we actually started the conversation and engaged people in helping direct this is that many of those people weren’t involved in other aspects of our work before, and so the reality was that doing this health care work only helped expand our capacity and helped build the organization overall.
JK: That’s great. I think that’s all the time we have today, so Brad, I really want to thank you for taking the time to speak with us and for your great work overall and on LGBT health issues. Can you just let us know what your website is if people want to learn more about One Colorado?
BC: You bet. It is www.one-colorado.org.
JK: Great. Thanks so much.
BC: Thank you very much.
Listen to this interview (mp3)
Jeff Krehely is the Director of the LGBT Research and Communications Project and Kellan Baker is the Health Policy Analyst with the LGBT Research Project at the Center for American Progress.