Individuals who identify as lesbian, gay, bisexual, or transgender (LGBT) often have specific health issues that affect them in a greater proportion than non-LGBT individuals. For example, certain types of cancer are more common in the LGBT community (Massetti et al., 2015). Also, according to the U.S. Institute of Health, LGBT people are marginalized and underserved, largely due to stigma and discrimination. The Healthy People 2020 initiative was the first to establish the LGBT community as at-risk due to health gaps produced by sexual orientation and gender identity (Fredriksen-Goldsen et al., 2014). Although acknowledging disparities is a good first step, it has no meaning unless it is followed by measures that are intended to establish health equity.
Members of the LGBT population are more likely to have physical disabilities and overall poor health (Fredriksen-Goldsen et al., 2014). The HIV prevalence is highest among gay and bisexual men, while lesbian and bisexual women are at increased risk of obesity and the associated comorbidities such as metabolic syndrome, diabetes, and heart disease. Older LGBT adults have higher rates of smoking, excessive drinking, and limitations of activities of daily living (ADLs) (Emlet, 2016).
With regard to cancer, the Centers for Disease Control and Prevention, as well as the National Cancer Institute and associated agencies, have only recently began to track cancer information related to sexual orientation and gender identity. However, the data collected so far shows significant differences in the incidence of seven cancers when LGBT are compared with non-LGBT patients. These cancers are primarily site-specific and affect areas of the body that are related to sexual practices (such as anal and cervical cancer). The only exception is lung cancer (Massetti et al., 2015).
Mental health may be the most significant health issue for LGBT people, since the stigma attached to their identity can result in depression, anxiety disorders, and even suicide. For example, depression is six times more common for LGBT people than heterosexuals. With LGBT teens, suicide is a particularly critical problem. As compared to heterosexual youth, LGBT youth are four times as likely to attempt suicide; according to the National Alliance on Mental Illness (NAMI, 2017), 38-65% transgender teens have suicidal ideation.
The health disparities described above have their roots in social determinants of health such as decreased health care access, increased economic insecurity, greater experiences of discrimination, and poorer social support (Emlet, 2016). Many LGBT people choose not to reveal their sexual/gender identity to their doctors for fear of discrimination. For example, if a woman’s gynecologist asks her if she needs birth control, she may feel uncomfortable replying that she is a lesbian. Instead, she may say that she is not sexually active or that she has already gone through menopause. There are two serious effects of her lack of frankness: first, the doctor does not have all the information s/he needs to diagnose the patient. Second, the need to lie or cover up her identity can cause a lesbian or bisexual woman to have lower self-esteem and self-acceptance, which can contribute to depression and anxiety (Bostwick et al., 2014).
All individuals have a right to good health and to reach their full health potential. A social system that prevents people from having access to adequate health care is unjust and violates human rights (Fredriksen-Goldsen et al., 2014). The concept of health equity looks at several levels, including structural, environmental, individuals, and community factors in determining health. In order to provide health equity, both policy and practice changes are needed. For example, policies that ensure nondiscrimination in employment, housing and public accommodations, as well as marriage equality and non-relative caregiver benefits, are essential in this regard (Day & Weatherby, 2016). Specifically, sexual and gender identity must be added to the 1964 Civil Rights Act (Fredriksen-Goldsen et al., 2014). Another important policy that requires clear delineation at the federal level is the difference between freedom of religion and freedom to discriminate against minorities. The freedom of religion clause has been used to explain violations of marriage equality, for example. If sexual minorities are to be equal to other groups with regard to health, other civil rights must be granted as well. Discrimination must be outlawed; prejudice and stigma must be met with education and legal opposition where possible.
- Bostwick, W. B., Boyd, C. J., Hughes, T. L., West, B. T., & McCabe, S. E. (2014). Discrimination and mental health among lesbian, gay, and bisexual adults in the United States. American Journal of Orthopsychiatry, 84(1), 35.
- Day, T., & Weatherby, D. (2016). The Case for LGBT Equality: Reviving the Political Process Doctrine and Repurposing the Dormant Commerce Clause.
- Emlet, C. A. (2016). Social, Economic, and Health Disparities Among LGBT Older Adults. Generations, 40(2), 16-22.
- Fredriksen-Goldsen, K. I., Simoni, J. M., Kim, H. J., Lehavot, K., Walters, K. L., Yang, J., … & Muraco, A. (2014). The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. American Journal of Orthopsychiatry, 84(6), 653.
- Massetti, G. M., Ragan, K. R., Thomas, C. C., & Ryerson, A. B. (2016). Public health opportunities for promoting health equity in cancer prevention and control in LGBT populations. LGBT health, 3(1), 11-14.
- National Alliance on Mental Illness (NAMI). (2017). LGBTQ. Retrieved from http://www.nami.org/Find-Support/LGBTQ