HEALTHY PEOPLE GOALS
1. 0Core : High priority and have a target, baseline data, and identified data set. 2. Developmental : High priority but does not yet have objectives or criteria for data collection. 3. Research : Where there are significant disparities or high health burdens, but more research is needed to identify evidence-based methods for improving health (ODPHP, 2020a). LGBTQ objectives for Healthy People 2030 fall under the major goal of improving the health, well-being, and safety of LGBTQ people (ODPHP, n.d.b). The objectives are then classified under the following categories: adolescents, drug and alcohol use, mental health, infrastructure, and sexually transmitted infections. Within these categories, there are a variety of objectives. The majority are baseline, which means that data has been obtained from 2020 outcomes, but it is not known if there have been improvements (ODPHP, 2020a). Participants also shared experienced lapses in confidentiality such as using incorrect pronouns, physician sharing HIV+ status with family at bedside rounds after surgery, and other situations that eroded patient trust. Another area of concern was perceived discomfort and heteronormative expectations of healthcare. These examples ranged from unfamiliarity with terms of address, lack of knowledge of LGBTQ health needs, too much focus on sexual health, and implicit bias such as assuming that a woman needed birth control because she is sexually active, that a lesbian’s partner is her “husband,” or that gays or lesbians do not have children. Participants also identified overt discrimination and homo and transphobias, and discussed feeling like a “freak” or categorized (by staff and providers through refusal of care, excessive use of personal protective equipment inappropriate for the situation, and putting the LGBTQ person on display; Kcomt et al., 2020; Smith & Turell, 2017). Healthcare Professional Consideration: Patient-provider relationships are defined by the skillful execution of practice expertise and patient-centered relationship skills to effect excellent health outcomes” (Smith & Turell, 2017). Social workers are trusted professionals who can improve health outcomes of the LGBTQ community through open and nonjudgmental communication. funds (including Medicare and Medicaid; Medina & Mahowald, 2020). These protections and the removal of limits on chronic or pre-existing conditions mean an increase in access to care. However, there are still problems for transgender individuals, especially people of color, desiring transition- related care. A Center for American Progress study (as cited in Medina & Mahowald, 2020) found that 43% of transgender individuals and 48% of transgender people of color were denied transition surgery, with 38% of transgender individuals and 52% of transgender people of color being denied hormone therapy for transition (Medina & Mahowald, 2020). patients are lesbian or gay, or that certain heterosexual patients have high-risk sexual practices. It is important for a provider to talk openly and objectively with these patients about potential risk factors. The attention to parity should extend beyond conversation to fixtures and practices. Health history forms may contain presumptive language about sexual partners. Staff members may exhibit a bias based on a patient’s appearance or way of speaking.
A goal of Healthy People 2020 was to increase the health, safety, and well-being of LGBTQ people (DeSalvo, 2015). Results were minimal and focused on population-based data systems to increase their collection on Healthy People objectives, or recommendations for LGBTQQ or states and territories to increase their data collection in the Behavioral Risk Factor Surveillance System (ODPHP, 2020a). While these are important issues, work must be accomplished at the local level as well. Uniformity in data collected and increased data collection on transgender individuals would contribute to available data. The inclusion of sexual orientation and gender identity questions on health history forms is an excellent beginning to open discussions in the healthcare setting. Healthy People 2030 is the fifth version of the publication; its goals are more focused than previous versions. There are three categories of objectives: Accessing or avoiding healthcare Quality of care is important for all patients and providers and is paramount to achieving positive outcomes. Part of the healthcare experience results from the patient-provider relationship along with the general experience of the patient in the healthcare setting, whether clinic, hospital, or community. A qualitative study by Smith & Turell (2017) examined the differences in expressed needs of different groups (lesbian, trans woman, gay, and HIV+ gay men) seeking healthcare in the LGBTQ community. Although this study has several limitations, including small sample size (n=26) and exclusion of persons of color/trans men, similar findings were identified in other studies (Kcomt et al., 2020; see also Kates et al., 2018; Whitehead et al., 2016). Findings revealed an overall critique of healthcare and a general stressor. As expressed by participants of this study, these feelings were of stigma and the stress resulting from the general heteronormativity in healthcare, lack of knowledge of LGBTQ healthcare needs, and microaggressions or phobias of clinicians and staff (Smith & Turell, 2017). Participants had a wide range of feelings on topics and several areas of agreement. First, there were differences regarding identity disclosure to providers, with the HIV+ group noting the importance of informing the clinician on their positive status. Levels of comfort on disclosure varied from no concern “for the straight people’s discomfort” (p. 643) to great concern about how one’s healthcare would be affected by disclosure and how information would be stored and shared (Smith & Turell, 2017). Nondiscrimination in access to healthcare The Affordable Care Act (ACA) implemented in 2010 and the expansion of Medicaid in 2014 have increased the rate of LGBTQ adults who have insurance. In states that have adopted the expansion, eight percent are uninsured and 25% have Medicaid compared to states that did not adopt the expansion (rates are 20% uninsured and 13% have Medicaid; Health and Human Services [HHS.gov], 2015; Medina & Mahowald, 2020). The ACA set nondiscrimination protections for LGBTQQ people which included prohibition of discrimination or refusal of care based on sexual orientation and gender identification in any ACA health plan as well as any health program receiving federal Importance of history Health disparities and unidentified risks exist for many reasons, including poverty, inadequate access to healthcare, environmental threats, and individual factors. One important potentially unrecognized weakness is obtaining the appropriate health history in a nonjudgmental manner. Each provider should act as a concerned practitioner, looking out for the well-being of each patient. Providers should ask open-ended questions, encourage patients to share important information about potentially risky behaviors, and listen in a nonjudgmental manner.A primary care provider may be aware that certain
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