Op-ed: Addressing Health Disparities in the LGBT Community

Miriam Hollins is Seattle-area Respiratory Therapist and is currently pursuing a Master’s in Healthcare Administration at the University of Washington School of Public Health. She started her healthcare career as a Combat Medic in the Army where she served on Active Duty for six years. She then went to Respiratory Therapy school and earned her Bachelor’s Degree in Healthcare Management before beginning graduate school. The following is an op-ed she wrote for State of Reform about the disparities the LGBT community faces in healthcare.


The Lesbian, Gay, Bisexual, and Transgender (LGBT) community has a long history of discrimination, stigma and struggle, especially concerning their access to culturally competent, high quality health services. LGBT individuals encompass all races, ethnicities, religions and social classes. The health disparities that LGBT individuals face are linked to societal stigma, discrimination, and denial of their civil and human rights (Office of Disease Prevention and Health Promotion (ODPHP)). The lack of awareness of their needs by health professionals has hindered much of the LGBT community’s ability to achieve a high level of health (Ard and Makadon). Having an all-inclusive intake form is a way to increase awareness and helps to obtain a complete health history. There are no LGBT specific diseases; however, there are numerous health disparities, which affect a majority of the LGBT population.

Having a complete understanding of the LGBT health disparities is crucial to begin improving the health of that population. The LGBT people experience a higher prevalence of a range of medical and behavioral health issues. The Fenway Guide lists common LGBT health disparities as follows:

  1. LGBT youth are more likely to attempt suicide and be homeless
  2. LGBT populations have higher rates of tobacco, alcohol, and other drug use:
  3. LGBT populations have a higher prevalence of certain mental health issues.
  4. Transgender individuals have a high prevalence of certain mental health issues
  5. Gay, bisexual, and other men who have sex with men (MSM) are at higher risk for HIV and other sexually transmitted infections.
  6. Young MSM and transgender women, especially those who are black, are at especially high risk for HIV.
  7. Lesbians and bisexual women are more likely to be overweight or obese.
  8. Lesbians are less likely to get preventative services for cancer.
  9. Elderly LGBT individuals face additional barriers to optimal health because of isolation and lack of culturally appropriate social services and providers

It is important to note that these disparities do not all require special different approaches from those a clinician would use with the general population. More complex disparities (such as HIV) may require additional training, but can still be addressed in the primary care setting. The long list of disparities can be largely attributed to the long history of social discrimination and the stigma attached to being LGBTQ. This discrimination has leaked into the healthcare setting.

Whether it is a hospital or clinic all providers licensed in Washington State should start using all-inclusive intake forms, which would identify LGBT patients at the start of any course of care. Not implementing this change would mean there is no place for LGBT patients to identify their sex, gender, pronouns, sexual history, sexual preference, etc. A healthcare provider cannot adequately address the needs of a patient whom they know little about. A huge barrier in the LGBT population is the hesitation of self-disclosure for fear of discrimination.  Having all-inclusive intake forms will make it easier for the LGBT population to self-disclose, as well as give the provider a complete history so they can better address their healthcare needs. It opens up the door to have an open, honest discussion in which both parties feel comfortable. Historically, LGBT patients have felt discriminated against and have found that not all facilities are openly LGBT friendly. A simple one-page LGBT friendly intake form is an easy start, and would pave the way to achieving better health overall and eventually eliminating the health disparities in the LGBT population.

 

References:

Ard, Kevin L and Harvey J Makadon. Improving The Healthcare Of Lesbian, Gay, Bisexual and Transgender (LGBT) People: Understanding and Eliminating Health Disparities. Boston: The Fenway Institute, 2012. Publication.

Makadon, Harvey J, et al. Fenway Guide To Lesbian, Gay, Bisexual, and Transgender Health. Philadelphia: American College of Physicians, 2015. Book.

Office of Disease Prevention and Health Promotion (ODPHP). Healthy People.gov: Healthy People 2020. n.d. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health. 09 11 2017.