The LGBT community is diverse. Although L, G, B, and T are often tied together as an acronym that suggests homogeneity, each letter represents a wide range of individuals of different races, ethnicities, ages, socioeconomic status and identities. Each letter deserves the same amount of care, attention and healthcare services. Sadly, what binds them together as social and gender minorities, especially in international countries, are the common experiences of stigma and discrimination that occur within healthcare, the struggle of living at the intersection of many cultural backgrounds and trying to be a part of each. With respect to healthcare, a long history of discrimination, overall lack of awareness, and simple education of health needs by health professionals. As a result, LGBT people face a common set of challenges in accessing culturally-competent health services and achieving the highest possible level of health.
The International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA) reported that no less than 80 countries around the world consider homosexuality illegal. In some of them (Iran, Mauritania Saudi Arabia, Sudan, Yemen, parts of Nigeria, and Somalia), homosexuality is punishable by death. This is an extreme situation and these laws reflect severe intolerance of sexual minorities in several countries.
Several years ago the WHO set up the Commission on the Social Determinants of Health which published a report entitled Closing the Gap in a Generation. The list of social determinants of health included: early childhood development, globalization, health systems, employment conditions, priority public health conditions, measurement and evidence, women and gender equality, urbanization, and social exclusion. Sexual orientation was excluded as a social determinant of health despite evidence that shows sexual minorities experience lower levels of health due to stigma and discrimination. The needs of the LGBT population in other countries continue to be ignored.
Cultural competence is the ability to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients. Culturally-competent health care systems can help improve health outcomes and quality of care, and can contribute to the elimination of many disparities. This could be a solution to many issues revolving around LGBT sensitivity and cultural competence. Lack of cultural competence may lead to patient dissatisfaction and excluding certain communities results in death and a large increase in annual costs. Some ways that we can move the healthcare system towards these goals include providing relevant training on cultural competence and cross-culture issues to health professionals and creating policies that reduce administrative and linguistic barriers to patient care. Let me explain.
In many cases we emphasize the need to address the broad health and well being issues and needs of LGBT people, rather than exclusively using an illness-bases focus such as HIV/AIDS in gay men or mental health in transgender individuals. We often critically examine the limitations of population health, the social determinants of health, and public health goals, in light of the lack of recognition of gender and sexually diverse individuals and communities. Moving forward, I believe that these steps should be included in the discussion towards equality and inclusion:
- Acknowledging the unique health and social care needs of LGBT individuals,
- Employing anti-oppressive, inter-sectional analyses, and
- Offering recommendations on how to make population health, public health goals, and design public health promotion and education more inclusive of gender and sexual diversity.
Representation matters. For example, in 2005 (over 10 years ago, wow!) Canada and the Public Health Agency of Canada announced a new set of Public Health Goals for Canada (similar to HealthyPeople 2020 reports in the U.S.). It’s intent was to provide a series of guideposts for health improvements and the enhance quality of life. Each recommendation provided a valuable beginning for understanding, conceptualizing, and developing a discourse of public health that captures objectives and strategies that are inclusive of LGBT individuals and communities. One of the goals includes enabling children and youth, particularly those that identify as gender or sexually diverse or are members of same-sex families, to reach their full potential and grow up happy, healthy, confident and secure. This would require the systemic participation of the healthcare, social service and education sectors. The links between the health and well being issues of gender and sexually diverse populations and Canada’s goals offer a blueprint for the kinds of initiatives and activities that must take place throughout the world to ensure the overreaching goal that everyone is receiving equal care – physically, mentally, emotionally, and spiritually.
We will continue to argue that an expansion of public health promotion and health education discourse would recognize gender and sexually diverse populations. Considering an approach such as Canada’s public health goals would contribute to the development and implementation of more inclusive, diverse policies that will fully benefit LGBT populations and communities.