Running Head: LGBT HEALTHCARE 1

LGBT Healthcare: Addressing Disparities and Improving Outcomes

Nicole D. Habel

Professor Kathy S. Faw RN, MSN

Bon Secours Memorial College of Nursing

NUR 3113

October 29, 2016

Honor Code “I pledge..”

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Introduction

Vulnerable populations are those at an unequal risk for incidence of disease, disease

burden, and mortality. Most often, these populations become vulnerable involuntarily and face

many social structures and barriers that limit their access to basic human rights such as health

care. A relevant example of a vulnerable population is that of the lesbian, gay, bisexual, and

transgender (LGBT) community. Political reform has increased federal rights for the LGBT

population, however, we still remain decades behind in delivering equitable healthcare. Not only

do LGBT individuals share the same health problems as their heterosexual counterparts but they

are also met with additional health risks in the face of unequal access to healthcare (Pelletier &

Tschurtz, 2012). The following paper investigates the health disparities of the LGBT community.

It will examine social determinants of health met by this community and what evidence-based

practices can improve their health outcomes. Furthermore, this paper will introduce what global

approaches are addressing the health needs of the LGBT community and minority communities

at large.

Social Determinants of Health

Healthy People 2020 defines social determinants of health as “conditions in which people

are born and live that affect a wide range of health, functioning, and quality-of-life outcomes and

risks” (Healthy People, 2016.) The health outcomes of the LGBT community are deeply

influenced by social determinants such as limited access to health insurance, providers lacking

training in cultural competence, professional schools offering little training on LGBT health, a

history of policies denying equal benefits and legal protection, and a long-standing stigma that

homosexuality and non-binary gender expression are “constructed as invalid relative to

heterosexuality” (Lim et al, 2014).

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The aforementioned social constructs create a healthcare atmosphere that discriminates

against the LGBT population and drives them to avoid seeking preventive health care services.

Although further research is needed on the health outcomes of this community, LGBT

individuals face increased risks for mental illness and HIV infection, among other fatal

conditions, than their heterosexual counterparts (Lim et al, 2014). More specifically, lesbians are

more likely to suffer from obesity and secondary conditions such as diabetes and heart disease.

Men who have sex with men carry the risks that occur with having unprotected sex: HPV-related

anal cancer, higher rates of HIV infection, and long-term side effects of the antiretroviral therapy

used to treat AIDS. Nineteen percent of transgender individuals report being denied care from

their providers (Lim et al, 2014).

Evidence-based Interventions Addressing Health Needs

Much like other minority populations, the LGBT community is in no way homogenous

and in order for care to be culturally competent, this population requires utilization of

individualized, patient-centered care. This transformation starts with the providers. The Institute

of Medicine has raised concerns about the lack of education in medical schools regarding LGBT

health and how the internalized attitudes of providers affect their ability to provide non-

discriminative care. Closing the gap in health equality for LGBT individuals can begin with steps

as simple as training future providers to practice self-awareness of any internal bias, to

understand social determinants of health, and to communicate sexual orientation and gender

identity openly with every patient in an inclusive way.

The Millennium Development Goals (MDGs) were established by the United Nations in

2000 to promote inclusive health care and basic human rights for all. The MDGs provides a set

of indicators that “measure progress towards” the established goals (Millennium Project, 2006).
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There are eight over-arching goals in this initiative however only one is particularly relevant to

the LGBT population: Combat HIV and AIDS. Monitored by the World Health Organization,

this goal is measured by indicators of condom use rate and what percentage of the population

possesses appropriate education regarding HIV and AIDS. Counseling on safe sex, behavioral

risk reduction, and thorough teaching on the transmission of sexually transmitted infections

would benefit the community at risk for HIV and AIDS. (Cleveland Clinic Journal of Medicine,

2011).

Global Approach in Addressing “Health for All”

Global organizations are recognizing the disparities among the LGBT community and are

acting to set goals and improve their health outcomes. For instance, Healthy People 2020 (HP

2020) is an organization that has established four overarching goals to improve public health.

Namely, two of HP 2020’s goals could directly eradicate the health barriers in the LGBT

community. The first of these two initiatives is to achieve health equity, eliminate disparities,

and improve the health of all groups. HP 2020 urges researchers to further collect data and

access health records in order to better understand the health disparities that exist in the LGBT

community. In order to eradicate health barriers, we must begin combatting this lack of research

so we might better understand precisely what barriers these individuals encounter.

The second relevant initiative by HP 2020 is to create social and physical environments

that promote good health for all. HP believes this goal can be achieved by improving culturally

competent training for medical students and providers, implementing anti-bullying policies in

schools, and providing more accessible mental health services (Healthy People, 2011). These

global approaches will benefit the LGBT population specifically as well as other vulnerable

populations worldwide.
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Conclusion

In conclusion, the LGBT community has specific barriers to equitable healthcare that

require further research in order to eradicate those barriers. Other social determinants of health

for this community include medical students and providers lacking the appropriate education in

LGBT health and cultural competence and a social stigma demeaning the validity of

homosexuality and gender identity. Through large scale initiatives such as the Millennium

Development Goals and Healthy People 2020, evidence-based practices are opening up

opportunities for the LGBT community to receive more equitable health care and subsequently

enjoy longer, higher quality lives. Lastly, the most valuable effort to improve LGBT healthcare

exists in the improvement of culturally competent care from self-aware providers and in the

development of curricula that educates such providers.

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