Understanding and Addressing LGBTQIA Healthcare Disparities

Although there has been so much progress for LGBTQIA rights in our country and throughout the world, there are still many areas that are in need of evaluation and improvement. One such area is healthcare for those in the LGBTQIA community. There are many that assume you can treat the healthcare of those in the community the same as the rest of the population, but this is not the case. Not only are the healthcare needs of the LGBTQIA community unique, but each community under that umbrella has specific and necessary healthcare needs.

Kathleen A. Bonvicini, the former CEO of the Institute of Healthcare Communication, states that there persists “a dearth of cultural competency education and training for healthcare professionals focused on clinical assessment and treatment of LGBT patients.” 1 As we delve more into this lack of knowledge and awareness, we see how these deficits lead to health disparities. Michael Merchel from the American Heart Association highlights findings that both gay men and bisexual women “were at higher risk for high blood pressure than their heterosexual peers.” 4 Another example is the higher rates of HIV among transgender women and gay men which is associated with increased risk for heart disease. 4 Additionally, Merchel goes on to state that “health care professionals who aren’t aware of LGBTQ needs can be insensitive about even basic medical needs.” 4 This includes when lesbian women are asked about birth control or a trangender person is instructed to get an exam for anatomy they do not have. The best way for healthcare professionals to address this is to approach everyone as individuals. This entails making no assumptions about a person’s identity and simply asking for clarification rather than speculating.4

Another important aspect of healthcare that has come to the forefront of attention in recent years is mental health. With the normalization of mental health as an essential aspect of healthcare over the past few years, many mental health professionals became aware of disparities based on demographics. Numerous studies have demonstrated that there is a “higher prevalence of depressive and anxiety disorders among lesbian, gay, and bisexual groups as compared to heterosexuals.” 2 Furthermore, it has been found by several different studies that “these disparities are the result of the stress that prejudice and perceived discrimination can cause.” 2 

On the topic of prejudice and discrimination, one cannot ignore the COVID-19 pandemic and how it exposed some of the glaring health disparities and systemic discrimination within not only our country, but the world. In the American Journal of Human Biology, a commentary from James K. Gibb and coauthors entitled “Sexual and gender minority health vulnerabilities during the COVID-19 health crisis” highlights how sexual and gender minority people faced immense disparities and discrimination prior to the COVID-19 and how these inequities were magnified during pandemic conditions.3 Just one example of this is the Hungarian government attempting to employ emergency COVID-19 powers to strip legal recognition and protections from transgender citizens.3 Similarly, in 2020 the US Department of Health and Human Services finalized a rule that reversed protections against medical discrimination of transgender patients.3

Today in the United States, the rights of the LGBTQIA community are being struck down or challenged in both federal and state governments, just over 7 years after same-sex marriage was legalized. Though it is easy to say this is a political issue, there will be significant negative ramifications on the health and wellbeing of sexual and gender minorities. The current political climate in the United States is one that, unfortunately, has become hostile towards the LGBTQIA community in certain state governments and among some members of the U.S. Congress. Following the reversal of Roe v. Wade in June by the United States Supreme Court, a concurring opinion from Supreme Court Justice Clarence Thomas invited new legal challenges to contraception and same-sex marriage rights 5, the latter of which has become a new stressor to the mental health of thousands upon millions in the LGBTQIA community. Although this garnered national headlines due to the profile of the statement’s author, this came as no surprise as throughout the country, there already have been several state governments attempting to limit, or strip away entirely, LGBTQIA rights. And when you have a government that is attempting to institutionalize discriminatory policies against you, it must be said that this is extremely stressful and damaging to the mental health and physical wellbeing of those in the LGBTQIA community.

Having established some of the disparities that face the LGBTQIA community, we begin to weigh what is the best way to rectify these disparities. It is clear that the best way to eliminate these disparities, as well as the challenges to LGBTQIA rights, is to raise awareness and increase advocacy for the LGBTQIA community. There are a plethora of ways to go about this through the multitude of LGBTQIA advocacy organizations in our state as well as throughout the country. Just one example of an advocacy organization in Texas is Equality Texas 6. If you wanted to specifically seek out health advocacy organizations, GLMA: Health Professionals Advancing LGBTQ Equality 7, The Fenway Institute (by way of Fenway Health) 8, and the National Coalition for LGBTQ Health 9 are just a few examples at the national level. Lastly, two examples of long-standing, credible organizations that have an extensive history of fighting for LGBTQIA rights in our federal and state governments are the Human Rights Campaign 10 and the American Civil Liberties Union 11. All of these organizations provide excellent resources to help you, or others, become more informed and aware of these issues. Most importantly, these organizations provide opportunities for you to contribute and get involved in the push for equity for the LGBTQIA community.

    In 2022, we as a population continue to fight for equity, not only in the United States, but across the world, and one vital area of this push for equity is health care. It has become glaringly apparent in recent years that there is a serious lack of equity in not only LGBTQIA health care, but sexual and gender minority rights that are constantly under attack as we speak. As a general population, the best course of action we can take is make ourselves aware of the disparities and discrimination faced by sexual and gender minorities and do our best to advocate for their basic human rights including the right to health care. When it comes to health professionals, the best way to progress LGBTQIA health and health care is to continue to educate more health professionals on the specific and unique needs of the LGBTQIA community. By continuously raising awareness and advocating for the rights of the LGBTQIA community, more and more people will know what is needed to rectify the health disparities within our communities and attain that ever-elusive status of equity.

References

  1. Bonvicini, K. A. (2017). LGBT healthcare disparities: What progress have we made? Patient Education and Counseling, 100(12), 2357–2361. https://doi.org/10.1016/j.pec.2017.06.003 
  2. 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), 35–45. https://doi.org/10.1037/h0098851 
  3. Gibb, J. K., DuBois, L. Z., Williams, S., McKerracher, L., Juster, R. P., & Fields, J. (2020). Sexual and gender minority health vulnerabilities during the covid ‐19 health crisis. American Journal of Human Biology, 32(5). https://doi.org/10.1002/ajhb.23499 
  4. Merschel, M. (2022, June 14). Why the world of LGBTQ Health doesn’t fit under a single label. www.heart.org. Retrieved July 11, 2022, from https://www.heart.org/en/news/2022/06/14/why-the-world-of-lgbtq-health-doesnt-fit-under-a-single-label
  5. Barragán, J. (2022, June 24). In Roe Decision, justice Clarence Thomas invites new legal challenges to contraception and same-sex marriage rights. The Texas Tribune. Retrieved July 27, 2022, from https://www.texastribune.org/2022/06/24/roe-wade-clarence-thomas-contraception-same-sex-marriage/ 
  6. Equality Texas. (n.d.). Equality Texas. Retrieved 2022, from https://www.equalitytexas.org/ 
  7. GLMA. (n.d.). GLMA Home Page. GLMA. Retrieved 2022, from https://www.glma.org/ 
  8. Fenway Health. (2022, February 8). The Fenway Institute. Fenway Health: Health Care Is A Right, Not A Privilege. Retrieved from https://fenwayhealth.org/the-fenway-institute/ 
  9. National Coalition for LGBTQ Health. (n.d.). What’s the state of LGBTQ Health in the United States today? National Coalition for LGBTQ Health. Retrieved 2022, from https://healthlgbtq.org/ 
  10. Human Rights Campaign. (n.d.). Human Rights Campaign. Retrieved 2022, from https://www.hrc.org/ 
  11. American Civil Liberties Union (ACLU). (2022, February 16). LGBTQ Rights. American Civil Liberties Union. Retrieved 2022, from https://www.aclu.org/issues/lgbtq-rights 

About the Author: Nathan Punay is a Senior at UTSA graduating with a Bachelor of Science in Health with a concentration in Community Health and Preventative Services. This summer, Nathan has been completing his internship with the Institute for Health Disparities Research and hopes to spread awareness of LGBTQIA health disparities within our community.

Understanding Children with Chronic Illness & Improving their Learning Environment 

Childhood is a unique time in a person’s life. Learning new skills, making new friends, and participating in fun activities are all things carried dearly from childhood. However, life for a child with a chronic illness can look very different. While most kids focus on learning and playing in their daily lives, many children with chronic illness face hospitalizations and stress from having to cope with their illness. A child dealing with sickness may lose confidence in themselves, steer away from social interactions and are at risk for mental health issues caused by stress. Not only is it a journey for the chronically ill child, but for caretakers such as parents or even schoolteachers. Understanding the hardships of chronic disease & accommodating the child’s learning environment are major factors in being an advocate for your child. 

Unsurprisingly, this issue remains a work in progress in the healthcare sector and for parents of this generation. To decipher your child’s physical, emotional, and medical needs requires dedication, experimentation, and above all, patience for your child and yourself. In the past, the number of children suffering from long term illness was not as great as today. Currently, chronic disease has reached the forefront of health concerns. Approximately 45% of Americans suffer from at least one chronic disease.1 Around 43% of children in the United States have at least 1 out of 20 chronic health conditions.2 Common chronic conditions include asthma, diabetes, obesity, hypertension, attention deficit disorder, cancers and birth defects. Healthcare has improved greatly over time for those suffering with chronic disease, but not every demographic will share the same benefits due to health disparities. Racial/ethnic minorities are 1.5 to 2 times as likely to have major chronic health disease than white populations.1 For example, there are disparities in asthma care between African American & white youths with African American youths having four times as many Emergency department visits as white youths.1 In addition to differing cultural and socioeconomic backgrounds, healthcare resources and education on chronic illness vary greatly between states, to cities and even zipcodes. Ultimately, these factors create a barrier for most to get the appropriate help and knowledge necessary to accommodate their child.

Considering the obstacles parents often endure to understand and meet their child’s medical needs, it is imperative that we don’t lose sight of the emotional and developmental impacts for the child. Children are at risk of developing mental struggles and insecurities related to their illness, which unfortunately impacts their social and learning environments like school. For example, children coping with disease may have lower levels of emotional well-being and experience depression or anxiety disorders. Fortunately, children can benefit from projects that are focused on making their learning experience more accessible and convenient in the classroom. For example, Section 504 of the Rehabilitation Act of 1973.3 Section 504 is a civil rights law that states students with disabilities may receive accommodations as well as supplementary services to ensure their individual educational needs are met as adequately as those of non-disabled students.3 In regard to public education, the law prevents schools from placing students in segregated classes solely due to their physical, mental or learning disability.3 This act has allowed students to share the same opportunities as their peers when participating in academic activities in class or extracurricular activities outside of the classroom. Students who benefit from this act are those with chronic illnesses like asthma and diabetes, mental health struggles such as anxiety disorder or depression, learning disabilities, as well students who require vision or hearing aids among many others.

Today, chronically ill children have more resources than ever before. With section 504, families can tailor their child’s individual educational needs at school to promote not only academic success, but also to uplift the child’s perspective of themselves and their circumstances in life. Assistance in the classroom allows children to participate on an even playing field which makes room for growth in confidence and self-esteem. While great strides have been made on this issue, we mustn’t forget that barriers still exist for minority and low-income populations. For example, a resource that provides low income families with health resources is the Children with Special Health Care Needs(CSHCN) Program.4 The CSHCN program helps children who are 20 and younger or have cystic fibrosis at any age receive the proper services necessary for their health and improve their  well-being.4 Services offered through the program include medical, mental health, dental, special medical equipment and supplies as well as family support services.4 What makes this program important is that communities who normally wouldn’t be able to afford these services are eligible, such as those who live at or below the federal poverty line.4 

At the end of the day, learning about your child’s needs can feel like an obstacle course, full of winding pathways and bumps in the road, but being their voice can be incredibly empowering. While many families are able to benefit from the progress made over the years for chronically ill children, there are communities who do not have as many resources provided to them. Aiding low-income communities by supplying them with appropriate resources to medical care and mental health support are vital for the well-being of children and their families as a whole.

References

  1. Price, James H., et al. “Racial/Ethnic Disparities in Chronic Diseases of Youths and Access to Health Care in the United States.” BioMed Research International, Hindawi, 23 Sept. 2013, https://doi.org/10.1155/2013/787616 (Accessed: 5 April 2022).
  2. Bethell, Christina D. “A National and State Profile of Leading Health Problems and Health Care Quality for US Children: Key Insurance Disparities and Across-State Variations.” Academic Pediatrics, 1 May 2011, https://doi.org/10.1016/j.acap.2010.08.011(Accessed: 5 April 2022).
  3. Texas Project FIRST. Available at: https://www.texasprojectfirst.org/node/40 (Accessed: 7 April 2022).
  4. Children with Special Health Care Needs Program. Available at: https://www.hhs.texas.gov/services/disability/children-special-health-care-needs-program (Accessed: 12 April 2022)

About the Author 

Autumn Skye Herrera is a senior majoring in health science at the University of Texas at San Antonio. She is completing her internship with the Institute of Health Disparities Research this semester and hopes to spread awareness about chronic illness in childhood, specifically in connection to health disparities.

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