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Position statement: Employment discrimination based on sexual orientation and gender identity

        The American Academy of Nursing opposes discrimination based on sexual orientation and gender identity. This position is consistent with its support for diversity and efforts to eliminate health disparities. Employment discrimination adversely affects physical and mental health (
        Institute of Medicine, Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities
        The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding.
        ;
        • Sears B.
        • Mallory C.
        Documented evidence of employment discrimination & its effects on LGBT people.
        ). By perpetuating social stigma and adding to minority stress, it contributes to health disparities among lesbian, gay, bisexual, and transgender (LGBT) people, including those who have not directly experienced workplace discrimination. Fear of discrimination may discourage many people from disclosing information about sexual orientation to their health care providers (
        • Ponce N.A.
        • Cochran S.D.
        • Pizer J.C.
        • Mays V.M.
        The effects of unequal access to health insurance for same-sex couples in California.
        ) or from completing advance directives and powers of attorney for their partners (
        Institute of Medicine, Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities
        The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding.
        ).
        Employment discrimination negatively influences opportunities for acquiring or keeping employer-sponsored insurance. Although the number of Americans receiving insurance through their jobs has dropped over the previous decade, it remains the primary source of insurance for 60% of Americans (
        State Health Access Data Assistance Center
        State-level trends in employer-sponsored health insurance. SHADAC Report.
        ). LGBT adults are more likely than non-LGBT adults to be uninsured (17.6% compared with 13.2%). This disparity, likely caused in part by employment discrimination (
        • Ponce N.A.
        • Cochran S.D.
        • Pizer J.C.
        • Mays V.M.
        The effects of unequal access to health insurance for same-sex couples in California.
        ), contributes to reduced access to ESI. The Affordable Care Act has increased access to health insurance for LGBT and non-LGBT individuals, but disparity in coverage remains (
        • Gates G.
        In U.S., LGBT more likely than non-LGBT to be uninsured.
        ).
        Federal laws barring employment discrimination do not currently include protection for LGBT people. Only 21 states have laws prohibiting discrimination based on sexual orientation, and only 16 of these also ban discrimination based on gender identity (
        • Pizer J.C.
        • Sears B.
        • Mallory C.
        • Hunter D.
        Evidence of persistent and pervasive workplace discrimination against LGBT people: The need for federal legislation prohibiting discrimination and providing for equal employment benefits.
        ). Many cities and counties also prohibit discrimination based on sexual orientation and/or gender identity, as do policies of many private employers. Discrimination in federal employment is currently barred by a 1998 Executive Order issued by President Clinton (
        • Clinton W.
        Executive Order 13087, Further Amendment to Executive Order 11478, Equal Employment Opportunity in the Federal Government.
        ). In July 2014, President Obama issued an Executive Order that extended this antidiscrimination measure to federal contractors and expanded it to include gender identity (
        • Obama B.
        Executive Order—further Amendments to Executive Order 11478, Equal Employment Opportunity in the Federal Government, and Executive Order 11246, Equal Employment Opportunity.
        ). These Executive Orders, although important, are not fixed in law; they can later be rescinded, and they lack effective enforcement mechanisms.
        Federal antidiscrimination legislation has been introduced in Congress multiple times beginning in 1994, so far without success. The lack of federal law barring employment discrimination against LGBT people leaves millions at risk of losing or being denied employment based on sexual orientation or gender identity.
        Several health professional organizations have adopted position statements opposing discrimination based on sexual orientation or gender identity, including the , the
        American Psychiatric Association
        Position statement on homosexuality and civil rights.
        ,
        American Psychiatric Association
        Position statement on discrimination against transgender and gender variant individuals.
        , the
        American Psychological Association
        Transgender, gender identity, & gender expression non-discrimination.
        , and the
        National Association of Social Workers
        Code of Ethics. Section 4.02: Discrimination.
        .
        The American Academy of Nursing supports efforts to end employment discrimination based on sexual orientation and gender identity, including proposals for federal and state legislation to prohibit such discrimination. The Academy looks forward to working with other nursing and health professional organizations in moving toward this goal as well as on efforts to encourage private employers to adopt antidiscrimination policies.

        Acknowledgments

        The position statement was prepared by the Expert Panel on LGBTQ on behalf of the American Academy of Nursing.

        References

          • American Medical Association
          Policy H-65.992 Continued support of human rights and freedom.
          2007 (Retrieved from)
          • American Psychiatric Association
          Position statement on discrimination against transgender and gender variant individuals.
          2012 (Retrieved from)
          • American Psychiatric Association
          Position statement on homosexuality and civil rights.
          American Journal of Psychiatry. 1973; 131: 497
          • American Psychological Association
          Transgender, gender identity, & gender expression non-discrimination.
          2008 (Retrieved from)
          • Clinton W.
          Executive Order 13087, Further Amendment to Executive Order 11478, Equal Employment Opportunity in the Federal Government.
          1998 (Retrieved from)
          • Gates G.
          In U.S., LGBT more likely than non-LGBT to be uninsured.
          2014 (Retrieved from)
          • Institute of Medicine, Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities
          The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding.
          National Academies Press, Washington, DC2011
          • National Association of Social Workers
          Code of Ethics. Section 4.02: Discrimination.
          2008 (Retrieved from)
          • Obama B.
          Executive Order—further Amendments to Executive Order 11478, Equal Employment Opportunity in the Federal Government, and Executive Order 11246, Equal Employment Opportunity.
          2014 (Retrieved from)
          • Pizer J.C.
          • Sears B.
          • Mallory C.
          • Hunter D.
          Evidence of persistent and pervasive workplace discrimination against LGBT people: The need for federal legislation prohibiting discrimination and providing for equal employment benefits.
          Loyola Univ Los Angeles Law Review. 2012; 45 (Retrieved from): 715-779
          • Ponce N.A.
          • Cochran S.D.
          • Pizer J.C.
          • Mays V.M.
          The effects of unequal access to health insurance for same-sex couples in California.
          Health Affairs. 2010; 29: 1539-1548
          • Sears B.
          • Mallory C.
          Documented evidence of employment discrimination & its effects on LGBT people.
          2011 (Retrieved from)
          • State Health Access Data Assistance Center
          State-level trends in employer-sponsored health insurance. SHADAC Report.
          2013 (Retrieved from)