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.
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