Health Disparities in the LGBTQ Community Bako Orionzi
Health Disparities in the LGBTQ Community Bako Orionzi, Nicole Cairns, Jennifer Janssen, Madia Ampey
“Just recently-within the week--was given a complete physical at Mayo Clinic and informed the P. A. of my sexuality. The warmth of the room chilled dramatically. ”
General Info Sexual orientation and gender identity are largely missing from public health surveillance. The census does not have an accurate count for the population. Therefore, any reliable prevalence number has no accurate population number to get an accurate comparison rate = occurrences/population # Gallup polls estimate the population is 3. 5% LGBT, 2010 SHAPE estimates 6. 8% in Hennepin County. Rainbow Health Initiative, Minneapolis MN
Minority Stress Theory Prejudice and stigma directed toward LGBT people bring about unique stressors. These stressors cause adverse health outcomes including mental disorders Meyer 2003
Minority Stress Theory Ex. of stressors: 20 -40% of the homeless youth are LGBT They are only 5% of the whole youth population Ex. of adverse health outcome: 20 -40% of LGB youth report suicide attempts
Meyer 2003
Social Determinants of Health ● Social determinants of health (SDOH) refer to the social, economic, educational, community-based opportunities that influence people’s health ● Examples: ○ level of education ○ access to doctors ○ safety ○ quality of neighborhoods ○ access to health foods ○ income level ○ etc.
National Data: Poverty 12. 1% of children living with married different-sex couples live in poverty while… 25% of children living with a male same-sex couple live in poverty 19. 2% of children living with a female same-sex couple live in poverty Transgender and gender nonconforming people are 4 x more likely to be living in poverty than the general population African American children in male same-sex households have the highest poverty rate of any children in any household type The Williams Institute, UCLA School of Law
National Data: 19% of our sample reported being refused care due to their transgender or gender non-conforming status, with even higher numbers among people of color in the survey 28% of respondents were subjected to harassment in medical settings and 2% were victims of violence in doctor’s office LB youth have twice the pregnancy rate as heterosexual peers 61% of new HIV infections reported are in people who have identified as gay or bisexual
“I was forced to have a pelvic exam by a doctor when I went in for a sore throat. The doctor invited others to look at me while he examined me and talked to them about my genitals. ”
Demographics of MN Study Voices of Health, 2014 Rainbow Health Initiative. (2015). Voices of health: A survey of LGBTQ health in Minnesota. Minneapolis, MN. Survey of LGBTQ health in Minnesota 1, 859 people completed the survey of which 1, 351 identified as LGBTQ varying incomes, races, sexual identities, sexual orientations
Discrimation 9% experienced health care discrimination in the past 12 months 15% of transgender respondents experienced discrimination compared to 7% of cisgender people
“My partner was brought to ER to be seen for chest pain. When they brought him back I checked him in. I was told I could not sign any paperwork as I was 'not real family. ' Even though they gave him morphine they insisted he sign. The clerk left me at her station and never returned. I had to go find someone to let me back to see him. We were together for 24 years at that point. The sad thing is I work at the hospital we brought him to as a RN. Discrimination is strong and alive. ”
Quality of Care 12% had experienced poor quailty care in the past 12 months 25% of transgender people who responded experienced poor quality care compared to 11% of cisgender respondents
Insurance Coverage 88% of LGBTQ respondents have health insurance compared to 95% of general population in MN
"[I] wasn't allowed to receive gender therapy and have it covered by my insurance company because it was viewed as an elective treatment-not needed. They said they'd charge me $120 per session and I had to have a certain amount of gender therapy in order to qualify for testosterone, so I decided not to get on testosterone instead. "
LGBTQ General Health Risks 25% smoke everyday or some days per week 38% reported binge drinking On average, eating only 2. 4 cups of fruits and vegetables per day (recommended 4. 5 cups per day)
Mental Health 60% report being diagnosed with depression 50% report being diagnosed with anxiety Half of LGBTQ responders identified mental health as a priority issue affecting the LGBTQ community
Mental Health: Youth LGBTQ youth are more like to report internal distress and suicidal ideation (2013 Minnesota Student Survey)
Patients “out” to their doctors: 62% were “out” to their doctor about their sexual orientation or gender identity 40% of bisexual people were “out” 71% of both gay and lesbian people were “out” 49% of LGBTQ people of color 65% of white LGBTQ
“I was told my "decision" to become trans and subsequent lifestyle were the reasons I was depressed anxious and “if you (I) were just your (my) normal self, you (I) wouldn't experience these obstacles. ” I believed that I was causing my own depression by selfishly choosing to be the man I inherently knew I was. ”
Physician Competency in LGBTQ health 32% thought their doctor was “very competent” 33% thought their doctor was “somewhat competent” 7% thought their doctor was “not at all competent”
“There are very few doctors who prescribe hormones in the cities (or at least are open about it) and there are even fewer doctors who are competent at it” “I had to remove my own catheter once due to a nurse not wanting to touch my genitals. ”
“Just a note to say how much gratitude I feel for your amazing, truly accepting heart! Just talking to you once gave me so much hope! Your knowledge and accepting manner gave me more comfort than I've ever had with a Physician. I have seen psychologists and psychiatrists before to try to deal with my gender, with dismal results. In twenty minutes you made me feel human again. After so many years living in fear, your acceptance gave me hope! A remarkable thing for an old cynic like me. So. . . thank you!”
Resources Meyer I. H. (2012). Minority Stress and the Health of Sexual Minorities [Power. Point]. Retrieved from: http: //diversityscience. psych. ucla. edu/speakers/pdf/Meyer_Psych_Diversity_Lecture_2 -9 -12. pdf Injustice at every turn: The Task Force, National Transgender Discrimination Survey Report http: //www. thetaskforce. org/static_html/downloads/reports/ntds_full. pdf) Ray, N. (2007). Lesbian, gay, bisexual and transgender youth: An epidemic of homelessness. Washington, DC: National Gay and Lesbian Task Force. Retrieved June 1, 2012, from http: //www. thetaskforce. org/downloads/Homeless. Youth. pdf Paul, J. , Catani, J. , Pollack, L. , Moskowitz, J. , Canchola, J. , Mills, T. , et al. (2002). Suicide attempts among gay and bisexual men: Lifetime prevalence and antecedents. American Journal of Public Health 92(8), 1338– 1345. Meyer, Ilan H. "Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. " Psychological bulletin 129. 5 (2003): 674.
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