Black stethoscope on rainbow flag background, symbol of LGBTQ+ community pride and health equity

Health Equity and the LGBTQ+ Community


Black stethoscope on rainbow flag background, symbol of LGBTQ+ community pride and health equity

Though American society has grown more accepting in the last few decades, there remains significant disparities in healthcare and increased health risks for those in the LGBTQ+ community.

Just as with any other group, the LGBTQ+ community is made up of people from myriad racial and ethnic backgrounds, cultures, incomes, religions, and traditions. One shared experience for the community, however, is discrimination and stigma.

In order to provide the best quality care, healthcare and behavioral health professionals should strive to understand the historical discrimination the LGBTQ+ community has faced, as well as the nuances between important terms like sexual preference, gender identity, and sex assigned at birth.

Data and identity

Sexual orientation (SO) questions are included in 11 federal surveys and, of these, seven also have an inquiry regarding gender identity. Gender identity questions were added to the National Health Interview Survey (NHIS), a principal source of US population health, beginning in 2013, and in the National Survey on Drug Use Abuse and Health (NSDUH) in 2015.

Understanding sexual orientation, gender identity, and sex assigned at birth among the LGBTQ+ community is imperative in today’s healthcare industry and climate:

  • Sex assigned at birth refers to the sex a person was born with. Knowing this information in a healthcare setting helps determine health risk factors and the need for screening, particularly if there are remaining natal organs (i.e., breasts, ovaries, testes).
  • Gender identity refers to an individual’s personal sense of having a certain gender, like male, female, transgender, or non-binary.
  • Sexual orientation identifies who the individual is attracted to romantically or physically.

These feelings cannot be identified by appearance and should be gathered directly from each individual in their own words.

Related CE Course: LGBTQ Competency for Healthcare Professionals

The subtle impact of implicit bias

To identify health risks, healthcare professionals must see, talk to, and examine patients. This sounds obvious, but there are barriers that may prevent professionals from assembling a complete patient history. Often, a lack of training or limited experience in caring for sexual minority people can make healthcare professionals hesitant to proceed.

Implicit bias can also prevent risk identification in the LGBTQ+ population. Bias can stem from religious or cultural backgrounds, fear of the unknown or unfamiliar, and preconceived ideas from media representation.

If the general healthcare community or individual caregivers have a preconceived idea of gender as male or female; sexual orientation as based on gender at birth; or sexual activity as between heterosexual individuals (and do not venture from this idea), pertinent health information about a patient may be missed.

Related Webinar: Implicit Bias Education and Training in Healthcare

Barriers to care

Internalized biases are not the only challenges LGBTQ+ individuals face when it comes to receiving quality care. A great deal of healthcare paperwork is heteronormative, without options for those outside of the cisgender/heterosexual paradigm. For LGBTQ+ patients with partners, extra documentation is required to include their partner in their care.

Insurance coverage may also be inadequate. While the U.S. requires federal and state employees with same-sex married spouses to receive the same benefits as heterosexual married couples, 45% of the LGBTQ+ population live in states that do not have LGBTQ-inclusive insurance protection.

These systemic and institutionalized barriers to quality care not only affect an LGBTQ+ individual’s physical health, but also their mental health and quality of life.

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Nondiscrimination legislation

Small steps toward health equity have been made within the last few years. The Affordable Care Act (ACA) and the expansion of Medicaid (implemented in 2010 and 2014, respectively) have increased the rate of LGBTQ+ adults with insurance.

The ACA set nondiscrimination protections for LGBTQ+ individuals, like prohibiting discrimination or refusal of care based on sexual orientation and gender identification in any ACA health plan, as well as any health program receiving federal funds.

However, there are still problems for transgender individuals, especially people of color (POC), desiring transition-related care. A Center for American Progress study found that 43% of transgender individuals and 48% of transgender POC were denied transition surgery, with 38% of transgender individuals and 52% of transgender POC being denied hormone therapy for transition.

Healthcare equity for all

Improving care for a historically marginalized population requires change at all levels, from clinicians to behavioral health professionals to lawmakers.

On the clinician level, the National LGBTQIA+ Health Education Center has published suggestions for improving healthcare environments for LGBTQ+ patients.

One suggestion includes posting a nondiscrimination policy, signed by the staff, in plain view of patients. A nondiscrimination policy helps ensure commitment to an environment in which all people are valued and respected and provides an opportunity for staff members to examine their own beliefs and assumptions about race, age, sex, gender, and marital relationships.

Using an intake form that allows a patient to provide personal information in a nonjudgmental manner will also help set the tone for quality patient-provider interactions. Additional suggestions include providing more inclusive options for screening questions, using open-ended questions, and using the term “partner” rather than “spouse.”

Asking the patient about their definition of behavior, sexual activities, language, or terminology prevents misperceptions that endanger health and encourages a more open, equitable relationship between patient and clinician.

Related CE Course: LGBTQ for Healthcare Professionals Improving Access to Care

This article is adapted from the 2-hour course LGBTQ for Healthcare Professionals Improving Access to Care, written by Cheryl Jackson, DNP, CRNP.