Health care is designed to do just that: care for the health and well-being of everyone. Better yet, health care systems are increasingly positioned as institutions to model support and inclusion for those they serve. Rural communities in particular lean on care providers and organizations to not only deliver medical care, but also to serve as community leaders.
LGBTQ+ patients, however, continue to face significant barriers to care and acceptance in health care settings. Those who identify as LGBTQ+ in the United States are twice as likely to lack insurance as non-LGBTQ+ individuals (Baker and Durso, 2017). In a national survey, 8% of LGB respondents and 29% of transgender respondents indicated that a care provider had refused to see them based on their sexual orientation or gender identity (Mizra and Rooney, 2018). In that same survey, 9% of LGB respondents and 21% of transgender respondents indicated that a care provider had “used harsh or abusive language” with them in a care setting (Mizra and Rooney, 2018). These gaps and barriers are even more profound in rural communities. While all rural communities are different, when looking at national data it is clear that rural communities are significantly less support LGBTQ+ protections than their urban counterparts (MAP, 2019).
Cornerstone Whole Healthcare Organization (C-WHO) and partners – including Valor Health, Primary Care Development Corporation, Family Medicine Residency of Idaho, Dr. Neil Ragan, University of Utah and the Cambia Health Foundation – recognize that the LGBTQ+ community in Idaho and beyond face significant marginalization in health care, a context that should feel inherently safe and supportive. In response to these great inequities, C-WHO developed The Pride in Idaho Care Neighborhoods (PiICN) Project. The PiICN Project’s overall goal is to provide a scalable care model that will enhance health outcomes, increase patient and provider confidence in care encounters, lower the cost of care, and reduce the stigmatization and marginalization of the LGBTQ+ community in rural health care settings.
To date, The PiICN Project has facilitated a novel partnership between a community access hospital and local residency to provide access to gender affirming services in rural Idaho, trained over 80 staff in the tenets of the family acceptance project to promote services for LGBTQ+ youth, co-developed practice recommendations with the National Rural Health Association and, in just six months, doubled the number of local providers trained in management of PrEP.
Through this work, the PiICN Project has identified best practices as well as those to be avoided. The project team aims to share these findings with other rural communities of care across the state and country to promote the development of more inclusive, safe and culturally appropriate care environment for all marginalized rural community members. Available resources include:
The work continues as C-WHO and partners work to scale the project to other minoritized communities and address newly identified inequities. For example, in the course of this work, the project team learned that Idaho has an approximately 40% late-stage diagnosis rate for HIV, four times higher than neighboring Mountain West and Pacific Northwest communities (AidsVu, 2021). Based on experience with rural primary care sites, the project team guesses this has a lot to do with reticence to screen for the condition and discomfort with discussion of sexual health. This work has occurred in the context of increasingly hostile local legislation to limit protections and care for LGBTQ+ youth. So, while we can celebrate the progress made this Pride Month, we can also work together to seek opportunities to do even more because we know we can and must do more.
Rachel Blanton is the Chief Officer of Innovation and Operations with Cornerstone Whole Healthcare Organization, Inc. (C-WHO), a 501(c)(3) private non-profit, serving rural and other vulnerable populations, dedicated to improving the conditions for health among all communities. Rachel has been recognized as an “Emerging Leader in Public Health” by the Kresge Foundation and as a Community Leader by the Federal Reserve.
Pride in Idaho Care Neighborhoods
Helping develop a more inclusive, safe and culturally appropriate care environment for all vulnerable rural community members
By By Rachel Blanton, MHA, Chief Operating Officer at Cornerstone Whole Healthcare Organization
June 30, 2022