LGBTQQI Health Disparities

As a queer woman, I feel like it is quite obvious that us LGBTQ folks have had it pretty tough. Although the world is changing, ever so slightly (same-sex marriage being legalized in America, same sex-adoption legal in every state, etc), we are still up against more than just hatred and naivety. The actual depth of  what we are fighting, and the product of this fight, is unthought-of by many. Equality in healthcare is a big one.

Why is this important? LGBTQQI individuals are twice as likely to be uninsured and often forgo seeing a doctor due to fear of discrimination or harassment, leading to worsening health and sometimes death. If we are not guaranteed the same quality of care, we are automatically at a disadvantage to living a healthy life.

The discrimination we face, alone, is linked to an increase in the likelihood of psychiatric disorders, substance abuse and suicide. In addition to this this, the societal stigma that we face leads to extreme intolerance from health care workers and a lack of access to our basic human and civil rights. Much of the mental illness that LGBTQQI individuals face is theorized to result from “minority stress,” where an LGBTQQI person experiences internalized homophobia, depression and anxiety. This type of stress can can intersect with race, ethnicity and social class, dependent on the person, magnifying the symptoms of these disorders and illnesses. In addition to these illnesses, the CDC states that “Negative attitudes” toward LGBTQQI people, increases their risk for “experiences with violence”,  which makes our access to quality healthcare even more crucial.

Although there is no “LGBTQQI-specific illness”, many statistics and/or studies address the facts; Individuals who are on the LGBTQQI spectrum have a higher rate of mental illness(as addressed above), they are 2-4 times more likely to smoke cigarettes, there is a higher rate of breast and cervical cancer, and we are at an increased risk for eating disorders, the list goes on. All of these elements, combined with a doctor’s lack of education in the LGBTQQI population, is a recipe for a sickening disaster.

Regarding mental healthcare, the Diagnostic and Statistical Manual of Mental Disorders, which is used as a tool for assessing and diagnosing psych patients, listed homosexuality as a”mental disorder” until 1987 (it was partially removed in 1973 and completely removed in 1987).  However, “Gender Dysphoria Disorder” (or simply, being transgender) remains in the DSM. This is a big deal, mostly because as long as this is in the DSM, transgender people are considered to have an “ailment” due to the fact that they do not identify with the gender they were assigned at birth. This perpetuates a dangerous attitude towards an entire population of trans people, affecting their encounters with medical professionals.

The fact is that doctors are obligated to remain unbiased and deliver culturally competent healthcare, but there is an obvious shortage of health care providers who are educated in cultural competency in LGBTQQI health, specifically for transgender individuals. In fact, the IOM (Institute of Medicine) proclaimed, “medical schools teach very little about sexuality in general and little or nothing about the unique aspects of lesbian, gay, and bisexual health, and it is rare for students to receive any training in transgender health.

Sexual desire and gender identity is very fluid and there is a large spectrum of LGBTQQI identities. Also, sexual orientation and gender identity are not specifically asked on most national or State surveys, (although this is a good thing. like, get out of my business, am I right?). Because of these things, it is difficult to see how many people are actually affected by the cultural incompetence in the world of healthcare.  However, let’s just think for a second- Do you know of a gay, transgender or intersex person who has been harassed, questioned, judged or made to feel unsafe or straight up awkward in a hospital or healthcare setting? For most of us, unfortunately, the answer is yes.

Now, what can healthcare workers do about this, in order to hold themselves more accountable for our health, as LGBTQQI people? We can ask that all health care settings be inclusive safe spaces; a place where we feel genuinely welcome. Screening recommendations for breast or prostate exams, must be modified for individuals who have undergone hormonal treatments or surgery, we should be asked what pronouns we would like to hear from medical staff, and we should not be made to feel anything other than the gender we identify with. Psychologists must be better trained at giving us options to cope with the external attitudes of society, that often extinguishes our passion for life. There should be training on cultural sensitivity and LGBTQQI populations and the psychological and physical illnesses that we are especially susceptible to, including how to prevent these predispositions and they should be asked to constantly keep themselves in check on personal beliefs that may act as barriers to providing LGBTQQI individuals with the best care possible. On top of this, health care workers just need to learn to be polite! It’s not that hard, y’all.

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