Inclusive, Affirming, Accessible: How to Support LGBTQ+ Health Needs with GLMA and OutCare Health

On the Pride edition of the ChilCast, we feature two very special guests in an exciting and sobering look at the ways in which LGBTQ+ people interact with (and are often failed by) the American healthcare system and the technology within it.

How can healthcare tech enable this marginalized population to receive better care and better outcomes? Where is the intersection of technology, access to care, and health equity? We dive into all this and more on this special edition episode.

Chilmark Research is proud to feature our two distinguished guests, both of whom bring robust backgrounds in LGBTQ+ healthcare and advocacy to the discussion:

Dr. Dustin Nowaskie is a queer, nonbinary psychiatrist who is making waves in the world of LGBTQ+ healthcare. With a deep personal identification and a strong civic commitment, they have dedicated their career to improving the lives of LGBTQ+ individuals.

Alex Sheldon is a professional researcher, strategist, and advocate with over 15 years of experience in the field of human rights with a concentration in LGBTQ+ rights. Prior to joining GLMA, Alex was the Head of Research & Social Impact at an LGBTQ+ start-up company, where they specialized in economic inclusion for LGBTQ+ people.  Alex currently serves on the Board of Directors at the Equality Federation.

Resources from this episode:

OutCare Health:

OutCare Health (outcarehealth.org) is a leading nonprofit organization dedicated to promoting health equity for LGBTQ+ communities worldwide. OutCare's mission is to empower LGBTQ+ people with comprehensive information, resources, support, and education, including an affirming healthcare provider directory, mentorship, education, training, research, community building, support groups, webinar series, blogs, and much more. OutCare's vision is to create a world where every LGBTQ+ person has access to quality healthcare and feels empowered to live their healthiest, most authentic life.

OutCare’s OutList is the largest international directory of LGBTQ+ affirming providers. People looking for providers can access the directory at outcarehealth.org/outlist. Providers can join the directory at outcarehealth.org/add-provider-listing.

OutCare empowers patients and community members with affirming healthcare, resources, and support. Learn more at outcarehealth.org/patient-resources.

OutCare empowers providers with affirming education, training, and many more resources. Learn more at outcarehealth.org/provider-solutions.

GLMA:

GLMA is a national organization committed to ensuring health equity for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities and equality for LGBTQ+ health professionals in their work and learning environments.  To achieve this mission, GLMA utilizes the scientific expertise of its diverse multidisciplinary membership to inform and drive advocacy, education, and research.

GLMA's website: https://www.glma.org/
GLMA's press release about the lawsuit in TX to defend gender-affirming care: https://glma.org/news_manager.php?page=27415
Info on GLMA's Annual Conference on LGBTQ+ Health:
(ChilCast listeners receive a 30% discount with code 2023chilmark30)
https://www.glma.org/conference.php
Info on how to become a GLMA member: https://www.memberleap.com/members/newmem/new-mem-reg.php?org_id=GLMA

Transcript

John Moore III: [00:00:15] Welcome back to ChilCast: Healthcare Tech Talks. Today we are going to be picking up a conversation that I started last month during Pride Month of 2023. Due to the unforeseen loss of my father, we had to push out the recording of this episode. But as all of us on this call agreed, pride should always be something that we talk about; LGBTQ+ rights and how that affects healthcare is something that should always be on our minds. So we were happy to be doing this a little bit late and look forward to sharing it with the full community. Today I am joined by Alex Sheldon, who is the executive director of GLMA, which was formerly known as the Gay and Lesbian Medical Association. And we are also joined today by Dr. Dustin Nowaskie, who is the founder and president of OutCare Health and a practicing psychiatrist in LA. So the purpose of today's conversation will be to discuss how health equity and other matters around how people access care and have a relationship with the American medical system has affected the LGBTQ+ community. Both these people that we have on our panel today are on our discussion are very well versed in that and have taken a good chunk of their career to try to make the medical system more friendly and welcoming to some of these marginalized communities. So, Alex, do you want to start by just providing a quick introduction of yourself and what you do with GLMA?

Alex Sheldon: [00:01:41] Hi all. Thank you so much for having me today. My name is Alex Sheldon. I use they/them pronouns and I'm the executive director at GLMA, the oldest and largest association of LGBTQ+ and allied health professionals in the country. We are proud to represent thousands of health professionals across the country who are dedicated to advancing Lgbtq+ health equity through systemic change. So I actually came to glamor with a background in research policy and strategy, having worked in the Lgbtq+ rights movement for many years in international public health and at the intersection of those two areas as well. And as a non-binary person myself, I have firsthand experience dealing with the health care system that was simply not designed for me. And being barred from services that I know are crucial to my health and well-being, including gender affirming care. Never before have I seen such a coordinated attack on our rights to health care. So I'm particularly excited to talk to you all today, because now more than ever, we need everyone who touches the health care system to be on high alert and to step up and stand with us while we fight for our right to health. We're literally fighting for our lives right now. And that's also why I'm so honored to lead GLMA at a time when access to gender affirming care is under attack. GLMA works to advance Lgbtq+ health equity through three core areas of work, education, advocacy and research.

Alex Sheldon: [00:03:10] Starting with research, we understand that Lgbtq+ health research is crucial for improving the health and well-being of our community and for promoting a more equitable and inclusive health care system for all. That's why years ago we launched the Lesbian Health Fund, the only research fund dedicated solely to advancing the understanding of the unique health needs of Lgbtq+ women and girls. And since its inception in 1992, has funded 126 research projects and awarded over $1.2 million in grants. And these grants are typically crucial catalysts for larger multi-million dollar studies funded by federal agencies. And in addition to supporting LGBTQ health research through life, we often utilize groundbreaking research findings to design educational opportunities to improve clinical practice, inform our policy decisions, and generally ensure equitable and inclusive care and general awareness of specific health issues affecting the Lgbtq+ community. Now an advocacy is a vital resource for policy makers and coalition partners throughout the country working to promote Lgbtq+ health equity.  GLMA builds power by harnessing the expertise of our vast membership to promote supportive evidence for innovative Lgbtq+ inclusive policy and challenging mis and disinformation that underpins discriminatory policy. Since 1981, when we were founded, GLMA has advanced LGBTQ causes in all areas of policy, from local to federal initiatives. Early on, we really focused on HIV and Aids and the issues faced by physicians coming out at work. But as the climate and culture have changed, we have become a leader in myriad areas of health, health policy, advocacy related to Lgbtq+ communities.

Alex Sheldon: [00:04:52] And I'm proud to say that today we remain a trusted expert in LGBTQ health equity, and we continue to drive change at all levels, focusing on our twofold agenda, both ensuring health equity and access to affirming care for LGBTQ folks and also equality for LGBTQ plus health professionals in their work and learning environments. And I'm also very excited to share that. We just announced yesterday that we have filed suit in Texas. We are a plaintiff in the case to block SB 14 Texas's ban on gender affirming care, and in doing so, we get to represent our our members in the state who have provided that care for years. And we get to step up and challenge that decision, that that legislative decision in the courts where it's needed most right now, and very proud that we get to advocate on that level. And lastly, an education. And I know we'll chat a little bit about education a little bit later, but we are very passionate about educating current and future health professionals. On the latest in Lgbtq+ health, which is key to Glamour's mission of ensuring health equity for all Lgbtq+ people and also equality in health, professional work and learning environments. We're an accredited provider of continuing education and continuing medical education, and we work to provide high quality practice changing education applicable to diverse audiences and health professions. And through programs like our Amplify Fund, we actively seek to uplift the voices of historically excluded communities such as bipoc, gender diverse and two-spirit folks, intersex people, refugees and new migrants and indigiqueer people.

Alex Sheldon: [00:06:26] Our goal is to center the most marginalized in our health professional educational content, knowing that by centering those folks, we will end up with a more inclusive health care system for all. And we also work to educate and empower LGBTQ patients so that they can educate, so that they can be educated and advocate for themselves. But the cornerstone of our education work is definitely in our annual conference on Lgbtq+ health. And since the inception in 1981, Glamour's annual conference on Lgbtq+ Health has served as a premier scientific conference for Lgbtq+ and allied health professionals, where we can all come together and share innovative health care breakthroughs and interventions, as well as the latest research on Lgbtq+ health. The conference is open to health care providers of all disciplines researchers, academics, administrators, policy experts, advocates, and literally anyone who thinks that LGBTQ health equity should be a priority. And we're thrilled to announce this year's conference will be virtual, taking place September 28th through 30th. So if you've never been before, this is definitely the year to join us. You don't even have to leave your home, your couch or anything. You can join us simply from the comfort of your home. Just go to glamor.org.org/conference for more information there.

John Moore III: [00:07:43] Thank you, Alex. And now, Dustin, do you want to provide a little background on who you are and what you do at out care?

Dustin Nowaskie: [00:07:51] Yeah, absolutely. Thanks for having me today, John. So, yeah, I'm Dustin Nowaskie. My pronouns are they/them/theirs. I am a non-binary queer psychiatrist. I've been in health care now for about ten years and have been out as a queer individual for many, many years before that. And I love my job. I love providing clinical care. I primarily devote most of my care to Lgbtq+ patients at this point. And I'm also a founder and president of Out Care Health. I started out care back in 2015. We just celebrated our eighth birthday, which was really exciting for us and monumental. But I started out care for a lot of reasons, both personally and professionally and as a community member and patient myself, I saw a lot of stigma discrimination that played out in health care environments. But I also realized that a lot of lack of awareness was within academia and across communities, and I wanted to do something about it. Whenever I started medical school. So that was many years ago. But as we stand today, Out Care is a leading international nonprofit organization dedicated to promoting health equity for Lgbtq+ communities worldwide. Our mission is to empower Lgbtq+ people with comprehensive information resources, support education, including an affirming health care provider, directory mentorship program training, research, community building support groups, webinar series blogs, and much more. We were doing a lot in a lot of LGBTQ plus spaces, but our ultimate vision is to create a world where every LGBTQ plus person has access to quality health care and feels empowered to live their healthiest, most authentic life.

John Moore III: [00:09:27] That's fantastic. That's that's quite the impressive list of content and activities that you guys run. And you still have time and bandwidth to have a practice of your own. That's pretty impressive. So Dustin actually was introduced to us due to a recent partnership that care made with pear sweet, not pear therapeutics, just to be clear, pear sweet. So Dustin just wanted to talk very briefly about what that partnership looks like and why you chose to work with them.

Dustin Nowaskie: [00:09:53] Yeah, absolutely. So yeah, we've really enjoyed our recent collaboration and partnership with Pear. Sweet Pear Sweet has a customizable, easy to use navigation program that enables anyone, including community health workers, resource coordinators and volunteers, to better assess and address social drivers of health and scalable, cost efficient and person centered ways. And so it was absolutely a very, very close partnership that we were very thankful and privileged to have because historically throughout care we've provided a lot of information and education and directories, but we haven't really formalized that process in the past. And so this partnership was really something that we had been looking for for many, many years. And whenever they approached us, we were very excited to meet them. And so what we're doing is we're utilizing all of their technology and their programing so that we can formalize all of this information and centralize it in a more robust way than what we were previously doing. And so we have launched a LGBTQ plus care navigation program where if people cannot find exactly the information that they're looking for on our website or elsewhere, then they can work with our LGBTQ plus care navigators to get a little bit more in depth information about providers and community resources and you name it. It's been very, very successful since we launched our program and our partnership, and we're very excited to continue it for years to come.

John Moore III: [00:11:15] That's that's really exciting. And I'm really happy to hear that you're doing that. As we all know, social determinants are a huge issue in the health care space and, you know, it's one of the main areas where technology is starting to be leveraged to try to address because it's one of the only ways that we can actually track what people need. You know, as far as a technological solution to this, that's still very much in development and a lot of experiments are rolling out. But we do have the understanding that this is something we need to start tracking and taking some measures to address because it is such a driver of equity problems in space.

Dustin Nowaskie: [00:11:49] Yeah, you're you're very right, John. I mean, just to kind of pivot off that, you know, as a provider myself, I was trained in very traditional Western medicine, right? That a lot of health care is driven by medicine and prescriptions. And then more and more I'm in practice, I realize actually that social drivers of health are absolutely paramount and should always be integrated in care. And more often than not, they're much more impactful than a prescription and a medication. And this is very, very true for LGBTQ plus communities as well.

John Moore III: [00:12:17] Yeah, somebody with ADHD. I can absolutely attest to the fact that medication is not the only and every solution to that condition. And, you know, it's like that with everything pretty much. And I'm excited about the potential for matters because it's something we've been covering at Chilmark for a while from when this first started to become a talking point and there was literally nothing out there to track or, you know, provide resources. And seeing how that's evolved over the last 4 or 5 years has been really exciting to see that we're trying to at least incorporate that into health care. Whether or not it's health care's responsibility to address them is something we need to kind of decide as a society, but at least getting it into the overall practice of care and this longitudinal patient understanding that we try to are trying to develop with all these new tools and technologies. Let's start by talking about the medical landscape for LGBTQ plus individuals and why there's a need for organizations like both of yours. How does the health care experience differ for this community? Um, Alex, do you want to start?

Alex Sheldon: [00:13:15] Yeah, I'm happy to. So Lgbtq+ individuals encounter very distinct hurdles within the medical landscape. We often face bias and discrimination leading to suboptimal health care experiences, and those translate directly to worse health outcomes. Health research consistently reveals significant disparities in Lgbtq+ health, and we've shown higher rates of mental health issues, including depression, anxiety and suicidality. And we've also seen that our community faces disproportionate rates of substance abuse of tobacco use and STIs and even cardiovascular health issues and cancer essentially across all health outcomes. Lgbtq folks are see are showing very stark disparities. And all of these issues are compounded even further when we consider bipoc Lgbtq+ community members, Lgbtq+ people with disabilities and various other identities affected by intersecting oppressions. So organizations like Glamma feel like we're in. We're just essential because we play a crucial role in bridging the gap between healthcare providers and LGBTQ individuals to ensure that they achieve affirming and high quality care that truly centers their needs. We do so by advocating for LGBTQ health equity in policies at all levels. We promote policy changes from local policies and your local health care networks all the way to the federal and federal government agencies. We provide resources and education. We're an accredited education provider for CME and credits or continuing education and continuing medical education for health professionals. And we foster a very supportive environment and network of health professionals committed to addressing unique healthcare needs of the community.

John Moore III: [00:15:07] Fantastic. So real quick, just to clarify, can you just explain what kind of CME credits and credits you guys can offer?

Alex Sheldon: [00:15:16] Yeah, absolutely. So as an accredited provider, we work with our extensive network of Lgbtq+ and allied health professionals to create a very comprehensive idea of LGBTQ health and how to promote health equity in all health spaces and all health disciplines. And we do so through webinars throughout the year. And those are all for continuing education and continuing medical education, because we are able to do this all throughout the year and because we have 41 years of experience hosting this conference and bringing to bear that vast expertise of a multidisciplinary membership, we really push the envelope when it comes to LGBTQ health education. We go much further in looking at intersecting identities and really shaping groundbreaking practice shifting education for these health providers. We have things that are talking about substance use. We have sessions on trans inclusive pelvic exams and how to provide care for those populations. We have essentially we really look at what is going to be shifting practice right now where it is needed most.

John Moore III: [00:16:23] All right. Thanks, Alex. Dustin, do you have anything that you would like to add?

Dustin Nowaskie: [00:16:27] Yeah, absolutely. Thanks, John. And thanks, Alex, for all of all of your words. I absolutely echo everything that you said. I think it's very, very important that when we're thinking about the LGBTQ plus landscape, there's a lot of different lenses and perspectives that we can consider. Stigma and disparities absolutely are something that has been well documented in the research for many, many years. I also like to remind people that you can also think about from the lens of prevalence and influence. So when we think about LGBTQ plus communities, we're talking about a lot of people in the world. Rates have always absolutely been underestimated. And historically it was always quoted that 3 to 5% of the US population was LGBT. But recently through Gallup, we've learned actually that that that prevalence rate is probably much, much higher. It's probably in the range of 7 to 10% of the US and maybe even more of Americans identify as LGBTQ plus. And if you quantify this, we're talking about 30 to 40 million people in the US alone. And if you expand that worldwide, we are talking about millions and millions of people across the world. But also, if you think about it from economic influence and power, we know that LGBT people as consumers, it's a huge industry. We're talking about trillions of dollars annually. But if you segment that out to LGBTQ plus health care, we're talking about hundreds of billions of dollars annually. But despite all of this prevalence and influence, we still see that there are heavy amounts of social, political and health care, stigma and marginalization.

Dustin Nowaskie: [00:17:54] You know, the research consistently shows that well over half and about one fourth or more of LGBTQ plus people and patients experience respectively, social and health care stigma. As a provider myself, I absolutely recognize that the research is definitely under-representing how much stigma and marginalization there is in the world, because essentially almost 100% of every LGBTQ plus patient I've seen has experienced some type of LGBTQ plus marginalization. And because of this perpetual stigma, we know that there is stress on the body which manifests as physical and mental health conditions. As Alex mentioned, there are a lot of mental health conditions as well as physical conditions that are at a much, much higher rate for LGBTQ plus people. And actually the multitude is very high. The research consistently shows that the rate is probably in the range of times 2 to 4 the rate of cisgender heterosexual populations. But as Alex was mentioning, we're only scratching the surface at the intersectionality and diversity within LGBTQ plus communities, and we're barely understanding whenever we're talking about multiple identities, how does that impacts one health and overall well-being? And so we know actually for certain subgroups and subpopulations, for instance, people who identify as bisexual, people who are gender diverse, and especially people who are trans women of color, have a much, much higher rate of physical and mental health conditions. Sometimes the rate is times 8 to 10, the rate of cisgender heterosexual populations.

Dustin Nowaskie: [00:19:25] And we actually collect our own data throughout care health because it's very meaningful for us when we're thinking about how can we better improve LGBTQ plus health care, we actually need to understand the data and what is currently going on. We are very, very good partners with Healthgrades and we launched a study last year during Pride Month, a very monumental study looking at LGBTQ plus health experiences. And what we found was quite alarming actually. We found that nearly half of LGBTQ plus people have experienced gaslighting from health care providers. We also found that 20% of LGBTQ plus patients have experienced medical related traumas such as emotional, physical and even sexual traumas. These rates are at a much, much higher rate compared to cisgender heterosexual patients. But if you even expand that out. Out to just trust and satisfaction in general with health care systems. The numbers are also alarming. In that study, we found that only half of LGBTQ plus people trust their primary care doctors. And this is very surprising but also very concerning as well. I think back in the 60s, right, it was like, who did you trust the most? It was your doctor. You went to your doctor. You told them your whole life story. You told them everything about you. And that was the person that you could absolutely depend on and trust. And we're seeing that narrative shift very drastically for LGBTQ plus people. We also found actually that very few of them trust pharma, very few of them trust insurance companies, and very few trust US health care systems in general.

Dustin Nowaskie: [00:21:05] So in that study, we found that 15% of LGBTQ plus people trust insurance companies and only 17% of LGBTQ plus people trust US Health care systems at a much, much lower rate compared to cisgender heterosexual communities. And the question has been for many, many years, things are not changing. The rates have been the same for many, many years, if not the entire time we've been collecting this data. We really need to think of novel, innovative ways to approach health equity, especially for LGBTQ plus people. And as Alex mentioned, Glamma is doing a lot of work in the policy and the political space, but also in the educational space. And we without care are doing a lot of work in the education and training sector of health care. We train a lot of hospitals and clinics and insurance companies. Really we start with foundational topics, but we work our way up to very, very advanced topics for particular health care topics. We we also have continuing medical education units that are attached to our trainings now through one of our partners, and we're hoping to expand this training. I think I myself have probably I probably have over 100 different LGBT topics on my computer alone. And throughout care, we train tens and tens of thousands of people every year in LGBTQ plus care and LGBTQ plus equity.

John Moore III: [00:22:28] That's fantastic. So thank you for sharing all that.

Alex Sheldon: [00:22:32] Dustin and also can pick up a little bit. I definitely agree with everything that Dustin was saying. I think sometimes people overlook the importance of creating an affirming health care environment. I think some people assume that an affirming environments, meaning those that don't welcome or affirm LGBTQ plus people for exactly who they are, they think that those environments are simply uncomfortable or a mild nuisance, one that LGBTQ people can kind of just grin and bear it or push through. But the reality is that LGBTQ people, our entire community encounters stigma and discrimination in so many areas of our lives and health care environments like doctor's offices and other health care systems and settings are just incredibly vulnerable places. So going off of what Dustin said, that that trust between a provider and a patient is so incredibly crucial and that will directly impact the quality of care that is provided between the provider and the patient and an uninformed, affirming or hostile environment or even the perception of such an environment is going to deter LGBTQ people from seeking the care that they need and deserve. And our community will literally delay care in order to avoid that unsafe environment. And so what I always want to bring up here is that we're not simply talking about LGBTQ plus people delaying or avoiding their annual checkup or routine screening, even though those are important things. We're talking about all types of care, including lifesaving care like cancer care, like chemotherapy.

Alex Sheldon: [00:24:06] And this bears out in the research. Lgbtq plus people are shown to have worse cancer outcomes and decreased quality of cancer care. And those two things are directly linked. So think about that for a minute. An LGBTQ person could be battling cancer to try to save their own life and may skip their chemotherapy appointment to avoid the indignities of being treated poorly by their providers. So creating an affirming health care environment is really not a trivial matter. It's why glamor works so hard on their multi-pronged approach, because it's literally life and death. And I always bring up the fact that we have been doing this now for 41 years because we have watched the landscape of LGBTQ plus health equity shift so dramatically over 40 years, and yet it is still nowhere near what we would believe is equitable care for LGBTQ plus people. So imagine 41 years ago, the first glamor representatives got together for a conference to talk about the emerging issue that would become the HIV and Aids crisis. And these were physicians that literally could not be out in their workplaces because for fear of being fired or discriminated against in those very workplaces, which is still a threat today in our political environment. But those folks came together in order to reshape that landscape for health equity, for LGBTQ plus folks. And that is what we continue to do today.

John Moore III: [00:25:32] I totally agree. I mean, we're an analyst firm, so we take more of a, I guess, business approach to how we provide our value to the market. But we also see ourselves as an education organization trying to help spread best practices and an understanding of the technologies that will really make a change to the experience of care for everyone, for patients, for providers, just for country as a whole. So it's really nice talking to some fellow educators or people that see themselves as playing that role as well, just from a different angle. So as I think about that, what are some some of the unexpected takeaways or best practices that you've learned from developing your respective education programs?

Dustin Nowaskie: [00:26:12] I can jump in here. We there's a lot of takeaways that we've learned throughout care, health and education. Yeah. I mean, I think one of the biggest pieces that we've learned is, you know, people don't know what they don't know. Right? And so, you know, we initially when we started education, we were doing very foundational trainings and my assumption was that providers would have some level of understanding, right about terminology and disparities. And while that is true for many providers, it is definitely not 100% nor the majority. And so we do have to keep in mind that even if providers have been practicing for many years, there may be a lot of different gaps, right? And it may be about one particular topic, but often it is across multiple different topics, if not all topics. And so I am a huge advocate and we absolutely prioritize throughout care health to start with the foundation, but then work our way up. One of the biggest takeaways that we found also when working with medical institutions, health care environments and especially insurance companies and payers, is that they often use a checklist or a one and done type of approach. And so, for instance, they may go into an endeavor of LGBTQ plus care and LGBTQ plus equity. They'll formulate a training or a panel that they will deliver often during Pride month.

Dustin Nowaskie: [00:27:34] And there is no follow up. And this is super problematic because a lot of our research throughout care health has actually shown that one and done trainings don't serve anyone. They don't serve the educators that are leading it because they feel very frustrated that they're only scratching the surface. It doesn't serve the providers because they're not getting enough knowledge that they need to actually deliver this very complex intersectional type of care. But also it doesn't serve patients as well. You know, it is not patient care is not a checklist. And you definitely cannot say a one on one will translate into great affirming care. And so what we found actually was a lot of industries still today in 2023 rely on these one and done types of endeavors. So we absolutely prioritize longitudinal in-depth training. So our model is actually that we work inside ecosystems. So whenever anyone reaches out to us for training and education, we want to know what are they doing currently today, what has worked for them in the past. We'll amplify that. You know, we'll pump in a lot more information. We're very, very huge advocates of absolutely tapping back into the data and the past research and literature so that everything is modern and up to date because terminology, trends, understanding of LGBTQ plus care and equity does change over time, sometimes quite rapidly.

Dustin Nowaskie: [00:28:50] So we do amplify what is being done currently, but we also want to fill in those gaps over time. So we have done many different endeavors where we've trained groups in a longitudinal series where we've done ten weeks straight, 12 weeks straight of training. Sometimes we'll do it at regular intervals where we'll do it quarterly, things like that. But the biggest takeaway that we found is that even if an institution or a medical school or whatever organization we're talking about, even if they do make it a priority to increase their training and education, it still often is not enough. And so I find some institutions will market or communicate, you know, that they're delivering three hours, right? A year of LGBTQ plus education. And the average right now is probably in the range of 1 to 2 hours per year. But three hours is not enough. Our research has shown actually that providers need at least 35 hours, but it's probably close to 40 to 50 hours of different. And that's the key different LGBTQ plus education and training over time before they actually fill affirming to provide that type of care. And so we are talking about a lot of training. We're talking about a longitudinal commitment of LGBTQ plus equity.

John Moore III: [00:30:01] That's a fantastic breakdown. Dustin Alex, did you have anything to add that you didn't already kind of bring up in your conversation about the conference?

Alex Sheldon: [00:30:07] Yeah, I have to agree with Dustin there. I think the longitudinal education is absolutely the key to shifting this landscape of LGBTQ health equity. And the thing that we focus on quite a bit is all in how LGBTQ health, as well as just the medical community itself. They both favor change and fluidity. We constantly as a community find new. Horizons, new definitions, new identities, and new ways to articulate our unique experiences as LGBTQ plus people. We even evolve all of our symbols over time, including our gloriously evolving pride flag that seems to change every year to further articulate who we are to the world. And I believe that the medical field is such an incredible, actually very natural accomplice to the LGBTQ community in this, because in order to maintain these licenses, to stay health professionals, you have to complete continuing education to keep that, to keep to stay in your profession. And so in order to keep up with LGBTQ health equity trends, you have to continue on in pursuing that education that is up to date and evolving alongside of the community. The one piece that I would say that has been a little bit of a surprise or that has emerged from some of our trainings, especially in working in health care settings directly with administrators and executives, is that often people will talk about how to create an affirming space for their patients, but they don't do the same amount or make the same amount of investments for the health care providers who are LGBTQ plus who are working in those settings.

Alex Sheldon: [00:31:46] And as we know, those two things are very much interrelated and will only progress if the other does progress itself. And so we often work with health providers and health networks in order to create more affirming places, whether that is a chief medical officer, a physician who is transitioning later in life. And the organization needs to figure out exactly how to create an affirming space for someone in those places, or if it is a young resident who has been assigned to a health network that is in a state that is passing an affirming, that is passing regressive anti LGBTQ legislator, we work with those folks to figure out how to create the most affirming space for their providers as well as their patients.

Dustin Nowaskie: [00:32:32] Yeah, yeah, absolutely agree. Alex John, I have actually one more point that just came to mind. When we've worked with medical institutions and specifically medical institutions, but we also see this play out in hospitals and clinics as well. Um, you know, there's something to be said about lived experience, right, in delivering education. And so we get a lot of feedback and we have in the past, but we continue to get the same feedback that while even if lgbtiqa+ education is being delivered, sometimes it's through a biased lens, right? And so we have unfortunately heard horrific stories of great topics being delivered, but with an extra layer of bias or assumptions added to it from the educator themselves, who often assists in heterosexual identifying. And so sometimes people don't connect, right? Unless they actually believe that what you're saying is coming from a place of authenticity. And so I do think that institutions and organizations are getting better about implementing and understanding the importance of lived experie nce.

Dustin Nowaskie: [00:33:32] But unfortunately, what ends up happening is that, as Alex has mentioned a couple of times now, there are not near enough providers who are LGBTQ plus identifying or out. And what happens with some of these institutions is that they will tokenize and they will go to the queer person, the LGBTQ plus person who is out and there is this huge expectation then that they will change the entire ecosystem and really revamp their LGBTQ plus care and their equity. And it's tokenizing in many ways. Now, sometimes the individual may absolutely have the tools and resources to make that change, but often they do not. And they're 1% of an entire organization that is given a huge burden. And so we find that institutions now are coming to us to say, you know, we don't want to do this approach. We don't want to put it on the one LGBTQ plus identifying provider. We actually need an entire organization that is LGBTQ, plus identifying with the lived experience of stigma, of discrimination, but also knows how to deliver education in a very digestible, comprehensive way.

John Moore III: [00:34:35] That all makes sense. That definitely resonates. So thinking about the fact that you guys are providing this education after people are already out there in the world. You know, you're trying to help train the providers of care. How much of this stuff that you're doing now do you think should really be started while these clinicians are getting trained? Like what should be done in medical school? How much of this type of advocacy, work or understanding the lived experience piece and creating a truly inclusive environment should be taught at the core medical education level versus once a clinician is actually out there practicing.

Alex Sheldon: [00:35:10] I can start there. John, thanks so much. So one thing that Glamma has has worked on for quite a long time is working with health professionals in training. We have a health professionals and training or hpet program that is the only interdisciplinary health professional student and health professional in training program in the country. And what we hear consistently from these health professionals and training and these students is that they are not receiving an adequate amount or commensurate amount of education about LGBTQ plus folks in their medical education. So we truly believe that LGBTQ plus health issues need to be an integral part of core curriculum in medical schools, in nursing schools, in all levels of social work, school and all levels of health professional training that we can provide. This is going to include this is going to improve all health outcomes and health professional experiences because medical students need the knowledge and skills to deliver that culturally competent and affirming care to LGBTQ plus patients. But we also think that continuing medical education outside of school can raise that bar even higher. So in general, medical professionals who are in training at the time need to have that base foundational work to be able to even start to provide that affirming care.

Alex Sheldon: [00:36:31] But once they're out and they can focus on continuing medical education, they can focus on intersectional identities and unique issues like substance use and safe sex practices for all bodies and STI prevention and even end of life care, and then being able to focus on updating health care professionals on this emerging research, best practices and evolving health care needs. So we think both education during school and training is incredibly important to really set that foundation to be able to provide culturally competent and affirming care and also to signal to all health professionals that this should be a part of core curriculum and should be an integral part of their ongoing training, but then supplementing medical school training with continuing medical education to raise that bar even higher to make sure that we're focusing on emergent issues, intersectional issues and all of the unique health needs that will evolve over time for the community.

Dustin Nowaskie: [00:37:29] I completely agree with you, Alex. There are huge, huge, substantial gaps in Lgbtq+ education across all health care professionals, schools and institutions. It definitely needs to start foundational at the learner level and then work your way up to more advanced healthcare. And medicine, though, is really, really bad about how do you translate knowledge and facts into actual hands on experience and clinical care and implementation of that knowledge. And so we find that there are huge gaps in learners, you know, learning these flat facts. But then also then there's a gap in how do you apply these facts to actual clinical care. It's very complex. It's not an easy task to do. Couple that with that Lgbtq+ education is the awareness is now getting there, but it's still hugely lacking. And so there are a huge proportion of older providers that never received any Lgbtq+ education and so they also need the foundations. Then we can work their way up into how do you apply these skills? And as Alex mentioned, there unfortunately are not that many mentorship programs or internships to help medical students. And so throughout care, we we mentor a lot of medical students a year getting them involved in education, but also research so that they can understand these complexities and then also be advocates for themselves, but also for their institutions and their colleagues and peers so that this information is interwoven into the curriculum, which is a huge key differentiator. Lgbtq plus care and education has always been considered this like, quote, specialized or segmented topic. But LGBTQ plus people are everywhere. They span every health condition. They span every community. We are not a specialized topic. We live and breathe every second of the day across the world. And unfortunately, at the health care professional education level, these topics are not interwoven from day to day education. They absolutely need to be. Some institutions are trying to get there, but they're finding a lot of challenges. We are nowhere near where we need to be with this actual huge integration of these topics.

John Moore III: [00:39:36] You just mentioned that some organizations are trying to tackle this. Do you guys have anyone, any, you know, programs or initiatives that you could rattle off for our listeners that might be interested in learning more about what is out there? I know that there's the UCSF gender affirming health program is one of them, but what are some other ones that are that people are trying out and trying to integrate into medical education at this point?

Dustin Nowaskie: [00:39:59] Yeah, a couple that come to mind, actually, and I think you do see this play out with equity in general, is that we do see some institutions on the East and West Coast that really take this endeavor and push it a little bit further. So, yeah, you're right. A lot of the University of California systems here on the West Coast are absolutely integrating equity. And this understanding of longitudinal l-g-b-t-q-plus commitments interwoven into their curriculum at a at a better rate than the average across across the country. You know, there are some institutions in the Midwest and in the South that are are getting there. They're nowhere near the east and West Coast institutions. But unfortunately, you know, even if you look at those institutions that are doing it better than the average kind of to Alex and Mike's point earlier, there's still substantial gaps. And so we do see the needle moving a little bit. Right. So they there may be applying a couple more hours each year, but again, they're not getting nowhere near that 30, 40, 50 hours that really is needed before a learner or a provider feels like they are fully affirming to provide the best care to LGBTQ plus people.

Alex Sheldon: [00:41:09] Yeah, thanks for that, Justin. Yeah, I couldn't agree more. I think that there are there are many institutions who are now working in this space to try to change the landscape within medical education. And but what we see there is it's often on the shoulders and on the backs of the LGBTQ plus health professionals who are working in those institutions to create that curriculum, to push their administrators and executives to take on this this fight and to actually integrate that that care and that education into the curriculum. So it's almost like adding a second job on top of their already very taxing schedules. So one way that Glamma is working to to tackle this issue is last year at our 40th annual conference on LGBTQ Plus Health, we convened the first ever meeting of about 15 program directors of LGBTQ plus programs throughout the country who are working in curriculum development. And so what we can do by convening these folks is, one, hopefully provide that support network for people who, as I said, are taking on essentially a second job outside of their taxing schedules to create this curriculum. But what it can also do is help to share those resources so that we're not reinventing the wheel over and over, institution to institution. And it can provide an entry place for organizations that have no idea where to start.

Alex Sheldon: [00:42:35] So there are many organizations, many institutions on the West Coast, on the East Coast, and some emerging in the South and in the Midwest as well. But if they don't know where to start now, they have a place to go to so that they can actually access that information, figure out the first way to get their foot in the door. And they know that they're not alone in creating this type of curriculum and to be pushing their institutions to do more in that space. I think the other piece that's really important there is sometimes it's not even the faculty or the staff at some of these institutions who are working. It's the students who take it on themselves. We have heard from many health professionals in training that if they wanted to receive any education on LGBTQ plus health, they were told to seek that on their own and bring it back to educate their peers. And I cannot think of another health issue or health population that is asked to do that and take it on themselves. That is a pretty taxing thing to do to someone, especially overworked medical students and other health professionals in training. So we want to provide that, that those entryways, those those resources for organizations and those those very ambitious folks who are working to create those inroads in their institutions.

John Moore III: [00:43:45] That's fantastic. Hopefully some people that listen to this are going to be interested in applying this stuff to their own hospitals or their own programs, and we'll reach out. Definitely part of my goal in doing this episode. Okay. So shifting gears a little bit. We are a healthcare IT analyst firm. And so one of the things I want to talk to you both about is the implications around technology in providing care specifically for this community. So I've been listening to a lot of different things around AI and the implications for data use and some of the inherent biases and problems around the health care data that's being used to train AI today. There's this great book, More Than a Glitch by Meredith Broussard, who is talking about the different ways that AI is actually out there in the wild today and the various problems that have been already experienced and exposed due to not really thinking through that. Technology isn't always fully aware of the social implications and the social constructs around what it's computing. It is literally just computing inputs and then giving you an output. So it doesn't take into account all the nuances of how what's fair and what's equitable when you're looking at various kind of marginalized communities. So when we think about technology in health care, let's start with the positive. Let's start with what's working. So how do new technologies and remote care options increase the ability for marginalized communities to seek validating, culturally sensitive and aware care?

Dustin Nowaskie: [00:45:05] Yeah. I mean, I think in terms of, you know, the intersections of technology and care and equity and marginalized identities, I think is improving. Historically, it wasn't great. But I do think that the pandemic really pushed our understanding of what it meant to provide people the best care at their home. Right. And so I saw this play out for myself as a queer, patient and community member, but also as a queer provider, and that whenever a lot of us went remote and working over telehealth, actually from my perspective, I actually saw a lot more meaningful dialog, a lot more rapport building with my Lgbtq+ patients because they were more comfortable, right? They were more comfortable in their homes. They were more personal. They were talking about their care, their affirmation, and a lot of different types of ways than they were previously whenever we were in clinic or in the hospital. I think there's a lot of reasons why that may be, but I do kind of fall back on that idea that a lot of people don't like hospitals and clinics. They're a very sterile environment. It's a very stressful environment for many reasons. But also, like we were mentioning earlier, there is a heavy amount of stigma and discrimination within health care contexts. And I think that when people are remote or they're at home or they're in more comfortable environments, there is less burden, there's less stigma, there's less overt discrimination than what they may experience or what they anticipate they will experience, which is just as meaningful for people, whether it's an anticipatory amount of stigma or it's actually lived in the moment.

Dustin Nowaskie: [00:46:42] And so I do think that remote availability and telemedicine has really pushed equity to let people feel more comfortable. It's also opened up doors for accessibility. So historically, before there were provider directories like glamor and out care has for LGBTQ plus affirming providers, it historically was word of mouth, right? So you ask your fellow Lgbtq+ friends and families and communities and resource centers, you know who treats LGBTQ, plus people. Now, with remote technology and telemedicine, that accessibility is opened up on a broader scale, typically at a state level scale. So for instance, the LGBTQ plus affirming providers that may be in very heavy metropolitan areas now can deliver rural care to LGBTQ plus people. We often find actually that the rates of disparities and stigma are at a much, much higher rate in rural America compared to cities and heavy metropolitan areas. And so what technology and remote care options have done actually has really relieved that stigma and burden to a to some degree. Now, has it completely changed the community itself? Absolutely not. But it has provided an avenue for an LGBTQ plus provider to provide affirming care to that person in a community that they may have no other option.

Alex Sheldon: [00:48:08] Yeah, I couldn't agree more with what Dustin said. I think for a very, very long time there was this fallacy that people believed about the LGBTQ Plus community, that we all lived on the coast, we all lived in these big cities and that we all had access to all of the trappings of living in big cities. But the reality is over 3 million LGBTQ people live in rural areas. So telemedicine and other remote care options and virtual visits have provided convenient and also confidential means for LGBTQ plus two LGBTQ plus individuals to access health services from the comfort of their own homes in the comfort of their own communities. So not only do we no longer expect people to leave their home and leave their their family life to move to the coast in order to provide to provide themselves with an affirming environment. But that is now actually in the day to day access to all sorts of services. So what really gives me quite a bit of hope is also watching the tech industry really thrive in this environment and come to create, come together to create even better services for all folks, but especially for LGBTQ folks. So not only do we see telemedicine and virtual visits, but we also see at home testing, we see at home access to gender affirming hormone therapies. We see more remote intakes for gender affirming surgeries. All of these things contribute to better health outcomes for LGBTQ plus people. And also one other piece that I think has changed dramatically because of our new push towards technological innovation and telemedicine is that more LGBTQ health professionals and allied health professionals are able to access education. So I know that everyone is very sick of having Zoom meeting after Zoom meeting, but that has enabled us to provide extensive education through Zoom webinars that are able to then provide education that is leading to better access to equitable care all throughout the country.

John Moore III: [00:50:17] That's fantastic. I totally agree. That's why I brought up the question. I figured that there was something to be said for being able to access this stuff remotely and in the comfort of your own home. So it does make it less judgmental. There's less fear of going out into the public and being judged in this place where you're supposed to be totally open and transparent with the person you're talking to. I've been listening to a lot of podcasts about this topic and reading about this as well, and one of the things that I've learned from these various resources is that there's often what's referred to as the curb cut effect with things that help marginalized communities. They typically end up actually being a net gain to all of society. So I think that that's something that I don't think that you guys necessarily touch on that directly. But I think it's something that a lot of people need to internalize is that this isn't just for your community. This isn't just to make things more inclusive and affirming for your community. It is partly that, But there's also going to be downstream effects of health care just being better because it is wrestling and grappling with these issues and trying to address them.

John Moore III: [00:51:15] One other thing I want to bring up is the Sasha Costanza-chock, who wrote the book Design Justice. I recently listened to a podcast with them and they brought up some fascinating points about how to incorporate marginalized communities into the design and development of new technologies and new tools and some of the failings of that. What happens when you fail to bring in marginalized communities and, you know, there's some of those kind of more broad effects of not taking into account one marginalized community that then affects many other marginalized communities. So Sasha specifically brings up the TSA body scanners as one of the prime examples of very poor, equitable design. You know, there's a lot of marginalized people that end up being excessively screened, excessively, kind of patted down just because they don't fit the the model that this technology is supposed to be assessing everyone based on the model is very limiting. And if you're anything outside of that model, you're going to be flagged. So as we think about some of the impacts of technology in the space, where are some areas where technology is actually failing and creating more problems for your communities?

Alex Sheldon: [00:52:19] So much of what you just said, John, really resonated with me. We refer to that sort of targeted approach as something called like targeted universalism, meaning if you target it the most marginalized, the most heavily affected in a certain situation, then you are going to improve that situation for everyone. And if you don't, if you actually only think about maybe the majority of people or even the folks who are less marginalized, then you are absolutely going to leave behind so many people. So we refer to that as targeted universalism. And we believe that it is a key if you center LGBTQ plus folks and also particularly if you center trans and non-binary folks and if you center trans and non-binary folks who are also people of color, then you are going to witness some of the harshest realities in health care settings and you are going to be able to design a much more equitable and accessible health system for all. We would all benefit for more privacy. We would all benefit from more access, we would all benefit from lower costs. Everyone would benefit from those things that happen to disproportionately affect LGBTQ plus folks and disproportionately affect bipoc LGBTQ folks and trans and non-binary people. So there are a few places where I think right now that technology is really not is not really hitting the mark. And I think still that we're seeing a lot of issues in medical billing.

Alex Sheldon: [00:53:45] And I know that this is something we talked about when we spoke before, but there is there's still a lot to be desired when it comes to medical billing right now. It really still adheres to a very binary approach to gender and still still adheres to a very heterocentric or like something that centers heterosexual or straight people in its design. So I think one of the first issues that always comes to mind is in insurance coverage for gender affirming procedures. Some insurance companies categorize these procedures as cosmetic or elective, and it leads to denials or limited coverage. And we still see today in 26 states, so fully half of the country it's legal to prohibit the coverage of transition related care, even if that coverage is fully available to cisgender folks. And it's even worse when it comes to non-binary individuals who identify outside of this traditional male and female, binary and medical billing systems lack options or codes to accurately, accurately reflect non-binary identities, leading to challenges in obtaining appropriate medical coverage or appropriate coverage for gender affirming care, or even just routine medical services. I know when it came to myself and actually accessing gender affirming care just last year, I was finally able to access top surgery, which is for folks who aren't familiar, a double mastectomy that is considered gender affirming.

Alex Sheldon: [00:55:14] Care to to help. Myself and other non binary and non gender non-conforming people to present in a way that actually fits with their own gender identity and in trying to access that gender affirming care in my home state of North Carolina. Not only did it take over a year to go through all of those systems, but I was constantly being coded as either a male or a female in medical billing procedures in order to adhere to the actual technological needs of those systems. So I was misgendered at nearly every single turn throughout trying to access that care all the way to actually being in the hospital, to receive the surgery and being misgendered by the nurses there, because simply it was not allowed in the technology there to actually account for my actual gender identity as a non-binary person. And so I think that this is where technology, as I had said before, technology and medical and the medical community and LGBTQ folks all should favor fluidity and change and I do not think that technology has caught up to the idea that we can create these identities outside of these experiences of binary assumptions about gender and sexual orientation. And that is a place where I think that we, knowing how often technology changes and shifts, we can make real changes now, but it simply hasn't been done yet.

Dustin Nowaskie: [00:56:39] I absolutely agree with everything that Alex has said. You know, to take it a little bit further, I think we often forget that technology is built by someone or groups of people, right? And so I think people get excited about technology. They're getting excited about AI. But there is this wrong assumption that it's it's data, it's technology. Therefore, unfortunately, the assumption is it's not bias. But again, someone built it, someone made it through a lens which only they understand. Right. It's a very limited scope. And so because of that building, that implementation, it has bias with it from the beginning. And as Alex has alluded to, we see this play out in technology all the time. And I actually have witnessed many programs, many very innovative, exciting pieces of technology that I think, oh, this is going to be monumental for LGBTQ plus people. I go in and I see the language, the communication, the visibility, how it's being portrayed, how it's being communicated is all very biased. And often and sometimes it can be even discriminatory, it can be offensive. And so I often think that we are advancing pretty quickly with technology, but I think we're almost advancing too quickly where we're not getting that feedback from the people that have the lived experience and have those perspectives to make this technology as as equitable as it can be. And so there's actually a lot of literature. And even in my own experience, I've seen this play out that new technology can sometimes even perpetuate and make disparities even more prevalent than what they already were because they're perpetuating this stigma, this bias, this marginalization. And so I think there's a disconnect here. I think we get very excited. We move very quickly, but we also don't kind of bring ourselves back, take a step back, look externally, what are the implications for everyone, but also for specific communities that have very specific needs, wants and desires?

John Moore III: [00:58:45] Absolutely. So the baking and bias thing is one of the biggest issues that we see right now. And you see it most with the racial side of things, because there's been the most obvious, you know, the most discussion and the obvious disconnect between actual biological factor versus a social factor is very prevalent in the race discussion. But yeah, I mean, what you end up with are tools that are supposed to be fully objective, not biased at all. And so people that are using them view them as not being biased and view them as being fully objective and completely forget to validate or vet whether or not the decisions and the recommendations coming out of these tools are actually, you know, fair and equitable, and you end up creating this kind of vicious cycle of the AI learning from its own bias and then perpetuating that bias further. And then, you know, the outcomes then create this vicious cycle of continuing to embed the bias deeper and deeper into the social structure and the social norms of how, you know, care provider or whatever that tool is helping to enable. So when you think about technology going forward, where are some of the opportunities that just haven't been addressed yet? Or where are some areas that you think innovators could really make a significant impact today by developing new offerings?

Dustin Nowaskie: [00:59:56] Yeah, I can jump in because it's it's a very complex question that I don't think has a simple solution. If it did, I think we would have figured it out by now. But I do see technology absolutely increasing care accessibility and limiting gaps into affirming care. I mean, we're seeing that play out now with telehealth companies where, again, people LGBTQ plus people are accessing LGBTQ plus affirming providers in a quicker, more efficient way from their homes and uncomfortable environments more than they ever were. And I absolutely think that that is critical and that will continue. I do think that there is opportunity here for for many companies that and industries that are coming up with very advanced technological solutions to tap into organizations like Alt Care and Glamma that have the lived experience, that actually understand the perspectives and where the where the community was, where we are now and where we want to be. That is very, very critical. But I also see that there's an opportunity then to really start to address things that are outside of traditional medicine and prescriptions where we're talking about social drivers of health. What is important for you based on your values, your goals, your identities? Do you need help with things like transportation coverage, getting insurance, all of these things that are much, much lower rate compared to cisgender heterosexual communities, but then also community building? I think technology has a huge opportunity to really start to bridge communities within themselves, right? So putting communities, LGBTQ plus communities and network with one another, but also bridging these huge gaps of stigma between marginalized communities, we heavily see a lot of inter racism, inter, you know, inter homophobia, inter transphobia within communities.

Dustin Nowaskie: [01:01:53] And it's an unfortunate problem. There is stigma within our own communities, but even outside of our communities. I do see technology absolutely embracing this thing that we're in it, we're all in it and we all want to be affirmed in our own unique ways, which is why we were very excited to partner with Pear Sweet. This technology is enabling us to provide that one on one interaction with people who are Lgbtq+ and people who are LGBTQ plus patients, but also understanding their values, their goals, and then letting them know all of the resources, all the services that we have without care so that sure, we can get you a provider. That's that's pretty straightforward. We have a directory. But what about all these other things that you need in your life? Do you need a mentor? Do you need an advocate? Do you need a support group? Do you know where your Lgbtq+ center is? All of these things really tie in to overall health and well being, not just finding a doctor.

Alex Sheldon: [01:02:50] Yeah, I can. I completely agree. I really think that community building and digital organizing has always been such a key part of the Lgbtq+ movement generally. And I think we're seeing that emerge more and more in LGBTQ health equity, move in the movement for LGBTQ plus health equity and having an informed population informed about their own unique health needs, informed about the ways in which they experience health disparities and the ways in which they can advocate for themselves in health settings is going to lead to improved LGBTQ plus health outcomes. So I think one of the ways that that is working and I know Al-khair is too, and just educating the patient population in how to advocate for themselves in these settings, knowing exactly what they can ask of their providers, knowing that they can actually leave those providers and find other health professionals that can provide that affirming care and just empowering Lgbtq+ communities to step up and step up for themselves and advocate for themselves to receive the care that they need. I think a long time ago there wasn't actually as much information about these disparities, but also there wasn't as much access to that information for the general populace.

Alex Sheldon: [01:04:09] While many health professionals might have had access and know about some of the disparities that our community experiences, our community itself may not have known that these were things to think about and to get tested for, to provide, to access preventative care for, and to really advocate for themselves to get that affirming care that they need. So I see a lot of opportunity for our population to continue to educate themselves to to work towards advocacy in those spaces. And then I also see so many opportunities that are happening in LGBTQ plus advocacy and policy. So in digital organizing and bringing in allies to fight and stand up shoulder to shoulder with us when anti LGBTQ plus policies are being passed at all levels, levels that sort of digital education is increasing, is changing hearts and minds and helping us to build out more allies and to build more power that will hopefully not only change access to care, but will change the like actually change the landscape for the next few decades to come.

John Moore III: [01:05:16] Yeah, that makes sense to me. Obviously, the long tail effect of all of this increased advocacy and increased activity that we're seeing from these communities. You know, you don't always see the effects in your term. You know, what was the Stonewall riots like decades ago? And we've gotten so much further than then than, you know, when that was going on. But even so, one would have hoped that we would have been even further along by today. But, you know, social change takes a while and you've got to start somewhere. So all of that makes a lot of sense for kind of continuing this narrative and trying to get more people out there understanding exactly what the real implications for all of this are. So as we think about wrapping this up, we've got this has been a fantastic conversation so far. I really appreciate all of the insights and all the information you're sharing. So as we think about the future of this problem and we think about the future of actually, you know, providing more inclusive care, what are some easy and what are some more complicated or involved ways that people in health care or in technology development can be better allies for both their peers in medical care as well as for the individuals they serve?

Alex Sheldon: [01:06:24] I'd like to start by saying that it's really difficult to characterize this current political landscape we're experiencing as anything but hostile. We really I want to make this plea to all health professionals and tech enthusiasts listening right now that we are truly in a fight for our lives right now. We have seen over 500 anti-lgbtq+ bills introduced throughout the country, and a huge proportion of these bills are directly targeting trans and non-binary access to health care. And this is all a part of an extremely well funded and well coordinated plan to erode the rights to bodily autonomy and our right to make decisions about our body, our health and essentially our future. And it's all coming up because the opposition is weaponizing medical Mis and disinformation in order to target and dehumanize our community. So I would love for everyone who's listening to get involved and really question when you are hearing information about LGBTQ plus health care and health equity and challenge those sources and make sure that you are actually hearing from our community in all of those circumstances. Because right now we are being targeted and scapegoated and dehumanized across all levels of policymaking. This is a place where Glamma truly works tirelessly to shape and change policy from employment policies and local hospital networks to state level legislatures at the federal and federal policy as well. And we do so by bringing to bear the vast, vast, vast expertise of our multidisciplinary health professional membership so that we can inform LGBTQ plus inclusive policy development and combat that Mis and disinformation.

Alex Sheldon: [01:08:15] But we truly cannot do that alone. We need health professionals, LGBTQ, plus and allied alike to step up and mobilize in order to to combat that Mis and disinformation. One of the ways that we're working in that space is to do exactly that. We are training and mobilizing health professionals to provide direct testimony in state legislatures who are considering bans on trans health care. And we are also training them to speak to the media to reach the general population and change hearts and minds, hearts and minds about this important life saving health care. And this is a really crucial advocacy tool of ours that we bring this health expertise to bear to inform policy making, especially as we witness the continued weaponization of mis and disinformation. But I think what's giving me maybe some measure of solace here in this situation is that the legislation that we're seeing is not standing up in courts. We're recently in both Florida and Arkansas. Judges blocked the bans on trans health care and issued scathing opinions about their lack of merit. And I was very proud to be a part of the amicus briefs that informed those judges decisions. And we hope to see more health professionals join our ranks to join in this fight, because it's truly life or death right now.

Alex Sheldon: [01:09:32] And lastly, I think one of the places that that gleam is working as well to organize and to to push more inclusive policy. And I hope that health professionals and tech professionals will join us is in our role in advocacy within organized medicine and other health professional associations. So Glam is the only LGBTQ plus organization with a voting seat at the House of Delegates at the American Medical Association. And that gives us the opportunity to propose and advocate for the adoption of LGBTQ plus resolutions, and also to make sure that we're educating other health professionals to become more inclusive in those spaces. And again, this is where we need allies and other health professionals to not only be working in your incredibly powerful and incredibly meaningful jobs, reaching patients and clients, but to also think about your education and your professional expertise as a tool for advocacy to change the federal, the state and your local landscapes and policies. If you were able to join these organizations, as you've been able to hear from today, you will be able to bring that expertise to bear and make the have a truly rippling effect and have more and more impact on the lives of LGBTQ plus people throughout the country.

Dustin Nowaskie: [01:10:51] Yeah, I mean, I think there are a lot of a lot of easy steps that allies and LGBTQ plus people can take in the world to advance LGBTQ plus care and LGBTQ plus equity. I come from a perspective that I think that we always need to start with education, making sure that we're educating ourselves about what we what we think we know, and especially what we don't know. And the way to do that, I think about it from three pillars or perspectives. I think that everyone can absolutely be better active listeners. I think as humans we need to be much more flexible to change than what our current society and how our culture is. But most importantly, I think that we need to do a much, much better job about being vulnerable with ourselves and being vulnerable with others, truly understanding what is the lived experience, what is going on socially, politically in health care, in education, in law enforcement and religious context and housing. Right. There are just so many, so many contexts that we're really not understanding in depth. And I think that we need to absolutely be much, much more vulnerable with ourselves and others to really understand all of that complexity. Um, and in order to do that, I think, you know, these I say they're easy steps, but then often the case is where, where do we go, right, to get this information and education.

Dustin Nowaskie: [01:12:11] And that's what we're trying to do throughout care health. We we have on demand trainings. We have live trainings. As I said earlier, we go into ecosystems so that we are really trying to figure out what are you doing? Well, we'll amplify that, but also how can we fill in the gaps and help you get to a point where you want to be in terms of equity. And so we have the national LGBTQ Plus curriculum, which is a very comprehensive library of modules that really spans clinical information, but it's also heavily non-clinical. So this is applicable to everyone in the workforce, whether it's health care, non-health care, where you can truly understand what is going on in the current LGBTQ plus landscape, but also where can we be? What do LGBTQ plus people need? So I invite anyone to reach out to us. We we have individuals that take their curriculum, but we also work with many industries where we provide the curriculum to all of their members, not just providers, but health care professionals, staff members, people working the front desk, every single touchpoint within the health care journey. We want to make sure that everyone has this knowledge and that they're equipped with it.

Dustin Nowaskie: [01:13:16] But I know that you also asked what is a complex step, and for me, it's really systemic change, I think sometimes. But more often than not, actually industries take this one and done approach. As I mentioned earlier, they do panels, education during pride, and then they don't do anything for the rest of the year until next June and that you will never get systemic change. And so a more complex endeavor is to take all this information, be a listener, be flexible, be vulnerable, but then also push out that change to everyone in the ecosystem, which is a very, very hard thing to do. And I can't imagine that a single individual could never do that. But I don't even think a group of people or a single department within an institution can do that. You really need to lean in on organizations like Out Care Health, where we have a very large national and international presence, where we work with so many different industries to make that systemic change. So for those of you who are listening and you want to create change, go back to your employer, figure out what you're doing, and then externalize what others are doing so that you can tap into that great change and work.

John Moore III: [01:14:25] That's fantastic. Thank you both for sharing that. Hopefully it resonates with some people and it gives them some motivation and, you know, a path forward if they decide that they really want to be, you know, more engaged in allyship. I know that, you know, somebody who tries to be an ally myself. I don't always know where to start. And, you know, Pride Month and BLM, you know, whenever there's a big BLM thing, both of those help me find resources. So I think that it really just starts with, like you said, educating and understanding what we don't know or don't understand yet because of our own lived experiences. All right. So one final question before we wrap up. And do you have any reading recommendations to share with our community?

Dustin Nowaskie: [01:15:03] Yeah, I can. I can jump in here. Yeah. Something comes to mind immediately. It's a really good friend of mine who is also our out care moderator for our out talk webinar series. Our webinar series is specifically for diversity intersectionality, and John Sovak has been an amazing moderator. I've known John for many, many years and they are a licensed marriage and family therapist stationed in Pasadena, California. And they recently wrote a book that's that's out for purchase, but it's called out It's a Parent's Guide to Supporting LGBTQ plus Children and Kids through coming out and beyond. Um, probably the most consistent request and inquiry that I hear is how can we best support LGBTQ plus children, adolescents, young adults and their families? There is a lot of complexity that goes into coming out depending on where you're at in the world and where you're at with yourself. And a lot of parents have really no resources or services to turn to. And this book is a beautifully written journey on the coming out process and how we can best support our Lgbtq+ youth, adolescents and young adults. So I, I highly, highly recommend it.

Alex Sheldon: [01:16:18] Thanks. I think one one book that comes to mind for me is the book called A Medical Apartheid. And it really goes through the very detailed history of the exploitation of black and brown bodies in the creation of modern medicine. And I think that for me, this this is so important not only because there we understand that health disparities affecting the LGBTQ plus community affect black and brown people even more than their white counterparts. But I think it is because it speaks to the real root of mistrust in the medical profession. And if we can actually atone for some past harms and we can come to terms with the fact that a lot of medicine and medical, the medical community was was founded on racist and homophobic and transphobic ideals at the time, then we can really start to chart a path to true systemic change. And so that is that book to me was was really was really mind shifting and really gave this context for me that so brilliantly articulated where that trust comes from. And I really don't believe you can rebuild that kind of trust without going back to what caused it in the first place. And that exploitation is at the root of that. So I highly recommend that book. And then of course, there are a million medical journals and things that I think that are really important. But another piece that I really always encourage people to pick up are the standards of care that are published by Path when it comes to treating for treatment and and care for trans and non-binary people. And that is something that is just articulating the standards of care that are needed at this time in order to create more equitable access for trans and non-binary folks. That's a little bit of a nerdier read and more for health professionals in themselves. But I do think that that is something that everyone should be up to date on if they are working in this health care space.

John Moore III: [01:18:26] Mean, that's perfect because that's a lot of what our community is know. Most of the people that are following us and listening to this podcast are already in the health care industry. So that's a great recommendation. Well, thank you both for joining me today. This has been a incredible conversation. I I'm personally walking away with a lot more understanding of this space than I actually expected. I thought I already had a decent grasp, but definitely had a few new points and, you know, insights here that make me better understand what's going on, on, you know, on your side of things. And when the problems that you guys are trying to address, is there any closing remarks or anything that you guys would like to add other than and you know, also include how people can reach out to you, if you don't mind?

Dustin Nowaskie: [01:19:06] Yeah, nothing additional on my end. But yeah. Anyone ever interested to to reach out and to join us? We call it the out care family. You can go to our website. It's our care health.org and you can always reach out to us at our info at care health.org email. Thank you for having me, John.

Alex Sheldon: [01:19:24] I think one of the main messages that I want to send to health care professionals listening and really anyone who touches the health care industry, whether it's through tech or through clinical practice, is that by participating in educational opportunities to learn more about Lgbtq+ health and Lgbtq+ patients through glamor and out care, you can actively shift the experience that your Lgbtq+ patients and clients will have when they see you. So you can be a part of that shift by joining glamor now, as well as we face the most threatening political environment that we have ever seen by joining glamor and supporting education opportunities and also our advocacy efforts and research. This means you're literally joining thousands of other health professionals who believe that Lgbtq+ health equity is worth protecting and worth fighting for. So as I said before, this is a fight that is based in Mis and disinformation about health care for trans and non-binary people. Simply by joining glamor. You're lending your expert voice to counter these vicious lies, so there's really no better time to get involved and no better way to show your support than joining with us. Now you can use all of your education and your practice in a clinical space or all of your practice and research, or any way that you touch health care to build a better landscape for Lgbtq+ people in this country.

John Moore III: [01:20:50] Wonderful. All right. Well, thank you both again for taking the time out of your day to day. And I look forward to sharing this next week.