A New Era for LGBT Health.

Abstract

This is a historical moment for launching a journal devoted to LGBT health, and it is with great enthusiasm that we do so. Recent progressive developments have created an extraordinary window of opportunity to profoundly lower the barriers to healthcare for LGBT-identified persons, to research the most important health concerns and needs of specific LGBT populations, and to train clinicians in the best practices to meet those needs. By providing a much-needed authoritative source and multidisciplinary international forum in LGBT healthcare services, education, and policy, LGBT Health aims to ensure that the current window of opportunity does not close but opens into a new era for sexual and gender minority health around the globe. LGBT Health employs the LGBT acronym as an umbrella term that is much more inclusive than apparent in its component letters. We use it to include not only lesbians, gay men, bisexual, and transgender individuals, but all of those who have experienced, or who are at risk of experiencing, discrimination and stigmatization on the basis of variation in sexual orientation, sexual identity, or gender identity. This includes, but is not limited to, those who are questioning their sexual orientation or gender identity, as well as those who identify as gender queer, asexual, or intersex. While the struggle for LGBT health equality is far from new, developments during the last 3 years, including the recent end of the Defense of Marriage Act, have laid a particularly promising foundation to support substantive and enduring change. In addition to mandating humane nondiscriminatory hospital visitation policies, the Presidential Memorandum on Hospital Visitation signed by President Obama in 2010 solicited recommendations as to how the Department of Health and Human Services (HHS) could better address the needs of the LGBT community. Shortly thereafter, HHS established an Internal LGBT Coordinating Committee to ensure that the concerns of sexual and gender minority persons would be considered throughout its activities. The LGBT health initiatives begun over the last three years by HHS are described on their website (www.hhs.gov/ secretary/about/lgbthealth_objectives_2012.html). They range from measures to address anti-LGBT discrimination, violence, and bullying, to the concerns of sexual and gender minority persons across the lifespan, including LGBT youth, who may be at risk for homelessness or suicide, and LGBT older adults, who too often bear the consequences of a lifetime of discrimination and mistreatment. They also address the current need for training the health workforce in culturally competent, patient-centered health care for sexual and gender minority persons, including funding of the National LGBT Health Education Center at Fenway by the National Institutes of Health (NIH), an agency of HHS. Every 10 years, HHS sets a health agenda for the next decade. The agenda promulgated in 2010, Healthy People 2020, is a landmark in being the first of these decade-long plans to address LGBT health concerns. The 2011 Institute of Medicine’s (IOM) Report, The Health of Lesbian, Gay, Bisexual, and Transgender People, solicited by the NIH, confirmed many of the health disparities and barriers to care long known by the LGBT health community. It also identified specific gaps in our knowledge of LGBT health, established priorities for LGBT health research, and outlined a specific agenda to advance the health of sexual and gender minority individuals and populations. On June 27, 2013, the NIH held its first ever ‘‘Listening Session,’’ seeking LGBT community input to determine the highest priorities within LGBT health research. In the same year the IOM published its report, The Joint Commission (TJC) published Advancing Effective Communication, Cultural Competence, and Patientand Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide. This guide urges hospitals to create a welcoming and safe LGBT-inclusive environment and makes recommendations for doing so. These recommendations carry considerable weight since TJC certifies healthcare organizations for Medicare reimbursement, and most states also consider TJC accreditation as a condition for Medicaid reimbursement. Since 2011, TJC requires an LGBT nondiscrimination statement for accreditation, and it is currently fieldtesting additional measures of LGBT cultural competence that may factor into accreditation decisions in the future. There are also positive developments for LGBT health within the U.S. Department of Defense (DoD) and Veterans Health Administration (VHA). In the wake of the repeal of ‘‘Don’t Ask, Don’t Tell,’’ the DoD recognizes the need to research the health services needs of LGB veterans (the repeal does not benefit transgender veterans), who, though always present, had previously served invisibly, making their needs impossible to assess. The VHA has also taken amazing strides toward LGBT inclusiveness. Nearly 80% of its hospitals participated in the 2013 Healthcare Equality Index (HEI), a Human Rights Campaign–administered survey that evaluates LGBT inclusiveness. In 2013, HRC evaluated 718 healthcare facilities in all 50 states and trained over 4,000 healthcare administrators nationwide in LGBT patient-centered care. HEI respondents who meet four key