A Milestone in Lesbian Health Advocacy: The Institute of Medicine Report
For more than 20 years, lesbian health advocates have focused their attention on the need for quality health care services for lesbians as well as for research on lesbian health.
Their efforts helped lead to the establishment of gay, lesbian, bisexual and transgender community health centers and offices of gay and lesbian health in public health departments in large metropolitan areas. Lesbian health advocacy efforts also led the U.S. Department of Health and Human Services to sponsor the first Lesbian Health Roundtable in 1994.
As a result of the roundtable, the National Institutes of Health expanded research on lesbian and bisexual women's health by providing increased funding to researchers who would include lesbians in their studies. Further advocacy efforts led two of the country's largest women's health studies — the NIH Women's Health Initiative and the Harvard Nurses' Study — to include questions on sexual behavior and orientation. While this inclusion was significant, many more questions remain about how to conduct research on lesbian health and whether lesbians were at higher risk for certain illnesses.
To help lay the foundation for future research into these areas, the National Institutes of Health Office of Research on Women's Health and the Centers for Disease Control and Prevention's Office on Women's Health took action in 1997. They provided funding for the Institute of Medicine to establish a committee on "Lesbian Health Research Priorities."
Established in 1970, the Institute of Medicine is a component of the National Academy of Sciences, a private corporation created by an act of Congress in 1863. The institute is widely recognized as a national leader in the analysis of health problems relating to policy issues. Its reports have a great influence on the experts who shape the nation's health policies and on agencies and organizations that conduct research, provide medical services, and educate physicians, medical students and the public.
Before 1997, the Institute of Medicine had never before addressed the issue of lesbian health. A "Lesbian Health Research Priorities" committee was asked to:
• review and assess the current science on lesbian health and suggest possible areas for future research;
• hold an invitational meeting on physical and mental health concerns of lesbians and on the problems involved in conducting research in these areas; and
• report on the current state of research and lesbian health needs, and suggest future research areas.
On Oct. 6-7, 1997, the Institute of Medicine held a "Workshop on Lesbian Health Research Priorities" in Washington, D.C. At the meeting, members of its lesbian health research committee heard from an array of experts on topics ranging from how to define the term "lesbian" in lesbian health research to health issues such as cancer and substance abuse.
In January 1999, the Institute of Medicine released Lesbian Health: Current Assessment and Directions for the Future. The 154-page report defined three specific research priorities:
• increased research on lesbian health and the development of more sophisticated methods of conducting that research;
• increased research on how to define sexual orientation and how to capture the diversity of the lesbian community; and
• increased research on barriers to access to mental and physical health care and ways to increase lesbians' access to these medical services.
The report explains what is known about lesbians' risk for conditions including cancer, mental illness, HIV infection, substance abuse and sexually transmitted diseases. It notes that lesbians are less likely to access the health care system for a variety of reasons, including lack of insurance, insensitivity and homophobia by health care providers, and the growth of managed care systems that may limit lesbians' access to lesbian-friendly providers. It also underscores the stigma still associated with conducting lesbian health research — and the resulting barriers this places on getting the information lesbians need.
The Institute of Medicine committee developed eight specific recommendations for increasing knowledge of lesbian health. These recommendations include:
• increased funding for lesbian health research;
• routine inclusion by researchers conducting studies on women's health of questions on sexual orientation;
• the development of study designs that will capture the diversity of the lesbian population;
• an extensive survey to assess differences in health risks due to sexual orientation; and
• the development of strategies to train researchers to conduct lesbian health research.
Lesbian health advocates have used the report's release and its findings to call for increased funding for and research on lesbian health issues.
Institute of Medicine report — Lesbian Health: Current Assessment and Directions for the Future
