LGBTQ Pride and Public Health

Ginger Lee, MPH, Bureau Manager, Collective Impact & Operations,
Long Beach Department of Health and Human Services

Ginger b&w 2 headshot carla.jpeg

June is LGBTQ Pride month.  Pride is a time when lesbian, gay, bisexual, transgender, queer and questioning people join together to further strengthen community by celebrating joyously, with parades and other events.  Pride is also a time when the LGBTQ community remembers its history. And for public health professionals, Pride is a time to reflect on what we can do to address social conditions that negatively affect the health of LGBT people, and to strengthen conditions that support health within our LGBTQ communities.

The first Pride parade took place in the streets of New York in 1970 to mark the one year anniversary of the Stonewall riots.  The riots were a reaction to a police raid on the Stonewall Inn in Manhattan.  Knowing this helps to clarify why Pride is a time when the LGBTQ community revels in simple privileges such being highly visible yet safe, claiming one’s own identity, shedding the burden of rejection, and enjoying the loving embrace of “family.”

  Long Beach, California, Department of Health & Human Services preparing for the Pride parade.

Long Beach, California, Department of Health & Human Services preparing for the Pride parade.

Public health professionals know much more now than we did in 1970 about the inextricable link between social health, mental health and physical health.  A paradigm shift is nearly complete, away from a sole focus on individual behavior, toward a population health focus rooted in a stronger understanding of how social conditions and trauma directly affect health.

Pride serves an important purpose in supporting the health of the LGBTQ community, since health disparities often can be attributed to social conditions affecting groups.  The LGBTQ community has endured systemic and legally sanctioned discrimination, shaming by institutions and systems, shunning by families of origin, the HIV epidemic, and being targeted for brutality and violence because of who LGBTQ people  love or how they express their gender.  Because many LGBTQ people are also people of color, stressors and conditions known to negatively affect health are often multiplied.

Pride is a time when the LGBTQ community comes together to remind one another and the wider community of all their beauty, diversity and strength.  It is a time when, surrounded by like-minded people, the LGBTQ community can relax, be affirmed, and celebrate victories.

There are plenty of victories to celebrate.  Same sex marriage is legal.  A major form of societal rejection, lack of acceptance into the institution of marriage, has been removed by law.  Equal tax treatment and other benefits are now available for any legally married couple.  LGBTQ people can adopt and serve as foster parents.  Gender neutral restrooms are being written into law, and many universities and cities already have adopted gender neutral restrooms.  While there is no federal anti-discrimination law that provides explicit protections on the basis of sexual orientation or gender identity, as of this June, 18 states and the District of Columbia have adopted anti-discrimination laws that included protections for transgender people.[1] 

And yet in March 2018, the president signed a transgender military ban.  Just this month, June 2018, a divided Supreme Court absolved a Colorado baker of discrimination for refusing to create a wedding cake for a same-sex couple.

The Human Rights Campaign has just released its 2018 LGBTQ Youth Report.  The findings from more than 12,000 LGBTQ youth ages 13-17 from all 50 states and Washington D.C. are chilling.  Seventy four percent said they do not always feel safe in the classroom; 73% have experienced verbal threats, and 11% have been sexually attacked or raped because of their actual or assumed LGBTQ identity.  Seventy seven percent reported feeling depressed or down over the past week, with more than 70% reporting feelings of worthlessness and hopelessness in the past week.  LGBTQ youth of color and transgender teenagers experience unique challenges and elevated stress.  Only 11% of youth of color surveyed believe their racial or ethnic group is regarded positively in the U.S.[2]

LGBTQ youth are rejected from their homes at higher rates than their non-LGBTQ peers.  As a result, they are overrepresented in the youth homeless population, foster care and juvenile justice systems.  The Williams Institute reports the incarceration rate for LGB people is three times the rate of the general population.[3]  While LGBTQ youth make up about 5 to 10% of the overall youth population, about 40% of homeless youth are LGBTQ.[4]

LGBTQ youth are also at higher risk of suicide.  LGBTQ youth are almost five times as likely to have attempted suicide compared to heterosexual youth.[5]

LGBTQ older adults are more vulnerable as well.  Since many did not have children, they can lack that level of social support.  Older adults can be more apprehensive about how they will be treated by the health care system or in senior care facilities[6], which can cause some people to avoid or delay care.  Older women partners have experienced twice the effect of the gender pay gap than mixed gender couples.

The National Center for Transgender Equality reports that the transgender community experiences rates of unemployment at three to four-times the rate of the general population.[7]  The transgender community can also be apprehensive about seeking care in medical settings, potentially driven by previous experiences with care that was not culturally competent.

While studies can illuminate disparities in general, specific data at more local levels often do not exist.

Long Beach, California celebrates Pride with a flair, and there are many other signs that Long Beach is a welcoming and affirming city.  The City has invested in creating visible signs of welcome, such as painted rainbow crosswalks.  Long Beach benefits from a thriving LGBTQ Center that offers services related to community building and culture, physical and mental wellness, and legal assistance for people of all ages.  California State University Long Beach offers a minor in Queer Studies.  Long Beach is home to several popular LGBTQ establishments, and LGBTQ specific events and entertainment are readily available as points of connection.  Public health messages and programming are often woven into this rich LGBTQ fabric.

   Rainbow crosswalk in Long Beach, California

Rainbow crosswalk in Long Beach, California

There has been a significant cultural shift toward greater support and acceptance of LGBTQ people.  Even so, there is still work to do.  Public health professionals can act to protect LGBTQ youth and to make our services, workplaces, schools and jurisdictions more welcoming for LGBTQ people of all ages.  Looking at our policies, programs and our own individual workspaces through an LGBTQ-friendly lens can help us identify important opportunities to create changes that support health and wellness.  The table below offers questions to help guide this approach.

Questions for Health Departments

Pride is a time of celebration.  Pride is a time to remember the progress we’ve made toward equality and inclusion, and, at the same time, to acknowledge that this progress has come at a high cost.  Public health professionals and policy makers are in a position to make the changes needed to improve the health and wellness of the LGBTQ community.  Regardless of whether we are in a policy making role, we in public health have an especially crucial role to play in promoting inclusiveness and equality for the LGBTQ community, and for the sake of the broader communities we serve.

 

[1] https://ballotpedia.org/Transgender_bathroom_access_laws_in_the_United_States.

[2] 2018 LGBTQ Youth Report, Human Rights Campaign.

[3] LGBQ Youth Disproportionately Incarcerated in the U.S. Juvenile Justice System. Wilson, B.D.M; Jordan, S.P.; Meyer, I.H.; Flores, A.R., Stemple, J.D.; Herman, J.L. Williams Institute. April 2017.

[4] https://truecolorsfund.org/our-issue/

[5] CDC (2016). Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9-12: Youth Risk Behavioral Surveillance. Atlanta, GA: U.S. Department of Health and Human Services.

[6] BGT Aging: A Review of Research Findings, Needs, and Policy Implications. Choi, S.K; Meyer, I.H. Williams Institute. August 2016.

[7] James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.

Hepatitis Awareness Month 2018: Addressing Hepatitis A

By Meghan McGinty, PhD, MPH, MBA, Deputy Director of the Big Cities Health Coalition, and Michelle Cantu, MPH, Director of Infectious Diseases and Immunization, NACCHO

This blog originally appeared here on The National Association of County & City Health Officials (NACCHO) Essential Elements Blog.

The month of May is designated as Hepatitis Awareness Month in the United States and May 19th is Hepatitis Testing Day. During this month, NACCHO will highlight the role of local health departments (LHDs) in responding to this silent epidemic and work to bring increased attention to viral hepatitis. Through a series of three blog posts, NACCHO will focus on the most common types of viral hepatitis, which are hepatitis A, hepatitis B, and hepatitis C. This series seeks to raise awareness of the importance of vaccination for hepatitis A and B, testing for hepatitis B and C, and the availability of effective care and treatments that, in the case of hepatitis C, result in a cure for most people. Additionally, the series will highlight current events related to viral hepatitis – such as outbreaks of hepatitis A in jurisdictions across the country and soaring rates of hepatitis B and C associated with increased injection drug use that is being fueled by the opioid epidemic – and how LHDs are on the frontlines of responding to these worrying trends.

Local Health Department Hepatitis A Outbreak Response

Each day, LHDs are on the frontline of defense monitoring and responding to upwards of 70 nationally notifiable infectious diseases. One of those diseases, hepatitis A, is a liver infection caused by the hepatitis A virus. Hepatitis A is highly contagious, which means a timely, local, on-the-ground response is especially important to contain outbreaks.

The United States is currently experiencing a multi-jurisdiction outbreak of hepatitis A. While commonly spread through contaminated food, this hepatitis A outbreak is spreading from person to person. Beginning in 2017, the spread of hepatitis A has occurred primarily among people who are homeless and people who use drugs. Outbreaks are occurring or have occurred in CaliforniaIndiana, KentuckyMichigan, and Utah.

LHDs and governments throughout the nation actively work to address these outbreaks by:

  • offering mass vaccination, where appropriate;
  • cleaning and sanitizing infected areas;
  • increasing access to handwashing;
  • conducting outreach to healthcare providers and the healthcare community; and
  • providing public education about prevention, treatment, and response.

In November 2017, NACCHO hosted a webinar on the Hepatitis A 2017 Outbreak Response – Lessons from Big CitiesDuring this webinar, representatives from the San Diego Health and Human Services Agency, the Los Angeles County Department of Public Health, and the Detroit Health Department shared details regarding their local responses to this unique outbreak, lessons learned, and how other health departments can prepare.

In California, the outbreak began in San Diego County in November 2016 and spread to Santa Cruz, Los Angeles, and Monterey counties. Since November 2016, in California alone, over 700 people were infected with hepatitis A, 461 people were hospitalized, and 21 have died in outbreaks related to inadequate sanitation and hygiene. California health officials have responded vigorously to contain this outbreak. For example, Governor Jerry Brown declared a state of emergency allowing the California Department of Public Health to expedite the purchasing of the hepatitis A vaccine. This also allowed Emergency Medical Technicians (EMTs) to administer the vaccine, outside of a clinical setting, to individuals in underserved communities, including people experiencing homelessness and people who use drugs.

In San Diego, the Department of Environmental Health has provided hepatitis A prevention guidance including how businesses can disinfect surfaces that should be cleaned often, such as counters, sinks and bathrooms. The San Diego Health and Human Services also issued guidance for how sidewalks, streets, and gutters should be sanitized. Sanitation is key to preventing infection, and soap and water hand washing is also essential. The County of Los Angeles Department of Public Health is teaching residents why, when, and how you should wash your hands. Their motto is, ‘handwashing is the key to health.

Fortunately, due to the crucial work of local and state public health departments, hepatitis A cases across California have slowed dramatically and the outbreak response has been demobilized. California continues to monitor reported hepatitis A cases and provide preventative services to individuals from underserved communities.

Similarly, Michigan experienced a hepatitis A outbreak beginning in August 2016. There have been 821 cases, 662 hospitalizations, and 25 deaths. Public health officials there continue to respond to this outbreak. In Detroit, health officials worked with their state health department to conduct outreach by providing letters to the healthcare community and Medicaid providers to inform, provide guidance, and share available resources. Additionally, health officials have provided public education about prevention, treatment, and response. Resources like answers to frequently asked questions help educate Michigander’s about how to stop the spread of hepatitis A.

LHDs in other parts of the U.S. have actively worked on prevention activities in their communities. In an effort to reduce the risk for a similar outbreak, Seattle & King County (SKC) Public Health took preventative measures by working with government and community partners to ensure adequate sanitation and hygiene practices took place at homeless encampments throughout the city. SKC health officials developed outreach materials for prevention at encampments and adapted San Diego outreach materials for people experiencing homelessness. These are just a few examples that highlight the extensive work LHDs have conducted since the beginning of the 2017 hepatitis A outbreak.

Resources to Address Hepatitis A

Learn more about hepatitis A statistics and surveillanceguidelines and recommendations, and vaccination recommendations. Resources for public health professionals and patients are also available. Further, check out the CDC Hepatitis Awareness Month webpage to see what you can do to get involved in this health observance, and check out the NACCHO webpage to learn more about our efforts to support the elimination of hepatitis.

Chicago health commissioner: Big Tobacco is targeting our youth and we must stop them

By Dr. Julie Morita, Commissioner, Chicago Department of Public Health

The U.S. Food and Drug Administration recently announced a crackdown on e-cigarette sales to minors, but before then, the city of Chicago had already taken matters into its own hands. The City Council passed an ordinance to require tobacco dealers to post warning signs at their doors about the health risks of e-cigarettes and other tobacco products. These signs, once designed and distributed, will also contain quit-line numbers to help our residents beat a nicotine addiction. 

Give Women the Gift of Good Health

By Mysheika W. Roberts, MD, MPH, Health Commissioner, Columbus Public Health

As we celebrate all the women in our lives for Mother’s Day and National Women’s Health Month, we are reminded that despite the advances women have made in many areas, great disparities still exist when it comes to their health. 

Women make the majority of health care decisions for their families and are powerful partners by advocating and modeling healthy lifestyles and behaviors for their children, colleagues and friends. But when it comes to their own health, they are often left behind.

Supporting Older Adults in Houston: Ramps, Rails and Toilets

By Deborah A. Moore, Assistant Director, Human Services Division, Houston Health Department and Scott Packard, Chief Communications and Public Affairs Officer, Houston Health Department

When you think of Older Americans Month, toilets probably aren’t the first thing to come to mind. But at the Houston Health Department, commodes are a major component of one of the Harris County Area Agency on Aging’s most gratifying programs.

Allow me to take a step back to explain.

Multnomah County’s Community Powered Change

By Rachael Banks, Public Health Director, Multnomah County Health Department

After years of unacceptable disparities data, we knew we had to do something different.  In the summer of 2015, Multnomah County Health Department (MCHD), set out to create a community health improvement plan (CHIP) centered on things that are largely outside of the control of the individual. In response, MCHD released a request for proposals (RFP) for the coordination of a CHIP that was created in partnership with communities of color. Oregon Health Equity Alliance (OHEA) was selected as the contractor to lead the development and implementation process for the CHIP.

Throughout 2016 OHEA, with the support of MCHD’s Health Equity Initiative (HEI), intensive community engagement and outreach (forums and interviews) were conducted to gather input from a variety of communities including: African-American, Asian, Immigrant/Refugee, Latino, Native American, Pacific Islanders, and youth and elders of color. The outreach and engagement was followed by a tremendous amount of planning, analyzing and prioritizing areas over the next year. Through these engagement efforts, a framework was developed outlining 23 goals and over 150 strategies.

Sexually Transmitted Diseases (STDs) are Making a Comeback – Recognizing April as STD Awareness Month, We Highlight BCHC Activities to Address Vast Increases in (STDs)

By Chrissie Juliano, Director, Big Cities Health Coalition

STD Awareness Month is an opportunity to focus on raising awareness of a problem that affects millions of Americans every year. STDs in the United States are at record highs, despite years of dropping rates, with the latest CDC data showing chlamydia, gonorrhea, and syphilis infections rising to exceed 2 million reported cases nationwide.  The increases are dramatic - 4.7% for chlamydia, 17.6% for syphilis, and a whopping 18.5% for gonorrhea. In short, we’ve lost ground in this fight. Left undiagnosed or untreated, STDs can cause serious long-term problems. Importantly, they are largely preventable and treatable.

On Earth Day: Local efforts are making a difference on climate change

The world-wide scientific consensus is clear: climate change is real, it is being driven by human causes, and we must act now to avoid its worst effects. However, it also clear that leadership in the fight against climate change will not come from Washington, D.C. anytime soon. The EPA is being targeted for huge budget cuts, and the U.S. withdrew from the Paris Climate Accord. In a heartening trend, businesses, community organizations, non-profits, states, counties and cities are stepping up to fill this leadership vacuum. Within this growing coalition there is one player that is often overlooked: local Health Departments. We have a unique perspective and the community connections to play a significant role in helping our communities adapt to the effects of climate change while also fighting against its causes.

Making Public Health Visible

By Narintohn Luangrath, Special Assistant to the  Baltimore City Health Commissioner and
Dr. Leana S. Wen, MD, MSc, FAAEM, Baltimore City Health Commissioner

At a commencement ceremony several years ago, Dr. Linda Rae Murray, then-president of the American Public Health Association, recounted a famous saying: “When public health works, we’re invisible.” She followed that by urging the graduates to “refuse to be invisible, because […] we need to lend our strength and our science to broad social movements whose goal is to make things better.”

When public health is invisible, we only end up talking about it when things go wrong; people tend to think about public health agencies as entities that respond to infectious disease outbreaks or shut down a restaurant due to health code violations. We frequently think about health as healthcare, but what determines how long and how well we live is less about what happens in the doctor’s office and more about where we live, the air we breathe, and the availability of other resources in our communities. At the Baltimore City Health Department (BCHD), we believe that all issues – education, housing, employment, public safety, and beyond – can and should be tied back to health. We are committed to making the progress earned through public health visible, and to make the case for incorporating health-in-all policies across the City.

Wanted: Leaders for a TB-Free United States

By Joseph Iser, MD, DrPH, MSc, Chief Health Officer, Southern Nevada Health District

This blog originally appeared in County Line Magazine

 

Every year on March 24 the health care community commemorates World TB Day to bring attention to a preventable disease that still impacts many people in the United States and around the world. This year’s theme is “Wanted: Leaders for a TB-Free United States. We can make history. End TB.” It is a call for health care partners to work together on a local, national, and international scale to eliminate the disease.

Health care providers are instrumental in this process. For many patients, TB can present as a bad cold or respiratory infection that won’t go away. Physicians should always consider the possibility of TB when examining a patient with an ongoing respiratory infection, especially if it is accompanied by a persistent cough, night sweats, loss of appetite, and fatigue.

Seattle's Food Safety Rating System is One Year Old

In 2017, King County launched our new food safety rating system with the goal of making it the best rating system in the country. With a year under our belt, Public Health – Seattle & King County’s food safety team is proud to say that the new system has achieved measurable success.

  • Over 75 percent of all restaurants in King County now have easy to understand food safety rating signs in their front windows. This has greatly improved the ability for consumers to quickly assess the food safety practices at each restaurant.
  • Anecdotally, our food safety investigators report an increased interest from restaurant owners in improving their food safety practices, which means that the placards are motivating restaurants to do better. The number of perfect scores from all restaurants across King County increased 3 percent in 2017 from 52 percent to 55 percent.
  • The ratings provide a more complete picture of food safety than any other rating system across the country. Ratings reflect the trend of critical food safety practices over time in each restaurant and take inspector differences into account to make sure the playing field is level.
     

The 90 Days of the White House Opioid State of Emergency are up, and communities have little to show for it

By Chrissie Juliano, Director of The Big Cities Health Coalition

Today marks 90 days since the President declared the opioids crisis a public health emergency, and the White House announced last week that it would extend the declaration for another 90 days. To date, little has changed in the federal approach to the epidemic, and unfortunately, the emergency declaration has amounted to little more than administratively nibbling around the edges of a major national public health crisis.  Simply extending the emergency declaration does little to address the epidemic. What is needed is funding and leadership at the federal level.

Measles: An Ongoing Challenge to Prevent and Control Reintroduction Outbreaks

By authors including Jeffrey Gunzenhauser, MD, MPH, Interim Health Officer and Medical Director
and Franklin D. Pratt, MD, MPHTM, Immunization Program, Los Angeles County Department of Public Health

Since measles was eliminated from the United States in 2000, efforts to control reintroduction outbreaks have faced a variety of challenges. An outbreak in California was largely isolated to Los Angeles County and primarily affected a single social group in which anti-vaccination beliefs and behaviors prevailed. The outbreak resulted from a single individual who acquired infection from an unknown source, developed rash on Dec. 2, 2016, and subsequently exposed siblings and other contacts. This produced a clear chain of transmission. In total, 24 cases resulted from this outbreak, with 18 occurring in Los Angeles County and six occurring in nearby jurisdictions.

What a Long Strange Year 2017 has been in Public Health: Historic Storms, “Banned Words,” and Deep Funding Cuts – Just to List a Few

By Chrissie Juliano, Director of the Big Cities Health Coalition

In 2017, governmental public health shined in our country. In the face of historic natural disasters in Texas, Florida, Puerto Rico, and California, public health staff on the front lines dedicated to serving the American people – no matter what – did their work and delivered. Many stayed behind when others fled, or travelled from their safe, dry homes to help those in danger, save lives, or clean up.

Fighting Flu in Big Cities: Lots of Germs in that Big Petri Dish

By Chrissie Juliano, Director of the Big Cities Health Coalition

Fighting seasonal influenza (the flu) is serious business. It may sound rather pedestrian compared to headline-grabbing diseases like Ebola or Zika, but fighting flu, and other such “routine” outbreaks, is what local public health departments do every day to protect lives.

In a moderate to severe year, seasonal flu kills more Americans than car accidents. Over the past 30 years, it’s killed anywhere between 3,000 and 49,000 people in single a flu season. It also costs Americans $87 billion in direct costs and lost productivity. In short, there are many reasons to fight flu.

Beyond Thoughts and Prayers

By Dr. Rex Archer, Director of Health, Kansas City, Missouri Health Department

After the trauma of the events surrounding the Las Vegas mass shooting, stories of horror and heroism unfolded from that horrible act.  My compassion and prayers felt somewhat hollow.  I am in a position to move my compassion to actions that make a difference and to save many lives.  That is why I am in public health. Yet, the enormity of the challenge seems daunting.

Acts of Nature are Public Health Emergencies

By Meredith Li-Vollmer, Public Health - Seattle-King County

The news from Hurricane Harvey has been heart wrenching. Among the memorable images that emerged was one of nursing home residents sitting in wheelchairs, waist-deep in flood water as they waited for help to arrive. As reported by the New York Times, among the thousands of posts to volunteer rescue groups were common pleas such as “East Houston, 9:53 p.m.: Needs evacuation, one elderly person in a wheel chair” and “Northeast Houston5:36 a.m.: He’s on bottled oxygen now, and running out. Nausea from lack of oxygen has already started.” As some of the most vulnerable in the community struggled, news also covered the toll that the hurricane has taken on the world-class hospitals in the Houston area who were well prepared with back-up generators but hampered by the extremity of the weather and flooded roadways to evacuate patients and bring in emergency vehicles, food, and supplies. Hurricanes and floods aren’t just acts of nature. They are also public health emergencies.

“Back to School” Season: Backpacks, school supplies and cancer prevention

By Dr. Julie Morita, Commissioner of Health, Chicago Department of Public Health

Flipping my calendar from July to August, always yields a sense of melancholy as I can see the less structured, long, warm days of summer rapidly disappearing and the busy, regimented, new school year entering into sight. While many people overcome the sorrow of the summer ending with “Back to School” shopping for backpacks, new clothes and school supplies, since becoming a pediatrician almost 25 years ago, I have sought consolation in knowing that “Back to School” means that millions of school-aged children throughout the US will be receiving health examinations and vaccines, which prevent serious diseases including measles, mumps, whooping cough, and polio.

How the Senate's Obamacare repeal bill would wallop the urban poor, and especially those who rely on Medicaid and public hospitals

By Dr. Mary T. Bassett and Stanley Brezenoff

If there was any hope that Senate Republicans could bring some sanity into the national discussion around the future of our health care system, such hope completely vanished on Thursday. Like the House's health care bill, the Senate's proposal is nothing less than an all-out attack on public health and our public hospital system, and its consequences will be devastating for New York City and the country.

Showing up for LGBTQ communities

By Jesse Chipps, HIV Planning Council Administrator, Public Health - Seattle & King County

June is National Lesbian, Gay, Bisexual and Transgender (LGBT) Pride Month, and each year at this time hundreds of King County employees, department directors and public officials march together in Seattle’s Pride Parade. Rainbow tinsel laden vehicles, bubble machines, and matching t-shirts pull the group together as One King County.