This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Earlier this year, a broad coalition of Michigan LGBTQ+ leaders collaborated in seeking state funding to help decrease health disparities experienced by Michigan's 400,000+ LGBTQ+ residents. On Aug. 24, they celebrated success. Their efforts resulted in $10 million being earmarked in the state's 2023-2024 budget to reduce those disparities, the first state investment of its kind. The funds will directly support the work of community-based organizations that are already providing health-related services to LGBTQ+ Michiganders.

"Anytime you're dealing with a population that has generationally and perpetually had very little access to care, let alone to quality care, you're going to run into health disparity issues," says Angela Gabridge, coalition co-chair and executive director of MiGen, a Ferndale nonprofit serving Michigan's LGBTQ+ elders. 
Angela Gabridge and MiGen Program Director Kat Mehrer.
Gabridge notes that the National Institutes of Health designated sexual and gender minority populations as a health disparity population in 2016.

"Factors that contribute to that include lower utilization of health services, not feeling safe or comfortable sharing gender or sexual identity with health care providers, stigmatization of identity or sexual orientation, and, of course, outright discrimination by health care providers," she says.
 
Gabridge cites a 2022 survey of more than 5,000 LGBTQ+ people across the United States, in which 56% of gay, lesbian, and bisexual respondents and 70% of trans and non-binary respondents reported experiencing discrimination in health care. Those percentages disproportionately increased in populations of color and among older adults.
 
"You have communities that are traditionally marginalized and are economically in a much different position than the general population, far more likely than the general population to be under-employed or unemployed, underinsured, or uninsured," Gabridge says. "We particularly have a lot of older folks who wouldn't have had access to partner and spousal benefits, as well. That has resulted in economic and other social determinants of health disparities."
 
MiGen was just one of numerous coalition members that created the funding request and presented it to the state. The others included ACLU of Michigan, Affirmations LGBTQ+ Community Center, Corktown Health, Equality Michigan, Gender-identity Network Alliance, Great Lakes Bay Pride, Jim Toy Community Center, LGBT Detroit, OutCenter SW Michigan, Outfront Kalamazoo, Ruth Ellis Center, Salus Center, Stand with Trans, Transgender Michigan, and Trans Sistas of Color Project. The Michigan Department of Health and Human Services will decide how to distribute the funds to qualified community-based organizations.
 
"Many things about this are really exciting," Gabridge says. "Obviously, it's historic. This is the first time the state of Michigan has done any sort of allocation within the state budget specifically for LGBTQ+ communities. Another part that's incredibly exciting is that this large coalition of LGBTQ+ organizations and stakeholders statewide worked together in order to advocate for the creation of this allocation."
 
Also located in Ferndale, coalition member Affirmations LGBTQ+ Community Center has been a hub for southeast Michigan LGBTQ+ communities for the last 30 years. Affirmations Executive Director and coalition co-chair Dave Garcia says the community's health needs have grown significantly in recent years.
Dave Garcia.
"Significant health disparities exist for Michigan's LGBTQ+ residents, especially mental health disparities. Our programs have expanded a lot, especially since COVID," Garcia says. "We didn't do our food programs at Affirmations until COVID. Now, we're doing food banks all the time. There is also homelessness in our community, significantly more than in the straight community. We're trying to meet those homeless needs, as well."

Garcia sees a lot of health disparities among the people Affirmations serves, disparities that are exacerbated for those seeking transgender and transitioning health care, which he believes is largely ignored by the health care industry.
 
"A lot of the disparities exist because of discrimination that our community faces in society in general, but also in the health care system," Garcia says. "I think there is a lack of cultural competency, a lack of scientifically accurate information and care. There's no escaping the discrimination that our community faces on so many different levels, from the time that young people are in school all the way through our seniors. One of our largest groups that needs Affirmations is our seniors."
 
Garcia shares that many LGBTQ+ older adults have lost jobs and lost families. When they lose a partner, they rarely have the same social security benefits that the straight community has.
 
"They end up going into an assisted living facility, and often those facilities are religion-based. Often, they go back into the closet in the last years of their life," Garcia says. "We need to be training health care workers to be better advocates and caretakers of our communities."
 
Because same-sex marriage was not legalized nationwide until 2015, older LGBTQ+ adults only recently gained rights to access partner and spousal benefits. Stigmatization of gender identity and sexual orientation was also much higher in prior generations than it is now.
 
"Here at MiGen, when we say LGBTQ+ older adults, we say ages 45 and up, and I think that gives a lot of people pause," Gabridge says. "People say, '45? Oh my gosh, why so young?' It's for a variety of reasons. One is that LGBTQ+ folks are far more likely than non-LGBTQ+ folks to be in a caregiving role. And sadly — and this is where the health-disparities piece comes into play — our communities are far more likely to experience chronic conditions, life-threatening conditions, comorbidities, and other health disparities at much younger ages than the general population."
 
Younger LGBTQ+ populations endure health disparities, as well. In Detroit, the Ruth Ellis Center provides trauma-informed services to LGBTQ+ youth and young adults with an emphasis on young people of color as well as young people who are experiencing homelessness, involved in the child welfare system, or experiencing barriers to health and well-being.
 
Jeynce Poindexter.The center's Integrated Primary Health Services, provided in partnership with Henry Ford Health, include general medical issues, chronic medical issues, vision and hearing screening, STD testing, HIV prevention, testing, and guidance, transition care, and birth control. The center's Integrated Behavioral Health Services, contracted through Detroit Wayne Integrated Health Network, provide individual, family and group counseling, substance use disorder prevention and treatment, and case management. Ruth Ellis Center case worker and coalition co-chair Jeynce Poindexter says that all of these programs will be able to increase capacity thanks to the new state funding.
 
"That's the beauty of the situation that we're in. It's already written in the budget," Poindexter says. "We're not trying to reinvent the wheel or come up with fresh ideas. What we want to do is invest into those programs that already exist."
 
Poindexter also works with the Ruth Ellis Center's housing program and is vice president of the Trans Sistas of Color Project, another coalition member. In all the various capacities in which Poindexter serves Michigan's LGTBQ+ community, she says the impact of the new funding will be profound.
 
"As you can imagine, I get to witness firsthand the effect and the impact of the disparities," Poindexter says. "And let's be clear, these disparities are even deeper than the statistics or what even I can translate, because these are disparities that have not been addressed and acknowledged for years, ever, in the way that they are being acknowledged with this $10 million."

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Angela Gabridge photos by Nick Hagen. All other photos courtesy of the subjects.