The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding
At a time when lesbian, gay, bisexual, and transgender individuals— often referred to under the umbrella acronym LGBT—are becoming more visible in society and more socially acknowledged, clinicians and researchers are faced with incomplete information about their health status. While LGBT populations often are combined as a single entity for research and advocacy purposes, each is a distinct population group with its own specific health needs. Furthermore, the experiences of LGBT individuals are not uniform and are shaped by factors of race, ethnicity, socioeconomic status, geographical location, and age, any of which can have an effect on health-related concerns and needs.
While some research about the health of LGBT populations has been conducted, researchers still have a great deal to learn. To help assess the state of the science, the National Institutes of Health (NIH) asked the Institute of Medicine (IOM) to assess current knowledge of the health status of lesbian, gay, bisexual, and transgender populations; to identify research gaps and opportunities; and to outline a research agenda to help NIH focus its research in this area. A committee of experts was convened by the IOM to consider this task, and its findings are presented in its report, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.
Conducting Research on LGBT Populations
Researchers face a number of challenges in understanding the health needs of LGBT populations, including a lack of data. In order to address this, the committee recommends collecting data on sexual orientation and gender identity in health surveys administered by the U.S. Department of Health and Human Services (HHS) and other relevant federally funded surveys. Data on sexual and gender minorities should be included in the battery of demographic information that is collected in federally funded surveys, in the same way that race and ethnicity data are collected. In addition, data on sexual orientation and gender identity should be collected in electronic health records and could be included among other demographic information collected. While all data collected in electronic health records are subjected to high levels of privacy and security protections, information on sexual orientation and gender identity could be perceived by some as more sensitive than other information.
Asking study participants about their sexual orientation and gender identity also presents a challenge for researchers. While questions designed to elicit this information have been developed and used, the committee recommends that NIH support research to evaluate the questions and develop additional measures. Similarly, questions about sexual orientation and gender identity on federally funded surveys should be standardized to allow for the comparison and combination of data across large studies.
Another challenge for researchers is the relatively small proportion of the U.S. population that LGBT populations represent; therefore, it is labor intensive and costly to recruit a large enough sample in general population surveys for meaningful analysis of these populations and subpopulations. The NIH should support methodological research aimed at developing innovative ways to conduct research with small populations and determining the best ways to collect information on sexual and gender minorities in research, health care, and other settings.
Currently, opportunities for conducting NIH-sponsored research on LGBT health are limited. To encourage more research on LGBT health issues, the NIH should create a comprehensive research training program that would raise awareness of LGBT health issues among researchers. The committee recommends that the NIH encourage researchers to include sexual and gender minorities explicitly in their samples, using the NIH policy on the inclusion of women and racial and ethnic minorities in clinical research as a model. This would prompt researchers to consider these groups more frequently when applying for research grants.