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health disparities

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Councilmembers David Grosso and Robert White introduce legislation to improve LGBTQ health data

For Immediate Release:
June 5, 2018
 
Contact:
Matthew Nocella, 202.724.8105 - mnocella@dccouncil.us

Councilmembers David Grosso and Robert White introduce legislation to improve LGBTQ health data

Washington, D.C. – Today Councilmembers David Grosso (I-At Large) and Robert White (D-At-Large) introduced a bill to improve the documentation by D.C. agencies of health outcomes and behavioral risk factors of the lesbian, gay, bisexual, transgender and questioning (LGBTQ) community, as the federal government prepares to limit its collection of this critical public health data.

“At a time when the federal government is retreating from its responsibility to protect everyone’s human rights, D.C. must do everything it can to ensure those rights,” said Councilmember David Grosso. “We have a responsibility to meet the unique health needs of our LGBTQ residents.  Requiring our agencies to collect this critical public health data will better inform our policymaking and improve the health outcomes of all District residents.”

“We celebrate Pride in June, but we must go beyond words and parades to affirm and support our LGBTQ friends and neighbors. We need to push back on these proposals by the Trump administration that would impact their health by pretending they don’t exist,” said Councilmember Robert White.

The LGBTQ Health Data Collection Amendment Act of 2018 would require the District Department of Health to collect demographic data on sexual orientation and gender identity through its annual Behavioral Risk Factor Surveillance Survey (BRFSS).

The BRFSS is a cross-sectional telephone survey conducted by state health departments in all 50 states and the District of Columbia with technical and methodological assistance provided by the Center for Disease Control.

It would also require the Office of the State Superintendent of Education to collect information on the sexual orientation, gender identity, and gender expression of respondents to the school-based Youth Risk Behavior Surveillance System (YRBSS). YRBSS monitors six types of health-risk behaviors that contribute to the leading causes of death and disability among youth and adults.

“Having a better understanding of how our students identify and the impact their sexual orientation or gender identity has on their behavior and risk factors will enable schools to better serve our students’ non-academic health needs,” Grosso, chairperson of the Committee on Education, said. “When those needs are met, we know they are better prepared to succeed academically.”

All levels of government rely on the data from these surveys when making policy choices to address public health issues. Recently, Trump administration officials with the Center for Disease Controls hinted that they would discontinue the collection of this data.

Additionally, the bill would require that the data collected be used in the annual report on the health of the District’s LGBTQ community, a collaborative effort of the Department of Health and the Office of LGBTQ Affairs.

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Grosso and Department of Health exchange letters on LGBTQ health

In May, Councilmember Grosso wrote to Director of the Department of Health Dr. Nesbitt regarding implementation of his bill LGBTQ Cultural Competency Continuing Education Amendment Act of 2015, which became law on April 6, 2016, as well as other LGBTQ health issues including data collection under the BRFSS and a local survey. On June 10, the Director responded. You can read both letters below:

Councilmember Grosso's letter:

Director Nesbitt's response:

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Committee Approves Grosso’s Bill to Improve Health of LGBTQ Residents

For Immediate Release: 
December 9, 2015
Contact: Darby Hickey
(202) 724-8105

Committee Approves Grosso’s Bill to Improve Health of LGBTQ Residents

Washington, D.C.--Today, Councilmember David Grosso (I-At Large) joined his colleagues on the D.C. Council Committee on Health and Human Services in a unanimous vote to approve the LGBTQ Cultural Competency Continuing Education Amendment Act of 2015. Introduced by Grosso and Councilmember Yvette Alexander in April, the legislation requires medical professionals, renewing their licenses in D.C., to take two credits of cultural competency training focused on patients who identify as lesbian, gay, bisexual, transgender, gender nonconforming, queer, or questioning their sexual orientation or gender identity.

During the hearing on this bill, we heard truly heart breaking stories from LGBTQ residents about mistreatment they experienced at the hands of medical providers,” said Grosso. “In particular, our transgender friends and neighbors face disrespect and misunderstanding in medical settings, and this bill will continue our work to correct this serious problem.”

As many as one in five transgender people in D.C. have been denied medical care due to their gender, according to research released by the D.C. Trans Coalition last month in the "Access Denied" report. Locally and nationally, higher instances of chronic conditions among LGBTQ individuals have been documented, including higher rates of STDs and HIV, suicide attempts, mental illness, and some cancers.

“Quality medical care is often a life or death issue, and it is always a human right,” said Grosso. “I am grateful to Committee on Health and Human Services Chairperson Alexander for moving this legislation forward, for the health and well-being of our residents.” 

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Mayor expects to back ‘cultural competency’ bill

By Lou Chibarro, November 3, 2015, Washington Blade

D.C. Mayor Muriel Bowser on Monday said she expects to support the current version of a bill pending before the City Council that would require continuing education programs for licensed healthcare professionals that include LGBT-related “cultural competency” training.

Bowser’s comment follows testimony on Oct. 29 by her director of the city’s Department of Health, Dr. LaQuandra Nesbitt, calling for major changes to the bill – the LGBTQ Cultural Competency Continuing Education Amendment Act of 2015. LGBT advocates oppose her suggested changes.

Nesbitt told the Council’s Committee on Health and Human Services during a public hearing on the bill that she and Bowser support the general intent of the measure but believe it should be expanded to include cultural competency training “for all populations and sub-groups to whom healthcare professionals provide services.”

LGBT healthcare advocates joined more than a dozen representatives of healthcare organizations, including doctors and clinical social workers, in testifying at the hearing in favor of the version of the bill introduced in April by Council members David Grosso (I-At-Large) and Yvette Alexander (D-Ward 7). Alexander chairs the Health and Human Services Committee.

“I expect that we’ll support the Council bill,” Bowser told the Washington Blade following a news conference on Monday. “We will probably go with how they wrote it and if there are ways to enhance it down the line that’s what we would do,” she said.

The mayor’s comment will likely generate a collective sigh of relief from LGBT activists who expressed concern that Nesbitt had been pushing for a broader bill that could decrease its effectiveness in addressing the need for cultural training on medical issues impacting LGBT people.

Grosso told the Washington Blade he has no objection to cultural competency training pertaining to other population groups. But he said adding other groups to the bill would dilute its ability to address what he and others have said is lack of understanding and cultural sensitivity by many doctors and other health care providers toward LGBT patients.

The current version of the bill would amend an existing health care licensing law to require health care professionals, including doctors and mental health practitioners, to receive two credits of instruction on LGBT subjects as part of their continuing education programs.

“Despite the District’s strong policies against discrimination, our community, which is more than 10 percent of the District’s population, remains at risk,” said Rick Rosendall, president of the Gay and Lesbian Activists Alliance, in his testimony before the committee.

“[R]egarding the scope of this bill: Why is it limited to LGBTQ?” Rosendall asked. “For one thing, only so much can be covered meaningfully in two credits worth of training time. More crucially, our community faces the particular challenge of invisibility,” he continued. “If we are subsumed under a generic, all-encompassing category, we are effectively excluded.”

Alison Gill, senior legislative counsel for the Human Rights Campaign, told the committee that a 2009 nationwide survey found that more than half of LGBT respondents reported being refused needed care or being treated in a “discriminatory, disrespectful manner” by health care providers.

“Culturally competent care is especially important for LGBT people, as they continue to face substantial disparities in health, resulting from the stress of pervasive stigma; substance abuse and other health-endangering coping strategies; a reluctance to seek medical care due to fear of and actual healthcare discrimination; and the disproportionate impact of sexually transmitted disease,” Gill told the committee.

With the exception of Nesbitt, all of the nearly 20 witnesses testifying at the Council hearing expressed strong support for the bill as introduced by Alexander and Grosso. However, the executive vice president of the Medical Society of the District of Columbia, K. Edward Shanbacker, submitted a letter to the committee opposing the bill.

“The Medical Society believes strongly that the medical profession alone has the responsibility for setting standards and determining curricula in continuing medical education,” Shanbacker said in his letter. “In the District, the mechanism for that is the Board of Medicine, which has in the past opposed content-specific requirements surrounding continuing medical education,” he said.

Grosso said he has an answer to those, including the Medical Society, who say only doctors’ organizations and medical licensing boards should develop continuing education training on cultural competency matters.

“My answer to them is well you haven’t put this one in place and it would be important for us to put it on the books now,” he said, referring to LGBT cultural competence training.

He pointed to testimony by witnesses at last week’s Council hearing who told of LGBT patients who have been treated in a disrespectful manor and sometimes refused treatment by doctors unfamiliar with the special health needs of LGBT people, especially transgender people.

Dr. Raymond Martins, senior director of clinical education and training at D.C.’s Whitman-Walker Health, told the committee many of the mostly LGBT patients he has seen at Whitman-Walker have reported unpleasant experiences with other physicians and healthcare providers.

“Sadly, in this metropolitan area as well as throughout the country, physicians and other health providers do not receive adequate LGBT clinical and cultural competency training during medical school and their post graduate years,” he said. “This unfortunately leads to discrimination and poor health outcome for LGBT people,” Martins testified.

Grosso said he is hopeful that the bill will be finalized and brought up for a vote by the full Council before the end of the year. Eight other members of the 13-member Council signed on as co-sponsors of the bill.

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Supporting Sustainable Communities through Health Impact Assessments

By Katrina Forrest

Poor health is not only physically and emotionally taxing for individuals, but there are important economic implications—these include increased costs to the healthcare system associated with the diagnosis and treatment of chronic conditions and lost time and productivity in the workforce.  While access to quality healthcare is without question a necessity, prevention is key.

Research indicates that there are a myriad of factors outside of the traditional health scope that shape health-related behaviors.  If we are to promote health and prevent disease, we must carefully consider and analyze all of the factors that impact health outcomes.  Economic sectors such as housing, transportation and agriculture can have profound impacts on the health and well-being of individuals and communities and yet these impacts are often not sufficiently evaluated.

As the District of Columbia continues to grow, with new development projects emerging every day, it is imperative that we assess how these projects positively or negatively affect the health of our residents.  By utilizing health impact assessments, we are able to better understand and identify the potentially significant unknown, unrecognized or unexpected health effects of policies, plans and projects across diverse economic sectors.

Health impact assessments rely on quantitative, qualitative and participatory techniques, to determine health impacts, the distribution of those impacts within communities and identify mitigation strategies to address adverse effects.  For example, in Washington State, legislation was enacted in 2007 to require a health impact assessment to examine the impact of a bridge replacement project on air quality, carbon emissions and other public health issues.

Recognizing the value of this tool, Councilmember Grosso introduced the Health Impact Assessment Program Establishment Act of 2015 .  This legislation establishes a health impact assessment program within the Department of Health to ensure that we are properly evaluating the potential health effects of construction and development projects on our residents and the communities they call home.

Implementing this comprehensive approach here in D.C. would help to promote sustainable development, improve and reduce health inequities, encourage cross-sectoral collaboration, and inspire a greater appreciation for public health in the policymaking process.   Grosso is committed to improving the health and wellness of every D.C. resident and this legislation is a critical step to accomplish that goal.

*This post is part of an ongoing series of posts by Councilmember Grosso’s staff to support professional development. All posts are approved and endorsed by Councilmember Grosso.


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LGBT ‘cultural competency’ bill introduced in D.C. Council

by Lou Chibbaro, April 14, 2015, Washington Blade

D.C. Council members David Grosso (I-At-Large) and Yvette Alexander (D-Ward 7) introduced a bill on Tuesday that would require continuing education programs for licensed healthcare professionals to include LGBT related “cultural competency” training.

The LGBTQ Cultural Competency Continuing Education Amendment Act of 2015 would amend an existing health care licensing law to require healthcare professionals, including doctors and mental health practitioners, to receive two credits of instruction on LGBT subjects.

The bill says the two credits of instruction would pertain to “cultural competency or specialized clinical training focusing on patients who identify as lesbian, gay, bisexual, transgender, gender non-conforming, queer or questioning their sexual orientation or gender identity and expression (LGBTQ).”

All nine of Grosso and Alexander’s Council colleagues signed on as co-sponsors of the bill at the Council’s regularly scheduled legislative meeting on Tuesday.

“Over 66,000 LGBTQ citizens reside in D.C., and they deserve access to medical professionals who are sensitive to and knowledgeable about the unique health needs of the LGBTQ community,” Grosso said in a statement.

Alexander, who chairs the Council’s Health Committee, said she plans to hold a hearing on the legislation as soon as possible and move the measure to a vote by the full Council following a markup on the bill. She said the legislation is especially needed for the trans community, which she said historically has experienced discrimination in seeking medical and mental health related services.

“LGBT people face substantial systemic discrimination in healthcare due to a lack of understanding of the unique needs and challenges faced by the community,” said Sarah Warbelow, legal director of the Human Rights Campaign, which is coordinating a lobbying effort to help pass the bill.

The Gay and Lesbian Activists Alliance, Whitman-Walker Health, National Children’s Hospital, and the D.C. Center for the LGBT Community are working with HRC as part of a coalition pushing for the bill, according to a statement by HRC.

“Cultural competency is critical to reducing healthcare disparities for LGBT people and improving access to high quality healthcare, especially for transgender people,” Warbelow said.

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Grosso Introduces LGBTQ Cultural Competency Legislation for Clinical Medical Providers

For Immediate Release
April 14, 2015

Contact: Dionne Johnson Calhoun
(202) 724-8105

Grosso Introduces LGBTQ Cultural Competency Legislation for Clinical Medical Providers

Washington, D.C.—Today, Councilmember David Grosso (I-At Large) introduced legislation seeking to narrow LGBT health disparities in the District of Columbia with the introduction of the “LGBTQ Cultural Competency Continuing Education Amendment Act of 2015.” The legislation requires two credits of instruction on cultural competency or specialized clinical training focusing on patients who identify as lesbian, gay, bisexual, transgender, gender nonconforming, queer, or questioning their sexual orientation or gender identity and expression.

 “Over 66,000 LGBTQ citizens reside in D.C., and they deserve access to medical professionals who are sensitive to and knowledgeable about the unique health needs of the LGBTQ community,” said Grosso.

According to the Joint Commission field guide, “Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the LGBT Community,” LGBTQ patients face barriers to equitable care, such as refusals of care, delayed or substandard care, mistreatment, inequitable policies and practices, little or no inclusion in health outreach or education, and inappropriate restrictions or limits on visitations. These factors contribute to higher instances of chronic conditions among LGBTQ individuals; higher infection rates of STDs and HIV; higher prevalence of suicide attempts, mental health illness such as anxiety, depression, and addiction; and higher instances of some cancers.

“LGBTQ health disparities are real and this is a contribution to our efforts to narrow those disparities in the District of Columbia. I am proud that my colleague from Ward 7, Health and Human Services Committee Chairwoman Yvette Alexander joined me in co-introducing this bill. Together, we will continue to ensure the LGBTQ community enjoys a greater quality of life in the District of Columbia,” said Grosso.

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Grosso statement on proposed Commission on Health Disparities Establishment Act

Thank you Chairwoman Alexander and thank you to all of the witnesses here to testify today on Bill 20-572, the “Commission on Health Disparities Establishment Act of 2013.”

The District of Columbia has the seventh highest incidence rate and the highest death rate from breast cancer in the United States. And although the incidence rate for breast cancer is higher for white women in this city, African-American women from Wards 5, 6, 7, and 8 are overrepresented among those dying from the disease.

Even more troubling, African American women in the District are showing up for treatment with advanced breast cancer at rates that are almost double the national average. 

In a report published by the Center for Disease Control (CDC) in 2013, it was found that D.C. residents died at a higher rate from preventable heart attacks than any other jurisdiction in the country. 

The CDC report found that, in the District, the rate of avoidable deaths from heart disease, stroke and hypertensive disease was 99.6% per 100,000 population.  The most affected demographic was African-American males ranging in age from 65-74.

These disparities are also found when we discuss behavioral health.  A few years ago there was only one child psychiatrist that was east of the River.  Additionally, 35 percent of the District’s transgender population has experienced suicidal ideation while 39 percent do not have a physician for routine health care as reported by the DC Center for the LGBT Community.

Further, 58 percent of the District’s African-American males having sex with other males are living with HIV, which is significantly higher than the national average at 29 percent. 

We cannot allow these disparities to persist in our communities.  In February, the Department of Health compiled a very comprehensive Community Health Needs Assessment, the first of its kind for the District and I want to applaud the Department for this effort.

All District residents, regardless of race, ethnicity, age, sexual orientation, or gender identity deserve access to quality physicians, screenings and treatment.  I will continue to follow this issue very closely and I am eager to hear from and engage with the witnesses in the discussion to follow.

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Matters of the Heart

By Katrina Forrest

February is National Heart Month and with heart disease still serving as the leading cause of death for both men and women nationally, it is important to know the factors associated with the disease and take the necessary precautions to get screened, eat healthy and live an active lifestyle. 

Each year about 600,000 Americans (1 in 4) die from heart disease.  High blood pressure, high LDL cholesterol and smoking are the key risk factors and surprisingly, about half (49%), of Americans have at least one of the three risk factors. Other factors that lead to an increased risk for heart disease include diabetes, obesity, poor diet, physical inactivity and excessive alcohol use.

Here in the District, we face a startling reality when it comes to heart health related deaths and emergency response.  In a report published by the Center for Disease Control (CDC) in 2013, D.C. residents died at a higher rate from preventable heart attacks than any other jurisdiction in the country.  The CDC report found that, in the District, the rate of avoidable deaths from heart disease, stroke and hypertensive disease was 99.6% per 100,000 population.  The most affected demographic was African-American males ranging in age from 65-74.

Given the severity of this problem in the District, it would seem that emergency responders would have the requisite training to identify and understand the importance of swift action in exigent circumstances.   Unfortunately, this has not been the case. 

The District has a history of unresponsiveness from emergency service professionals entrusted with upholding the highest standards of care and response. In 1999, a 21-year old woman, Julia Rusinek collapsed on a busy street corner. A bystander saw her on the ground and ran to the firehouse less than a block from where she fell. Firefighters said another engine was on the way and that their ambulance crew was going off duty. She was declared dead at a hospital less than a mile from where she fell.  Last year on New Year’s Day, a 71-year old resident died of a heart attack when he had to wait 40 minutes for emergency responders on a day when one-third of D.C.’s firefighters called out sick.  D.C.’s Fire and EMS Department is in the news once again as yet another elderly man, age 77, collapsed and later died from a heart attack suffered on January 25, 2014. This latest incident elicited public outrage as the collapsed man lay dying in front of a N.E. fire station, while a firefighter stood idle, refusing to provide assistance until someone called 911.  

District residents are experiencing heart related deaths at a higher rate than anywhere else in the country and this problem should not be exacerbated by institutional policies that have led to a failure to act.   These deaths are preventable if residents have access to information on risk factors, quality health centers and free screenings, but when it comes to matters of the heart, we must also ensure that our emergency medical service providers are acting out of compassion and not a callous adherence to questionable policies.  Addressing these deficiencies is paramount to correcting this troubling problem in the District.

*This post is part of an ongoing series of posts by Councilmember Grosso’s staff to support professional development. All posts are approved and endorsed by Councilmember Grosso.

 

 

 

 

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Grosso Statement at the AmeriHealth Behavioral Health/Physical Health Integration Summit

As you all know, one of the major challenges for effective health care delivery is the integration of services, particularly behavioral health and physical health programs. It is very rare that patients come to health clinics or providers with just one issue and if we can do our best to treat the whole person, it improves quality of care and outcomes for our residents.

I’ve brought this up in every meeting I’ve had with AmeriHealth staff and so it’s very exciting and impressive that AmeriHealth, who is new to the District, has called for this summit.

For a long time in the District, behavioral health programs were solely reliant on grant funding and therefore the services were not as expansive or as available as they should have been for all of our residents.

Many health plans did not offer coverage for behavioral health services. Providers were not accessible in all parts of the city – for example, a few years ago there was only one child psychiatrist that was east of the River. And there was little outreach to our African-American communities who were long reluctant to discuss mental health and illness even though many of those residents were dealing with incidents causing mental trauma on a daily basis.

As a result, there is a gap in the District of Columbia between our white and higher income residents and their minority and low-income counterparts when it comes to considering behavioral health and receiving proper care.

According to the U.S. Department of Health and Human Services Office of Minority Services, African Americans are 20 percent more likely to report having “serious psychological distress” than non-Hispanic Whites. Yet, young adult African Americans are less likely to seek mental health services than their White counterparts.  In fact, the depression rate among African American women is estimated to be almost 50 percent higher than that of Caucasian women.

We know that when individuals are facing mental illness or challenge, and essentially cope and suffer in silence, the problem doesn’t go away; it just tends to manifest in other physical health issues becoming more costly and problematic as time goes on. This is why I think integration of behavioral health and physical health programs are key and I’m excited that you all are here to identify integration projects and make firm commitments to implementing them in 2014-15.

We have certainly come a long way in the District in terms of behavioral health services. I sit on the Committee on Education at the Council and every time I visit a school they are not just talking about the guidance counselor anymore, we now have psychologists and family therapists along with nurses and dentists who are coming directly to the schools to provide services because we realize how important it is to take care of the health of the whole child.

This summer I visited 12 primary health clinics throughout the District. With the rollout of the Affordable Care Act and the increase demand for health care, I wanted to get an on-the-ground feel of what health access is really like in the District. What I found were successful, mission-driven health clinics that are going above and beyond to meet the whole needs of the patients they serve. While they all were borne out of a need to serve a particular community or treat a specific health issue, they’ve evolved to treat the whole person. Behavioral health services are now integrated into all of them.

We need more clinics and health providers who see this importance in the District. That is why a couple of weeks ago when I sent my budget priorities for FY15 to the Mayor, I included a request that he infuse $3 million into the health professionals recruitment fund to help our clinics and hospitals recruit more providers to work and setup practice in our neediest of neighborhoods. Treating the whole patient is the only way we are really going to move the needle in terms of improving health outcomes for patients and reducing overall costs for care.

I want to thank you all for taking time out of your schedules to have these conversations. They are imperative for District residents and the patients you all serve!

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