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Breakout Session 3a

“From the Waiting Room to the Patient Room” by Karen Nicosia, MPH and Julia Applegate, MA

Karen RubinKaren R. Nicosia is the Education Manager at the Equitas Health Institute for LGBTQ Health Equity. She develops and delivers high-quality LGBTQ trainings for research, clinical, medical, behavioral health and social service providers and community members. In addition, Karen oversees the development, scheduling, and oversight of the Institute’s education branch. This includes managing logistics, staff, curriculum, program evaluation, continuing education credits, structural competency assessments, and occasionally assisting in facilitating focus groups.

Karen has almost 10 years of experience in training licensed and non-licensed professionals and the general public in topics related to LGBTQ health, advocacy, health policy, HIV/AIDS, and sexual health. Prior to coming to the Institute in 2016, Karen most recently worked for the Ohio AIDS Coalition as the Policy Manager, where she educated medical and social service providers and legislators on issues related to HIV/AIDS, organized a statewide advocacy day, and wrote public testimony. A proud New Jersey native, Karen holds a Master of Public Health with a focus on Health Policy and Administration from the University of Illinois at Chicago and a Bachelor of Arts in Anthropology and Art History from Case Western Reserve University. She currently resides in the Northern Woods neighborhood of Columbus with her two mischievous cats, Emma and Karl.



Julia Applegate

Julia M. Applegate directs the Institute for LGBTQ Health Equity at Equitas Health where she leads LGBTQ health education, research and community engagement efforts to improve the health and wellness of LGBTQ communities across Ohio. Prior to joining Equitas Health, Julia directed the LGBTQ Health Initiative at Columbus Public Health.

Julia has over 20 years of experience in curriculum design, education and public health programming/policy development. She has worked in public health programs focused on women’s health, HIV/AIDS, and LGBTQ Health. With over 10 years of academic teaching experience, Ms. Applegate is a skilled trainer and experienced presenter who has designed curricula, conducted Train the Trainer programs and presented at local, state, national and international conferences on public health, HIV/AIDS, gender and sexual orientation topics. Her trainings have focused on questions of health equity, diversity and inclusion-focusing primarily on marginalized and underserved communities. Ms. Applegate has worked on numerous federal grants and is an experienced grant writer. She has done policy and program development at the local, state and international level as a government employee and as a member of a Board of Directors. Ms. Applegate has several years of management experience as a public health professional and is currently working on obtaining a Master of Public Health degree from The Ohio State University. Julia lives in the Glen Echo area of Clintonville with her partner of 15 years, Liv Gjestvang, their two children, Karsten and Solveig.




Brief Description:

The LGBTQ community experiences a variety of health disparities compared to their heterosexual and cisgender counterparts. For example, they are at higher risk for suicidal ideation and attempt, homelessness, cancer, obesity, substance abuse, HIV, and mental health challenges. These health disparities are directly related to the social determinants of health and are highly impacted by poor health systems and negative interactions with the medical community. Because of this, cultural humility and structural competency are important tools for tackling larger issues of health disparities and health inequities faced by the LGBTQ community. According to Jonathan Metzl, MD, PhD and Helena Hansen, MD, PhD, “structural competency is a new framework for understanding and responding to the inequalities that make individuals and populations sick. This framework analyzes institutional and structural hierarchies and discrimination in order to confront the ways these lead to sickness and disease.” The environment of a medical center can be the decisive factor that determines whether or not members of medically underserved populations, especially members of the LGBTQ community, engage in and/or remain retained in medical care. A perspective that incorporates a commitment to structural competency forces practitioners to consider societal forces, such as implicit bias, legal protections, environmental factors (such as the physical clinic space), forms, and institutional policies as factors that influence an individual’s health outcomes. This presentation will examine the impact of structural competency practices on members of the LGBTQ community and will provide tips and suggestions on how a provider or organization can create structurally competent environments for the communities they serve.



1) Identify the relationship between health disparities and health inequities in the LGBTQ community.
2) Explain how structural competency is a tool to address health disparities.
3) Demonstrate ways to create a structurally competent space.


Presentation Slides:

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