5 Ways to Address LGBTQIA+ Disparities in Health Care

It could have been a disaster, but I was feeling so depressed after finally accepting that I’m a lesbian that I didn’t have the capacity to worry about what my medical provider might think.

So, when he asked me why I was visiting, I told my male, presumably straight, middle-aged, primary care doctor in a rural community that I had recently accepted that I was gay and was not handling it very well.

The next few minutes set the stage for my relationship with health care as a lesbian woman. My doctor moved toward me (as opposed to away from me), looked me directly in the eye, put his hand on my shoulder and said, “I realize that can be difficult. How can I help?”

Had he not been so accepting, I have no idea how my health would have been affected from that point forward. I have no doubt that that experience has made me more comfortable to come out to other medical providers, and that has been to my health benefit.

I wish I could say that my experience is the norm, but unfortunately it’s not. The truth is that our LGBTQIA+ communities are, in general, less healthy than our heterosexual counterparts and much of that is directly related to discrimination and social stigma. Our communities get the short end of the stick in terms of access, utilization, and LGBTQIA+-informed care.

Research that is intended to aid in the understanding of our health care concerns is not entirely inclusive. Often times there is no data collected on the transgender, intersex, or asexual populations.

Factors such as race, aging, or disability are also frequently excluded, despite the fact that these additional factors can have an enormous impact on a person’s health.

For example, according to Boulder County Aging Services, there are an estimated 2-7 million LGBTQ elders living in the United States and many of them are afraid to access senior health services citing fear of discrimination. It is not difficult to imagine. At a time when you may be at your most vulnerable, the idea of being denied health care or being harassed due to your status is likely terrifying.  

The consequences of the health disparities within our communities are severe. LGBTQIA+ people are at greater risk for many serious diseases compared to their heterosexual counterparts.

Why are we at greater risk? Well, because when people feel persecuted they often engage in coping behaviors that are less than healthy. They often neglect their health.

In fact, one study found that LGB people who live in states that do not have protective policies are five times more likely to have two or more mental health disorders than LGB people who live in states where protections are afforded.

Another study found that LGB people who had some kind of “prejudice-related major life event” were 3 times more likely to have a major health problem over the course of the following year. So, it is clear that our health and health behaviors are directly impacted by how we are treated in society.

The following information is based on research that describes the differences between LGBTQ health and health behaviors and their heterosexual counterparts:

• LGB smoke more.
• We are more likely to get cancer.
• We are more likely to harm ourselves.
• We are more likely to have a mental health disorder.
• We are less likely to seek health care.
• We are less likely to have health insurance.
• We are more likely to have disordered eating.
• We are more likely to abuse substances.

By now you may be thinking –“Thank you, Robin. If I wasn’t depressed before, I am now.” Well, try not to drop too far into despair. There is hope.

LGBTQIA+ health education programs, such as the National LGBT Health Education Center of The Fenway Institute, are traversing the country providing much needed training to providers in major cities and smaller community health systems.

And in several major cities and pockets of progressive communities across the United States, hospitals and clinics exist that focus their care primarily on the LGBTQIA+ populations.

While this may not be possible in every community, I hope it’s clear by now that providers and health care systems must do a better job at treating LGBTQIA+ people and their unique health care needs. That includes rolling out the welcome mat, getting educated about health issues specific to the LGBTQIA+ people, actively working to reduce health disparities in the population, and using their knowledge to provide the best care.

There are several ways that health care advocates are training providers to do this.

For example, safe providers are being encouraged to advertise in various ways, including posting “Safe Space” or rainbow triangle stickers in the windows of their practices.

Providers are being trained to notmake assumptions about a person’s health. Sexual orientation can be very different from sexual behaviors, so providers shouldn’t assume, “Well, since my patient never has sex with men, I guess I don’t have to ask…” They must be comfortable discussing sexual health with their patients and begin using health assessments that can help determine patient risk.

Providers are encouraged to be sensitive to the legitimate fears and discomfort that some transgender or gender non-conforming people may have when getting procedures like mammograms or pap smears because of previous harassment from providers.

It is recommended that providers look at their intake forms and revise them to be more LGBTQIA+ inclusive. Are male and female the only options under gender? Is married, single, or divorced the only options available under relationship status?

It is also necessary for providers to ask themselves if their practice would be safe for LGBTQIA+ employees. Is sexual orientation or gender identity included in all of the anti-discrimination policies, and is there a clear grievance procedure for patients and staff?

This is what providers are doing. Now, what can you do?

1. Take Action, in Spite of These Disparities

It’s up to you to be proactive about your health. Think about your risk factors. It is very difficult to change poor health behaviors, but it is important to try. Do your best. Ask for help. Perhaps even find people who are willing to make changes with you.

There are online resources that can help you to make specific behavior changes. For example, smokefree.gov provides specific information and resources for LGBT people who are trying to quit smoking.

Utilize preventive health care. Getting routine services like mammograms, pap smears, and colonoscopies can be life-saving, and are sometimes free depending on your health coverage and age.

2. Tell Your Doctor about Being LGBTQIA+

I know that this is difficult, and you are never obligated to come out to anyone, but consider how important this is to your health. You may not even be aware of all the ways your status is relevant to your health.

Yes, you do risk being rejected. You may have to educate your own provider. You may have to look for a different provider. But it’s worth it.

It is impossible for your doctor to provide you good care when such a major part of who you are is left out of the discussion.

3. Promote LGBTQIA+-Friendly Providers in Your Community

Encourage your local providers to be more accepting and to receive specific training in LGBTQIA+-informed care.

If you are looking for a provider, ask people you trust.

If you have a provider that you believe is good at providing LGBTQIA+-informed care, encourage them to advertise their safe space to the community.

4. Demand That Our Advocacy Groups Remember This Issue

Encourage your politicians and political advocacy groups to push for LGBTQIA+-friendly legislation and policies designed to close the health disparity gaps.

Standards of care and best practices for working with LGBTQIA+ people are being developed and should be adopted by hospitals and private practices. Medical training facilities need to educate future medical providers in LGBTQIA+-informed care.

Reach out to those who have the power to make sure this happens.

5. Research Some of These Resources

The following resources may be very helpful for people who are not in areas with care specific to LGBTQIA+ people.

• The National LGBT Health Education Center of The Fenway Institute provides health education and resources to LGBT individuals.
• The Gay and Lesbian Medical Association operates a provider directory and gives specific suggestions for what LGBT people should discuss with their providers.
• The blog for the network for LGBT Health Equality provides great information and resources.

There are many other resources, but these will provide you with a good start.

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Our communities are successfully fighting for equality in many ways and our health care must be one of the issues at the front of the line.

We cannot accept discrimination against us and we need health care providers to do better and be better educated on LGBTQIA+ health care issues. We want providers trained and we want protections afforded to us.

Together we need to send the message – “This stuff is total BS and we expect change.”

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Dr. Robin Landwehr is a mental health counselor and an unapologetic feminist. She holds a Doctor of Behavioral Health degree from Arizona State University, a M.S. degree in Mental Health Counseling from Capella University, and is a licensed counselor in North Dakota and Florida. She is a National Certified Counselor through the National Board for Certified Counselors. Robin has worked in several areas of human services including: domestic and sexual violence, substance abuse, homelessness, child abuse and neglect, mental health disorders, and health concerns that are affected by our behaviors. You can follow Robin on Twitter @RobinLandwehr1 or visit her sometimes neglected personal blog at the Hippie in Me Blog.