LGBTQIA+ Health Equity Part One: Disparities in Healthcare

Believe it or not, it was only 35 years ago when the American Psychiatric Association completely removed homosexuality from their list of mental disorders. Like much of the progress for LGBTQIA+ rights in America, changes to the healthcare system can be attributed to the revolutionary Stonewall riots, in which the homosexual community denounced hiding their identities. It wasn’t until the HIV/AIDS crisis that LGBTQIA+ health was first acknowledged, and the brutal injustices in the U.S. healthcare system towards HIV/AIDS patients was met with brave advocacy fueled by the momentum gained in the Stonewall riots.  

Health inequities seen today are born from historical discrimination, and the lasting impacts of injustice and stigma in the U.S. healthcare system require intentional effort and dedicated allyship. 

While this month is about celebrating the progress and historical milestones for the LGBTQIA+ community, it is also important to bring awareness to the disparities that continue today. Members of this community are less likely to have access to the health care they need, and many who have access to care report unfavorable interactions with their providers. This is why it’s important to acknowledge just how recently progress has been made, and how much still needs to be done to overcome stigma, provide culturally competent care, and achieve health equity. 

Health inequities and disparities can vary by factors such as race, ethnicity, gender, and sexual orientation, and for individuals of historically marginalized groups who have any variation of intersecting identities, health disparities may compound and contribute to even larger inequity gaps. Inequities in health are associated with higher risk for illness and disease and worse health outcomes for individuals belonging to a minority group, solely because they belong to that group. For the LGBTQIA+ community, this includes being at a statistically higher risk for suicide or suicidal thoughts, mood disorder and anxiety, higher rates of certain cancers, and less likelihood of a regular healthcare provider.

Though there is ample data to demonstrate the inequities facing LGBTQIA+ members, studies do not always paint an accurate picture of how marginalized groups experience health inequities first hand. Furthermore, as an ally, I recognize my limitations in fully understanding the disparities facing LGBTQIA+ members. So to amplify LGBTQIA+ voices, I created an anonymous survey for employees here at Elation, giving them the opportunity to share their personal experiences in healthcare. Here’s what they had to say:

How has your experience in the U.S. healthcare system been different to your peers?

“As a queer person, with non-traditional relationships, what I have struggled with the most is judgment from providers about my lifestyle choices. It is especially disheartening in moments when what I am needing is empathy and information from them that enable me to stay safe and healthy. On multiple occasions, the response I’ve received is effectively ‘stop being you,’ or ‘engage in more traditional relationships.’ “

“I feel like even though I mark my sexual orientation on patient intake forms it’s not really something physicians organically touch on. I think it’s because a lot of times bisexual and pansexual folks can be excluded from the queer community and because a lot of physicians don’t have the tools or the training to address the specific needs of their queer patients. I feel like I have to be more proactive about the questions I have instead of it coming up organically as it would for any other patient.”

“Personally, my experience has not been different to my (straight) peers or before I came out as gay… However, I believe that since I live in a large esque metropolitan city, this is why my providers have not treated me differently. I also believe that as I am cisgender and fairly feminine, this has most likely assisted me in being seen as ‘normal.’”

“The moment I mention I am pansexual, the questioning turns towards STD safety and borderline makes me feel like a social pariah.”

“Finding care where I can trust my provider to be looking out for my best health interest has been difficult. Finding providers who can use correct pronouns, and not misgender me the entire length of the visit. Being told by fertility providers that because of how masculine I am, I should not attempt to gestate children. In postpartum care being completely ignored by nurses/lactation/doctors within the hospital. Being denied ice postpartum for injury during birth because I was not the person who had given birth (I was). Continuously being asked which parent I am to my children (I have two children)”

Though there are a variety of social determinants that impact the overall health and well-being of the LGBTQIA+ community, shortage of healthcare providers who are “knowledgeable and culturally competent in LGBT health” is a contributing factor to oppression and discrimination, according to Healthy People 2020. Whether poor experiences in healthcare are a result from implicit bias or a lack of training, it is critical for healthcare providers to not only acknowledge disparities facing their LGBTQIA+ patients, but strive to provide high quality and culturally competent care. Here’s what a handful of our employees recommend:

What advice would you give to a healthcare provider to improve the LGBTQIA+ experience in healthcare?

“Remember that first and foremost, we are human. We all deserve to be treated with dignity, and a trusting relationship with a provider can only be built if there is no fear of judgment. Invest in multicultural competence as a part of standard training and continuing education for healthcare providers.”

“Treat everyone equally. Hetero-normative people engage in risky behavior all the time.”

“I would ask them to consider the stigma that queer folks face in their daily lives and try to strengthen the relationship between patients and physicians by giving patients space to talk about their concerns in relation to their sexuality, especially as it pertains to mental health.”

“Make no assumptions. READ up on this, educate yourself and do not expect your patients to educate you.”

“Sharing their pronouns, and telling me that if I felt safe doing so please share my own.”

“I would advise them to have something on their website such as “LGBTQIA” friendly. I would encourage them to have the option as “homosexual, trans, etc” on health questionnaires. I would also encourage them to ask [for] pronouns in person and on questionnaires.”

Elation Health is dedicated to supporting practices and partners who go above and beyond to make progress for the LGBTQIA+ community. Look out for part two of this series, which includes my interviews with a few of our customers who are leaders in this space.

If you or someone you know needs help, you are not alone. Please find LGBTQIA+ resources and crisis hotlines here

Nina Cloven

about

Nina Cloven, MHA is Elation's Manager of Primary Care Advancement. She received her MHA from John Hopkins Bloomberg School of Public Health and BA in Public Health from Texas A&M University.