June is Pride Month, an annual observance dedicated to celebrating and advocating for the rights and inclusion of the LGBTQIA+ community. It is marked by a series of events, parades, and activities that promote the visibility of the LGBTQIA+ community, raise awareness about issues, and foster a sense of unity and pride within the community. In this post, we'll discuss some of the health disparities and inequities faced by the LGBTQIA+ population.
Every year when June rolls around, it marks the beginning of summer, and you see rainbows popping up everywhere for Pride Month. The history of Pride Month dates back to the Stonewall uprising in June 1969, which was a pivotal event in the LGBTQIA+ rights movement in the United States. Prior to the Stonewall riots, LGBTQIA+ individuals faced widespread discrimination, harassment, and criminalization of their identities. On June 28, 1969, police raided the Stonewall Inn, a popular gay bar in New York City. Fed up with ongoing mistreatment, patrons, and activists fought back against the police, sparking several days of protests and demonstrations in the surrounding neighborhood. This uprising marked a turning point, galvanizing the LGBTQIA+ community to organize and demand their rights. In the following years, LGBTQIA+ activists and communities began commemorating the Stonewall uprising with events and marches known as "Gay Pride" or "Christopher Street Liberation Day" marches. The name "Christopher Street" refers to the street on which the Stonewall Inn is located. Over time, the movement gained momentum, with more cities across the United States holding Pride marches and celebrations in subsequent years. These events aimed to raise visibility, promote LGBTQIA+ rights, and demand equality under the law. Over time, the focus expanded to address broader issues, including discrimination, HIV/AIDS, transgender rights, and intersectional justice.
The rainbow flag, which is now widely associated with Pride Month, was designed by artist and activist Gilbert Baker, who chose the rainbow as a symbol of hope, with each color of the flag representing a specific meaning. The flag was first flown at the 1978 “Gay Freedom Day” parade in San Francisco and has now become a ubiquitous symbol of Pride - in more recent evolutions, varying multi-color and multi-striped flags are used to communicate specific identities within the LGBTQIA+ community. The most recent evolution of the flag in 2017 was the Philadelphia Pride flag, which added black and brown stripes to recognize and uplift people of color in the LGBTQIA2-S communities. (Here's an article to get a more comprehensive history of the rainbow flag.)
So as rainbow flags adorn city streets and celebrations ignite, Pride Month serves as a time of joy and solidarity for the LGBTQIA+ community. However, reflecting on the persistent health inequities that impact this community is crucial amidst the vibrant festivities. From inadequate healthcare access to discrimination in medical settings, the LGBTQIA+ population faces unique challenges in achieving optimal health and well-being.
Understanding Health Equity for LGBTQIA+ Individuals
Health equity can be defined as the principle of ensuring that everyone has a fair and just opportunity to achieve their highest level of health. In the pursuit of a just and inclusive society, the fight for health equity stands at the forefront. While progress has been made in addressing healthcare disparities, it is crucial to recognize that certain populations continue to face unique challenges. For the LGBTQIA+ population, this means having access to comprehensive and culturally competent healthcare that respects their unique needs, identities, and experiences.
Let's discuss some of the health disparities faced in the LGBTQIA+ population.
Stigma and Discrimination: LGBTQIA+ individuals often face discrimination and stigma in healthcare settings, which has been described as a major barrier to health in this population. In these scenarios, individuals develop a fear of seeking care or being open about their identities, which can result in delayed treatment, inadequate preventive care, and poorer health outcomes. This Seelman, et al. 2017 article published in Transgender Health, a peer-reviewed journal, concluded that there may be a significant association between delaying healthcare due to fear of discrimination and worse general and mental health. Though this was specific to transgender adults, the findings can be easily translatable to the broader LGBTQIA+ population. Sadly, there are many examples of discrimination in healthcare settings, so the fear is valid. These examples range from patients being denied access to a particular therapy to the children of LGBTQIA+ parents being turned away from clinician offices. While there are federal protections in place - Section 1557 of the Affordable Care Act, many states lack explicit statewide laws against healthcare discrimination in this population.
(Note: Seelman et al. also highlighted another key issue - a severe limitation in studies leading to significant gaps in knowledge. We'll address the topic of clinical trial diversity in a future blog post, but in the meantime, check out this guide from Clara Health that discusses building inclusive clinical trials for the LGBTQIA+ community.)
Lack of Provider Knowledge and Training: As we discussed above, the evolution of Pride Month only started in the 1970s, and the LGBTQIA+ population has had limited visibility in society. As a result, many healthcare providers may not possess adequate knowledge or training to understand the specific health concerns and needs of LGBTQIA+ individuals. A study conducted in the UK assessed medical students' level of knowledge of the LGBTQ+ population and preparedness for working with this patient population. The findings highlighted that students felt underprepared - ~40% reported having any teaching on LGBTQ+ healthcare (nearly all specified that it was through one-off or irregular sessions), and only 1 in 8 felt their knowledge and skills were sufficient, while nearly all wanted more knowledge on LGBTQ+ healthcare. This knowledge gap can hinder effective care and lead to inappropriate or insensitive treatment. The good news is, this is changing -
A recent Medpage opinion piece makes a compelling case for mandatory LGBTQ+ health education in medical schools
Some medical schools are carving out specific pathways to actively train their students in LGBTQ health
And now, there is even a US News & World Report guide on how to choose a medical school at the forefront of LGBTQ health
Economic and access barriers to health insurance coverage: Many LGBTQIA+ individuals encounter difficulties in obtaining adequate health insurance coverage. This lack of coverage can result in delayed or forgone medical care, preventive screenings, and necessary treatments, amplifying health disparities. Furthermore, economic disparities within the LGBTQIA+ community, including higher poverty and unemployment rates, can hinder access to quality healthcare. Affording essential medications, mental health services, and gender-affirming care can be financially burdensome for many. An Issue Brief published in 2021 by the Department of Health and Human Services highlighted that the uninsured rates within the LGB+ community have steadily increased over the years. This report by the Kaiser Family Foundation further details the demographics, insurance coverage, and access to care for transgender adults in the US.
The Consequences of Health Disparities
Each of the aforementioned disparities leads to specific population health issues that are not ideal - ranging from higher rates of certain health conditions, delayed diagnosis of certain conditions, and overall poor health outcomes.
Mental health - People who identify as LGBTQIA+ are at least twice as likely to have mental health challenges compared to the general population. They experience unique stressors, such as discrimination, sexism, and violence, which can lead to anxiety, depression, suicidality, eating disorders, and substance dependence.
Stay tuned! Next week, we will have a special guest blog post from a mental health expert working with LGBTQIA+ youth.
Substance Abuse - The LGBTQIA+ population has higher rates of substance use compared to the general population, which can lead to a range of health problems, including addiction, overdose, and chronic health conditions.
Cancer - Higher rates of certain cancers, such as cervical or anal cancers, which can be related to HPV infection, have been observed in the LGBTQIA+ population. [It is important to note that we have access to a vaccine that is nearly 100% effective at preventing HPV infection. The only catch is that it has to be administered before any exposure to HPV, so we're back to the issue of access.]
Cardiovascular conditions - Higher rates of cardiovascular diseases have been observed in the LGBTQIA+ population, such as heart disease and stroke, which can be related to stress and discrimination.
Obesity - Higher rates of obesity compared to the general population have been observed in individuals within the LGBTQIA+ population, which can lead to a range of concurrent health conditions, including diabetes, heart disease, and stroke.
Promoting Health Equity During Pride Month (and all the months)
Many of the topics we discussed are systemic and societal issues that will take time to change, but small changes taken by individuals can be a start. Here are some of our perspectives on things we can do:
Supporting and advocating for comprehensive non-discrimination laws and insurance coverage that includes things like hormone therapy and surgeries for gender-affirming care and access to other medically necessary procedures is vital.
Enhancing cultural competency through education and training and culturally competent messaging can foster better understanding and open communication for and with the LGBTQIA+ community.
Creating environments of inclusivity through language, communication, practices, and more.
Supporting and uplifting community organizations that provide vital resources, support networks, and advocacy efforts.
Pride Month serves as an opportune moment to recognize the health inequities faced by the LGBTQIA+ community and renew our commitment to creating a more inclusive and equitable healthcare system. By advocating for policy reforms, enhancing cultural competency within healthcare, and fostering community support and resources, we can work towards eliminating the disparities that hinder the well-being of LGBTQIA+ individuals. Let us celebrate Pride Month with joy, solidarity, and a resolute determination to nurture a healthier and more equitable future for all.
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