Institute of Medicine: Recommended LGBT Objectives for Healthy People 2020

The Healthy People 2020 initiative explicitly includes lesbian, gay, bisexual, and transgender individuals as a disparities population to prioritize for health improvements. In March 2011, the Institute of Medicine (IOM) issued a report commissioned by the Department of Health and Human Services making recommendations regarding which Healthy People 2020 objectives to prioritize.

The report recommends 24 objectives to prioritize (the numbers are the numbering used for the Healthy People 2020 objectives):

• Adolescent Health 5: Increase educational achievement of adolescents and young adults.
• Access to Health Services 1: Increase the proportion of persons with health insurance.
• Access to Health Services 3: Increase proportion of persons with a usual primary care provider.
• Access to Health Services 7: (Developmental) Increase the proportion of persons who receive appropriate evidence-based clinical preventive services.
• Cancer 1: Reduce the overall cancer death rate.
• Environmental Health 1: Reduce the number of days the Air Quality Index (AQI) exceeds 100.
• Early and Middle Childhood 1: (Developmental) Increase the proportion of children who are ready for school in all five domains of healthy development: physical development, social- emotional development, approaches to learning, language, and cognitive development.
• Family Planning 8: Reduce pregnancy rates among adolescent females.
• Healthcare-Associated Infections 1: Reduce central line-associated bloodstream infections (CLABSI).
• Health Communication and Health Information Technology 1: (Developmental) Improve the health literacy of the population.
• Heart Disease and Stroke 2: Reduce coronary heart disease deaths.
• Heart Disease and Stroke 5: Reduce the proportion of persons in the population with hypertension.
• HIV 17: Increase the proportion of sexually active persons who use condoms.
• Injury and Violence Prevention 1: Reduce fatal and nonfatal injuries.
• Mental Health and Mental Disorders 4: Reduce the proportion of persons who experience major depressive episodes (MDE).
• Maternal, Infant, and Child Health 8: Reduce low birth weight (LBW) and very low birth weight (VLBW).
• Nutrition and Weight Status 10: Reduce the proportion of children and adolescents who are considered obese.
• Nutrition and Weight Status 17: Reduce consumption of calories from solid fats and added sugars in the population aged 2 years and older.
• Physical Activity 2: Increase the proportion of adults who meet current Federal physical activity guidelines for aerobic physical activity and for muscle-strengthening activity.
• Substance Abuse 14: Reduce the proportion of persons engaging in binge drinking of alcoholic beverages.
• Substance Abuse 13: Reduce past-month use of illicit substances.
• Sleep Health 4: Increase the proportion of adults who get sufficient sleep.
• Tobacco Use 1: Reduce tobacco use by adults.
• Tobacco Use 3: Reduce the initiation of tobacco use among children, adolescents, and young adults.

However, the IOM committee “was disappointed” that it could not include in its priorities three Healthy People 2020 topic areas  – social determinants of health; health-related quality of life and well-being; and lesbian, gay, bisexual, and transgender health -because no objectives have been developed for these topic areas.  The IOM committee decided to recommend objectives for these topic areas, consistent with its prioritization of objectives.  For the lesbian, gay, bisexual, and transgender health topic area, the IOM committee suggests that some objectives from the prioritized 24 could be modified to address the LGBT topic area.   Accordingly, the IOM report recommends the specification and prioritization of the following sub-objectives (denoted by the “LGBT” after the Healthy People 2020 objective) to reduce lesbian, gay, bisexual, and transgender disparities:

• Adolescent Health 5LGBT: Increase the educational achievement of lesbians, gay men, and bisexual and transgender adolescents and young adults.
• Access to Health Services 1LGBT: Increase the proportion of lesbians, gay men, and bisexual and transgender persons with health insurance.
• Access to Health Services 5LGBT: Increase the proportion of lesbians and transgender persons with a usual primary care provider.
• HIV 17LGBT: Increase the proportion of condom use among gay or bisexual males aged 15 and above who are sexually active with other men or women.
• Mental Health and Mental Disorders 4LGBT.1: Reduce the proportion of gay, bisexual or questioning males and females aged 12 to 17 years who experience major depressive episodes (MDEs).
• Mental Health and Mental Disorders 4LGBT.2: Reduce the proportion of lesbian, gay men, bisexual, and transgender persons aged 18 years and older who experience major depressive episodes (MDEs).
• Nutrition and Weight Status 10LGBT: Reduce the proportion of lesbian and bisexual female adolescents who are considered obese.
• Substance Abuse 13LGBT: Reduce the proportion of lesbians’’, gay males’’, bisexuals’’, and transgender persons’’ past-month use of illicit drugs.
• Substance Abuse 14LGBT: Reduce the proportion of lesbian, gay males, and bisexual persons engaging in binge drinking of alcoholic beverages.
• Tobacco Use 1LGBT: Reduce tobacco use by lesbian, gay men, and transgender adults.