Evaluating LGBT Health Access in the USA

Coursey 11

Daniel Coursey

Professor Yessick

EXD 330

16 May 2017

Evaluating LGBT Healthcare and Equality in the United States

Healthcare rights and LGBT equality have been controversial discussion topics in the United States in recent years. Much political fervor ensues at the mere mention of these issues, as politicians and policy makers seek resolutions to health care and insurance discrepancies and to provide equal rights to LGBT people as well. Navigating the complexities of public policy and law can be a lengthy process, but an important one. As a nation built on the principles of liberty and justice, the powers that be in government must recognize the importance of equality as well. U.S. public health officials and lawmakers need to enact policies that provide adequate LGBT health research, education, access to mental health and social support services, and legal protections for LGBT citizens since research suggests that these individuals have poor mental and physical health outcomes compared to their heterosexual counterparts.

Equality is important to America's LGBT population who look to lawmakers to provide them with equal representation and equal protection, despite their sexuality. In his research article Charles Emlet, professor of Social Work at the University of Washington Tacoma and an investigative researcher with Aging with Pride: National Health, Aging, Sexuality and Gender Study discusses the inequalities faced by older adult LGBT populations. He asserts that this inequality creates shame and a negative self-image, as indicated by research participants, with bisexual women and transgender individuals shown to be at greater risk for both inequality and poor health outcomes related to identity issues and a lack of adequate social support. Disparities are not just limited to those with identity issues, as HIV positive individuals were shown to suffer far greater than those without HIV, are who were undiagnosed. HIV positive individuals were revealed to have far worse mental health concerns, were more inclined to drug use and abuse, and were shown to have worse overall health conditions than those without HIV. Research indicates that HIV status is a growing concern for an aging LGBT population, who are soon likely to make up most the HIV-positive population.

Further research suggests that bisexual and transgender members of the LGBT population, and those with HIV-positive diagnoses suffer greater inequality than their counterparts. Shame, lack of support, and mental health and substance abuse were common among participants, as was a poor self-identity. Overall these individuals were shown to have poor health, low-incomes, and poor social status. These findings reiterate Emlet's principle assertion that certain subgroups have worse health outcomes than the general LGBT population (Emlet 19-20).

Social justice must become a priority in the United States. Charles Emlet points out that environmental, personal, and socio-economic characteristics have effects on both personal health and the overall health conditions of a population. Race, ethnicity, income, and education are determinants of health care access in LGBT and heterosexual older adults. New research data suggests that there are important discrepancies in policies, services rendered, and research efforts when comparing the general LGBT population, LGBT subgroups, and their heterosexual counterparts. Poor mental health, limited functioning in normal daily activities, and behaviors such as smoking were reported at higher rates in the population of LGBT older adults than in heterosexual peers. Emlet points out that the studies conducted by Conron, Mimiaga, and Landers and Dilley et al. found that extreme alcohol consumption and other risk behaviors were surveyed at higher rates among bisexual women and lesbians than heterosexual women as well (Emlet 17).

Community-based support services, much like those offered for seniors and the disabled, can be impactful to the LGBT population. Social interactions among LGBT older adults can be either beneficial or distressing. The size of one's social network can be impactful, and research suggests that a support system can be quite an asset. Conversely, the effects of discrimination and negative social situations can be detrimental and life-altering. Gender identity, HIV status, racial and ethical background, and age discrimination occur and can be compounding to LGBT older adults. Most HIV-positive LGBT older adults have experienced discrimination due to their age and HIV status. Emlet illustrates how Wight and fellow researchers have found that age discrimination often becomes an internal conflict for gay males who feel vilified and that this internal conflict leads to higher rates of depression. Improved social interactions and self-perceptions are vital to health and "positive sexual identity as a sexual minority, physical activity, and transgender identity were associated with increased mental health quality of life..." (Emlet 18).

Research is vital to LGBT equality measures and resource and policy development. In "The Continuing Development of Health Disparities Research on Lesbian, Gay, Bisexual, and Transgender Individuals" researchers Stall et al. of the University of Pittsburgh's Graduate School of Public Health suggest that acquiring new data from empirical cross-generational studies will give better insight into the appropriate methods and timing for providing interventions. It is especially important to focus on the utilization of collective research data to analyze the healthcare differences between LGBT and heterosexual populations. A lack of qualitive health research for certain population subgroups suggests that there could be unobserved health conditions and concerns for varying ethnic groups, transgender individuals, those who are bisexual, as well as those women who identify as lesbian. Further, this research seeks to develop appropriate questions and documentation geared toward properly identifying previously underserved members. Stall et al. argue that such documentation is crucial in making decisions regarding which LGBT subgroups are facing the greatest level of disparities and thus should be prioritized when conducting research and providing interventions (Stall et al. 788).

LGBT research has been limited and researchers have only just begun to analyze the vast differences within LGBT subgroups and different social and economic backgrounds, and the varying effects on health. Stall et. al further examine how adequate research methods are important to the field of public health. In efforts to promote social equity in healthcare, it's essential to resolve the inequalities that exist in regards to LGBT health. Such processes would require research that is conducted various cross-generational cohorts over time. They assert that it's essential that future researchers are provided adequate research training and support from senior researchers to promote the agenda of providing resolutions and interventions to diminish the impact of LGBT health and stress the need to promote the agenda of providing resolutions and interventions to diminish the impact of LGBT health discrimination. Sufficient research is critical to understanding "theoretical relationships that explain drivers of health disparities within populations [which] are the basis for sound intervention design" (Stall et al. 788).

Health resources and sex education are also essential to improving LGBT health. In their formative research article, Steinke et al., a team of individual researchers involved in social work, health research, HIV prevention, and neurosciences, provide evidence for the importance of adequate health education resources for LGBT individuals. It was discovered that current LGBT sex education was minimal or nonexistent. Surveys from LGBT populations concluded that health education provided in schools is often the only source of sex education provided to LGBT individuals who report that the "majority described it as irrelevant, unhelpful, or hurtful for SGMY because of an exclusively heterosexual and cisgender focus" (Steinke et. al, 5).

Much like with their heterosexual peers, infection control and pregnancy prevention measures are an important aspect of LGBT sex education. Steinke et. al point out that while bisexual, gay, and transsexual individuals seemed to have a basic understanding of sexually transmitted diseases and infections, they had limited information about the possibility of unexpected pregnancies, and that often lesbian and bisexual women were unaware of these risks at all. Participants admitted that they were either misinformed or lacking sufficient knowledge about appropriate contraception and infection prevention methods. Sexual and Gender Minority youth also reported a lack of trusted mentors or credible resources, with most exclaiming that they lacked even one person in which to discuss their sexual health education with, instead relying on support and information from other youth. Transgendered youth, worried that sufficient information about hormone treatments and genetic binding could not be obtained from peers, were instead relying upon online resources. Lesbian, gay, and bisexual youth also looked to Google searches and YouTube videos for help with coming out, health education, and general topics regarding homosexuality. Yet, even this information seemed irrelevant, inconclusive, or too complex to be considered truly credible resources for survey participants (Steinke et al. 546).

Critics of improved LGBT health policies might argue that the individuals have the same opportunities and access to resources and physicians as their heterosexual peers. However, discrimination experiences and negative stigma are prevalent among LGBT populations and such experiences lead to poor health choices and insufficient utilization. Macapagal, Bhatia, and Greene, doctors at Northwestern University's Feinberg School of Medicine, report that LGBT individuals were less likely to seek help from health providers for HIV, mental health, and substance use due to discrimination fears (Macapagal, Bhatia, and Greene 435). Such evidence supports the need for increased research and training to ensure that healthcare providers are better prepared to serve these members of society, avoiding discriminatory practices.

Healthcare staff and providers need to be trained to meet the needs of the LGBT population, including sensitivity training to avoid discriminatory practices. While the research conducted by Macapagal, Bhatia, and Greene shows marginal improvements in LGBT health use and access compared to earlier surveys, it highlights regular differences in the postponing of health services and negative overall healthcare experiences. For example, transgendered individuals were more likely to have negative experiences, to lack adequate health insurance coverage, and were more likely to postpone seeking healthcare. Such poor health outcomes were also indicated among queer or questioning members as well. The rate was highest for those questioning when compared to other LGBT populations and heterosexual counterparts. Stigma and shame were thought to be the reasons these individuals had the worse outcomes. Inadequate provider training was also a highly plausible explanation for such disparities, as research findings indicate that education about queer, questioning, and transgender patients was limited and that providers often lacked education beyond the normal lesbian, gay, and bisexual spectrum (Macapagal, Bhatia, and Greene 45).

Beyond research, interventions, health education, and provider training lies the issue of legal and policy changes that would improve healthcare access and quality for LGBT people in America. Much of the research conducted on LGBT health provides that negative stigma and discrimination experiences are the primary reason for the health disparities faced by LGBT individuals. Health official and lawmakers should seek appropriate measures to eliminate such discrimination and to create protections for these citizens. Such in the assertion of Public Policy scholar Ilan Meyer of University of California Los Angeles School of Law, who examines the importance of policies that curb inequality and stresses that positive social support is crucial to generating positive health outcomes for LGBT people (Meyer 1357).

In his research article, Meyer highlights legal changes that were the result of years of advocacy, citing marriage equality rulings as one such progressive measure. However, Meyer asserts that there are persistent problems facing LGBT equality including laws in 29 states that permit employees to terminate LGBT employees without at will and providing little to no workplace protections for these individuals and further examines the desire of some to create religious liberty bills which he suggests would exist to provide for legal discrimination based on religious objections, including to homosexuality. Meyer asserts that such laws would permit discriminatory practices in healthcare, housing, employment, and various other factions of daily life (Meyer 1357-1358).

In concluding, it's important for lawmakers and public health officials to address inequalities faced by LGBT Americans. Research suggests that these citizens have poorer physical and mental health outcomes compared to their heterosexual counterparts, and experience discrimination impacting health and sexual education, LGBT health research, healthcare access and utilization. Negative stigma and discrimination experiences create for these individuals a poorer quality of life, and so the powers that be should evaluate these disparities and aid and protections in policy and law, to ensure that the United States of America is an equality-driven, socially responsible nation.

Works Cited

Emlet, Charles A. "Social, Economic, and Health Disparities Among LGBT Older Adults." Generations: Journal of American Society on Aging Summer 2016: 16-22. CINAHL Plus. Web. 17 Apr 2017.

Macapagal, Kathryn, Ramona Bhatia and George J. Greene. "Differences in Healthcare Access, Use, and Experiences Within a Community Sample of Racially Diverse Lesbian, Gay, Bisexual, Transgender, and Questioning Emerging Adults." LGBT Health 3.6 (2016): 434-442. EBSCOhost. Web. 22 Feb 2017.

Meyer, Ilan H. "The Elusive Promise of LGBT Equality." American Journal of Public Health (2016): 1356-1358. Public Affairs Index. Web. 15 Jan 2017.

Stall, Ron, et al. "The Continuing Development of Health Disparities Research on Lesbian, Gay, Bisexual, and Transgender Individuals." American Journal of Public Health May 2016: 787-789. EBSCOhost. Web. 17 Apr 2017.

Steinke, Jessica, et al. "Original Article:Meeting the Needs of Sexual and Gender Minority Youth: Formative Research on Potential Digital Health Interventions." Journal of Adolescent Health (2016): 1-8. EBSCOhost. Web. 21 Feb 2017.