By Yasmeen Saadi for The Daily Yonder.
Broadcast version by Nadia Ramlagan for West Virginia News Service for the Public News Service/Daily Yonder Collaboration

The history of medical treatment in the LGBTQ community is riddled with stigma and discrimination - from the view of homosexuality as an illness to the criminalization of same-sex intercourse.

While policies and discussions have helped improve these perceptions, according to recent research, there is much work left to be done to support the health of queer and trans people, especially in rural areas.

Zac Ramsey, a doctoral candidate at the West Virginia University (WVU) School of Public Health, set out to uncover some of the barriers in healthcare directly impacting rural LGBTQ individuals. He talked to five rural healthcare providers and five researchers who study the LGBTQ population and learned that health encompasses far more than physical well-being.

"These providers and these researchers were really talking about health as a holistic idea," Ramsey said. "Health as your physical, your mental and your social."

This broader definition that connects physical, mental and social health took into account factors like discrimination and heteronormativity that can impact a patient's relationship with healthcare. For example, assuming that a patient is cisgender or heterosexual, while that may not be the case, may lead doctors or healthcare providers to ask the wrong questions or give inaccurate advice.

"Go in without the assumptions and ask the questions, 'Are you seeing somebody,' not, 'Do you have a girlfriend? Do you have a boyfriend?'" Ramsey said. "Having that open language certainly opens the door."

Ramsey said asking open and inclusive questions allows individuals to believe that providers genuinely care about their health.

A specific challenge mentioned by two providers in the study was gaps in health insurance coverage for sexual and gender minorities. For example, many insurance companies do not understand prescribing testosterone to someone whose medical record is labeled female. Similarly, if all the markers are changed to male, insurance companies may not cover necessary procedures like a Pap smear.

Sensitivity training that makes physicians and providers more aware of their language and interactions with patients can lay a foundation to improve healthcare for the LGBTQ population.

"It just comes down to drilling into the individuals to not assume that they understand the patient just from a chart," Ramsey said.

A Social and Emotional Check Up

Beyond primary care, the last few years have been especially fraught, with the Covid-19 pandemic affecting not only physical, but social and emotional health as well.

Deputy director of the University of Minnesota Rural Health Research Center, Carrie Henning-Smith, conducted a study focused on individuals' systems of social and emotional support during the Covid-19 pandemic based on sexual orientation and rurality.

Research shows that being socially isolated or lonely is associated with higher risks of mortality, cognitive decline, hypertension, and a variety of other negative health outcomes. Therefore, social and emotional support are critical to ensuring an individual's ability to be healthy in the long-term.

Within her study, Henning-Smith used data from the 2020 National Health Interview Survey to compare the prevalence of social and emotional support between lesbian, gay and bisexual adults and heterosexual adults, in addition to comparing rural and urban populations. She found that rural lesbian, gay, and bisexual adults reported the lowest levels of having their social and emotional needs met and the greatest decrease in social and emotional support during the pandemic, with 23.5% saying they had less support than they had a year earlier.

"It's hard when you have a small population within a small population," Henning-Smith said. "It's hard to have adequate funding and adequate resources to make sure that you have funded programs and funded resources that you need."

Rural spaces have additional challenges, with fewer resources and fewer people who share the same lived experiences. With high-speed internet and public transportation harder to come by, rural residents are less able to travel and connect with those that might provide them the social and emotional connection they need.

To help increase support for the rural LGBTQ community, Henning-Smith suggested adding more welcoming spaces like community centers, parks or cafes that signal to people that they are safe and accessible. Further, she said anti-discrimination laws in every state need to be put in place to protect peoples' rights.

"There's a tendency to assume that rural places just don't understand LGBTQ issues or that if you're a member of the LGBTQ community you wouldn't want to live in rural places, and that's just absolutely false," Henning-Smith said.

"We know that LGBTQ folks live in every community across the country, so I think urban residents need to see and recognize their community and their peers in rural spaces."

Yasmeen Saadi wrote this article for The Daily Yonder.

People who are part of the Deferred Action for Childhood Arrivals program, known as DACA, will be dropped from their CoveredCA health plans at the end of August.

The move comes after the Trump administration changed a Biden-era definition of "lawfully present" to revoke health care eligibility for thousands of immigrants.

Christine Smith, policy and legislative advocate for the nonprofit Health Access California, said people only have a few weeks to get medical appointments in before their coverage ends.

"If you're enrolled in Covered California and you're a DACA recipient, the Trump administration just ended your coverage," Smith emphasized. "People should use as much of your health care as you can before the August 31st deadline."

The Centers for Medicare and Medicaid Services defended the move, saying it will save taxpayers money. CoveredCA estimated the change affects about 2,400 DACA recipients in the state who make too much to qualify for Medi-Cal and have jobs not providing health insurance. They can still buy private insurance but it is much more expensive. People who prepaid for their coverage can seek a refund.

Smith predicted it will be a blow not just to those who lose coverage but to the state's health care system as a whole.

"The lines in the ERs are going to be longer because people are not going to be able to get affordable preventive care," Smith projected. "They're just going to get sicker and then end up in the ERs. People will overall incur more medical debt. Hospitals will have more uncompensated care."

The change is nationwide. As of mid-July, about 538,000 people in the DACA program across the U.S. are ineligible to enroll in any state-based insurance marketplace and are unable to access premium subsidies or cost-sharing assistance.

Artificial intelligence is appearing more prominently in many aspects of life and research suggests older populations are curious, yet remain wary of using the technology in their everyday lives.

According to Stats Indiana, there are more than 1.5 million Hoosiers aged 65 and older, or 18% of the state's population. Experts said it is likely the demographic will use AI in some form in the next few years, either by choice or necessity.

Dr. Shaun Grannis, vice president of data and analytics for the Regenstrief Institute on Aging, said AI offers real benefits.

"It can reduce loneliness through conversation, provide reminders for medications and appointments," Grannis outlined. "It can support cognitive stimulation via games, storytelling, news updates."

The technology can also offer a low-pressure way to access information on public services, he added, which is valuable for those with mobility issues or those who feel intimidated by technology.

Grannis cautioned any tool which can be used for good can also lead to problems. He noted AI can create a false sense of companionship and mask social isolation. Overdependence is a legitimate concern, he argued, if the technology becomes a "crutch" for all forms of interaction.

"All cognitive activities or decision-making, it can actually lead to and create a negative feedback loop, lead to a decline in engagement and even basic self-management skills," Grannis explained. "This is risky."

Grannis believes one solution is designing AI systems to complement, not replace, human interaction. He stressed it can be done though building broader support ecosystems including family, friends, caregivers and community services. Grannis emphasized it would encourage real-world activity, prompting the user to go for a walk, call a grandchild or attend a local senior event.

If you have an extra five minutes, you can save a life because you can learn cardiopulmonary resuscitation at no cost from a new mobile, hands-only CPR kiosk.

The new kiosk is in the lobby of Saint John's Health Center in Santa Monica. The machine's touch screen gives a brief overview of hands-only CPR and you can practice right there, on a mannequin.

Dr. Rigved Tadwalkar, cardiologist at St. John's, said it is an easy way for people to get more comfortable giving chest compressions in an emergency.

"It's a lot like a video game but of course, a lot more important than a video game," Tadwalkar pointed out. "It gives real-time feedback about the depth and rate of compressions, proper hand placement, which are all factors that influence the effectiveness of CPR."

The American Heart Association operates the St. John's mobile kiosk and a stationary model at L-A-X with support from the hospital. Santiago Canyon College in Orange County also has a mobile hands-only C-P-R kiosk now through September, sponsored by Edwards Lifesciences.

Steven Munatones, an Orange County business owner, said he survived what's known as a "widowmaker" heart attack which led to cardiac arrest nine years ago, thanks to his 17-year-old son, who gave him immediate CPR with instructions from a 911 operator.

"You don't have to put your mouth to anybody's mouth," Munatones explained. "You just put your hand on their chest and pump. He saved me, and others can do the same, anywhere. So, it's absolutely a lifesaving, heroic act that anybody can do."

Statistics show 350,000 Americans suffer from cardiac arrest outside a hospital each year and about 90% die, in part because they do not receive CPR. About 70% of those cardiac arrests happen at home, so people often depend on family or friends to give CPR before an ambulance arrives.