Including LGBT health in state population health assessment : Accomplishments, opportunities, and resistance

Sexual and gender minority persons, families, communities, and populations experience disparities and inequities in health needs, health outcomes, and health services access. Such disparities and inequities are concerns of public health, at local, state, and federal levels. Yet, few state-level health reports include information on health of lgbt persons, families, and populations, and data are lacking for assessing lgbt health disparities. To fill this considerable data gap, CDC recommends that national and state surveys should undertake consistent and routine measurement of sexual identity, orientation, and behavior; and including gender identity on population health surveys is recommended by other sources. Some states have included lgbt health with measurement of population health, such as the Behavioral Risk Factors Surveillance System (BRFSS) survey; other states have not undertaken formal assessment of sexual and gender minority health. Some states, including Virginia, have experienced considerable progress and considerable resistance toward including lgbt health in state health assessment. Efforts in Virginia have included ten years of community based participatory research on issues of sexual and gender minority health through the HIV Community Planning process under the Virginia Department of Health (for example, a multi-year study of transgender health with a statewide sample ); assessments made by lgbt organizations ( for example, regarding lgbt experiences of violence in a statewide community sample ); and attempts to add lgbt demographics questions to the statewide BRFSS survey. Examples of progress are countered by examples of resistance. Virginia is among the most populous states, with comparatively high levels of income, and education; Virginia also has among the most oppressive legal and policy regimes toward lgbt residents. The dynamics and scope of accomplishment, resistance, and opportunity toward including lgbt health in state population health assessment in one state will inform understanding and discussion of accomplishment, resistance, and opportunity in other states.