We appreciate NIH’s recognition of and response to our study. We also applaud the diversified efforts NIH has employed to gain a thorough understanding about the current state of lesbian, gay, bisexual, transgender, and intersex (LGBTI) health and health research.
Examining the agency’s actions through the three-phase cyclical framework provided by the National Public Health Performance Standards,1 it is clear NIH is on its way to accomplishing the initial two phases. The first phase includes systematic assessments of the current health of LGBTI populations, and the second includes developing policies and plans and working with key stakeholders and informants. The activities described in NIH’s response to our study, along with the funding of the 2011 Institute of Medicine report,2 can neatly be categorized into one of the aforementioned phases. We hope NIH will share the results of these efforts.
Moreover, we are eager to learn how these preliminary efforts inform the next phase of the framework—assuring policies, programs, and practices are bringing health equity to LGBTI populations. This third phase of the cycle should include:
Assurance of competent research and health workforces (e.g., investment in training researchers and practitioners),
Enforcement of policies that protect and serve LGBTI populations (e.g., inclusion of LGBTI populations in NIH’s definition of underserved and priority populations),
Stimulation of prevention and treatment research and programs (e.g., program announcements for research and interventions targeting LGBTI populations), and
Evaluation of NIH’s efforts (e.g., regular, publically available progress reports and updates).
For many of these, the Discussion section of our article provides detailed examples. Furthermore, we expect to see each item incorporated in NIH’s forthcoming Strategic Plan, and urge NIH to create a comprehensive set of specific, measurable, attainable, relevant, and time-bound (SMART) goals aimed at LGBTI health equity.
As public health researchers and practitioners invested in achieving LGBTI health equity, we are optimistic that NIH can—and will—foster and sustain an explicitly welcoming and affirming environment for investigations targeting LGBTI health equity. If NIH is successful in attaining the National Public Health Performance Standards for LGBTI health issues, their process can serve as a model for domestic and global public health agencies and funders to follow and engage in health equity for LGBTI populations.
Acknowledgments
The authors gratefully acknowledge all the researchers, practitioners, and funders who continue to work tirelessly to assess and improve the health and wellbeing of LGBT populations.
References
- 1. Centers for Disease Control and Prevention, Office for State, Tribal, Local and Territorial Support. National Public Health Performance Standards (NPHPS): The public health system and the 10 essential public health services. 2013; Available at: http://www.cdc.gov/nphpsp/essentialservices.html. Accessed March 7, 2014.
- 2.Institute of Medicine (IOM) The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: National Academies Press; 2011. [PubMed] [Google Scholar]