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  • Writer's pictureJen Ottolino

It’s Time to Focus on Health Equity for LGBTQIA+ Individuals

Updated: Feb 22, 2023

The percentage of Americans identifying as LGBTQIA+ doubled between 2012 and 2022. How can we ensure that members of this growing population get the health care they need to live vibrant and healthy lives?



Health Equity, Defined

The World Health Organization describes health equity as the state in which everyone can realize their fundamental right to good health and attain their full potential for well-being. This is regardless of factors such as:

  • Age

  • Race

  • Ethnicity

  • Sex, gender, and sexual orientation

  • Disability

  • Socioeconomic status

As a society, striving for health equity means systematically identifying and eliminating health disparities that result from socioeconomic factors and living conditions. It also means recognizing that discrimination, stereotyping, and prejudice negatively affect the health and health access of certain groups and taking steps to amend that.


LGBTQIA+ Health Equity



Many studies have shown that LGBTQIA+ individuals around the world face greater physical and mental health risks compared to the general population. At the same time, those in sexual and gender minorities may be reluctant to seek treatment—even for urgent conditions—if their previous health care experience was discriminatory or non-inclusive. For example, studies have shown that:

  • Gay youth are more at risk for eating disorders and alcohol and substance abuse [1].

  • Lesbian and bisexual women have higher rates of breast cancer [2].

  • Older LGBTQIA+ adults are more likely to rate their health as poor, report more chronic conditions, and have less social support [3].

  • LGBTQIA+ people are less likely to have health insurance [4] and are more likely to report poor care and unfair treatment by healthcare providers [5].

These issues will only become more complicated as the LGBTQIA+ population grows, and the population is indeed growing. A recent Gallup poll [6] indicated that the percent of Americans identifying as LGBTQIA+ doubled between 2012 and 2022 and is now at 7.1%. Yet, less than 1% of funded projects at the National Institutes of Health address the LGBTQIA+ population according to Eidos, a new health initiative at the University of Pennsylvania.


These data underscore that the time is now to prioritize health equity for the LGBTQIA+ population. Societies and health organizations should conduct more research and collect more data specific to the LGBTQIA+ population. This will lead to a better understanding of these individuals' unique health care needs so that evidence-based programs can be designed to address them.


Organizations Advocating for LGBTQIA+ Health Equity

Sometimes, non-inclusive health care practices originate from systemic prejudice toward sexual and gender minorities, but other times, it’s simply a matter of ignorance. Even well-intentioned practitioners may be unaware of LGBTQIA+ individuals’ needs because they never received any training in culturally competent care for this population.

These four organizations are working to change all that.

1. The National LGBTQIA+ Health Education Center is part of the Fenway Institute, which pioneers innovative, equitable, accessible health care for all people along with transformative research and education. The National LGBTQIA+ Health Education Center aims to optimize quality, cost-effective health care for lesbian, gay, bisexual, trans, queer, intersex, asexual, and all sexual and gender minority individuals. The Center offers the following:

  • Technical assistance: Available for health organizations that are ready to take LGBTQIA+ health to the next level through intensive on-site staff trainings and consultation.

  • Web-based learning: Courses offer opportunities for CME credit and range from individual modules to six-month/year-long courses to help health professionals better understand LGBTQIA+ patients and communities, identify and eliminate health inequities, facilitate access to cost-effective health care, and increase longevity and quality of life for patients. Some training modules are available through the online learning platform AMA Ed Hub: “Trauma-Informed Care for Trans and Gender Diverse Individuals, “Behavioral Health Care Outside the Binary,” “Health Disparities, Stigma, and Terminology,” “Affirming Care for People with Intersex Traits,” “Addressing Social Determinants of Health for Black LGBTQ People.”

  • Educational conferences: Advancing Excellence in Sexual and Gender Minority Health and Advancing Excellence in Transgender Health, which also offer opportunities for CME credit.

Highlight: The Center has an extensive digital library of free resources on the latest developments, issues, and best practices in providing affirming LGBTQIA+ healthcare. Library visitors can view and download over 100 publications, toolkits, training videos, and more.


2. Whitman-Walker Health is a community-centered enterprise committed to advancing social justice and equality in the health sphere. Since their founding in 1973, they have worked toward creating a society “where all persons are seen for who they are, treated with dignity and respect, and afforded equal opportunity to health and wellbeing.” Their clinics in Washington DC offer culturally competent, gender-affirming health care, behavioral health treatments, and dental care services. Their Institute focuses on research, advocacy, and education to promote living and loving openly and achieving equality and inclusion.

  • Research: The organization’s historic relationship with the LGBTQIA+ community is the foundation of its research efforts. Studies focus on HIV and other infectious diseases, physical and mental health outcomes for marginalized populations, and models of care.

  • Policy and Advocacy: Whitman-Walker’s policy team works with healthcare providers, researchers, and local and national advocacy groups on a range of issues important to LGBTQIA+ health. They dismantle the structural barriers to health and wellbeing through new policy ideas, policymaker education, strategic partnerships, and litigation.

  • Education: The institute coordinates trainings for medical students and health professionals on topics such as LGBTQIA+ health, HIV care, and the diagnosis and management of sexually transmitted infections. Additionally, the Institute offers general and specialized LGBTQIA+ competency training to licensed clinicians across many disciplines.

Highlight: With the National LGBT Cancer Network, in 2018 and 2019 Whitman-Walker convened two summits of leading educators, health care providers, researchers, and patient advocates from across the US to develop best practices for LGBT+ cultural competency training for health care providers and staff.


3. The National LGBT Cancer Network The National LGBT Cancer Network works to improve the lives of LGBTQIA+ individuals with or at risk for cancer by educating the community about this group’s increased cancer risks and the importance of screening and early detection; training health care providers to offer culturally competent, safe, and welcoming care; and advocating for LGBTQIA+ individuals with cancer in medical and research organizations as well as in the media. Their main activities and programs include the following:

Highlight: On the National LGBT Cancer Network website, you can search for LGBTQIA+-friendly cancer screening and treatment providers.


4. Launched in early 2022, The Eidos LGBT+ Health Initiative is newer compared to the other organizations on this list. Expect to see groundbreaking work from them in the near future. They are a first-of-its-kind academic social enterprise lab housed in the School of Nursing at the University of Pennsylvania, and their aim is to transform LGBTQIA+ health. They plan to achieve this by bringing together educational, research, and community resources to develop innovative solutions to health disparities faced by the LGBTQIA+ population. The initiative has four goals:

  • To propose innovative research related to LGBTQIA+ health

  • To create a space that joins together different voices and perspectives

  • To train students to develop creative solutions to improve the health of members of this population

  • To catalyze evidence-based strategies and programs focused on this group’s health issues

Highlight: In early 2023, Eidos hosted thought leaders from the private and non-profit sectors of the health industry for an online panel discussion. The topic of the discussion was “Connecting Conversations: Culturally Competent Care and LGBTQ+ Communities.”


Progress Toward Health Equity



While we’re a long way off from achieving true health equity for this population, signs of progress are emerging. At all levels of society, one step at a time, organizations and individuals are moving toward understanding the unique health needs of LGBTQIA+ individuals. The companies and organizations that have been the first movers in their industries have set powerful examples for others.


One salient example is the managed healthcare company, Cigna, which “understands the importance of addressing health disparities facing the LGBTQ+ population and is working to close these gaps.”


Some of Cigna’s recent actions include:

  • Appointing a National Medical Director for LGBTQ+ Health and Well-Being

  • Forming an LGBTQ+ Colleague Resource Group

  • Expanding in-network access to transgender care

  • Providing training for employees and over 600 Cigna clinicians

It’s a hopeful day when a powerful multinational insurance company refines its culture and retools its services to provide better health care for a historically marginalized population. On that optimistic note, let’s continue with this important work.


 

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