Report 2022-102
April 27, 2023

California Department of Public Health
It Has Missed Opportunities to Collect and Report Sexual Orientation and Gender Identity Data

April 27, 2023

The Governor of California
President pro Tempore of the Senate
Speaker of the Assembly
State Capitol
Sacramento, California 95814

Dear Governor and Legislative Leaders:

As directed by the Joint Legislative Audit Committee, my office conducted an audit of the California Department of Public Health's (Public Health) role in collecting, reporting, and using sexual orientation and gender identity (SOGI) data. We determined that Public Health has been slow to adopt and enforce standardized guidelines to ensure the consistent collection and reporting of SOGI data, which has limited its ability to identify and address health disparities among those in the lesbian, gay, bisexual, transgender, and queer or questioning population.

Public Health collects health-related demographic data using a variety of reporting forms, questionnaires, and surveys (forms), but the department has not had clear and consistent policies regarding how such forms should collect SOGI data. Of the 129 forms we reviewed, 105 were exempt from the requirement to collect SOGI data but were not prohibited from doing so, and only 17 of the remaining 24 forms collect complete SOGI data. The lack of consistent SOGI data collection procedures, and ultimately the low number of Public Health forms that currently collect SOGI data, indicate that changes to state law may be warranted to compel more consistent and useful SOGI data collection practices.

Public Health also has a limited ability to analyze and use the SOGI data that it does collect to implement and deliver critical services. It is unable to collect or export SOGI data for the majority of reportable communicable diseases in California because it has not resolved technical barriers that limit its electronic communicable disease surveillance system from collecting SOGI data. Instead of resolving the technical issues, the department plans to replace its current system with a new surveillance system in 2025. Finally, local health jurisdictions and health care providers reported that they needed guidance from Public Health regarding the collection of SOGI information and standardized SOGI definitions. However, Public Health has not provided them with such guidelines, training, or resources.

Respectfully submitted,

California State Auditor