You have our best wishes for success and our cooperation as you assume your responsibilities as Health and Human Services (HHS) Secretary. We, the undersigned, believe HHS needs to embrace a comprehensive diversity that includes LGBT (lesbian, gay, bisexual, transgender) employee participation and recognition of LGBT as an integral component to American public health. This memorandum suggests policies and actions to support that goal. PUBLISH YOUR COMMITMENT TO DIVERSITY AND NON-DISCRIMINATION. You can base your policy on Secretary Shalala's memorandum for all employees to include the establishment of LGBT special emphasis program managers with budget authority in each operating division. Your public commitment, which explicitly prohibits discrimination on the basis of sexual orientation, can expand the definition to include protection for gender identity and gender expression. * Include Federal GLOBE (Gay, Lesbian, Bisexual, Transgender Employees, www.fedglobe.org) or any HHS agency GLOBE group as a Special Emphasis Group for all HHS agencies. * Provide all managers and supervisors a copy of OPMs Guide to Employee Rights material from Addressing Sexual Orientation Discrimination in Federal Civilian Employment. Place it on HHSs and all HHS agency internal web pages to provide access to its information for all employees, with mandatory annual training on this guidance. (www.opm.gov/er/address2/Guide01.htm) * Ensure all employees may access family and medical leave, including employees with a familial relationship that is not recognized currently by law or created by blood ties. * Clarify that households not related by blood, legal marriage, or adoption qualify for relocation assistance on the same basis as families related by blood, marriage or adoption (e.g., domestic partners). * Support HHS employee rights to add family members not related by blood or marriage (e.g., domestic partners) to health, dental, vision, and long-term care insurance and for retirement benefits, survivor benefits and Social Security benefits on the same basis as HHS employees whose families are related by blood or legal marriage. * Ensure all union contract renegotiations include a policy of non-discrimination based on sexual orientation and gender identity. ADDRESS NONDISCRIMINATORY USE OF HHS RESEARCH AND SERVICES FUNDING. Our agency funds research on human health, recommends best practices and policies for prevention and treatment, funds mental and physical health services, and provides health insurance coverage to children, seniors, disabled, and indigent Americans. HHS guidelines should prohibit discrimination based on sexual orientation or gender identity/expression throughout HHS-funded programs, recognizing the constraints of specific health issues and/or scientific aims. HHS should ensure all Funding Opportunity Announcements are non-discriminatory and include LGBT concerns where appropriate. Many issues appear in the HHS draft report, Strategic Plan on Addressing Health Disparities Related to Sexual Orientation, developed toward the end of the Clinton Administration; however, no action has been taken since that time. We ask you to refer to and finalize it as part of your efforts. The following are four important examples: * Lesbians constitute a medically underserved population given their lower pay scales, and propensity to have minimal or no employer-provided health insurance. The majority male healthcare system increases the opportunity for these women not to seek services. Lesbians have higher prevalence of breast and cervical cancer and lower prevalence of health coverage than many other female groups. This can lead to increased strain on the social welfare system including but not limited to hospital indigent care fund and Medicaid. The Institute of Medicine supports this as its members, along with the American Public Health Association, have advocated for lesbian inclusiveness since 1999. * Between 20 and 40 percent of homeless youth are LGBT; their suicide attempts are four times that of heterosexually-identified youth. The situation is particularly severe for youth whose parents renounce their LGBT children and for youth who age out of foster care. Research projects and best-practices programs to help adolescents, including LGBT youth, can assist their development. Family-oriented programs that provide knowledge and tools, such as negotiation skills, to parents and their children, can reduce suicides and homelessness to preserve American families and reduce demand for social welfare benefits of children who remain with their families. * Gay and bisexual men constitute the single American population that has experienced increases in HIV infections in recent years, particularly among Latino and African-American young men. This is an ominous trend as many Latino and African American men have relationships with men AND women. For example, African American, HIV-infected heterosexual women often report having intercourse only with a single male partner. * Aging issues negatively affect LGBT adults at a greater rate than their heterosexual counterparts. The MetLife 2006 study, Out and Aging: The MetLife Study of Lesbian and Gay Baby Boomers, found that individuals ages 40 to 61 who identify as LGBT provide care to LGBT elders at higher rates than do the general population. One in four LGBT respondents reported providing care to an adult friend or loved one within the last six months compared to only one in five of the general U.S. population. Due to a lack of relationship recognition for same-sex couples, the LGBT community is faced with barriers in the healthcare industry that can make the circumstances of care giving even more stressful, leading to higher burnout rates among same-sex couples, and other loved ones of LGBT citizens than among heterosexual couples. The Obama Administration begins to lead during challenging times that empower Americans to think and act in new inclusive ways. We at HHS can achieve this vision only when the Department can rely on all available human resources so we provide equal access to health programs to all Americans. The goals outlined in this memo will strengthen the Department for HHS employees and all we serve. To create a more fair and productive HHS, we ask for an opportunity to discuss these issues with you and to provide you with resources to assist you in this important work for all Americans.