LGBTQ+ | Practice & Science for LGBTQ+ Health Equity

It’s June, y’all… HAPPY PRIDE!

This month we’re celebrating Pride, the LGBQTQ+ community, and our lab of amazing LGBTQ+ and allied health researchers.

One of the main Pride events is kicking off in Columbus, Ohio this week, so we thought it was the perfect time to share a short introduction to Pride and why it’s important to public health.

What is Pride?

Pride is a month focused on celebrating lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community and history. The first Pride marches were held in New York City, Los Angeles, and Chicago on the one-year anniversary of the Stonewall riots – a series of spontaneous demonstrations that erupted in New York City on June 28, 1969 when police raided the Stonewall Inn, a gay bar.

At the time, “masquerade” or “cross-dressing” laws deemed that “men” and “women” must wear a specific number of clothing items that matched the gender on their state-issued ID. These laws were used to raid drinking establishments and arrest transgender and gender non-conforming individuals. Just after midnight on June 28, 1969, police raided the Stonewall Inn as they had before. But this time, Stonewall patrons fought back.

As Shane O’Neill, film producer of the New York times mini-documentary, “The Stonewall you know is a Myth. And that’s O.K.” noted,

“Stonewall was about people reclaiming their own narratives…”.

Pride Month is a time to celebrate LGBTQ+ community, identity, and culture. It’s an opportunity for LGBTQ+ folks and allies to show up, en masse, and just “be”. During Pride, we celebrate our progress in advancing civil rights for LGBTQ people. During Pride, we draw attention to the reality that LGBTQ+ civil rights and lives are under attack.

How does public health connect to Pride?

For public health practitioners and scientists, Pride is a time to assess what we are doing to address the social conditions that threaten the health and safety of LGBTQ+ people in our communities.

In 2023, 491 bills targeting LGBTQ+ individuals have been introduced in state legislatures.

130 bills target access to LGBTQ+ healthcare. These bills limit access to medically-necessary health care, like Medicaid and other insurance coverage, for transgender people. Many ban gender affirming care for young people and create criminal penalties to those providing gender affirming care.
228 bills target education. They prevent trans students from participating in school sports activities and use bathrooms that correspond with their gender, compel teachers to “out” students, and censor in-school discussions of LGBTQ+ people and history.

The slate of laws targeting LGBTQ people reflects a growing culture of violence. In 2022, anti-LGBTQ+ violence and extremism – including demonstrations, acts of political violence and murder, and the distribution of offline propaganda – surged around the United States. Anti-LGBTQ+ extremism harms LGBTQ+ people, who are up to 4x as likely to experience violent attacks as non-LGBT+ people.

Public health practice and science recognizes that the social conditions we experience effect mental and physical health. Trauma lives in the body in the form of chronic inflammation and pain. Trauma drives coping and health behaviors. It’s not surprising that LGBTQ+ people fare worse on leading health indicators. At a population-level, tobacco use, vaping, and binge drinking are higher among LGBTQ+ people. We also experience high rates of hypertension and heart disease; diabetes; asthma and COPD; and lung, cervical, anal, breast, and colorectal cancers. We lose too many to homicide and suicide.

As public health workers, funders, and scientists, we can protect and support LGBTQ+ communities. We can:

stand against legislation that puts the lives and health of LGBTQ+ people at risk.
develop services, organizations, and communities that welcome and are accessible to LGBTQ+ people.
include LGBTQ+ health case studies and share LGBTQ+ focused research in our curriculum and continuing education programs.
fund community-engaged research and initiatives to strengthen and support LGBTQ+ communities.
add sexual orientation and gender identity questions to surveys so our health and wellness is accounted for.
support local LGBTQ+ businesses.
speak up and show up with our LGBTQ+ neighbors, coworkers, family, and friends.

Final thoughts

LGBTQ+ people and communities are resilient. We are strong. We are hopeful. We endure. We matter.

All LGBTQ+ people deserve to feel safe, joyful, and connected.

We need public health to stand with us, to advocate with us, and to help us build toward justice for all people.

Today, I am celebrating because I work at an institution that is positively contributing to the health, wellbeing, and education of LGBTQ+ people. The Ohio State University was selected as one of 40 institutions nationwide for the Campus Pride “Best of the Best” index for LGBTQ+ students. The university received a 5-star rating on an index that rates institutional commitment to LGBTQ-inclusive policies, programs and practices. According to Campus Pride, campuses are scored from 0 to 100 on the Campus Pride Index, which assesses the presence of LGBTQ-inclusive policies, programs, and practices. Forty institutions scored 93 percent or higher and received a 5/5 ranking and place on the “Best of the Best” list. This rating is especially noteworthy given that OSU is a public university situated in a more socio-politically conservative state.

What makes an LGBTQ+ inclusive campus? The LGBTQ+ Campus Pride Index was developed by Campus Pride with a team of national LGBTQ researchers. The tool includes 50+ self-assessment questions, which (according to the CPI website) correspond to 8 LGBTQ-friendly factors:

LGBTQ Policy Inclusion
LGBTQ Support & Institutional Commitment
LGBTQ Academic Life
LGBTQ Student Life
LGBTQ Housing
LGBTQ Campus Safety
LGBTQ Counseling & Health
LGBTQ Recruitment and Retention Efforts

Individual questions are weighted to emphasize specific components, which are determined to be more additive to an LGBTQ+ inclusive, welcoming, and respectful campus. All 8 LGBTQ-friendly factors are equally weighted in the overall score.

What’s missing? While I’m celebrating today, as a public health scientist focused on LGBTQ+ health, I’m also aware the Campus Pride Index is not without gaps. In all transparency, I have never seen the full CPI instrument, so it’s challenging to evaluate its strengths and limitations. However, there are broad areas for potential bias we should all be aware of.

To start, the CPI relies on an opt-in method; campuses self-elect to participate, leading to selection bias. The item is also a self-report survey, which is filled out by campus administration, which increases the risk for self-report bias due to social desirability, or the tendency for people (or institutions) to generally present themselves in a favorable fashion. The CPI only rates the presence of positive/supportive policies and programs. Now, I’m all for being strengths-based (we need a little joy in the world!), but it’s important that we also understand how these strengths-based, LGBTQ+ programs and policies are enacted in real life. Unfortunately, the CPI does not include student, faculty, or other staff experiences, perspectives, or attitudes. This is problematic because the presence of policies does not necessarily reflect people’s lived experiences of those policies. Take these examples:

A university may have a policy that supports inclusive housing for transgender and gender diverse students; however, the process of accessing those services may or may not be challenging for students depending on how the information is disseminated and who is running the program. For a while I worked at an institution that had an LGBTQ-supportive dorm housing program, which was known to LGBTQ+ and allied faculty, but not well advertised on campus
A college may have paid staff responsible for LGBTQ support services; however, there is often not enough staff to meet demand. I have worked with multiple students (across college and university institutions in three states) and all have experienced challenges accessing LGBTQ+ supportive counseling services through campus health. Sure, all of these institutions had LGBTQ+ supportive paid staff, but most were under-staffed and with waitlists. When LGBTQ+ students were referred to counselors not trained specifically in LGBTQ+ needs, they were often met with microaggressions or, worse, outright hostility.

Finally, none of the CPI ranking indices take into account the experiences of multiple minoritized LGBTQ+ students, including BIPOC LGBTQ+ students, LGBTQ+ students with disabilities, neurodivergent LGBTQ+ students, and first gen LGBTQ+ students. These groups’ experiences of campus climate, policies and programs are unique, as these students experience intersectional discrimination and oppression because they hold multiple minoritized identities. Their lack of specific inclusion in the CPI measures is a HUGE gap in this instrument and needs addressed in future iterations.

Let me say it again… the presence of an LGBTQ+ policy or program does not necessarily reflect ALL LGBTQ+ people’s lived experiences of those policies. That is, the presence of an LGBTQ+ supportive policy does not automatically confer LGBTQ+ people’s safety and wellbeing on campus. BUT, policies and programs are critical foundations for increasing LGBTQ+ people’s safety and wellbeing at our university.

So… are we still celebrating? Yes, we’re still celebrating! There are few measures of campus climate for LGBTQ+ people; even fewer through which we can compare institutions nationwide. The Ohio State University is doing an excellent job putting in place foundational policies and programs to support LGBTQ+ people on campus. OSU is also doing the work of conducting their own campus climate assessments (see the 2019 Campus Sexual Violence Survey and the 2020 LGBTQ+ campus climate survey, led by the Undergraduate Student Government) to accompany national rankings, like the CPI. My hope is that as we learn about our strengths and limitations as an academic community, that we continue to ACT to improve our policies, programs, and their implementation to benefit diverse groups of LGBTQ+ students, staff, and faculty.

Looking for info on LGBTQ+ programs at OSU? Visit the LGBTQ+ at Ohio State Website.