LGBT PEOPLE IN MEDICINE: THE IMPORTANCE AND NECESSITY OF INCLUSION E. Cabrina Campbell, M.D. Associate Professor of Psychiatry Perelman School of Medicine University of Pennsylvania NAMME CONFERENCE 02/18/12

EMBODIMENT OF DIVERSITY  African American  Woman  Lesbian  Inter-racial Relationship  Bi-Racial Daughter  Founding Member of LGBTPM Faculty/Staff at Penn Med

LGBTPM Symposiums 2008Sallyann Bowman, M.D. University of Pennsylvania, School of Medicine “Career Narrative” 2009 Katherine A. O’Hanlan, M.D. Gynecologic Oncologic Associates (Formerly at Stanford) “ LGBT Health: The Medical is Political 2010Robin Williams, M.D. (then Penn Med Student) “My Right Self”

Importance: Human Rights in America Personal Autonomy Personal Autonomy Marriage Marriage Non-discrimination Non-discrimination Housing Housing Education Education Employment Employment Military service Military service

Necessary Inclusion: LGBT RIGHTS ARE HUMAN RIGHTS INTEGRATION INTO THE MILITARY Blacks 1948 Women1948 Today, the President signed into law a bill which lifts the current ban on homosexuals serving openly in the U.S. Military. During a signing ceremony at the Interior Department in Washington, D.C., President Obama said he is proud to sign the bill, which he says will strengthen national security. President Obama has been dedicated to lifting the ban on homosexuals serving openly in the military, since the beginning of his presidential campaign. Dec 22, 2010

DOMA Impact on LGBT Families DOMA Impact on LGBT Families Couple receives SSI in the amount of single person only. Couple receives SSI in the amount of single person only. Cannot file a joint tax return Cannot file a joint tax return Cannot have partner immigrate for citizenship Cannot have partner immigrate for citizenship Cannot receive SSI support when partner dies Cannot receive SSI support when partner dies Children cannot receive SSI if earner dies or becomes disabled Children cannot receive SSI if earner dies or becomes disabled Cannot bring body home from most states Cannot bring body home from most states Estate taxed at 55% before domestic partner inherits it Estate taxed at 55% before domestic partner inherits it

Marriage Benefits Health Marriage confers stability on the home, gives children security in their identity. Marriage confers stability on the home, gives children security in their identity. Marriage is correlated with reduced rates of cardiac disease and cancer Marriage is correlated with reduced rates of cardiac disease and cancer Marriage is correlated with with greater longevity. Marriage is correlated with with greater longevity. Gardner J, J Health Econ. Nov 2004;23(6) Janicki DL,. Psychosom Med. Nov-Dec 2005;67(6) King M. J Epidemiol Community Health. Mar 2006;60(3) King M. J Epidemiol Community Health. Mar 2006;60(3)

What do we want for our family? Safety from violence Quality education Job security Serve our country (military) Marry loved one Financial security for family (health insurance, social security, pension) Age through a healthy, contented life Equal treatment under the law

Importance: Experienced Discrimination Kaiser Foundation Survey revealed that LGBT 74% Have experienced verbal abuse. 74% Have experienced verbal abuse. 74% Have experienced discrimination in job, housing, healthcare, military. 74% Have experienced discrimination in job, housing, healthcare, military. 32% Have experienced physical violence. 32% Have experienced physical violence. 39% Are worried about being assaulted or beaten. 39% Are worried about being assaulted or beaten. Kaiser Family Foundation Report, Nov KFF.org

Discrimination leads to Reduced Quality of Life and Psychiatric morbidity. N=2,917 adults: N=2,917 adults: 42% of LGBT reported anti-homosexual discrimination with twice the rate of anxiety(panic), depression, substance abuse. 42% of LGBT reported anti-homosexual discrimination with twice the rate of anxiety(panic), depression, substance abuse. 58% reporting no discrimination did not have these psychiatric problems (normal profile) 58% reporting no discrimination did not have these psychiatric problems (normal profile) Mays & Cochran, Am J Public Health

Discrimination Experiences of oppression lead to social alienation, low self esteem, and increased risk of STD’s, drug abuse Experiences of oppression lead to social alienation, low self esteem, and increased risk of STD’s, drug abuse N=912 Gay men N=912 Gay men 17% had suicidal ideation 17% had suicidal ideation 44% reported anxiety 44% reported anxiety 80% had depressed mood 80% had depressed mood In every analysis, the only predictor of mental illness was experience of social discrimination In every analysis, the only predictor of mental illness was experience of social discrimination Diaz RM, et al Am J Public Health. 2001

Impact of Stigma on Development Stigmatized youth report no models for successful aging, relationships, and parenting Restricted perceptions of career options Limited in self-care, help-seeking & health promotion behaviors Ryan & Futterman, 1998

Risk factors for Suicide Among Gay Lesbian youth < 20 years old Discovering early in adolescence. Discovering early in adolescence. Rejection by family members. Rejection by family members. Rejection by faith organization. Rejection by faith organization. Experiencing violence due to orientation. Experiencing violence due to orientation. Having multiple socially marginalized statuses, e.g. race, ethnicity, and sexual orientation, depression Bagley & Tremblay, Crisis 2000;21(3): Having multiple socially marginalized statuses, e.g. race, ethnicity, and sexual orientation, depression Bagley & Tremblay, Crisis 2000;21(3):111-7.

Reparative therapy is contraindicated Reparative therapy aimed at changing an individual's sexual orientation, has been found to be: Reparative therapy aimed at changing an individual's sexual orientation, has been found to be: Ineffectiveno therapy works Ineffectiveno therapy works Unethicalto treat a normal sexual variant Unethicalto treat a normal sexual variant Harmfulstigmatizes the individual Harmfulstigmatizes the individual Need acceptance by society Need acceptance by society American Academy of Pediatrics: Pediatrics, 1993 American Psychological Association, 1995 American Medical Association, 1995

Diversity in the 2010 Penn Med Entering Class

Current State LGBT Education 85% Response from medical school deans Median total time 5 hours often preclinical yrs Wide variation of 0-32 hours Only 24.2% rated their coverage “good” or “very good” on a 5- category Likert scale Obedin-Maliver et al. LGBT Content in Undergrad Med. Edu. JAMA, September 7, 2011—Vol 306, No. 9.

Be Part of the Solution Include sexual orientation in non-discrimination policy: Diversity is a defining feature of an eminent medical school. The Perelman School of Medicine at the University of Pennsylvania embraces diversity and inclusion as core values. We are committed to the recruitment, retention, promotion and advancement of faculty reflecting a multitude of ethnicities, races, genders, gender identities, sexual orientations, historical traditions, ages, religions, disabilities, veteran status, and socioeconomic backgrounds. We are dedicated to enriching both depth and breadth of backgrounds, experiences, perspectives, and ideas represented in our institution to strengthen the quality of the education, produce innovative research and deliver the healthcare to increasingly diverse local and global communities. By fostering a vibrant and dynamic environment of inclusion, the Perelman School of Medicine will continue to welcome opportunities to address challenges and excel in academic medicine.

Equal Human Rights is Essential for Excellent Healthcare Find your strength in love