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In my line of work, I regularly hear stories of how LGBT people have been treated in the health care system. Many are tales of ignorance, discrimination and rejection. Some, always told with a mix of shock and appreciation, are positive accounts. Sadly, our people do not expect to be welcomed into health care.
I am the founder and executive director of the National LGBT Cancer Network, a nonprofit organization that addresses all three sides of the health care triangle: our increased health risks, our extra challenges as patients in the system, and our desperate need for more research and data.
As a group, our community has dramatically increased cancer risks, most resulting from the stigma of living as sexual and gender minorities in this country. For example, we use tobacco and alcohol at much higher rates than the general population. We are also at higher risk for multiple other health problems, as we also have increased rates of sexually transmitted infections (STIs), HPV, mental health issues, bullying, drug use and obesity.
Increased health risks require greater vigilance in health screening. In our community, unfortunately, screening rates are actually lower than in the general population. LGBT people experience greater difficulty in obtaining quality health care due to high medical expenses and their own high rates of being uninsured, previous discrimination, and lack of provider information about LGBT families, sexuality and health needs. Provider bias in the medical field is declining but still well-documented and most doctors do not know how their offices, intake forms and procedures make LGBT people feel unsafe and unwelcome. As a result, LGBT people avoid the health care system and too often, when they do see a provider, do not disclose their sexual orientation due to fears about adverse reactions and confidentiality. The failure to disclose often results in inappropriate information and lack of necessary screenings.
A big piece of our work is training health care providers to offer more safe, welcoming and culturally competent care to their LGBT patients. We encourage well-meaning providers to get beyond ”I treat all people the same” and recognize that the health disparities in our community – both between the various letters of the LGBT acronym and along gender, income, racial, cultural and age lines – call for a more tailored approach. One-size-fits-all health care doesn’t work for us.
Our new video and training package, Reexamining LGBT Healthcare, works by both appealing to the hearts of providers and backing up our case with science and hard data. Until now, this last part has not been easy to come by.
Today, the National Institute of Medicine is releasing a new report on the health issues facing the LGBT community, created by a committee of our community’s best health researchers and activists, including The Fenway Institute and Williams Institute. ”The Health of Lesbian, Gay, Bisexual, and Transgender People” is a truly groundbreaking document that brings together in one place the current state of all our knowledge about LGBT health issues, and makes recommendations for policies and procedures to improve our health. It is a historic commitment by the federal government and a document we can rely on.
As a leader of one of the organizations on the front lines in the struggle to better the quality of care for the LGBT community, this report is an invaluable tool. All of us who are trying to improve the health of our community and train health care providers to offer us more respectful and appropriate care need to arm ourselves with this report. We will quote it, refer to it, incorporate it into our Reexamining LGBT Healthcare program, and use it as evidence that the federal government finally recognizes our health disparities alongside those of other oppressed groups, like racial and ethnic minorities.
But, we will also use the report to highlight what is missing, and what we still desperately need. We need more hard data, a greater financial investment in LGBT health research, and more LGBT health education for providers and institutions. We won’t stop until all of us are healthy and all of us are safe within the health care system.
Liz Margolies is the founder and executive director of the National LGBT Cancer Network.