Thanks for publishing my photo, in this lovely book: Gay & Lesbian History for Kids, by Jerome Pohlen

Gay and Lesbian History for Kids covers  09455
Gay and Lesbian History for Kids cover 09455 (View on Flickr.com)
Gay and Lesbian History for Kids covers  09454
Gay and Lesbian History for Kids cover 09454 (View on Flickr.com)
Celebrating a new America #lovewins 58242
Celebrating a new America #lovewins 58242 (View on Flickr.com)

Amazon link: Pohlen Jerome. Gay & Lesbian History for Kids: The Century-Long Struggle for LGBT Rights, with 21 Activities (For Kids series). Chicago, Ill. : Chicago Review Press; 2015.

I didn’t know that the author of the poem “America,” Katherine Lee Bates, whose work was later set to music and became “America the Beautiful” was probably a woman who was a lesbian.

Or that the origin of the high five in 1977 was professional baseball player Glenn Burke, who was the first to come out as gay.

Or that Sally Ride, the first woman in space and the youngest American in space, was survived by her partner Tam O’Shaughnessy, who accepted her Presidential Medal of Freedom.

Or that as many as 1,000 people born as females served as men in the civil war, including Albert Cashier, who lived as a man but was forced to wear a dress until he died, with his authentic name on his headstone (“Albert D.J. Cashier”).

I was introduced to this book by its author, Jerome Pohlen, who asked to use a photograph I took on its back cover (the answer to these questions is always yes).

The book is full of stories of the shaping of much of the world’s art and literature by LGBT individuals, as Pohlen describes. From pieces and works of beauty and social importance (the outlawing of child labor) to the ridiculousness of bias (the US Postal Service regulations that only gay and lesbian themed books could be mailed if the subjects in them came to an unhappy end), there’s a rich accounting of the history of this minority population.

The importance, challenge, and responsibility of struggle

‘Why are we being intimidated by a bunch of jerks who don’t know anything about life? Who are they to tell us what we feel and how we’re supposed to behave? … Why not sort of dish it back and start talking openly?’ – Allen Ginsberg

And yet, within the community there was tension over how much was reasonable to ask for, how much of a group’s destiny should they be able to control. We know now that the answer is “everything” and “all of it.”

Pohlen, I think, describes well that it was the less comfortable, more vulnerable members of the LGBTQ community who led the fight (and win) for equality. It’s an important lesson for all people who seek authenticity and livelihood – connect with all members of your community, there’s always something to learn.

I paid close attention to the way in which transgender people were described in the book, and sensed an acknowledgement and respect of the contribution.

At the same time, I was not reading the book to make sure this or that organization or event was captured – in my mind this is not supposed to be a reference. It’s an educational guide, that stimulated me to do research on my own and revel in our history. I probably need to come out of the closet about the fact that I am a history geek – can you tell from the pages of this blog… 🙂 .

A journey that is not yet over

The next wave of equality has only just begun, today’s contemporary heroes aren’t being written about yet in books (which Pohlen acknolwedges), but they will one day.

As I read the book, I can’t believe that I have been in some of the places where history happened, and met some of the heroes described. The photograph used on the back cover was a moment that will live forever in time – a place, a house, THE home to so much exclusion that suddenly bore the colors of acceptance, made people gasp in silence.

I am posting a few photographs that I’ve either collected or taken in the places where the world learned to love better below. As it was said in this documentary of Marsha P. Johnson:

History isn’t something you look back and say it was inevitable … it happens because people make decisions that are sometimes very impulsive and of the moment, but those moments are cumulative realities…

The cumulative realities are breathtaking.

Spoiler alert

There are so many untimely deaths and painful tragedies described in the lives of the people who made such a difference for others. Glenn Burke, the originator of the High Five, had his career cut short (age 27) and died homeless of AIDS in 1995, one of millions who had and have so much potential to help the human race thrive.

However, the only change I would make to the book is to put one of the last passages in as one of the first passages:

First, the LGBT community has never given up on a struggle, even if it took decades to achieve. And second, in the end, they always win.

Thanks for the great book – it’s for adults, too.

Respecting all genders in an online Health Risk Appraisal: Kaiser Permanente’s new Total Health Assessment

Kaiser Permanente just launched its new Total Health Assessment on kp.org, with choices that respect the genders of our members. Here’s a screen shot:

Digital Health Coaching kp.or all genders respected 2015

When a user selects “Transgender or Gender Non-conforming” as their gender they will then select whether they would like screening information relevant to male or female biology:

Digital Health Coaching kp.or all genders respected 2015-2

The Innovation Story
The story behind this important change started with a person, a patient, who brought the disparity of a gender binary health risk appraisal to the attention of their employee benefits board, who requested Kaiser Permanente review for our members.

Upon review, we agreed that our current Total Health Assessment did not accomodate the gender spectrum of our members and initiated a conversation with its manufacturer, Johnson and Johnson Health and Wellness Solutions. With the facilitation of Doug Nau, in Kaiser Permanente’s Digital Services Group, KP worked with the physicians and health educators at Health and Wellness Solutions to craft this solution.

Now a part of the core product
Doug informed me that based on this work, Johnson and Johnson Health and Wellness Solutions has decided to make this part of their core product for all of their clients.

Doug said it best: “Scored a win here – its for everyone!”

I wrote previously about changes made to our Healthy Workforce Platform (Kaiser Permanente’s Healthy Workforce digital platform to respect all genders), impacting close to 200,000 people who power Kaiser Permanente.

This improvement impacts all of the 10,000,000+ members of Kaiser Permanente, and I assume/hope every patient in every health system who has access to this digital health coaching solution.

It’s important because many employers incentivize their employees to complete a/the Total Health Assessment in the interest of their good health.

Total Health for all, leadership by all
Respecting a person’s gender identity and providing accurate recommendations helps everyone achieve their health and life goals and sends an important message about inclusion. One of the most important roles of the physician is to recognize, acknowledge, and respect the patient. Their electronic systems should do the same.

The other important thing that helps everyone achieve their health and life goals is the ability to control their own destiny. I want to acknowledge Brenda McComb, PhD, Dean of the Graduate School of Oregon State University for her leadership in making this happen. When I asked if it was okay that I mention her, she said, “Ok by me to mention me but it is not just me of course. It is all of us pushing for change.” Duly noted and conveyed.

This experience is showing us that change happens, and it is being led by the members of the LGB and especially Transgender communities themselves. Isn’t the 21st Century marvelous? 🙂

As usual, comments and ideas welcome, feel free to post them below.

Just Read: Eliminating physician biases against gay and lesbian people, don’t forget the “T”

This is a study from Yale University about medical students’ explicit and implicit attitudes toward people who are gay and lesbian. Not surprisingly, medical students reflect the biases of the society around them:

Explicit and implicit attitudes among medical students 54443
A lot of bias: Explicit and Implicit attitudes among medical students against gay and lesbian individuals (Where’s the “T”?) (View on Flickr)

I created the chart above from the study data which shows that a little less than half of medical students today harbor openly negative attitudes toward gay and lesbian people. When looking at their unconscious attitudes, that jumps to 82 %.

This is about the same percentage as adult physicians’ negative implicit attitudes toward latino individuals, but more negative than adult physicians’ attitudes toward african american people. (see: Blair I V, Havranek EP, Price DW, et al. Assessment of biases against Latinos and African Americans among primary care providers and community members. Am. J. Public Health. 2013;103(1):92–8.)

What you do with it that matters

This data obviously doesn’t make people feel good about their potential treatment in health care, which can be hostile bordering on brutal (I’ll post on that in the near future).

What’s more important is that physicians and the profession in general should desire to know their biases, and do something about them. The researchers in the first paper correlated attitudes to prior contact with gay or lesbian individuals, and found that, indeed, having had positive contact was protective, as has been shown in the literature for many years.

In other words, there are things that can be done, we should not be disappointed that bias exists, we should be disappointed if it is allowed to continue unmodulated.

Enter the “hidden curriculum”

The commentary piece attached to this one brings up, again (for the nth time this month alone – must be newly popular?), the concept of the “hidden curriculum,” which has been foreign to me as a non-academic, so I appreciate it being defined here:

The compilation of implicit biases, explicit biases, institutional climate, and ingrained behaviors at an academic health center also form the foundation of the institution’s hidden curriculum, or what health professions trainees learn from what they observe and experience rather than what they are overtly taught.

This doesn’t strike me as good news, since recent research shows that the hidden curriculum seems to be promoting rather than eliminating bias (see: Just Read: Sexual and Gender Minority Identity Disclosure: “In the Closet” in Medical School | Ted Eytan, MD). For example this quote:

On my surgery rotation, we saw a male- to-female transgender patient who had “do-it-yourself ” silicone breast implants which had become infected. He [sic] was treated like a freak by the residents and attendings behind closed doors, joking at his [sic] expense. (25-year-old, third-year, lesbian, white, female, U.S. MD student)

I’d like to point out that the researchers in the study above didn’t get the pronouns right themselves when they transcribed the quote, so bias is quite pervasive.

There’s no “T” in this discussion of “LGBT”

I used the quote above to point out that while the topic of the commentary piece is “anti-LGBT” bias, bias against people who are transgender or non-conforming is not mentioned once.

The study of medical student bias did not address this bias (against transgender or gender non-conforming individuals) at all. There is currently no implicit attitudes test for people who are trans or gender non-conforming, but I understand one is being developed. It would have been useful to at least ask about explicit bias for this group, because if we think about the harm to gay and lesbian people in health care, imagine the special harm that people who are transgender face. I diagrammed it out here to assist:

Impact of implicit and explicit bias in the health of transgender persons 54442
Impact of implicit and explicit bias in the health of transgender persons (View on Flickr)

I’m wondering if academic medicine is going to follow, rather than lead, in changing the profession.

In my glass 3/4 fullness, that’s okay, the rest of us are here and we have accountability too. We have to change the health care industry’s position on providing medically necessary care, so that care is provided routinely in the first place.

In addition we need to bring a human understanding to the lives of the people we are serving, which seems quite lacking. That’s what #KPLantern is working to accomplish. Watch this space for updates 🙂 .

Papers cited:

Burke SE, Dovidio JF, Przedworski JM, et al. Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People Among Heterosexual First-Year Medical Students? A Report From the Medical Student CHANGE Study. Acad. Med. 2015.

Fallin-Bennett K. Implicit Bias Against Sexual Minorities in Medicine: Cycles of Professional Influence and the Role of the Hidden Curriculum. Acad. Med. 2015.

Just Read: Blindspot: Hidden Biases that shape, and could fix, society

Blindspot: Hidden Biases of Good People Mahzarin R. Banaji (@banaji) & Anthony G. Greenwald (via Amazon.com) | (Via your local library)

(The phrase “fix society” is a reference to the tragic death of Leelah Alcorn in 2014: Transgender teen who died of an apparent suicide: ‘Fix society. Please.’ – The Washington Post)

The topic of implicit or unconscious bias is integrated into a lot of the work I am doing today. I did a pretty exhaustive review of the research last year in preparation for this presentation (Presentation: Being a Transgender Ally and Unconscious Bias ). I am about to give a refreshed version of the presentation to fellow clinicians at Kaiser Permanente (which I’ll post here).

I figured it would be a good idea to read the book version of all the papers I read and the experts I spoke to last year (much of it chronicled here, many many posts…). This is that book.

I think this is a hard topic to grasp unless you dive in, but here’s a good overview:

Reflective or explicit attitudes are those that we are aware of having (for example, Mahzarin knows that she likes Star Trek, and Tony knows that he likes bebop), while automatic or implicit attitudes consist of associative knowledge for which we may lack awareness (for example, old = bad, shared by Tony, Mahzarin, and apparently 80 percent of everyone else). The two forms need not agree, which is a circumstance called dissociation . For example, explicit or reflective “I like elderly people” can exist in the same head with implicit old = bad.

Banaji, Mahzarin R.; Greenwald, Anthony G. (2013-02-12). Blindspot: Hidden Biases of Good People (Kindle Locations 3074-3078). Random House Publishing Group. Kindle Edition.

The other important thing to know is that the study of implicit or “unconscious” bias is not a niche activity confined to doctors.

http---www.cbsnews.com-news-ferguson-policing-eric-holder-implicit-explicit-racial-bias-(20150321)

Even Eric knows it (View Source)

Actually it’s almost the opposite, with rich application in a wide variety of professional settings, most notably, the law, as well as the military. If anything, medicine, sadly, lags behind these other disciplines in applying knowledge about how the mind works.

For me, the book ended abruptly, as I had delved deeper into the topic last year (and did a follow-up review this year), and applied it in a place where it hasn’t previously been thought of, in the health of people who are lesbian, bisexual, gay, or transgender (or a combo).

However, if this is unfamiliar territory to you, start here, with this book.

What was helpful for me was the concept of identity. For the KP Lantern project, we recently did a group empathy exercise where we were asked a simple question:

How and when did you first know your gender identity?

…which really raises a lot of other questions, like where does a person’s identity come from in the first place? From the book:

…to the rapidly developing brain of the infant, which is acquiring new stores of knowledge at an exponential rate, each such interaction is a building block, reinforcing the foundation on which a more fully formed social being will one day stand. The name we give to this foundation is identity, and unique as each individual is, identity is deeply bound to the characteristics that are true of “us” as a group and differentiated from “them.”

Banaji, Mahzarin R.; Greenwald, Anthony G. (2013-02-12). Blindspot: Hidden Biases of Good People (Kindle Locations 1953-1956). Random House Publishing Group. Kindle Edition.

Gender is a strong basis for identifying oneself as a member of a group, male and female being among the earliest social category distinctions that children make. At different points in development, a child comes to know that she is, for example, female, Irish, middle-class, brown-eyed, and athletic.

Banaji, Mahzarin R.; Greenwald, Anthony G. (2013-02-12). Blindspot: Hidden Biases of Good People (Kindle Locations 1977-1978). Random House Publishing Group. Kindle Edition.

The studies of infants and young children in the book are fascinating and adds layers and layers onto ideas about things that I formerly accepted as just a given in human development.

The cornerstone of measuring implicit attitudes is the Implicit Association Test (IAT) (@ProjectImplicit), which works in magical (based on science) ways by gently short circuiting the parts of your brain connected to your stereotypes and categories of things around you. If you don’t know where to start, start by taking one of the tests, you’ll see what I mean.

I recently posted my IAT results on this blog. It’s almost a certainty that if I repeated the tests, the results would be same (and I actually did repeat the gay/straight test, with the same result).

So a person is biased, so what?

Two answers to that question:

1. Yes, so what? That’s the nature of humanity & it’s boring (to paraphrase one of the experts I spoke to).
2. What’s exciting is what you do with that knowledge, and you can do things.

The book doesn’t delve into what can be done as much as a physician type might want to (we’re programmed/biased to look for the treatment plan), but things can be done.

From modifying our own biases, to the prize, modulating and eliminating them in society.

The benefit of that is huge – all of the behaviors modulated by our biases that we are unaware of can go from preventing human potential to promoting it.

Vivienne Ming, PhD (@NeuralTheory) and I will be discussing this very topic at the upcoming XX in Health event in New York. (@XXinHealth).

The first step is to know.  I’m glad I do.

Most people, we’ve discovered to our happy surprise, would rather know about the cracks in their own minds. In the same way that they would want to know about a high level of blood cholesterol so that they can take action against it, they wish to confront potentially harmful mental content.

Banaji, Mahzarin R.; Greenwald, Anthony G. (2013-02-12). Blindspot: Hidden Biases of Good People (Kindle Locations 926-928). Random House Publishing Group. Kindle Edition.

“What good is intelligence if you cannot discover a useful melancholy?” the Japanese poet Ryūnosuke Akutagawa is said to have asked, by which he meant that knowledge that provokes a feeling of distress is only of value if it can be put to some use.

Banaji, Mahzarin R.; Greenwald, Anthony G. (2013-02-12). Blindspot: Hidden Biases of Good People (Kindle Locations 1076-1078). Random House Publishing Group. Kindle Edition.

Just Read: The Next America: Boomers, Millennials, and the Looming Generational Showdown

I don’t know where I came across this book by Paul Taylor (@paultaylordc) from the Pew Research Center (@PewResearch) but I did, and it combines a lot of interests of mine (and a lot of other people). Specific to me, an ongoing following of the Pew Internet (@PewInternet)’s former researcher and brilliant community colleague in DC, Susannah Fox (@SusannahFox), and a lot of work I’ve done in diversity and inclusion as well as technology, that has caused me to read a lot of the reports cited in the book. So it’s in one package here, which is great.

I’m going to make a small editorial comment in the era of open leadership which is that I’m confused by the extremely restricted copyright notice in the book itself, which is paired with an extremely un-restricted embed-as-you-please approach on the Pew Research site itself. So I’ll respect the book of course, but embed from the site. I think the book adds some helpful comparisons over time of the type “When Gen X was Gen Y’s age…” which is important.

Actually this is the only quote I’d like to share:

As a people, we’re growing older, more unequal, more diverse, more mixed race, more digitally linked, more tolerant, less married, less fertile, less religious, less mobile, and less confident .

Taylor, Paul; Pew Research Center (2014-03-04). The Next America: Boomers, Millennials, and the Looming Generational Showdown (Kindle Locations 157-159). PublicAffairs. Kindle Edition.

This is a good setup for the book, which walks the reader through the changing demographics of our country. Very helpful in understanding the importance of immigration to our future, as well as mythbusting about the institution of marriage, which has been in decline farther and faster than before the LGBTQI community came to it

The Generations

As is the case in the study of demography these days, Generation X is ignored, it’s all about the Baby Boomers and the Millenials. No big deal. I choose to interpret based on the data that Generation X is a lot closer to Millennials in social circumstance and attitudes than it is to the Baby Boomer generation.

Just one more quote that I thought intriguing:

The sheer size of the Boomer cohort has led to a lifetime of stressful intragenerational competition for a limited share of top spots in schools, colleges, and careers.

Taylor, Paul; Pew Research Center (2014-03-04). The Next America: Boomers, Millennials, and the Looming Generational Showdown (Kindle Locations 592-594). PublicAffairs. Kindle Edition.

This is not the situation for Generation X, of course.

The Gini Coefficient and Income Inequality

I was introduced to the Gini Coefficient which is a measure of income distribution (inequality), closer to 1 is more unequal, and I did a little searching. It seems that there are different estimates of the U.S.’ number. The U.S. Census number is .4811, where others like the World Bank and the OECD come up with a more moderate number.

I don’t have a preference for either, I’m embedding the OECD numbers below, because they show the comparison which shows big differences between countries. Hint: look at France.

Diversity, inclusion, generational change

The picture here is pretty clear. In the area of acceptance, the world is learning to love better. Two relevant charts below:

Growing Support for Same-Sex Marriage across Generations
How the Generations See Themselves

Of note, I couldn’t help noticing the congruence of these two quotes, from very different people.

“If We Want People To Like Us, We Have To Like Them First” – Bobby Jindahl, Governor of Louisiana

and

“At the end of the day, if you are for the community, you love the community, and you help the community grow, it will show you the love you show it,” – Mally H, a 21 year old transgender woman, in Washington, DC

Just something to think about, which is that it appears that everyone agrees, love always wins 🙂 .

Photo Friday: Washington, DC USA, 1968 and 2014

I have been learning how to combine photos recently, and I am a fan of everything Washington, DC, history, and diversity, so….

Only one of the two photographs in the composite is mine. The other was taken on April 4, 1968, the day Martin Luther King, Jr. was assasinated. Unbeknownst to me (until recently), one of the most popular hangouts for the LGBTQ community in Washington used to be a photographic studio.

The 1968 photo comes from an amazing collection now housed at the Library of Congress. I decided to leave the 2014 joggers in the image to convey a healthy respect for the sacrifices that were made by those who came before us. It’s part of the reason I came to Washington, DC in the first place, to learn and observe.

Detailed description and links below.

A crowd mills in and around Sabin’s Records at 9th & U Streets NW, Washington, D.C. after the assassination of Dr. Martin Luther King Jr. on April 4, 1968. Note plywood being handled on the 9th Street side of the building. 

This viewpoint is from the offices of Scurlock Studios at 900 U Street looking toward the northwest corner where U Street intersects 9th Street NW. At this intersection Florida Avenue runs to the East and U Street runs to the West while 9th Street runs north and south. 

Part of the WUST radio station can be seen on the building one block north on 9th Street at V Street NW. The city exploded in anger at the news and experienced among the greatest property damage of the more than 110 cities that erupted April 4-7, 1968 and set a then U.S. record for mass arrests when more than 6,100 were detained. 

Twelve died, mostly due to becoming entrapped in burning buildings and over 1,100 were injured. Property damage was extensive as corridors and 14th Street NW, 7th Street NW, U Street NW, H Street NE and Nichols Ave SE (later Martin Luther King Jr. Ave) were set afire. 1,200 buildings were burned. 

For more information and related images, see flic.kr/s/aHsk4zGPDw Photograph by George Scurlock, Scurlock Studio. Courtesy of the Smithsonian Institution, National Museum of American History: Archives Center.