LGBT: Not Always Rainbows Within Healthcare

Healthcare, in one way or another, affects each person in our province. Whether you are a frontline worker, a patient or a caregiver, we all have some form of experience within the healthcare system. The healthcare system has the ability to leave a very positive or unfortunately, negative impact on a patient experience which could shape the way that an individual views health as a whole.

As with every vulnerable population, not every LGBT individual will have negative experiences within the healthcare setting. As an openly gay woman in leadership in healthcare, I have been very fortunate to have the experiences I have had thus far at the organization I currently work at. It was not many years ago that I was worried that if I spoke of my girlfriend that it would have a negative impact on the advancement of my career, and that people would only see that one aspect of me and let that define who I was to them. I am lucky that I have the support system that I have as others are not as fortunate. Without a support system in place, it increases the risk of negative outcomes for a member of the LGBT community.

Having early support from family and friends is an imperative start for the individual to “come out” to. With a lack of support at home, LGBT youth are at a higher risk of being kicked out of their home for being gay or identifying as transgender. On the other hand, if bullying and harassment begins at the school, it leads to an increase in the individual not graduating highschool as well as a decrease in overall wellbeing, including their mental health (Registered Nurses Association of Ontario [RNAO], n.d.). In a school based study out of Boston 1320 students were surveyed. Out of that number, 10% of the participants identified as LGBT. When the students were surveyed about suicidal ideation the LGBT youth’s response was that 30% of them had suicidal ideation, whereas their heterosexual classmates were only 6% (Hafeez et al., 2017).

The concern for LGBT individuals becoming a part of a vulnerable population doesn’t stop at increased risk of having a mental health illness. If bullying and harassment are occurring within school and the individual fails to graduate, this has the potential to place them in a lower socioeconomic class. According to RNAO (n.d.), about a quarter of trans people live on less than $15 000 a year, placing them below the poverty line in Canada. As we have seen in previous units, the risk for poor health of individuals when they are low on the socioeconomic status is extremely high.

Substance abuse and addiction are also incredibly high within LGBT individuals. According to Medley et al. (2015) 39.1% of LGBT aged 18 and older have used illicit drugs within the last year. Thereis also a high prevalence of cigarette, and alcohol use within the LGBT group, increasing the risk of health issues for the individual as well (Medley et al., 2015).

The history within healthcare and the LGBT group is fairly significant. In 1973 homosexuality was finally removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM). Prior to this individuals who identified, or were “outed” were treated with shock therapy to try and convert the person back to a heterosexual life (Government of Ontario, n.d.). For older generations of LGBT individuals it is incredibly hard to trust healthcare workers because of this. Individuals feel that they cannot speak their truth for fear of the past rearing its ugly head again. This can have a negative affect for the individual because of the lack of healthcare provided, as well as investigations for health concerns not being sought out.

Another concern within healthcare related to LGBT individuals is the heteronormativity of the healthcare field. Screening tests get missed for an individual who is born male but identifies as female and vice versa. This leads to an increase in cancer diagnoses within the LGBT population. “Individuals who identify as lesbian, also have a higher rate of heart disease, along with lower rates of screening for cervical and breast cancer” (RNAO, n.d.).

In order to gain back trust within the LGBT group towards healthcare providers we have to make an effort. Healthcare providers need to be educated in the needs of the LGBT group. Often the screening for cervical cancer is missed because the doctor feels as though the risk of Human papilloma virus (HPV) is low for a lesbian because they are not having intercourse with a male (RNAO, n.d.). By continuing to move forward, educating and advocating for LGBT patients, we should see an increase in trust.

Overall, when reviewing the LGBT group through the health equity framework the four spheres are imperative for improving the social determinants of health. The system of power is an upstream approach that will help aid programs for LGBT youth to feel as though they are a part of something in a positive way. Relationships and networks are the basis of a positive outcome for an LGBT youth. Throughout the coming out process it is imperative that you have your basis of support in order to have a positive experience. Individual factors are a person’s response to attitudes around them as well as their own. This may be difficult to factor in and improve and would take a lot of internal work. The fourth sphere is finally the physiological pathway which cannot be easily modified by intervention.

Healthcare has made significant gains within the LGBT group, but a lot more work is required. As long as we continue to develop and educate our providers we should see a shift in the care that we provide.

References

Government of Ontario, Ministry of Health and Long-Term Care. (n.d.). Health Equity Impact Assessment (HEIA) - ministry programs - health care professionals - moh. Retrieved March 21, 2022.

Hafeez, H., Zeshan, M., Tahir, A. M., Jahan, N., & Naveed, S. (2017). Health care disparities among lesbian, gay, bisexual and transgender youth: A literature review. Cureus, 9(4), e1184. doi: 10.7759/cureus.1184

Promoting 2SLGBTQI+ health equity - rnao.ca. (n.d.). Retrieved March 22, 2022, from https://rnao.ca/sites/rnao-ca/files/bpg/2SLGBTQI_BPG_June_2021.pdf

Medley G, Lipari R, Bose J, Cribb D, Kroutil L, McHenry G. Sexual Orientation and Estimates of Adult Substance Use and Mental Health: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. https://www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015.htm. Published October 2016.