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In March 2017, the Administration for Community Living (ACL) in the Department of Health and Human Services (USDHHS) announced that it would exclude the single question about sexual orientation (SO) that had been introduced at the federal level in 2014 in the National Survey of Older Americans Act Participants (NSOAAP). The Older Americans Act provides, among other services, meals, transportation, and financial support to people older than 60 years who need them the most. The national survey identifies health needs and services for the recipients of Older Americans Act services. The SO question simply asks whether the respondents identify themselves as lesbian, gay, bisexual, or straight.1
The ACL argues that it is struggling with the small number of participants who identify themselves as lesbian, gay, or bisexual (LGB), and has not even released the data collected over the past three years (bit.ly/2ntXyXl). The ACL has asked for public comments. This dossier is AJPHs contribution on whether, from scientific and ethical perspectives, a low response from the older LGB community in the NSOAAP justifies the erasure of the question.
RATIONALE FOR THE QUESTION
Kathy Greenlee (p.1211), who previously served as the US Assistant Secretary for Aging and Administrator of the ACL from 2009 to 2016, under USDHHS Secretary Kathleen Sebelius, opens this dossier by explaining that the SO question of the NSOAAP was carefully tested and implemented to remediate the dearth of data about the existence of older LGB participants. Without these data the administration cannot "accurately and meaningfully" improve their lives and health.
Greenlee, likely the most knowledgeable person about the SO question in the NSOAAP, is opposed to its abrogation (p.1211).
THE SCIENTIFIC ISSUE
The targeted sample size of NSOAAP is small. One data set I downloaded from its Web site for 2015 had about 1000 participants (Case Management, bit.ly/2ntXyXl). If, say, 5% were lesbian, gay, or bisexual, there would be an expected 50 people per year.
This number is comparable to numbers in race subcategories. For example, in that data set, there were 14 Asians, 35 American Indian and Alaska Natives, five Native Hawaiian or other Pacific Islanders, and 23 of other races
THE ETHICAL ISSUE
Government sampling has an important symbolic value. If certain populations are not included, especially when they previously...