Remarks to the National Coalition for LGBT Health

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by HRSA Administrator Mary K. Wakefield

October 18, 2011
Washington, DC

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I’m very happy to be here today, and I’m very proud to be part of an administration that is working hard to advance the rights and interests of Lesbian, Gay, Bisexual and Transgender individuals.

At HRSA, our agency’s mission strikes at the heart of the struggles faced by far too many LGBT Americans, a mission that is aimed at:    

“ improving health and achieving health equity through access to quality services, through a skilled health workforce and through innovative programs.”

In communities across the country, HRSA’s health programs are leveling the playing field for people who are underserved, geographically isolated, and medically vulnerable.  That includes LGBT people.

Let me briefly tell you about the range of health issues HRSA works on.  We use our $9.7 billion annual budget to manage 80-plus grant programs in partnership with state, local and community organizations across the country.  Most of you here today, I imagine, know HRSA through our health center and Ryan White HIV/AIDS programs.

• HRSA-supported health centers provide primary and preventive care to about 19.5 million patients annually at more than 8,100 sites (UDS 2010).  And our 900 Ryan White grantees provide top-quality health care and life-sustaining medication to more than half a million low-income and uninsured people living with HIV/AIDS.
• HRSA also oversees the National Health Service Corps, whose 10,000 primary care professionals work in medically underserved areas in exchange for student loan repayments and scholarships.  About half of all Corps clinicians work in health centers.  Both the Corps and health centers have been received billions of dollars in additional investments through the Recovery Act and the Affordable Care Act under President Obama.
• In addition, HRSA strengthens the nation’s primary care workforce by giving financial support to colleges and universities for training and curriculum development, and scholarship and loan repayments for students in the health professions.  These health professions programs also received hundreds of millions of dollars in new investments from the Recovery Act and the Affordable Care Act.
• Our Maternal and Child Health block grants to states pay for health care services, screening and counseling that reach 6 of every 10 women in the U.S. who give birth and their infants.
• We also house the Department’s Office of Rural Health Policy, which bolsters rural hospitals and coordinates coalitions of rural providers.  And we support the expanded use of telehealth to connect underserved people to distant providers through remote monitoring devices and teleconferencing.
• Finally, HRSA oversees the nation’s Poison Control Centers, federal organ procurement and allocation efforts, and the National Vaccine Injury Compensation Program, among others.

Through many of these programs, HRSA has been working on issues that impact LGBT individuals:

You’re probably aware that HRSA has, for a number of years, led Federal efforts to fight bullying.  Secretary Sebelius has expanded HRSA’s initial efforts to include the expertise of all of HHS and those efforts expanded further when the departments of Education, Agriculture, Defense, Interior, and Justice joined us at HHS on a Federal anti-bullying task force.

A new HHS website – stopbullying.gov – contains a specific section directed to LGBT youth.  At HRSA, we will continue our work in partnership with LGBT communities and stakeholders on anti-bullying efforts.

On the health center front, we have some grantees that began as LGBT centers and then expanded to provide primary care to the larger community.  Many of these health centers are also Coalition members and I want to congratulate two Coalition members – the AIDS Foundation Chicago and the Mazzoni center – for receiving health center planning grants last month.  These grants are part of awards totaling $10 million to aid 129 organizations across the country that would like to become community health centers.  These funds, made available by the Affordable Care Act, support organizations’ development as a future health center.

Last month we also awarded $248,000 to Fenway Health to create a national LGBT technical assistance and training center for health centers and state primary care associations.  That’s the first installment of a three-year grant that could total close to $850,000.

It’s the first time that HRSA has entered into a national cooperative agreement focusing on LGBT health, and it’s the largest HRSA grant ever awarded to target the health care needs of LGBT people.

We’re happy to be partners with Fenway Health in this endeavor, and we feel confident that our work with them will not only help raise awareness of existing disparities in health care for LGBT patients but will also improve providers’ ability to provide culturally competent care.

That’s one of our newer points of engagement with LGBT organizations.  HRSA’s longest involvement with the LGBT community, of course, has been as the home of Federal efforts to fight HIV/AIDS in the United States and around the world.  Through the Ryan White HIV/AIDS program, public health leaders in our HIV/AIDS Bureau have partnered with LGBT organizations across the nation to deliver services to HIV-positive patients.

And since 2000, HRSA has routinely collected and published data on transgender people in its annual Ryan White program reports.  And after we held a consultation with transgender Americans in 2005, HRSA began collecting transgender client data broken down into male-to-female and female-to-male categories.  That information is updated annually and available at the state level on our Web site: hrsa.gov

At our most recent Ryan White all-grantees meeting, held in August 2010, we sponsored a clinical session in providing care to transgender people living with HIV/AIDS.   The clinical session was presented by a transgender-identified physician who is the medical director of the Transgender Health Program at the Los Angeles Gay and Lesbian Center.  The meeting also included other workshops that focused on the needs and concerns of HIV-positive transgender people.

These efforts – in health centers, in HIV/AIDS care, and in our anti-bullying work – represent the foundation of HRSA’s work with LGBT communities.  And under President Obama’s leadership, we’re building on that foundation to extend our support of LGBT Americans even further.

We’re working hard to reach out to make sure that the LGBT community knows about HRSA and is connected to our services.

And we’re also working hard to learn from the LGBT community.

For example, earlier this year, my senior staff and I met with 16 leaders of your organization, the National Coalition for LGBT Health, to focus on ways to improve care to LGBT patients at health centers; to enroll LGBT providers in the National Health Service Corps; and to encourage cultural competency across HRSA’s programs.

In April, staff from our National Health Service Corps attended the 2nd Annual LGBT Health Student Symposium in Philadelphia, where they made a presentation about the benefits of serving in the Corps and fielded questions.  We will continue to attend future such conferences.  And earlier this month, the NHSC offered a webinar to its clinicians titled, “Providing Care to the LGBT Community: Cultural Competency Strategies.” 

From our Bureau of Primary Health Care, senior leaders there met in March and again in August with the National Association of Community Health Centers’ LGBT Workgroup to consider ways to improve the cultural competence of health centers on LGBT issues.

As a result of those meetings, later this month HRSA will convene a training and technical assistance call for all health center grantees on "Public Health Concerns of the LGBT Population."  The call will focus on health disparities and the unique health experiences and needs of LGBT patients, and grantees will share what they’ve done to promote access to care.

We’ve also made sure for the first time that LGBT populations are included in health center applications as a population served.  Organizations applying for funding are asked about their “community characteristics” and LGBT populations are now included on HRSA’s standard form.  

In another first – I am pleased to announce that this year’s annual “Women’s Health USA” chartbook will include data on lesbian and bisexual women’s health, as well as on same-sex couples.  This is the first time in the 10 year history of Women’s Health USA that data points on lesbians and bisexual women will be included.  We should be releasing that soon, so keep an eye on our Facebook page, Twitter feed, and HRSA newsroom.  I hope you’ll find the chartbook useful and will share through your networks. 

And in June – in yet another first – we were proud to join with our sister HHS agency, the Substance Abuse and Mental Health Services Administration (SAMHSA), to sponsor a joint LGBT Pride Month event at SAMHSA headquarters in Maryland.  Pam Hyde and I spoke, and we were joined by Office of Personnel Management Director John Berry and LGBT movement pioneer Frank Kameny.  You can find John and Frank’s inspirational speeches on our HRSA website at: hrsa.gov/ourstories/lgbt.

So, we’re advancing, we’re reaching out and that’s good.  But we’re also reaching in, to make sure HRSA’s culture and people reflect America.

Like President Obama, I value a well-trained, high-performing, diverse workforce, and I’ve challenged HRSA’s leadership to push harder to make sure we look like the people we serve.  And that, of course, includes the LGBT community.

One of my first hiring decisions as HRSA Administrator was the selection of my senior advisor, Tina Cheatham, who is a lesbian.  I’m sure that many of you know Tina’s work over the years for HRSA.

Yesterday you heard from Secretary Sebelius, my boss.  To support the work of her HHS-wide LGBT Coordinating Committee, I established the HRSA LGBT Workgroup, which has organized into subgroups on cultural competence, grants and administrative issues, and data and research:

• The Cultural Competence Subgroup has developed a list of cultural competence resources on serving LGBT people and offered recommendations to me on a listening session focused on LGBT health providers and students.

• The Data and Research Subgroup is focusing on HRSA’s data collection activities and future health services research on LGBT populations.  The group is preparing a research paper documenting HRSA’s LGBT data collection and reporting activities, which they’ll present at the 2012 National Health Promotion Summit.

• And, the Grants and Administrative Issues Subgroup is compiling a list of HRSA programs that may benefit LGBT people and is developing a plan to make the community aware of upcoming funding opportunities. 

I want to thank Hutson Innis for helping us spread the word through the LGBT Health Coalition’s Web site about how to become a HRSA grant reviewer.  You can link through the Coalition’s Web site to sign up to join the experts who serve on HRSA’s Objective Review Committees.  We’re always looking for a diverse set of expert reviewers to score applications for a wide range of HRSA grants – health professions training programs, rural health, health centers, and maternal and child health. 

What else will we do?

We’ll continue to meet with professional groups like the Coalition to help improve our grantees’ familiarity with the challenges LGBT patients face, and to develop strategies to increase culturally competent care for them. 

We’ll continue to listen to your good ideas on how we can eliminate health disparities.

We’ll work with SAMHSA and other HHS agencies on the recommendations around cultural competence.

And we’ll complete our review of a new grants policy statement that broadens the definition of cultural competence to include LGBT populations.

All this gives you an overview of some of the ways that HRSA is engaged with the LGBT community on the programs that we administer and the issues we deal with.

The drive for full equality for LGBT individuals is gathering strength across America.  And since its goal of equal rights is supported by the President of the United States, by Secretary Sebelius, and by me and Pam Hyde and other members of the administration, I think the future looks brighter than ever for members of the LGBT community.

I thank you for inviting me to be with you today.