On the second issue of the HMS blog, and in honour of LGBTQ+ History Month, course reps Farradeh and Syd are absolutely delighted to platform the research of our wonderful classmate, John “Jay” Kirkley.
Jay is currently pursuing a Masters of Philosophy in Health, Medicine, and Society at St. Edmund’s College. His background in grassroots activism, community organizing, and social policy have inspired him to investigate further what ‘health’ and ‘medicine’ are and can be. With his background in biochemistry and public policy, Jay believes the future of healthcare policy lies at the intersection of public policy, biomedical science, law, and the humanities. Effective policy requires the confluence of practice, theory, and communication, and he is dedicated to bridging these domains to drive such change. He thanks the HPS Department and his Course Representatives for the honor of writing for the HMS blog.
Ask a queer person if they’ve ever disappeared on paper. The answer is almost always, in some form, ‘yes’. Perhaps a medical form that didn't have the right box. A survey that assumed every partner was the opposite sex. A health study that corralled everyone outside the norm into a designated other. Measurement, in theory, makes us visible. But it also has a habit of making people vanish.
I know this firsthand. As a gay researcher and LGBTQ+ advocate who’s worked in Florida, I’ve watched data (or a lack of it) shape understandings of queer communities. In health reports, we’re statistics. In policy debates, we're points of debate – as if our identities are debatable. But the tools that count us determine who gets to be seen and whose experiences slip through the cracks. And as it turns out, those tools often come with fine print.
Take the Behavioral Risk Factor Surveillance System (BRFSS), one of the largest health surveys in the United States. Since 2014, it has offered states the option to include questions about sexual orientation and gender identity. For LGBTQ+ advocates, this was supposed to be an inflection point: a mechanism to track health outcomes for queer communities on a national scale. But when data collection rests on a state-by-state opt-in system, what you get is less a comprehensive dataset and more a patchwork quilt with half the squares missing.
Some states, like Hawaii and Louisiana, ask these questions almost regularly. Others, like Alabama and Oregon, have never asked them at all. Florida joined for three years, then removed sexual orientation questions from its survey – a decision that seemed less about methodological rigor and more about politics. The result? LGBTQ+ communities in these states disappear from the data, as if by bureaucratic sleight of hand.
Even when states do include LGBTQ+ questions, the options can feel like choosing between half-truths. Many surveys stick to a limited menu: lesbian, gay, bisexual, transgender. If you’re nonbinary, asexual, pansexual, or identify with any label that doesn’t neatly fit, you're often left with that ever-expansive category of other. Some surveys bypass identity entirely, focusing on behavior: Have you had same-sex partners? Are you male-to-female transgender? It’s an approach that might capture certain health risks, but it flattens identity into a checklist of actions. A bisexual woman in a relationship with a man vanishes from the data. A queer person who hasn’t been sexually active recently? Invisible. And so, little by little, the diversity of LGBTQ+ lives slips through the cracks.
These data gaps aren't just statistical nuisances – they have real-world consequences. Without accurate information, policymakers and advocates cannot address the mental health crisis facing LGBTQ+ youth, the barriers to healthcare that transgender individuals face, or the health disparities that cut across race, class, and geography. And when data collection is optional, so is accountability. After all, it's easier to ignore a problem if you never count it in the first place.
Of course, measuring identity was never going to be simple. Categories, by definition, draw lines: between who belongs and who doesn't, between what counts and what gets left out. For a community defined as much by its resistance to labels as by the labels themselves, those lines have always been a bit blurry. But the challenge isn't just technical – it's philosophical. Measurement is never neutral. The categories we use are shaped by history, politics, and culture. When health surveys offer a handful of static labels, they're reflecting a particular worldview: one that often treats identity as a fixed trait rather than a fluid, evolving experience.
So what would it look like to measure LGBTQ+ identities differently? It would mean acknowledging that identity is more than a series of checkboxes. It’s a relationship with oneself, with a community, and with the world. It would mean designing surveys that capture the richness of queer experiences without reducing them to boxes. And yes, it would mean holding states accountable when they choose to leave their LGBTQ+ populations out of the picture.
But measurement, for all its flaws, still matters. As anyone who's ever been told their identity doesn't count can tell you, being counted is a form of recognition. It’s a reminder that your experiences are part of the broader story. A story that deserves to be told in full.
This is where my research as an MPhil candidate in Health, Medicine, and Society comes into focus. As a philosopher of science, I study the tension between identity and measurement and the challenge of defining LGBTQ+ categories in ways that capture both individual experience and collective belonging. It’s a question that feels particularly urgent during LGBTQ+ History Month, a time to reflect not only on where we’ve been but also on the tools we use to shape where we’re going. After all, categories are not fixed. They evolve, shaped by the communities they represent and the histories they carry. And when we critically examine these categories, we open the door to more accurate, more inclusive ways of understanding who we are – and who we have the potential to become.
So as we mark LGBTQ+ History Month, I invite you to consider the categories that shape our world. How do the boxes we check (on surveys, in policies, in everyday conversations) shape what we see and what we ignore? And how might rethinking those categories help us imagine a future where every LGBTQ+ person, in all their complexity, is not just counted but truly understood?
In the end, the question isn’t whether we should measure LGBTQ+ identities. It’s whether we can do so in a way that captures the full richness of who we are without making anyone disappear in the process.