Scott Weber, Rebecca Fox and David Haltiwanger “The good we secure for ourselves is precarious and uncertain until it is secured for all of us and incorporated into our common life.” —Jane Addams Health disparities have been noted in a number of ethnic and racial minority groups in the United States. It is now recognized that lesbian, gay, bisexual, and transgender (LGBT) individuals may experience the same type of poorer health and health outcomes. As with other groups, this is partly explained by differences in access to health care, lack of knowledge regarding the health issues of the LGBT community, and, sometimes, overt discrimination. The National Coalition for LGBT Health (the Coalition) was established to respond to a lack of focus in clinical care and research on sexual orientation and gender identity minorities—and their health needs. In addition, there was a perceived need for an organization to engage in public policy advocacy for the LGBT populations. Research literature and clinical case studies were demonstrating variations in health behavior as well as disparities in access to care among these groups (Harris Interactive, 2008). The HIV/AIDS crisis, which inordinately affects younger gay men, helped to bring a focus to the health of sexual minorities. Research has begun to demonstrate significantly higher risks for sexually transmitted infections, substance use, partner violence and abuse, and some cancers in LGBT populations (Hidalgo, Peterson & Woodman, 1985; Marmot & Wilkinson, 1999; Diamant, Wold, & Spritzer, 2000; Dean, et al., 2000; Ellis, Bradford, & Honnold, 2001; Linde, 2003; Bradford, 2005; Makadon, 2006; Makadon, Mayer, Potter, & Goldhammer, 2008). More recent research is examining disparities in senior care as well as parenting identity development and family planning among LGBT adolescents and young adults. The Coalition, headquartered in Washington, D.C., was formed on October 14, 2000, when a group of community health advocates from across the U.S. convened in the nation’s capital to discuss the need for including LGBT health issues in the federal government’s Healthy People 2010 objectives. At that meeting, we recognized that a coordinating structure was needed to advance our interests at the White House, as well as in the U.S. Department of Health and Human Services, Congress, and elsewhere. Many of the participants at that first meeting knew each other from conferences put on by the National Lesbian and Gay Health Association, an organization that had ceased to exist due to organizational problems. Learning from that group’s demise, the leaders of the Coalition committed to a primary focus on advocacy, especially LGBT health advocacy within the federal government. We were committed to running a lean operation—beginning with a single full-time employee. In the beginning, the Coalition used donated office space at an LGBT community health center. In 2005, we moved into our own office space, became incorporated, and successfully pursued obtaining 501(c)(3) non-profit status. By obtaining grants from foundations, we’ve increased our resources and expanded our staff. With more personnel, we now have the ability to carry out policy analysis and to take the lead in federal advocacy in pursuit of the Coalition’s agenda. The coalition’s work is focused on five areas: (1) research, (2) policy, (3) programs and services, (4) professional and cultural competency, and (5) diversity of the national LGBT community (Box 88-1). The Coalition has 65 organizational members and 50 individuals. The organizations include national LGBT and HIV/AIDS groups, community health centers, community centers, and departments of health. Individual members tend to be researchers or activists concerned with LGBT health. The Coalition works with these groups in different ways. For example, the Coalition works with national LGBT organizations to increase their focus on health as a social justice issue. For local groups without an advocacy arm, the Coalition connects them into federal policy and advocacy work. Increasing numbers of nurses are involved in the work of the Coalition through participation in research projects; participation in policy advocacy work at federal, state, and local levels; service on the board of directors and other committee work; and personal or organizational memberships. The Coalition works on multiple levels within Congress, the Administration, federal Agencies, and the LGBT community and its allies. This work has included such issues as Healthy People 2010 and Healthy People 2020, working with the Substance Abuse and Mental Health Services Administration (SAMHSA), health care reform, and LGBT data collection. Healthy People 2010 was the catalyst for the formation of the Coalition. Healthy People provides science-based, 10-year national objectives for promoting health and preventing disease (U.S. Department of Health and Human Services, 2009). We believed it was vital that LGBT health objectives be included in this program, which is viewed as a blueprint for improving the Nation’s health (Box 88-2).
Taking Action
The National Coalition for Lesbian, Gay, Bisexual, and Transgender Health
The Coalition’s History
Members, Affiliates, and Staff Members
The Coalition’s Accomplishments
The Coalition’s Objectives in Healthy People 2010
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