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The health care debate is still raging across the country, and ensuring that it moves forward so that all Americans have access to affordable and high-quality health insurance is a critical first step. But acquiring and keeping health insurance coverage is only half the battle for millions of Americans.

New research from the Center for American Progress, for example, shows that lesbian, gay, bisexual and transgender (LGBT) people have health care needs and challenges that are starkly different from the rest of the population. The research also shows that racial and ethnic minorities who are lesbian, gay or bisexual face some of the greatest health care challenges in our country.

For example, lesbian and bisexual black women are the least likely to have had a mammogram in the past two years. Only 35 percent of these women have had mammograms recently, compared to nearly 70 percent of heterosexual African-American, Asian or Pacific Islander, or white women. One out of every five lesbian/gay/bisexual African-American adults has diabetes. Straight African-American and straight, lesbian, gay or bisexual Asian or Pacific Islander, Latino, and white adults are much less likely to have diabetes—fewer than 8 percent of these populations have been diagnosed with the disease.

Mental health needs are also a concern. For example, lesbian/gay/bisexual Asian or Pacific Islander adults are more likely than other groups to report experiencing psychological distress. Lesbian/gay/bisexual Latinos are similarly much more likely than all other racial or ethnic groups—gay or straight—to report problems with alcohol abuse and addiction.

Data on the general transgender population is notoriously sparse and anecdotal—information on transgender racial and ethnic minorities is even more so. But based on what we do know, people in this population face the largest obstacles to finding and affording high-quality and highly competent health care.


The odds are slim that doctors, nurses and other health care providers are aware of the health realities their LGBT patients of color face and are able to effectively treat them. Ulrike Boehmer’s review of 3.8 million citations of articles in the National Library of Medicine published between 1980 and 1999 found that just 3,800, or 0.1 percent, are related to LGBT issues. And 85 percent of the articles failed to include any mention of the racial or ethnic background of the individuals studied.

A clear first step to improve health treatment for LGBT racial and ethnic minorities is building the medical community’s knowledge of their unique needs. Unfortunately, no national government health survey regularly asks about a person’s sexual orientation or gender identity. The federal government already collects health data based on race and ethnicity, and adding questions on sexual orientation and gender identity would provide researchers with this much-needed information to better identify the health care needs of LGBT people of color. In turn, advocates could then fight for programs and funding that better and more competently serve this population. Medical schools and other institutions could also incorporate this information into their curricula and training programs to prepare future practitioners to treat and care for these patients.

Over time, this approach will reduce the disparities between LGBT people of color and other populations, and the federal government should take the lead in tackling this problem. The U.S. Department of Health and Human Services should particularly establish a dedicated Office of LGBT Health. Data collection should be a priority for this office, which must ensure that any federally funded health study that collects demographic information on categories such as age, sex, race, ethnicity, primary language or socioeconomic status must also include questions about sexual orientation and gender identity.


Insurance coverage is a vital health care reform issue, but it is not the only factor that prevents people from quality care in the United States. Our nation’s health care system needs to do a much better job treating the real needs of all its patients, and that includes LGBT people who are racial and ethnic minorities.

Jeff Krehely is the director of LGBT research at the Center for American Progress.