|
Newsletters>
Empower Yourself to a Healthier Life
August 1, 2007
Health disparity refers to differences in various aspects
of healthcare and health status among subgroups of the
population.1 This article will briefly discuss health
disparities in the LGBT community, as well as formulate
suggestions for improvement of healthcare at the
individual, community and public health policy levels.
Some Reasons for Disparities:
One barrier to healthcare may be related to stigmatization
and lack of diversity training in many healthcare
providers. In one study examining negative attitudes of
physicians toward LGBT individuals, it was found that 40%
of physicians surveyed expressed discomfort providing care
to lesbian and gay patients.2 Additionally, many healthcare
providers have not received training in issues unique to
LGBT persons. Increased risk for blood clots associated
with hormone therapy in transgendered women (MtF),
promotion of pap smears for lesbians, rectal exams in gay
men are medical issues needing more attention by healthcare
providers. Health forms and the way in which questions are
asked, many times promote discomfort, non-disclosure, and
defensiveness (e.g., “Are you married or single?”). Thus,
many physicians and other healthcare workers are not
trained to take personal histories for specialized
populations, and LGBT individuals may fear discrimination
or inadequate care if they do come out.
Also, while many organizations have, in recent years,
implemented health insurance coverage for same-sex couples,
coverage varies from state to state. Thus, if not covered,
LGBT individuals may not be able to afford needed
healthcare. And when coverage is available, insurance
companies in most instances do not reimburse for conditions
(e.g., infertility) and procedures (e.g., sex reassignment
surgery) unique to the LGBT population.3
Further, program evaluation and outcome research are
lacking. Studies are plagued by lack of government funding
and methodological problems such as recruitment
difficulties, sampling error, and defining sexual identity.
Health Concerns for the LGBT Community:
Cardiovascular Disease (CVD) is the leading cause of
mortality for all individuals in industrialized countries.
There are many factors contributing to the development of
CVD. Psychological factors (e.g., stress, anger), genetic
factors (e.g., family history), and behavioral factors
(e.g., diet, smoking, exercise) all contribute. Some of
these risk factors are increased in LGBT persons. For
example, rates of smoking and obesity are higher in
lesbians than in heterosexual women.4 LGBT individuals
experience more stress in their day to day lives related to
discrimination and isolation than heterosexual counterparts
and this stress may contribute to the development of heart
disease over time.3
Cancer. Lesbians are at a higher risk than heterosexual
women for breast, cervical, and ovarian cancers; one reason
stemming from lack of screening3. Gay men are at higher
risk than heterosexual men for anal cancer.3 MtF transexual
individuals who do not have their prostate removed are
still at risk for prostate cancer, and FtM transsexuals are
still at risk of breast cancer despite breast reduction
surgery.5
STDs. While 54% of those diagnosed with AIDS are men who
have sex with men, the impact of AIDS in the lesbian
community is yet to be established. Other STDs or
conditions related to sexual behavior to be aware of are
bacterial vaginosis in women, enteritis in men, human
papillomavirus, and hepatitis A and B.3 There are few, if
any studies on STDs in the transgender community.
Mental Health. Numerous studies have shown that LGBT
individuals are exposed to higher levels of daily stress
because of stigmatization, isolation from family and
society, and discrimination.3 High levels of stress, in
addition to contributing to physical illness, also may
precipitate the development of certain types of mental
illnesses. There is evidence of higher rates of depression,
anxiety, and suicide in LGBT individuals.3 With the lack
of social support, it is not surprising that LGBT
individuals have higher rates of mental health care
utilization than heterosexuals.
Substance Abuse. Studies assessing substance abuse rarely
ask about sexual orientation, thus, studies that do examine
rates of substance abuse in LGBT individuals are usually
conducted in bars and other non-representative
environments. Studies comparing rates of alcohol abuse in
the LGBT vs. general population yield conflicting results.5
One subpopulation, however, where drinking and substance
abuse rates seem to be higher is among LGBT youth.5
Call to Action to Reduce Health Disparities in the LGBT
Community:
This article would not be complete without a call to action
to improve the state of health and healthcare for the LGBT
community. Improvements should be implemented at several
different levels. At the level of public health policy,
there is a need for more outcome research in many of the
areas discussed. More research means more funding, whether
it be from federal, state, or local government sources, as
well as the private sector. Show support for organizations
that contribute funding to research LGBT health issues.3,5
While the trend in healthcare is toward “cultural
competence,” there are few programs that support training
and development of culturally competent health- and mental
healthcare providers. Desperately needed, are programs
providing diversity training and education for physicians
and mental healthcare providers, starting in medical and
graduate school. The American Psychological Association
and Gay and Lesbian Medical Association (GLMA) should work
together to further develop training programs for
providers.
Most important, empower yourself when it comes to
self-care! Educate yourself about various health risks. Be
aware of family history. See a physician for regular check
ups. If you feel discriminated against or feel you’re
receiving sub-standard care, communicate this! Seek
referrals from various organizations or interview
physicians/psychologists to make sure they are
knowledgeable about, and comfortable with LGBT issues. You
are your best advocate!
Resources:
National: GLMA: www.glma.org
Local: Fenway Community Health Center:
www.fenwayhealth.org (888-242-0900)
Mental Health: Rhode Island Psychological Association
(736-2900)
1Sidani, S, et al., (2002). Reducing Health Care Disparity:
Barriers to Health Care Utilization.
2Matthews, WC, et al. (1986). West. J. Med. 144, 106.
3Dean, L, et al., (2000). J. Gay & Lesbian Med. Assn. 4,
102.
4Solarz, A. (1999). Lesbian Health: Current Assessment and
Directions for the Future.
5GLMA. (2001). Healthy People 2010, Companion Document for
LGBT Health.
|
|
|
