Bringing LGBT Health Care to the World Health Organization

Around the world lesbian, gay, bisexual, and transgender (LGBT) individuals face worse health outcomes than the general population. We know the problem is in part due to the barriers they face to accessing health care. But because there is relatively little health research on this population globally, the true scope of the global burden is difficult to calculate.

These barriers range from denial of care, to inadequate or substandard care, to simply an unwillingness to go to a doctor because of discrimination or, in some countries, criminal penalties. Data confirms that within the community there are higher rates of depression and substance abuse; lesbian and bisexual women are at a greater risk of obesity and breast cancer; gay men are at higher risk of HIV and other sexually transmitted infections; elderly LGBT individuals face additional barriers to health because of isolation; and transgender individuals have higher rates of alcohol and tobacco use, are at higher risk for heart disease and are less likely to have health insurance than heterosexual or LGB individuals.

The World Health Organization (WHO) -- the health body of the United Nations -- has led efforts to reduce health disparities for women, ethnic, racial and religious minorities, those with disabilities, and others who have struggled to attain the health care they need. We think it is timely for WHO to take this same leadership role for the LGBT population. During the May 2013 WHO Executive Board meeting, the topic of what WHO should be doing on this front was scheduled to be discussed.

When the U.S., Thailand and Brazil petitioned to have an LGBT health item added to the Board meeting's agenda, we realized it would lead to a robust debate. Unfortunately, history was made in another way when a number of African and Middle Eastern countries, called for the item's deletion from the agenda. Never before in the history of WHO has one Executive Board member asked that an item, legitimately placed on the agenda by other member states, be removed.

Six hours of debate on whether this was a topic that should even be addressed by WHO ensued. Some delegates claimed that all populations in their countries have equal and guaranteed access, not acknowledging health disparities, and argued that any explicit discussion of LGBT health issues would be divisive and damaging to public health. These states also argued that any discussion of LGBT health is a political issue which belongs in the Human Rights Council instead of WHO. The most outspoken and contentious statements from these opposing delegations included vehement denial that there was any discrimination and stating sexual orientation was a choice and therefore outside the health arena.

Equally passionate supporters from the European and Americas regions spoke to how ensuring health access for all is a core part of WHO's work, and that this must include all vulnerable populations. In the statement I made on behalf of the U.S. government, I reminded my colleagues that while sensitive, this is clearly a global public health issue, and a significant public health burden that needs to be discussed.

Ultimately a compromise was reached. The item was removed from the day's agenda, and over the coming months the head of WHO, Dr. Margaret Chan, will talk with concerned governments to find common ground to identify WHO's role. If wording can be agreed, the item will presumably be added to the agenda of the January 2014 Executive Board meeting.

This is not the outcome we wanted at this time. Nonetheless, we also recognize that breaking new ground at the UN or any multi-state organization is difficult, and that topics regarding sexuality create additional hurdles to surmount. I am reminded that history has taught us that in the face of fierce opposition, even having a discussion is a step forward. My office and the Obama Administration are committed to ensuring all people, including those from the LGBT community, have full and equal access to the healthcare they need so they can live long, healthy lives. We believe that despite our religious or cultural differences, this is a goal all countries can and should support, and welcome Dr. Chan's leadership in finding a path forward. As President Obama recently reminded us, "regular access to a doctor or medicine or preventive care - [is] not some earned privilege, it is a right." And it is a right that all people, no matter where they live or who they love, should exercise. While we know we will not be able to prevent every individual act of discrimination, the U.S. will continue our robust global engagement to ensure that the health needs of LGBT persons do not remain locked in the closet.