Missouri Case Study 4: Nudging Missouri Hospitals on LGBT Welcoming Policies

Andrew Shaughnessy, Manager of Public Policy for PROMOAndrew Shaughnessy

Manager of Public Policy, PROMO


Building off of the work of Tracy McCreery, former Manager of Public Policy for PROMO, my name is Andrew Shaughnessy, current Manager of Public Policy. In the last installment of our Missouri Case study, Tracy observed firsthand the difficulty in getting Missouri-based hospitals, which clearly have LGBT friendly policies, to stand up as leaders in filling out the Human Rights Campaign’s Healthcare Equality Index (HEI). Don’t worry – this still remains the case for some hospitals – but we are seeing a positive shift from many of our targeted hospitals.

Going into this year, our work centered around hospital outreach and education around LGBT welcoming policies. We were interested to see how Senior-level Hospital Executives would react to our outreach efforts for the HEI and its welcoming policy requirements. Given the prior environmental circumstances we faced, we were pleasantly surprised by the reaction we have received thus far. From what we have heard back from our first round of outreach, we know that our work is affecting positive policy change for LGBT Missourians.

Several targeted hospitals, including two network wide hospitals, which will include 14 new hospitals to our original list, have committed to improving their LGBT welcoming policies. Out of the targeted 20 hospitals that PROMO had originally reached out to regarding HEI requirements, we have made contact with, and provide technical policy assistance to seven. Four Senior-level Hospital Executives disclosed to us that our outreach efforts had ‘inspired’ them to take action and update their policies.

Now whether they chose to be recognized as ’2014 Leaders’ will be the next challenge we face, however I can sleep easier knowing that this effort is working. Sometimes all hospitals simply need is a nudge from local LGBT organizations to start the process. Andrew Shaughnessy Manager of Public Policy, PROMO


It is well established that LGBT people have higher rates of smoking/ tobacco usage than heterosexuals. It is also known that gay and bisexual men and transgender people have higher rates of HIV than their heterosexual counterparts. It has been found that 85% of people with HIV have a history of lifetime tobacco usage. I could not find research that stated the number of HIV positive GBT people who smoke (and if you find it please leave it in the comments section!) one can probably extrapolate that smoking rates among GBT HIV positive people is considerable.


Cancer risk is increased by HIV, and there are several types of cancer that affect HIV positive individuals, including lung cancer, and several others. HIV+ smokers are more likely to develop Pneumocystis carinii, a type of pneumonia that is of specific concern to HIV positive people, while Mycobacterium avium complex, a life threatenting bacteria which affects around 40% of HIV+ people was found in Tobacco. The host of other health related problems that smoking causes (hypertension, COPD, etc) surely do a compromised immune system no favors.


While stigma stress certainly makes quitting smoking difficult, finding ways to combat smoking among HIV positive GBT people is clearly a much needed area in which there is work to be done. We must advocate for more research and evidence based interventions to be done in the area of smoking and tobacco cessation for GBT people living with HIV.


My Other Chelsea Neighbor

The rich white gay man does live in Chelsea. He is my neighbor and he is both buff and healthy. I recently met his “cousin” in the new Terrence McNally play last week,Mother and Sons, although that version had a fabulous Central Park West apartment with a view, a husband and a perfect child.

I live in Chelsea, too.

My friend Jay, a transgender man, lives in Chelsea also, but his apartment is in the housing projects. You won’t run into Jay in the neighborhood these days; he is homebound, recovering from surgery for lung cancer that cruelly developed only a few years after his difficult bout with breast cancer.

I am not pretending that I just invented the financial rainbow; we all know that the diversity in our community extends to the range of socioeconomic classes we belong to. I am writing because those of us who live in poverty are hidden, while the lives of the wealthy are highlighted in media and the news. More importantly, money has a huge impact on our health and health choices.

Jay attributes his poverty initially to being made homeless as a youth, thrown out of higher education, being physically assaulted and facing discrimination severe enough to cause PTSD. Exposure to DES in utero then created multiple chronic illnesses in early adulthood, derailing all his efforts to get his life back on track. The final drain on his remaining resources was his decision to care for his dying partner, Eleanor. It was during that time that Jay himself developed breast cancer. The healthcare system treated him just as poorly as they had Eleanor; the surgeon would not call to give Jay his malignant biopsy results, but referred him instead to the Psychiatry Department, simply because he was transgender.

Poor LGBT people may be hidden, but they are not a minority. The Williams Instituterecently found that we have substantially higher rates of poverty in our community than in the general public. Separate out different racial groups, and the numbers tell the same story, with more LGBT African Americans living in poverty than their African American heterosexual counterparts.

Chelsea, NYC

Chelsea, NYC

One out of five working-age LGBT adults received food stamps last year and one quarter of same-sex couples needed that government benefit in order to eat. (The national rate of food stamp eligibility is only 16 percent.) Jay ate organic food more often than most, because he supplemented his food stamps with dumpster diving at Chelsea grocery stores, where truckloads of fresh organic food was discarded. When his health permitted it, Jay collected far more than he needed and his neighbors, especially the disabled, were invited to stop over and take what they liked. (He gathered thrown out cleaning supplies as well).

Cancer is not for those without financial resources. A new study found that 25 percent of breast cancer survivors experienced financial decline and the difficulties were more often reported by those who began with lower incomes. Sadly, but not shockingly, poor people endure greater pain and suffering from cancer than most Americans.

Poverty exerts multiple additional stressors on cancer patients; it limits health care access, degrades nutritional status, restricts transportation alternatives to healthcare settings, limits access to alternative and complementary care, restricts the ability to research one’s cancer, “and frankly”, as Jay said, “the hopelessness and hardship of poverty grinds away the will to live.”

After returning home from the hospital, Jay had a friend go to the pharmacy with 5 prescriptions for post operative pain medications. Medicaid insurance refused to cover the main pain medication, a sustained release form of Oxycodone. Clearly, he couldn’t afford to pay for the drug himself. As a result, he had to use ibuprofen, which is contraindicated because of his kidney impairment, and the unmanaged pain made him unable to sleep. “That’s grisly”, he explained.

Since that time, Jay learned that what he believed to be stage 1 lung cancer turned out to be inoperable stage 4. He’s on borrowed time, navigating his way through all the issues that arise with very aggressive lung cancer, but compounded in his case by Medicaid’s refusal to cover not only his pain medications, but also diagnostic scans prescribed by his doctors. He is finding it impossible to fight for his care while too sick to function.

Jay said, “I can see why patients give up and just lapse into defeat. It’s way too much to deal with, and even I, lifelong fighter, often have moments of wishing to just fall asleep and never wake up.”

I run a national LGBT cancer organization and I am outraged and heartbroken.

Most of our research evidence addresses the greater cancer risks in the LGBT community, but that is only the beginning of our health story. LGBT people then face greater barriers to accessing quality healthcare and for people, like Jay, cumulative experiences like this have thrown him into poverty. Every life is unique and some have better outcomes, but the root cause of it all is discrimination. For Jay’s sake and for all our LGBT brothers and sisters, we must keep fighting. Discrimination is killing us.

Follow Liz Margolies, L.C.S.W. on Twitter: www.twitter.com/cancerlgbt

As published on Huffington Post’s new LGBT Wellness blog, see original at:


The George Washington University is Now Accepting Applications

lgbthealth gwu

The LGBT Health Policy and Practice Graduate Certificate Program at The George Washington University is now accepting applications for the 2014-2015 class. This is the second year of the program at the university.

This is an opportunity for grads or soon-to-be grads, with LGBT issues-focused career goals anywhere in the country, to add to their resumes while in graduate school or working full-time. The program is open to anyone in the U.S. or abroad with a Bachelor’s Degree who works or is training to work in the health care or health policy fields, and who wants core competency in LGBT physical and mental health domains.

Classes for the 10-month, 12-credit, hybrid online/on-campus program begin online June 23rd. If you are interested you should apply now. Applicants usually receive feedback within two weeks of submitting their applications. Tuition for the 2014-2015 program year is $10,800. To apply now, click here.

More information: You can view a video about the program here. For additional detailed certificate program information, please visit GWU’s website here.   If you are interested you can also contact Dr. Stephen Forssell by email or phone at Forssell@gwu.edu or 202-994-6316.  

#SaludLGBTT Wrap-Up: Working Together as Advocates



Corey Prachniak is an LGBT rights, HIV policy, and healthcare attorney. He serves on the Steering Committee of the Network for LGBT Health Equity and tweets @LGBTadvocacy.

This is a series of posts covering Corey’s work in Puerto Rico for the Salud LGBTT conference.


Corey captures the sun setting over the San Juan Bay – and a great summit.

Now that the hundreds of us who participated in the Salud LGBTT summit in Puerto Rico last weekend have had a chance to return home and recuperate (and, in my case, pour on the aloe vera), I wanted to write a quick wrap-up on my experiences there.

In addition to the two days we spent talking about topics ranging from trans health to e-cigs, many of us spent time networking, developing collaborations, and making lasting friendships. People came from all over the island and the continental U.S. not only to share their experiences but also – and more importantly – to learn from the experiences of others.

Chances are that those of you reading this blog, like the attendees of the conference, come from all different backgrounds and specialties. Some are students, activists, lawyers, healthcare providers, community health workers, and academics. Some are focused on tobacco control, others on LGBT rights, and still others on healthcare disparities generally. And we each have different intersectionalities with respect to our own orientations, gender identities, races, ethnicities, abilities, and social groups. In short, we each bring different things to the table, both personally and professionally.

Over the weekend, I had a realization that there is none among us who can “do it all” with respect to LGBT health. We can’t all prioritize everything or be experts on every topic. One prominent activist told me that she sometimes feels pressure to prioritize one sub-group within the LGBT community over another. But rather than despair at this truth, or just give in and pick favorites, she and I focused our discussion on how to create collaborations so that we’re all working together towards a common goal.  By recognizing and using the expertise of others, we can focus on doing novel work ourselves.

So that was my lesson from the Salud LGBTT summit: to not reinvent the wheel trying to change the world alone, but to join forces with others to keep our wheels moving forward together. That means creating more opportunities like this amazing summit to gather and not just speak, but also listen.

Congratulations to Juan Carlos Vega and the entire board of Salud LGBTT for a successful and inspiring weekend! I look forward to seeing the attendees – and hopefully many new faces – next year.

To read more coverage of the Salud LGBTT summit, click here.


HealthEquity Logo
CDC’s Office on Smoking and Health seeks ex-smokers
to be in Tips From Former Smokers campaign!
The Centers for Disease Control and Prevention’s (CDC) Office on Smoking and Health are recruiting additional candidates to be considered for an upcoming national education campaign, Tips From Former Smokers (Tips). This campaign is similar to previous campaigns seen here, real people who have had life-changing, smoking-related health problems will be featured. They are conducting a national search to find people with compelling stories who are willing to participate in their campaign.

The CDC and OSH are seeking people from all backgrounds, and are particularly looking for candidates who are of Asian descent. All applicants must be tobacco-free for at least 6 months.

They are looking for ex-smokers who:

·         Have or have had colorectal cancer that was linked to cigarette smoking (ages 30–65).
·         Have or have had macular degeneration that was linked to cigarette smoking (ages 40–65).
·         Used cigars with cigarettes or used cigarillos or little cigars with or without cigarettes, thinking cigars, cigarillos and little cigars were healthier than cigarettes and developed a serious health condition while smoking (ages 20-60).
·         Used e-cigarettes or smokeless tobacco for at least a year while continuing to smoke some cigarettes; and
·         Thought using e-cigarettes or smokeless tobacco to cut back on some cigarettes would be good for your health; and
·         Despite cutting back, you were later diagnosed with a serious health condition.
All individuals should be comfortable sharing their story publicly and be able to articulate how their smoking-related condition has changed their life. The association between smoking and their condition must be clear, and candidates’ physicians will be contacted to verify that smoking contributed to the condition.

The CDC and OSH would like for you to help distribute this flyer (below). Please feel free to email it to anyone who might be willing to help CDC recruit for this campaign. The flyer can be posted in public areas or shared with anyone who may know people who fit the criteria above.

Feel free to print and share! click to enlarge

Feel free to print and share! click to enlarge

If you have questions, please send them to the CDC representative, Crystal Bruce, jgx6@cdc.gov.
Please put “Recruitment Question” in the subject line.



Michael G. Bare
Program Coordinator
National LGBT Cancer Network 

During the Conference on LGBT Suicide Risk and Prevention at the San Francisco State University, the component that struck me most (and made me want to make this a 2 part blog) was the work being done by the Family Acceptance Project around LGBT youth’s families and faith communities to increase support for LGBT youth and decrease the various problems that LGBT youth face: family and community rejection, depression, homelessness, substance abuse, STDs and suicidal thoughts and attempts. Caitlin Ryan, Project Director of the Family Acceptance Project, spoke at length about the issues the project tackles.

The theme that Caitlin pointed out that was, to me, the greatest take-away was the need to change the paradigm of the way LGBT activists and service providers think of the family in a social context. Historically, families were excluded from programmatic frameworks because of unsupportive or toxic relationships with LGBT young adults; the norm was to build an individuals self-acceptance outside of the need of a families acceptance. But with the emergence of an LGBT youth population, in part due to access to information, positive representation of LGBT people in the media, changes in public perception and increases in support programs for LGBT youth, excluding the family is no longer an appropriate option.

The Family Acceptance Project works at the systems level and at the community level with families, providers and faith communities to outline what are truly their family values: caring for, and creating supportive environments for their adolescents, regardless of their LGBT status. Identifying, and educating communities about how family rejection leads to negative health and mental health outcomes and how family acceptance helps protect against risk and promotes their LGBT adolescents’ well-being is a core component of the Family Acceptance Project’s prevention and intervention work.

While the Projects work in the Mormon community has been highlighted in the media, the Family Acceptance Project has worked across Christian faiths, and with Muslim and Jewish families with LGBT children and is currently working to develop specific research-based “Best Practice” resources for families from other faith backgrounds. Family acceptance is an integral part of ensuring healthy adolescents grow into healthy adults, and working with their faith is central to this work.

The Family Acceptance Project has produced this press release to spread the word about their Utah-Based program which addresses the risk for suicide and rapidly increasing reports of homelessness among Utah LGBT Youth.

Click “LGBT Suicide Prevention (Part 1 of 2)” to read the prior segment.