Saturday, October 27, 2012

Queer Ideas of Health at APHA

The American Public Health Association (APHA) is invading San Francisco this week, and I'm going for the first time in over a decade.
I'm very proud to be an epidemiologist. I'm deeply committed to public health.
And, I can't stand how public health thinks about the public's health these days, the trends that the field has taken lately. Especially in regards to gay health, but really it's much broader than that.

So, I'm trying to gird myself for what I know will be a very frustrating experience - seeing a ton of deeply committed people - deeply committed to doing good in the world - and with a few great exceptions, failing at it.

What I need, from you, is the strength to get through this APHA meeting with grace and charm. I need to listen with open ears, do my little bit to shift how people think about queer health, and most importantly, get a job back East!

Queer health on the agenda

There is a very active LGBT caucus within the APHA, with programming booked from cover to cover in the program. One could easily attend only the LGBT caucus events and never really interact with the thousands of other programs happening simultaneously. So the good news is we're there, we're taken seriously, we're in leadership roles (openly). That's great progress from the last time I went, when the LGBT caucus was insignificant, essentially a support group. Great sex, though.
But taking a closer look at the talks and posters, it becomes very clear that there is a very odd view of LGBT health being explored at APHA's meeting. I say 'odd' and not 'queer' because the view of LGBT health that comes screaming through the program book is one that focuses almost exclusively on disease and negative health outcomes, and even more troublingly, rarely interrogates homophobia / heteronormativity / stereosexism (my neologism for the view that there are but two sexes), at least does not interrogate these fundamental causes directly.
Health disparities rule the day. Not just in LGBT health, but most definitely in LGBT health. That, and individual-level analyses that can just as easily be interpreted to mean that we are inherently sick or sinful as they can be interpreted to mean that homophobia is unhealthy.
And if there is something good going on in gay health, like gay men being less likely to be obese, it must be because of some deep-seated pathology, like lousy body image.
I'm not sure where we went awry. How we came to wear these bizarre prism glasses that only allow us to see such a small fragment of LGBT health. A small fragment? Yes, a small fragment. Because what the average person steeped in LGBT health knows is a laundry list of health outcomes that we do worse on: for gay men: HIV, STD's, depression and suicidality, drugs and alcohol misuse, tobacco dependence, violence victimization, etc. For women, being obese, higher breast cancer risk, drugs and alcohol misuse, tobacco dependence, violence victimization, etc. For trans women, HIV, STD's, lack of access to care, violence victimization, drugs and alcohol misuse, etc. and for trans men, lack of access to care, and probably more, but we forgot to ask who was transmasculine and who was transfeminine, so we can't really say.
If I were then to ask OK, so what about the health advantages that LGBT people enjoy? Most probably would have to think a while before coming up with the fact that gay men are less likely to be obese. And a few might toss off the idea that lesbians, at least "out" lesbians, are less likely to experience an unintended pregnancy. How many would claim that gay men are less likely to perpetrate violence? More likely to volunteer, to provide intimate care for someone not related to them? Less likely to get someone unintentionally pregnant? To enjoy a vibrant, exciting, and life-affirming sex life?

But by far the biggest category is health similarities, and I doubt that anyone could name a single one with confidence. I'd have a lot of trouble with that myself despite thinking about it for a few years now.

At any rate, if you've been reading this blog, you've heard all these arguments before. And I need to make myself cheerful and winsome. Wish me luck.


  1. I am so far away from the data so I will ask: what do we know about the health of "bi" folks? Also, I am surprised that there are still few data on transmen and transmasculine folks.

    1. Great questions - I think the reason there's not as much data on transmasculine guys as transfeminine women is that transguys are (mostly) at much lower risk for HIV, and thus have not been in the funding stream. It may also be a reflection of the fact that the general public is more troubled by male-born becoming female than female-born becoming male, thus the former are the "subject" of more social anxiety (and thus more funding) - but that's just a guess.
      As far as the health of bisexuals, I'm not as up on that topic as I should be. Most studies have either lumped bisexuals in with lesbians and gays (and usually all three together), or bisexuals are excluded from the analysis entirely. I'm deeply suspicious of the literature on bisexual health because I suspect that what gets published is the exceptional more than the ordinary. But what IS clear from published data is that bisexual health is not "halfway" between L/G and heterosexual health.
      Among young populations, bisexuals are often reported to have worse health outcomes than lesbian and gay youth. That may well be the case for many of those health outcomes, but it also may be a reflection of the 'toxicity of the closet', because identifying as lesbian or gay may reflect 'coming out' as much as a sexual identity label. Another issue that complicates interpreting the health patterns of bisexual youth is that they are often identified based on the sex of their sexual partners, meaning that one's probability of being identified as "bisexual" increases with the number of sexual partners, if you're basing it on the sex of sexual partners, so bisexual classification is strongly conflated with having more sexual partners, which might well explain what health disparities are observed.
      There's quite a bit less research on bisexual adults, but the thing that's totally absent is what ways bisexuals are healthier than heterosexuals, gays, and/or lesbians??