The Mid-Atlantic Regional Public Health Partnership hosted its debut public health conference: Empowering Communities to Address the Social Determinants of Health. Over the course of the two-day virtual conference that took place in mid-January, students and professionals in public health learned about issues including racism as a public health crisis, LGBTQ+ health, gun violence, vaccination, the opioid epidemic and many more pertinent topics. The Mid-Atlantic Regional Public Health Partnership consists of the Pennsylvania Public Health Association, the Delaware Academy of Medicine/Delaware Public Health Association and the Maryland Public Health Association.
Some of the keynote and welcome panel speakers included Dr. Leana Wen, emergency physician and visiting professor of health policy and management at the George Washington University School of Public Health; Dr. Rachel Levine, secretary of health for the Commonwealth of Pennsylvania and professor of pediatrics and psychiatry at Penn State College of Medicine; Dr. Joshua Sharfstein, vice dean for public health practice and community engagement at Johns Hopkins University; and Dr. Karyl Thomas Rattay, director of the Delaware Division of Public Health.
Echoing one of her colleagues, Dr. Levine centered health equity as crucial to the public health response to the pandemic and as a whole. “What this pandemic has shown us is the iceberg below the water in the health disparities that exist in Pennsylvania and throughout our nation,” she told the audience. “It really highlights the vulnerable populations… African American communities, Latinx communities, in other states the Native American communities, that have suffered from health disparities for many years. We know that minority communities have higher rates of infection, comorbidities, severe disease and tragically, higher rates of death. We have to take that into consideration as we develop all of our programs.”
The speakers on the LGBTQ health panel consisted of Dr. Eric Halpern, who works in the Holloway Community Program at ChristianaCare in Delaware, where he provides primary care to people living with HIV and educates residents and staff about LGBTQ-competent care; Dr. Ethan Mereish, psychologist, researcher and health studies professor at American University, whose research centers on “understanding the effects of social, psychological and cultural determinants of health for LGBT individuals and racial/ethnic minorities;” and Lee Carson, director of the Philadelphia Area Sexual Health Initiative of the Public Health Management Corporation, and adjunct professor at Temple University’s School of Social Work.
Halpern focused partly on a lack of LGBTQ-competent medical care and potential solutions. He referenced surveys that examine LGBTQ patients’ impressions of the healthcare they received.
“The numbers are very high in these patients who do not feel comfortable going to a primary care provider because they either don’t feel like they’re being well recognized or they don’t feel the provider is able to give the right amount of competent care,” Halpern said in his presentation. “A number of them have said they feel like they’re always having to teach their primary care doctor, and if [that’s the case], they don’t always feel like they’re getting the right stuff that they need.”
Halpern emphasized that the most important factor in assuring LGBTQ-competent healthcare is ensuring that medical professionals have the tools they need to provide the right kind of care. At the hospital where he works, residents in internal and family medicine have access to lectures where they learn proper HIV and PrEP care, treating anal health, transgender care and hormone replacement therapy. He prioritized “making sure that patients feel safe, making sure that they’re addressed appropriately, making sure they’re welcome.”
Mereish focused primarily on the social determinants of the health of LGBTQ youth and how COVID-19 has affected their overall well-being. He cited the 2019 D.C. Youth Risk Behavior Survey, which surveyed roughly 9,000 high school students and 9,000 middle school students in Washington D.C. The survey found that 60% of LGB middle school students seriously considered suicide in the past year, in contrast to 25% of their heterosexual peers.
“It’s really alarming to think about these statistics,” Mereish said in his presentation. Similarly, the survey found that LGB high school students are roughly twice as likely to consider or attempt suicide than their heterosexual counterparts. Almost half of trans high schoolers in D.C. attempted suicide at least once, compared to 13.5% of their cisgender peers.
In terms of how COVID-19 impacts LGBTQ youth, Mereish cited a study conducted by a researcher at the University of Maryland who reviewed an online chat room geared toward young LGBTQ people. The researcher found that three different types of stressors affected LGBTQ youth: intrapersonal stressors such as not being called by the right pronouns, constant loneliness, and not eating; interpersonal stressors such as being stuck at home with unsupportive parents; and structural stressors such as being disconnected from one’s trans peers, for example.
Lee Carson focused on four topics in his presentation: the national Ending the HIV Epidemic initiative (EHE), LGBTQ access to appropriate healthcare, the effect of COVID-19 in LGBTQ communities and the need to give emotional health equal weight in overall healthcare.
He began with a few statistics indicating, as PGN has frequently reported on, that a disproportionately high number of Black men who have sex with men (MSM) in Philadelphia are living with HIV compared to white and hispanic MSM.
Ultimately, Carson told the virtual audience that he thinks that the EHE should focus more on the behavioral components of HIV risk, such as addressing depression and trauma. “Addressing these can help increase the impact of primary and secondary prevention efforts and help increase life satisfaction and quality of life beyond HIV prevention,” he wrote on one of his presentation slides. He told the audience that trauma-informed and cognitive approaches should permeate all aspects of HIV care, including testing and prevention.
Like Halpern, Carson discussed the obstacles that queer folks face accessing patient-centered care. He cited stats from the Pennsylvania Statewide LGBTQ Needs Assessment, which indicates that 27% of the 6,582 respondents identify as trans, nonbinary or genderqueer. “This just shows that a quarter of respondents either do not have health insurance or have it through Medicaid or Medicare,” Carson explained. “In 2016, Pennsylvania approved certain transitional medical procedures that are eligible for coverage under Medicaid and CHIP.”
As for the relationship between COVID-19 and LGBTQ health concerns, Carson reinforced that pre-existing health conditions such as heart disease and HIV put members of the community at higher risk. Social factors like working low-wage and direct service jobs, as well as relying on survival sex work, are also the culprits of increased risk for LGBTQ folks. Queer people of color are at the highest risk.
Finally, Carson conveyed that emphasis on the emotional components of healthcare should equal that of physical health, especially amid the pandemic, rampant racism, social uprisings and political upheaval.
“Many will sit in emotional pain for days, weeks, months, years and not do anything about it,” Carson said. “If we are in [physical] pain a day, a week, we’re going to the doctor to find out what’s wrong, and we have to shift away from that.”