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LGBTQ and Health Care: Advocating for Health Access for All

October 4, 2019

When marginalized individuals in society are denied access to comprehensive, high-quality health care, public health professionals advocate on their behalf. Today, the LGBTQ community can face unjust barriers to accessing something as simple as a yearly checkup — or even encounter doctors who refuse to care for their children because of their sexual orientation. Discrimination, a lack of proper training, and an insufficient understanding of LGBTQ needs contribute to the challenges this community faces in order to live healthy lives.

However, it is more than doctors and hospital personnel who are helping LGBTQ individuals. Public health professionals can play a critical role in improving LGBTQ health access.

They can raise awareness of certain issues and illnesses that may be affecting the LGBTQ community. They can advocate for legislation or government spending that can provide fundamental health services to large communities.

In addition, they can help address emotional and mental health issues that may be impacting individuals and groups. They can also continue to improve the health and livelihood of LGBTQ persons, even when they aren’t seeking medical treatment.

Those who wish to act as partners and help find solutions to the complex issues regarding LGBTQ health care may find their calling in a career in public health. Tulane University’s School of Public Health and Tropical Medicine offers an Online Master of Public Health devoted to strengthening the health of every community, training graduates to innovate solutions to our nation’s greatest public health challenges.

How Public Health Professionals Improve LGBTQ Health Access

Public health officials have a deep knowledge of health issues affecting specific communities, as well as a variety of skills and tools that can help them find solutions. They can work directly with communities who may have been impacted by a particular health crisis or health disparities and relay their findings and concerns to lawmakers and government officials.

They can also help increase awareness of certain diseases, illnesses, and health issues that threaten specific demographics and implement programs that reduce potential harm. This can include things like designing courses or seminars on safe sex or distributing information on proper sanitary procedures to help keep people safe from a flu or virus risk.

These officials understand that improving LGBTQ health requires a comprehensive approach. Public health professionals study the many areas that can influence health disparities in the LGBTQ community, including behavioral science, medicine, education, and policy.

LGBTQ Health Care Discrimination Issues

The Human Rights Watch report “US: LGBT People Face Healthcare Barriers” found that LGBTQ individuals can struggle to find services such as HIV prevention and treatment, hormone replacement therapy, and even basic primary care where they live. Reports of refusal of care are not uncommon within the LGBTQ community.

A 2017 survey by the Center for American Progress provides unsettling statistics about discrimination and mistreatment at physicians’ offices. Eight percent of LGBTQ respondents reported that within that year a healthcare provider had refused them a visit due to their sexual orientation. When they did receive treatment, 9 percent reported that the healthcare provider spoke to them using abusive language.

Transgender respondents described more extreme experiences, with 29 percent reporting healthcare providers refused them a visit due to their gender identity, and 21 percent reporting the healthcare provider spoke to them using abusive language. In addition, 12 percent of transgender people reported that within the year, a healthcare provider had denied them gender transition care.

Such experiences can trigger severe emotional distress, which often has its own consequences. According to the Office of Disease Prevention and Health Promotion, such discriminatory treatment can be associated with the LGBTQ community’s having higher rates of mental health issues, suicide, and substance abuse than the national average.

Some community health centers are designed specifically to serve the needs of LGBTQ individuals. However, 13 states do not have any centers like this. In the states where they do exist, most are in metropolitan areas, leaving LGBTQ individuals who live outside of cities in a predicament, especially if they have already been denied care.

Behavioral and mental health challenges can also impede the LGBTQ community from achieving optimal care. According to the National Alliance on Mental Illness, “LGBTQ people with mental health conditions may also find themselves fighting a double stigma. Many will experience prejudice based on their sexual and/or gender identity as well as the stigma associated with mental illness.” This double stigma can potentially discourage LGBTQ persons from seeking treatment for mental health issues.

LGBTQ Health Care Issues

A history of discriminatory attitudes toward homosexuality within the medical community and the general population has contributed to the present lack of comprehensive training in LGBTQ-specific health issues in many medical schools, as reported by NPR. This training gap can make it difficult for gay and transgender people to receive important information about how to minimize their own health risks.

For example, LGBTQ individuals might have a greater need than others to receive preventive care, such as the drug PrEP, which significantly reduces the risks of HIV infection if taken daily. Transgender people in transition might require information about puberty blockers and gender-affirming operations. Not receiving such information from a medical provider makes it much harder to be well informed on available precautionary measures against HIV infection or transitioning options.

Public health organizations are working on campaigns to optimize the health of members of the LGBTQ community and striving to ensure that these individuals have the necessary education and access to resources so they may pursue the healthiest life possible.

One such organization is the APHA Center for School, Health and Education, which provides valuable examples of how public health professionals can effectively respond to the inequities faced by the LGBTQ community. They collaborate with schools to advocate for healthier outcomes among gay and transgender adolescents by addressing their need for emotional support, as well as protection from discrimination.

One of the center’s strategies includes providing staff for the in-school support group Gay Straight Alliance. In addition, they have worked to create systemwide policies in school districts that explicitly protect students from discrimination based on sexual orientation and gender identity.

How Public Health Professionals Can Close the LGBTQ Health Disparities Gap

By working to identify, address, and mitigate the complex issues surrounding LGBTQ health care — both within and beyond a hospital’s or clinic’s doors — public health officials help ensure LGBTQ individuals have access to every opportunity to live healthy and fulfilling lives. Here are a few ways public health professionals advocate for the LGBTQ community in health care:

LGBTQ Health Policy

Local, state, and federal laws and regulations can serve a greater good and improve LGBTQ health access — or they can perpetuate discriminatory practices and put people at risk. Public health professionals fill a critical role in advocating for policy change that creates a more equitable healthcare system for all.

As an example of the impact of policy on the LGBTQ community, the Department of Health and Human Services recently proposed changing the language of the antidiscrimination provision of the Affordable Care Act (ACA) to eliminate definitions related to sex and gender identity.

This change could potentially strip LGBTQ individuals of discrimination protection in federally funded healthcare programs. Public health agencies will work to not only preserve such antidiscrimination protections, but also strengthen them and protect LGBTQ individuals who still face refusal of care and mistreatment.

Under the Trump administration, the Department of Health and Human Services has also proposed broadening religious exemptions in healthcare law. This would give insurance companies and healthcare providers far-reaching discretion to refuse care to patients based on their own religious or moral beliefs. Today, several states have religious refusal laws in place, which takes a toll on those facing discrimination.

The study “Religious Refusal Laws’ May Take Mental Health Toll on LGBT Americans,” published in U.S. News & World Report, compared the reported mental stress of LGBTQ communities in states with and without religious refusal laws. The findings associate the religious refusal laws with a 46 percent increase in reported mental distress for gay and transgender residents living in states with those laws.

Public health professionals can be a critical component in advocating for policies to correct this inequity. They may conduct grassroots efforts alongside LGBTQ individuals in their own neighborhoods and communities. They could hold educational outreach programs and events to give insight about these issues to people who may not be part of the LGBTQ community.

Media campaigns that raise awareness of LGBTQ healthcare crises and concerns can target a widespread audience. And public health professionals can advocate directly to policymakers and government officials in an effort to enact real change.

Cultural Competency Training in Health Care

The LGBTQ community benefits from access to health professionals who have cultural competency training in health care, which is defined as teaching health professionals to take an interpersonal stance that is open to others regarding the aspects of their cultural identity that are most important to them. A healthcare professional with cultural competency training is better able to address the physical and emotional health of LGBTQ clients.

LGBTQ individuals can face health struggles that include lacking access to clinics or hospitals that can provide necessary treatment, facing stigma or judgment, lacking a strong support community to voice their issues and concerns, and being at risk of threatening illnesses and conditions, such as HIV or AIDS.

Public health professionals, nurses, and doctors with cultural competency training in health care examine their beliefs and attitudes toward others, respect differences, and present an attitude of acceptance and a willingness to learn from others. They can help alleviate these concerns and improve the health, environments, and lives of LGBTQ persons.

Public health professionals can build welcoming, inclusive environments that foster open communication between providers and LGBTQ individuals. This could include starting a support group at a local church or community center or organizing a public event or program that sheds light on LGBTQ health issues. Using their cultural competency training, public health professionals can design and implement inclusive policies that ensure that members of the LGBTQ community have equitable access to health services and resources.

For example, according to the Southern Poverty Law Center — an advocacy group that uses education and litigation to promote justice for vulnerable members in society — transgender people are more likely to experience violence than any other marginalized group. As a result, they require care that sensitively responds to that reality.

Professionals such as community health workers can help transgender people receive referrals to counselors who are experienced with the issues that affect this community and who can give empathetic and competent support.

In addition, health agencies might also direct staff to use gender-neutral language in all verbal and written communications with those who use their services, or invite them to specify their preferred pronouns. This type of LGBTQ healthcare policy can help foster an inclusive environment and comfortable self-identification.

Improved Health Data Collection for LGBTQ

Health data collection refers to the ongoing process of collecting, analyzing, and using information about patients in order to create public health prevention programs. According to the World Health Organization, “To develop effective prevention strategies, [communities] need to improve their information.”

Collecting health data about the demographics of LGBTQ individuals in order to understand and resolve health disparities is an aspect of the Affordable Care Act. Understanding an individual’s sexual orientation and gender identity can help professionals better understand health problems in the LGBTQ community.

Boosting the collection and analysis of health data about LGBTQ individuals can lead to improvement in health policies. These efforts begin with educating the community about the real-world benefits and potential consequences of current or proposed policies relating to LGBTQ health. For instance, before they can enact positive change, lawmakers must fully understand both the human and financial costs to society that result from the LGBTQ community’s compromised access to health care.

Public health professionals must work to show lawmakers and community leaders the benefits of adopting evidence-based solutions, such as public education programs that have had a high success rate in other areas, or medical outreach programs proven to improve the livelihood of LGBTQ individuals. These solutions, all involving improved health data collection, are steps toward better equity in LGBTQ health care access and service.

Earn a Master of Public Health Degree and Make a Difference

Cultivating expertise in the core areas of public health — epidemiology, behavioral science, environmental health, biostatistics, and management — can prepare public health advocates with the tools needed to help the nation achieve LGBTQ health care access and create a more just society.

Tulane University’s Online Master of Public Health offers students the opportunity to study under the guidance of accomplished health innovators devoted to the public good. With a program focused on applying research to real-world environments, developing evidence-based policies, and working toward creating health systems that foster equity, graduates learn how to become powerful agents of change.

Discover how earning an Online Master of Public Health from Tulane University can launch a career serving local communities and promoting a healthier life for everyone, including the LGBTQ community.

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American Journal of Public Health, “Finding the Perfect Doctor: Identifying Lesbian, Gay, Bisexual, and Transgender–Competent Physicians”

American Public Health Association, “Creating The Healthiest Nation: Health and Educational Equity”

American Psychological Association, “Data on LGBT Populations to Be Collected in Major Federal Health Survey”

American Public Health Association, “Creating the Healthiest Nation: Health and Educational Equity”

Center for American Progress: “Discrimination Prevents LGBTQ People from Accessing Health Care”

Center for American Progress, “How to Close the LGBT Health Disparities Gap”

Center for American Progress, “Their Baby Was Denied Access to Care Because They Are Gay”

Centers for Disease Control and Prevention, Lesbian, Gay, Bisexual, and Transgender Health

Courthouse News Service, “Doctors with Gay Bias Denied Meds, Man Says”

Health Affairs, “HHS Proposes to Strip Gender Identity, Language Access Protections from ACA Anti-Discrimination Rule”

Human Rights Watch, “US: LGBT People Face Healthcare Barriers”

Human Rights Watch, “You Don’t Want Second Best: Anti-LGBT Discrimination in US Health Care”

The Joint Commission, “Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community”

National Alliance on Mental Illness, “LGBTQ”

National Women’s Law Center, “Health Care Refusals Harm Patients: The Threat to LGBT People and Individuals Living with HIV/AIDS”

NPR, “Medical Students Push For More LGBT Health Training To Address Disparities”

Office of Disease Prevention and Health Promotion, “Lesbian, Gay, Bisexual, and Transgender Health”

Southern Poverty Law Center, “Anti-Gay Hate Crimes: Doing the Math”

Transgender Law Center, Prescott v. Rady Children’s Hospital-San Diego

Tulane University, Online Master of Public Health

U.S. News & World Report, “‘Religious Refusal Laws’ May Take Mental Health Toll on LGBT Americans”

World Health Organization