The National Association of County and City Health Officials (NACCHO), representing the nation’s nearly 3,000 local health departments, hosted its 2019 Preparedness Summit on March 26-29 in St. Louis. More than 1,900 gathered to hear presentations from experts from the healthcare and emergency management fields, in addition to public health preparedness professionals, to address the gaps between these life-saving industries in an effort to work more collaboratively and efficiently in the face of emerging threats.
Tornados are now battering communities in the Midwest, destroying homes and forcing families into emergency shelters. This discussion features Preparedness Summit presenter Leighton Jones, Harvard Public Health Program Manager, on the topic of the special issues facing LGBT+ individuals and families living in temporary shelters. Mr. Jones led the session “The Lesbian, Gay, Bisexual, and Transgender Community — Considerations in Preparedness.”
Mr. Jones, what factors need to be considered when public health officials interact with members of the LGBT+ community?
If people don’t feel welcome in a disaster shelter, or don’t feel included when seeking disaster assistance, they will be slower to recover from the disaster and it could have an impact on their safety and/or health.
Preparedness planners often discuss and think about vulnerable populations like seniors, people with disabilities, or people with limited English proficiency, and the planning concerns that need to be considered in order to inclusively plan for the needs of the whole community. Considerations for the LGBT+ community often haven’t been included in these plans, even though LGBT+ people may be particularly vulnerable following a disaster.
What do you mean when you say some members of the LGBT+ community “re-closet” themselves when they are sheltering?
Re-closeting happens when members of the LGBT+ community enter a space when they don’t feel comfortable or where they potentially even feel threatened or unsafe. Re-closeting means that they hide their identity, they go back into a temporary closet, and it enables them to blend in better so they won’t be singled out, confronted, or harassed.
Are some members of the LGBT+ community more vulnerable to mistreatment in a shelter during a disaster than others?
Transgender individuals are probably most vulnerable during a disaster, because there is so much misunderstanding around trans issues in the general population. Trans people are often the targets of harassment and violence; they have a suicide rate that is nine times the rate of the general population, and 47 percent of trans people have been sexually assaulted.
Trans women of color are particularly vulnerable to violence. Safety in the upheaval after a disaster is essential for these people. Often they don’t have identification that matches their gender expression, and this can lead to increased challenges seeking assistance and living in a shelter following a disaster.
Disaster shelters are a microcosm of community life in general. In general society, 90 percent of LGBT+ youth say they have been harassed or assaulted in the past year. They are five times more likely to attempt suicide, and 40 percent of trans youth have attempted suicide. In general, society LGBT+ seniors are twice as likely to live alone as straight seniors. They are four times less likely to have children, and as a result, are often more isolated and lack the support structures that straight seniors often benefit from after a disaster. All these issues find their way into a disaster shelter, and preparedness planners need to understand these issues to provide a welcoming and safe environment for all those impacted after a disaster.
What systems lend themselves to coordination with LGBT+ communities and local health departments?
As with other underserved communities, it often starts with engaging members of the community in planning discussions. There are often local LGBT+ community organizations that are a good starting point. Recruiting LGBT+ community members to join disaster response volunteer groups, like the Medical Reserve Corps, is also a great way to expand exclusion in the local planning and response activities. For example, there may be an LGBT+ seniors group that would welcome a preparedness education workshop, or an LGBT+ business/professional organization that could partner with planning suggestions. There may also be specific local healthcare centers that specialize in LGBT+ healthcare that would be great partners in preparedness planning. Pride festivals and other LGBT+ community events might also be a good place to conduct outreach.
There is much work by many local health departments on HIV/AIDS education/prevention. This may be a source of connection into the LGBT+ community. Often this work is undertaken in a different office in the local health department than where preparedness planning occurs. Sharing information across different local health departments might assist this coordination.
How can communities be empowered to develop partnerships with local health departments on this issue?
Marginalized communities, like the LGBT+ community, often aren’t aware that local health departments usually have a desire to be inclusionary in their planning. There is usually good will on all sides of this partnership. Approaching your local health department with a passion to become involved in the planning process will often be welcomed.
Are there successful examples that show promise?
It looks like there is some good work happening in the Los Angeles County Health Department. The team from their Community Resiliency Unit had a poster presentation at the Preparedness Summit this year, and they have done good work around outreach to the LGBTQ community, particularly to LGBTQ people of color. The poster presenters were Benedict Lee and Tracey Simmons.
Are there any additional practical steps local health departments can take?
Local health departments can approach collaboration with the LGBT+ community in the same way that they have approached collaborations with disability groups, seniors’ groups, or people with limited English proficiency. Local health departments have made great progress in the last decade, and longer, on planning for these underserved communities, so the approach can be similar when examining our inclusionary planning with the LGBT+ community.
Is there a lot of research in this area?
Generally, there is very little research in the area of the LGBT+ community and disaster response. As with other disaster research, we saw a small amount of research activity after the September 11 attacks, and following Hurricane Katrina. Much of this is now a little outdated, since marriage equality is now federal law and trans issues have become more visible since those disasters.
What surprised you most when you did your research?
The thing that surprised me the most while doing the research is the lack of conversation around this topic on a national level. Disaster planners are usually compassionate people; it’s a profession that attracts that kind of person, so there is an openness to discuss this and elevate the conversation in this area. It just hasn’t been discussed much. There are a very small number of local efforts to include the LGBT+ community in disaster planning, but generally, this is an area that is rarely considered or discussed. Hopefully, we can begin to change that through raising awareness and expanding our inclusion.