As with any minority community, there are certain health inequalities and particular health needs for LGBT+ people, and this has been demonstrated internationally. The most prominent health disparities seen between LGBT individuals and heterosexual people are mental health, in particular depression, anxiety, self harm and suicide. In terms of physical health, a recent UK study demonstrated higher rates of particular cancers in the LGBT community, mixed rates of diabetes, and higher rates of drug abuse, binge drinking and smoking.
We’re talking huge numbers of people affected. Statistics are sketchy, but national estimates of the UK’s LGBT+ population vary from 1 in 50, to 1 in 10 individuals. That equates to up to 6.5 million people.
As a clinician, I tend to find myself on the care-giving side of the equation, and care for LGBT patients on a regular basis. However, speaking as a gay man, I am also part of the above statistics, and have been on the receiving end of care for more than one of the above mentioned conditions. In that respect, I feel I have a good insight into the health needs of a proportion of the LGBT+ community.
As an unwell patient last year, I began to look into some of these health disparities, in particular the higher rates of mental illness in gay men. I asked myself, “why?”.
I knew why I was unwell, but what was causing such high rates of mental illness in others? Was there something in the rainbow-coloured water?
A recent survey of over 108,000 LGBT+ people showed that 1 in 4 had accessed mental health services in the last 12 months. Many more had accessed any health services in the preceeding year, and unfortunately a significant proportion did not have a positive experience, which they have put down to being LGBT+. Thankfully I was one of the fortunate ones who did have a good experience when accessing healthcare, although part of me suspects that is because I’m a clinician myself.
Minority stress is the leading theory behind these vast numbers, and it means an accumulation of all of the small but harmful events that have occurred over the years. Both from internal and external sources. Essentially, as a minority community, growing up in a largely heterosexual world, we have been exposed to insults, put downs, abuse, stigma; both perceived and real. These have all chipped away at our inner resilience, or our armour which eventually leads to illness, or in the most extreme cases, death.
Another theory is that those advantaged groups in society (i.e. non-LGBT+) have the resources necessary to reduce the risk of disease, and have better access to healthcare to reduce the impact of disease. A clear example of this can be seen when looking at the health of those who live in inner-city deprivation, and compared to more affluent areas. Those in deprived areas generally have poorer general health, and shorter life-spans.
I know what you’re thinking now. Given the above two theories, poorer health is inevitable in LGBT+ populations. It’s a given.
It’s an unfortunate reality that LGBT+ (in particular the trans community) have to face on a daily basis. But how can we overcome this? How can we address this inequality, and reduce those rates of mental illness towards that of the general population? The answer…education.
“There is no knowledge that is not power”Ralph Waldo Emerson
By educating the general population, making LGBT+ and diverse relationships normalised in schools, on the television, in books and the media without stigma, we will eventually eradicate the minority stress that young LGBT+ children will be faced with. This is one of the reasons why Pride Month and Pride events around the country are so important. Simply having a presence in society will help. It will abolish the internal shame that we carry around, and consequently aid recovery for those in difficulty.
As a clinician, we’re very good at identifying those at risk of developing diabetes or heart disease and act accordingly by informing these patients and encourage changes to help prevent these diseases. When it comes to mental health however, we’re not as good at identifying at risk individuals, and we’re certainly not very good at intervening. This is even more true when it comes to the LGBT+ population.
At present, we don’t ask patients to disclose their sexual orientation or gender identity unless it is clearly relevant. Even then it isn’t always documented very well, so how are we to know who is at risk of both thge mental and physical health problems listed at the top of the blog?
I feel these important questions should be asked of all patients, but most importantly, it should be in a warm and comforting environment where patients feel accepted and supported to disclose these details.
How do we achieve this comforting and supportive environment? Again, it comes down to education. Doctors need better education at medical school surrounding LGBT+ health problems and how to promote openness. Also, the current NHS England Rainbow Badge campaign helps to signify to patients that this is a safe place to disclose these details.
If you were to ask older gay men what the biggest health problem affecting gay men in, they would likely answer HIV/AIDS. If you were to put the same question to a younger gay man, it is likely they would answer mental health problems.
Thankfully HIV/AIDS is no longer the death sentence it was thought to be back in the 1980s and 90s. With more efficient detection techniques, more accessible testing and more advanced medication, it can safely be put in the category of chronic disease, next to diabetes and kidney disease. Those with HIV are living fruitful and long lives thanks to daily anti-viral medication. There is even some early research that suggests a possible cure to HIV, which is astonishing considering the virus has only been known about for less than 40 years.
It is unfortunate that the condition still carries such significant stigma in society, and I suspect that it will continue to do so for many years to come.
LGBT+ people experience the same health problems that the rest of society suffers, just in different proportions. By normalising LGBT people in the community, that can help peoples’ perceptions and stigmas to change, and when this happens, everyone wins.