I was fortunate to be one of 350 people at the inaugural White House LGBT Conference on Thursday.  This was the first in a series of conferences focused on topics related to LGBTQQI (lesbian, gay, bisexual, transgender, queer, questioning and intersex) Americans — this one was on health.  It was a veritable who’s who of LGBT people serving in the Obama Administration — mostly the White House and agencies within the Department of Health and Human Services.  Not everyone was queer (I’m not using that as a pejorative term) but a surprising number of folks were totally out and proud.  Being surrounded by such LGBT-positive energy made me proud to be a lesbian American.  Yes, this is a move to court LGBT voters during an election year; and, yes, the role of Secretary Sebelius was mostly to remind us of all of the wonderful forward momentum that has been achieved under Obama.  But you know what?  I don’t care!  On the day that the NJ Assembly passed Marriage Equality (the Senate did so earlier in the week) and the Governor promptly vetoed the bill, I was only too happy to hear politicos waxing poetic about LGBT Health in ways that reflected that they actually knew something about it.

Health is about so much more than heredity, environment and lifestyle.  Given my genes, the fact that I live in New Jersey and that I consider cheese to be its own food group, I expect that my days are numbered.  Looking beyond those traditional factors that influence health there are others that are just as important.  In health circles the theory is called “Social Determinants of Health” — it posits that the interplay of social, political and economic factors, compounded by the traditional factors, means that certain groups of people have worse health outcomes than the general population.  It is used widely in discussions of racism and health but when I educate people about LGBT issues, I use it to explain how systemic heterosexism and homophobia negatively impact the health of LGBT people and therefore result in poorer health outcomes compared with our heterosexual and nontransgender counterparts.

There are a host of diseases for which LGBT people are at higher risk than heterosexual and cisgender people.  However, even when our risk is exactly the same our health outcomes are worse.  Why?  Because there are other factors that are really making us sick: compared with the general population, sexual and gender minorities are more likely to be unemployed (no wonder since we can be legally fired in half of the states in this country simply for being LGB and the number increases for T); are less likely to have health insurance (most people get it through their employer or their spouse’s employer – and we’re rarely covered by a partner’s insurance); and face discrimination at the hands of health care providers who are uncomfortable treating us (to avoid the extra stress and humiliation we don’t seek care until diseases reach critical stages if we go at all).  I am a highly educated middle-class white lesbian who has spent the last 16 years working in a health sciences setting and I haven’t had a mammogram since my baseline, which was almost 9 years ago.  If I avoid health care providers like the plague then just imagine the gravity of this situation for LGBTQQI people at large.

I am fortunate to work at a school that is committed to addressing health inequities.  The Dean encouraged me to start a LGBT Health Working Group, which now has 30 members composed of faculty, staff, students and administrators from 3 health professions schools at my university.  This group has a three-fold charge: integrating LGBT Health throughout the curriculum so we graduate culturally competent providers; pursuing funding and conducting research related to LGBT Health; and addressing the needs of SGM patients through our clinical services and community programs.

America is not a perfect place by any stretch of the imagination for LGBTQQI folks in 2012.  But there are people all over the country who, in whatever ways they can, are working to address LGBT health disparities and social determinants of health — from the White House to your local public school, we are making every day better than the one that came before.  I am hopeful that one day people will look back at this era and wonder how SGM people could ever have been treated differently from anyone else, much less denied the basic human dignity of full marriage equality.  I may need to cut down on the cheese and get a mammogram to live long enough to see that day but I firmly believe that it will come.