Admiral Rachel Levine, Assistant Secretary for Health and Human Services (Image via The Philadelphia Gay News).
By Mark Segal
From her time as Pennsylvania’s Secretary of Health to her recent swearing in as a four-star admiral in the U.S. Public Health Service Commissioned Corps, Dr. Rachel Levine has worked to further health equity for everyone, including the LGBTQ community. As Assistant Secretary of Health and Human Services and the highest ranking transgender official in the Biden administration, Levine has also been one of the most visible LGBTQ people in government.
Admiral Levine spoke to the Philadelphia Gay News about the federal government’s work to improve LGBTQ health outcomes, the need for LGBTQ visibility, and her thoughts on being a trailblazer.
The interview below has been lightly edited for content and clarity.
Q: We started to realize during the AIDS crisis in the late 80s, and especially now during the pandemic, the need for LGBTQ-specific healthcare. We’re also learning how LGBTQ people are sometimes afraid to go to mainstream clinics, but also how some mainstream clinics are beginning to cater to LGBTQ patients. What can we do to help take care of LGBTQ people’s health needs and concerns?
A: Health equity is really one of [U.S. Health & Human Services] Secretary Xavier Becera’s most important issues, and it is on my portfolio in many different aspects. Specifically, I’m co-chair of the Health Disparities Council. And the Health Disparities Council has an LGBTQIA+ coordinating council, looking specifically at the health disparities of LGBTQIA+ people.
So we’re looking across the department, in all of the operating and staff divisions. Our revised office of civil rights is there. That’s a classic Build Back Better office now. And that includes of course [Centers for Medicare & Medicaid Services (CMS)], and my office of the assistant secretary, and [Heath Resources and Services Administration (HRSA)], and CDC, and FDA, and NIH. Name a division and it’s at the table looking specifically at the health disparities facing LGBTQIA+ people.
There are a number of different priorities that we have. One is data. It always has been a challenge to collect data in terms of our community, sexual orientation and gender identity (SOGI) data. There are some best practices now that are well accepted ways to collect SOGI data. So we want to make sure that across the department, and really across the administration, that HHS and other departments are collecting SOGI data in a culturally sensitive way, and it’s voluntary. But without that data it makes it very difficult to direct finances and money and policy.
In addition, our previous administration actually excluded SOGI questions where they had been included, so we have to build all that back. So there’s a specific group working on data across the department of health and human services.
The second main focus is in terms of access to care, particularly in terms of insurance coverage.
The Office of Civil Rights had clearly stated our new policy in our administration, that the Affordable Care Act, and section 1557 of the ACA — which says you cannot discriminate on the basis of sex — includes sexual orientation and gender identity. It includes our community. So they are looking to promulgate rules and regulations to that effect. That will inform every single thing that we do across the agency, with particular emphasis on CMS, in terms of the Affordable Care Act.
The other [focus] is to look at each agency. Are we doing enough for search in terms of LGBTQIA+ people, in terms of epidemiology in terms of Covid, but many other conditions?
We can show that trans individuals are just like everybody else. We are doctors, we are lawyers, we are journalists, we are teachers, we work in stores, we work in business, we’re parents. We’re just regular people.
– Dr. Rachel Levine
Are we getting the data, and how are we getting differentiated data for the CDC? So, we’re all looking at that, and then there are work groups across the administration. I had a seat on the National Gender Task Force that was through the White House, and that is looking at equity, diversity and inclusion for LGBTQIA+ people. So it’s many different actions, and it is a priority of the administration and a priority of the secretary.
Q: Here’s an issue that our community doesn’t look seriously enough at: recently a 14-year-old boy in Tennessee committed suicide because of bullying. I don’t think we as a community, once we grow up and come out, realize the mental health issues that we’ve experienced. Coming out is a difficult and traumatic experience for most people, which could be akin to losing a close relative. And it’s an experience that we go through alone, with other issues on top related to the coming out process. What can we do to help mental health issues in the community?
A: There are a lot of intersections in that question. The first is that we’re seeing significant mental health issues for youth in general. And an example, the surgeon general just put out an advisory about concerns that we all have across the administration, about the mental health of our youth. And then there are clearly health disparities in that. Individuals of color, African-American individuals, Latinx youth, American Indian Native Alaskan youth, Asian-American Pacific Islander youth. So there’s lots of disparities, that includes of course LGBTQIA+ youth.
So we need to look at the access to mental health services in youth in general, and then pay particular attention to vulnerable communities, including vulnerable youth in our community. So we’re looking at action oriented outcomes. There are issues that we’re working on in the short term, in the medium term, and the long term. But first of all, we have to make sure that our youth have access to the regular services that we were discussing. Then we have to improve the education of psychologists, and social workers, pediatricians, and child psychiatrists, in terms of the specific needs of the youth of our community.
In terms of health equity in general, I really feel that we have made progress and that we’re continuing to make progress, especially in this administration with the clearly articulated support of our president. But we have not made progress unless we all make progress, so we have to deal with the specific vulnerable communities within our LGBTQIA+ community. To me that includes LGBTQIA+ youth, particular transgender and gender nonbinary youth; that includes LGBTQIA+ seniors; that includes LGBTQIA+ immigrants; and then particularly individuals of color in our community.
For example, it always tears my heart out when we acknowledge Transgender Day of Remembrance. The amount of people, particularly trans women of color, who are at risk not only of discrimination and harassment but of violence and murder, those numbers keep going up, which is just unconscionable and unacceptable. So we have our work cut out for us.
Q: I think you bring up a very good point. More trans people were murdered in 2021 than in any other year. I think that the pushback against the trans community is sort of a backlash, and it’s easier to attack trans people these days than it is gay men and lesbians because we’ve been very public and very visible, and the public still has their own images of trans people because they haven’t been as visible. And you of course are helping bring that visibility. What else can we do to help our trans people to achieve equality?
A: I think there are a number of different bases for the pushback that trans individuals have faced. One I think is political. Those in the country that are seeing this as a wedge issue that they can use for their political advantage, particularly in specific states throughout the country. And I think political people, who I am not, I’m a public health person, need to push back. We need to push back in the courts, and the Department of Justice will do that. So specifically thinking about those vulnerable trans youth and those who are not only not trying to empower them, but trying to limit their participation in activities in sports, and at the most egregious, trying to limit their access to care for evidence based treatment, gender affirming treatment, often at our nation’s children’s hospitals. So we need to push back in our medical community, we need to push back in the courts, and the Biden administration, we will do that from HHS. I know that the Justice Department will be pushing back as well.
The second, I think, is fear. As you said, I think that our country is becoming more comfortable with issues of sexual orientation, not everywhere but in many places. But from a gender identity perspective, we haven’t had the visibility, so what I’m trying to do is do that through two ways: through advocacy and being as public as I possibly can given the honor of my positions, and through education and policy. I think people fear what they don’t understand, and we need to educate them at the local, state, federal, and international level.
We can show that trans individuals are just like everybody else. We are doctors, we are lawyers, we are journalists, we are teachers, we work in stores, we work in business, we’re parents. We’re just regular people. The overwhelming vast majority are just trying to live their lives and also contribute to the common good. The more we can demonstrate that, I think the better things will be. And I think that not just my visibility, but more importantly the president’s open articulation of his support of the transgender community, which he has done on many different times now, including before congress, but even during the Transgender Day of Remembrance, I think, that says so much.
Q: You’re a pioneer, not just because you’re trans, but also because of all the policies that you’ve mentioned in this interview. You’re pioneering so many programs that the government never took on before. We were a community that was sort of left on its own; now the government is finally saying “you’re citizens, we need to take care of you like everybody else.” How does it feel to be pioneering so many projects at one specific time?
A: The best way I can say it is it’s an honor and a privilege. It’s clearly been an exciting time for me, to have the honor of serving in these positions. And I know that I stand on the shoulders of people who went before me, including you. I just feel very fortunate. What I want to do is take the privileges that I have and to give back. I want to do that through public advocacy and through working on policy. Because advocacy by itself is necessary, but it’s not sufficient. You have to do the policy work. So that is being done across HHS. There is also an inter-agency work group working specifically on transgender issues, not only in health but in the departments of housing, education, defense, commerce. Name a department and they are all working on specific transgender issues across the administration. So that is my honor and privilege to work in the Biden administration, to work with our secretary, and to support our community in every way I can. That’s where I find my gratification.
Mark Segal is the founder and publisher of the Philadelphia Gay News, a publishing partner of the Pennsylvania Capital-Star, where this interview first appeared.
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