BILL ANALYSIS Ó
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 673
A
AUTHOR: John A. Pérez and Lara
B
AMENDED: June 1, 2011
HEARING DATE: June 8, 2011
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CONSULTANT:
7
Orr
3
SUBJECT
Office of Multicultural Health: LGBT communities
SUMMARY
Adds consideration of lesbian, gay, bisexual, and
transgender (LGBT) communities to the duties of the Office
of Multicultural Health (OMH).
CHANGES TO EXISTING LAW
Existing law:
Establishes OMH within the California Department of Public
Health (CDPH) to perform various duties on behalf of CDPH
and the Department of Health Care Services (DHCS),
including:
Developing plans to address gaps in health status
and access to care among the state's diverse racial
and ethnic communities;
Conducting state-funded projects to improve
effectiveness of services to ethnic and racial
communities,
Disseminating information and serving as a liaison
within state departments and to health care providers
regarding racial and ethnic communities, and
consulting regularly with representatives from these
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communities; and
Ensuring that programs keep data and information
regarding ethnic and racial health statistics.
This bill:
Adds lesbian, gay, bisexual and transgender (LGBT)
communities to the entities included within OMH's
responsibilities. Requires OMH to also ensure that
programs keep data and information regarding gender
identity and gender expression.
FISCAL IMPACT
The Assembly Appropriations Committee analysis estimates
annual ongoing General Fund costs to CDPH of $100,000 for
an additional position in OMH to perform duties related to
the LGBT community.
BACKGROUND AND DISCUSSION
The author has introduced AB 673 as a way to address the
health needs of the LGBT community by integrating health
issues affecting the LGBT communities into OMH's mission.
Integrating LGBT issues into OMH will provide OMH with the
additional authority to seek funding for health initiatives
that target the LGBT community. Expanding the mission of
OMH to include issues that affect LGBT Californians will
help the state develop and implement more inclusive public
health policies that benefit all of California's diverse
populations.
Office of Multicultural Health
OMH was created in August 1993 through Executive Order
W-58-93 by Governor Pete Wilson, and in 1999 was
established in statute by AB 1107 (Cedillo), Chapter 146,
Statutes of 1999. OMH is a shared office within the Office
of the Director CDPH and the Office of the Director of
DHCS. OMH serves as a focal point in both departments for
improved planning and coordination of activities and
programs related to racial and ethnic populations in
California, and as a liaison between both departments and
outside stakeholders. OMH's programmatic costs are shared
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equally by DHCS and CDPH.
OMH is currently responsible for the following:
Performing strategic planning within state
departments to develop department-wide plans for
implementation of goals and objectives to close the
gaps in health status and access to care among the
state's diverse racial and ethnic communities;
Coordinating state-funded pilot projects and
planning projects related to improving the
effectiveness of services to ethnic and racial
communities;
Communicating and disseminating information and
performing a liaison function within the departments
and to providers of health, social, educational, and
support services to racial and ethnic communities;
Consulting regularly with representatives from
diverse racial and ethnic communities, including
health providers, advocates, and consumers;
Performing internal staff training, internal
assessments of cultural competency, and training of
health care professionals to ensure more
linguistically and culturally competent care;
Serving as a resource for ensuring that programs
keep data and information regarding ethnic and racial
health issues and measures, strategies and programs
that address multicultural health issues, as well as
issues that impact the health of racial and ethnic
communities;
Providing technical assistance to counties, other
public entities, and private entities seeking to
obtain funds for initiatives in multicultural health,
including identification of funding sources and
assistance with writing grants;
Reporting to the Legislature biennially on the
status of OMH's activities.
The OMH has a 21-member Council on Multicultural Health
(Council) which advises the Departments and Directors on
multicultural health issues. The Council is composed of
members from California's multiethnic communities, with
diverse professional backgrounds. The Council assists both
CDPH and DHCS in developing culturally competent policies
and programs and serves as a conduit for the exchange of
information with California's diverse racial and ethnic
communities.
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Health disparities and LGBT communities
The Center for American Progress (CAP) cites three major
factors contributing to significant negative health
outcomes for LGBT people: reduced access to employer
provided health insurance, the social stigma that exists
against LGBT people, and a lack of cultural competency in
the health care system. According to the Center for
Lesbian, Gay, Bisexual and Transgender Health (Center) at
the Columbia University's School of Public Health, barriers
to care for LGBT people include systemic bias in health
insurance and public entitlements, which routinely fail to
cover gay and lesbian partners or to provide reimbursement
for procedures of particular relevance to LGBT populations
(e.g., fertility services to lesbians and surgical
procedures required by transsexuals).
Social conditions also impact the health of LGBT
populations in a variety of ways. The Center claims that
areas affected can be conceptualized as ranging from the
direct impact of stigmatization and prejudice (e.g.,
exposure to violence, stress and poor access to care) to
failure to adequately address the special needs of LGBT
populations (such as gay-specific sexually transmitted
diseases, fertility challenges and genital reassignment
surgeries).
According to the Center, LGBT people may also have more
difficulty accessing quality health care and related
services in the health care system. A significant barrier
to LGBT people accessing needed health care is the lack of
LGBT-competency among providers and discrimination toward
people of other sexual orientations or gender identities in
the health care system. These and other barriers may lead
to delays in seeking care or an avoidance of preventive and
treatment services. Homophobia and heterosexism play a role
in the inadequate assessment, treatment, and prevention of
LGBT health problems, as well. The Center asserts that
because of negative attitudes among physicians and other
medical staff, LGBT individuals are subject to
discrimination and bias in medical encounters, and are
likely to receive substandard care, or remain silent about
important health issues they fear may lead to
stigmatization.
According to the Institute of Medicine 2011 Report, "The
Health of Lesbian, Gay, Bisexual and Transgender People:
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Building a Foundation for Better Understanding" LGBT
individuals experience unique health disparities. Although
the LGBT acronym is used as an umbrella term, and the
health needs of this community are often grouped together,
each of these letters represents a distinct population with
its own health concerns. For example, all individuals
should receive recommended early childhood immunizations,
but young adult and adult LGBT individuals, due to an
identified higher risk, should also be routinely immunized
for hepatitis A, hepatitis B, and influenza. CAP cites
statistics showing that transgender women have higher rates
of HIV diagnosis (six percent) than all other risk
categories, including men who have sex with men (four
percent) and partners of people living with HIV (five
percent).
According to the "Healthy People 2010 Companion Document
for Lesbian, Gay, Bisexual, and Transgender (LGBT) Health"
coordinated by the Gay and Lesbian Medical Association and
LGBT health experts, LGBT populations have long been among
those populations for whom little or no national-level
health data exist. Some state-level data from the federal
Centers for Disease Control and Prevention's (CDC) Youth
Risk Behavioral Surveillance System, a few household-based
studies, many studies using non-random samples, and
anecdotal information have indicated that LGBT populations,
in addition to having the same basic health needs as the
general population, also face health disparities related to
sexual orientation or gender identity. The limited nature
of research about LGBT populations makes it difficult to
document and prioritize their health needs.
The (CDC) believes that because LGBT people are members of
every community, come from all walks of life, include
people of all races and ethnicities, ages, socioeconomic
statuses, and from all parts of the country, the
perspectives and needs of LGBT people should be routinely
considered in public health efforts to improve overall
health of every person and eliminate health disparities.
Related bills
SB 416 (Kehoe) proposes to add questions regarding sexual
orientation, gender identity and gender expression,
domestic partnership status and the gender of a spouse or
partner as "voluntary" demographic information collected by
state entities in statewide surveys. Pending in the
Assembly Rules Committee.
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SB 747 (Kehoe) would require physicians and surgeons,
physician assistants, registered nurses, licensed
vocational nurses, nurse practitioners, psychologists,
marriage and family therapists, licensed clinical social
workers, psychiatric technicians and certified nurse
assistants to complete at least one course of two to five
hours in duration that provides instruction on cultural
competency, sensitivity, and best practices for providing
adequate care to lesbian, gay, bisexual, and transgender
persons, as specified. Pending in the Assembly Business,
Professions and Consumer Protection Committee.
Prior legislation
SB 613 (Solis) of 1999 would have required OMH to publish
an annual report on the state of multicultural health in
California. Also would have required the California Health
and Human Services Agency to establish an interagency task
force on multicultural health, composed of representatives
from specified departments. Vetoed.
AB 1107 (Cedillo), Chapter 146, Statutes of 1999,
established OMH in statute. OMH had been established by
executive order W-58-93 by Governor Pete Wilson in 1993.
Arguments in support
American Academy of Pediatrics (AAP) claims that LGBT youth
are at particular risk for victimization through bullying
and violence, which can result in multiple mental and
physical health concerns. AAP believes AB 673 will put
California in a better position to address LGBT issues by
yielding additional research and information, and use of
that information. Equality California supports the bill
because it will allow OHM to address the gap in health
disparities in the LGBT population. Planned Parenthood
Affiliates of California claim that members of the LGBT
community often have unique health experiences and needs,
but do not always receive the care they deserve. By
including issues of sexual orientation and gender identity
within OHM's scope, the state will be better able to
develop and implement more inclusive public health policy
to serve California's diverse population.
Arguments in opposition
The California Right to Life Committee, Inc. (CRLC)
believes this bill is an attempt to further advance the
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"homosexual movement." According to CRLC, "this bill would
require another government employee to address this special
group adding to the cost and to the bureaucracy." CRLC
claims that assisting public and private entities to write
grants and find funds is "another vehicle to bring this
group into mainstream acceptance." They do not believe
that health problems should be addressed by singling out
one group, and suggests the LGBT group itself take more
responsibility in addressing its health concerns.
PRIOR ACTIONS
Assembly Health: 12- 5
Assembly Appropriations:12- 5
Assembly Floor: 49- 24
COMMENTS
1. Council on Multicultural Health. OMH receives advice
from the Council on Multicultural Health on issues such as
improving access to quality health care and eliminating
health disparities. The author may wish to consider an
amendment to include LGBT representatives on the Council.
POSITIONS
Support: American Academy of Pediatrics, California
American Federation of State, County and
Municipal Employees
California Immigrant Policy Center
Equality California
Los Angeles Gay and Lesbian Center
National Association of Social Workers,
California Chapter
Planned Parenthood Affiliates of California
Oppose:California Right to Life Committee, Inc.
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