Long considered a nationwide leader in tolerance, San Francisco has taken a step further by creating what appear to be the first health system social-identity guidelines and policies in the U.S.
The Health Commission on Tuesday unanimously approved The City's first systematic sexual orientation guidelines in an effort to establish a consistent way to collect such information on patients. The policy will help doctors better understand what risk factors exist for San Francisco residents of all sexual orientations, according to health officials.
"This kind of information is not systematically collected anywhere else that we're aware of," said Dr. Tomas Aragon, health officer of San Francisco. "We've been asking since I can remember people's sexual orientation, but when it was asked, it was put into narrative notes. It wasn't a systematic collection of data."
Analyzing such patient background is important because health needs differ among various ethnic groups, sexes and genders, and sexual orientations, according to Aragon.
"Sexual orientation is a predictor of certain health outcomes," he said. "The distribution of health outcome varies by different risk groups."
For instance, men who have sex with men tend to be most impacted by HIV, Aragon explained. But until the guidelines are implemented, "sexual orientation isn't systematically collected in records in a way that allows you to analyze the data and determine the health needs," he said.
The guidelines -- which have been researched and evaluated for about two years with input from LGBT groups and academic groups at San Francisco State University -- follow two previous revolutionary social-identity policies established by The City: procedures for documenting ethnicity passed in 2011, and sex and gender in 2013.
"We thought there should be a policy about when it's asked, how it's asked, [and] at the same time recognize that it's a changing thing," Maria X. Martinez, senior staff to the director of health, said of the gender policy.
The sex and gender guidelines, for instance, require that patients are first asked about their gender. Patients are then requested to disclose their sex at birth. Ethnicity guidelines also call for a patient's ethnicity to be self-identified.
"It's important that people be able to see themselves and that they self-identify," Martinez explained. "[Gender and ethnicity] should be identified by the individual, not by someone else looking at them."
The City began exploring an ethnicity policy in 2006 and a sex and gender policy in 2008 as a way to streamline the collection, coding, reporting, interpretation and use of social-identity indicators.
Sexual orientation guidelines, which were first studied by health officials in 2012, are intended to help The City design its services and improve health outcomes for patients.
Also at Tuesday's meeting, the Health Commission for the first time heard proposed eligibility changes to the public health care option Healthy San Francisco that would align the service with the Affordable Care Act and seek to minimize gaps in health care coverage for residents.
The Health Commission is scheduled to vote on the proposed changes to Healthy SF at its Oct. 7 meeting.
Meanwhile, the commission on Tuesday unanimously passed a resolution in support of providing health care services to unaccompanied immigrant children fleeing Central America. Unaccompanied immigrants over 18 years old can now be enrolled in Healthy SF, with minors receiving pediatric care via The City's Healthy Kids program.
"This resolution I think speaks to the fact that as a commission and as a department, we welcome with open arms these people to get their care," said Dr. Edward Chow, the commission's president.