November 2020 President’s Message

GBTQ faced health care disparities before pandemic

by Patricia Wyatt-Harris, MD

Health care inequities have been magnified during the past few months due to COVID-19. But there is a unique population that faced challenges and health care disparities even before the onset of the pandemic.

Studies estimate that 3.5% of the U.S. population is lesbian, gay or bisexual, and 0.3% identify as transgender. It is important to address the health needs of this population in the public health arena and in our own practices.

I have been teaching medical students on the OB/GYN rotation about LGBTQ individuals and health care disparities. I have learned a lot.

Three factors make up a minority stress theory, which leads to negative health consequences. The first is “external stressors,” which include experiences such as bullying, family strife and workplace stress. The second is “expected victimization,” which involves the person being on alert or on edge for someone to attack them or make a negative comment. The third is “internalized negative attitudes,” in which people feel they are “less than” or “not worthy” because they are gay or lesbian. A combination of one, two or all three factors can lead to startling consequences.

LGBTQ individuals have higher rates of homelessness: 30% have reported experiencing homelessness at some point in their lives. They also have higher rates of incarceration. LGBTQ individuals are more likely to be uninsured or underinsured.

They also report higher rates of substance abuse. In a 2015 survey, 29% had used illicit drugs or nonmedical prescription drugs compared to 10% for the general U.S. population. They also report higher rates of smoking. These factors make it more difficult for LGBTQ people to access health care.

In July, the U.S. Supreme Court issued a landmark decision extending employment discrimination protections to LGBTQ individuals. In the past, 53% of LGBTQ employees reported that they had to hide their identity from their employers and co-workers. I think this decision will improve their ability to access health insurance and help them be less stressed about hiding their identity.

What can we do? We can examine our practices and make sure we are open to providing health care to this population. Make sure that staff is appropriate when caring for these individuals by using appropriate pronouns. Intake paperwork can include a space for the individual’s preference. We can also support legislation that decreases discrimination against this population.

As physicians, we are obligated to provide quality care to all our patients. With marginalized groups, that obligation and concern should be even greater.