LGBT health: A public health issue


Too often, anything related to ‘LGBT issues’ is left to LGBT organisations

By Catt Turney

February is LGBT History Month in the UK, a time to reflect on the history of LGBT (lesbian, gay, bisexual and trans)* movements, celebrate achievements, and look at the situation now. We in public health are very good at talking about health inequalities related to socioeconomic status – and rightly so – but there’s little discussion of LGBT-specific health needs or inequalities.

LGBT health

Granted, LGBT health is complicated. There’s a ‘cluster of factors’ contributing to the health inequalities faced by LGBT people, and these are difficult to untangle. There are health risk factors directly associated with same-sex sexual practices – for example, MSM* have a higher risk than other men of contracting HIV, even controlling for safe sex behaviour – and with being trans (the hormones taken by many trans people long-term may have adverse health effects, although little research on this exists). Additionally, certain unhealthy behaviours are more common in LGBT people (note the deliberate avoidance of the phrase ‘lifestyle factors’), for a complex mixture of reasons. On average, LGBT people are more likely to smoke, take drugs and have unhealthy drinking behaviour than the population as a whole, and lesbian and bisexual women are more likely to be obese than heterosexual women.

And mixed up in all of this, there’s the continuing discrimination and prejudice towards LGBT, particularly trans, people. As well as potentially exacerbating unhealthy patterns of substance use, these impact directly on mental and physical health. Rates of depression and suicide are higher in LGBT people than the general population, and homo- and transphobic physical attacks are still prevalent. These include attacks in schools, yet many schools still avoid the discussion of anything LGBT-related or actively present homophobic messages. In health services too, the reluctance of many LGBT people to ‘come out’ to every health professional they encounter means they may not receive the right advice. This reluctance seems to be justified – many LGB respondents to two Stonewall surveys reported that healthcare professionals ignored the fact that they were LGB, made inappropriate or homophobic comments, were only willing to talk about sexual health, or gave incorrect information. #Transdocfail, a Twitter hashtag launched last month by Counciller Sarah Brown, documents the horrendous treatment received by many trans people from health professionals.

Pushing for change

Until monitoring data is routinely collected on sexual and gender identity in healthcare, knowledge of the health outcomes of LGBT people will continue to be sparse. Similarly, schools and universities must address the homophobia and transphobia still rife in these institutions, including in medical training. There is already great work going on relating to these (I’m particularly impressed by the work of Shaun Dellenty, a headteacher who here elegantly skewers the moral panic often emerging in relation to teaching children about anything LGBT), but we need to acknowledge that these are public health issues and add our voices to calls for change.

As researchers, too, we have a vital role. Research is emerging – into the health and health needs of LGBT people (and targeted interventions to address these); homophobic and transphobic discrimination within education; and coverage of LGBT topics in medical training – but far more is needed.

This is a call then, for the public health research community to stop thinking that LGBT issues aren’t its problem. It’s now generally accepted that if people are obese/smoking/dying early, this is an issue for public health as a whole. This applies to LGBT health inequalities too. If public health researchers feel they don’t know enough about LGBT topics to study them, there’s a whole heap of resources out there, and the internet is very forgiving.  For researchers, ’I don’t know enough about X to research it’ is somewhat of a copout.

None of this is simple. We need to develop a system that addresses the health needs of LGBT people without falling into victim blaming or perpetuating the view peddled by much of the tabloid press and the far right that being LGBT makes one mad, bad and dangerous to know. This is no mean feat, but we have to start somewhere. Mainstream public health research needs to stop leaving LGBT health to LGBT organisations and get engaged.

* I’ve used LGBT in this blog as an umbrella term here for anyone who’s not heterosexual and cisgendered. L, G and B are self-defined sexual identities, T describes gender identity. These are distinct from MSM (men who have sex with men) and WSW (women who have sex with women), which describe sexual practices. This article offers an interesting discussion of the role of these labels in public health discourse.

Catt Turney (@CattTurney) is Research and Knowledge Exchange Assistant at DECIPHer.


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