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Carter VanIderstineLGBTQ+ Inclusivity in Healthcare
Edited by Mirabella Chan
With this being the beginning of Pride Month, it seemed only right that we took the time to provide some information on the state of LGBTQ+ inclusivity in Canadian healthcare and provide awareness of the unique health needs of these populations. For the sake of space, this article will focus on sexual orientation, rather than gender identity.
Pride Month has been around since around the 1970s to commemorate the Stonewall Riots in 1969, when police raided the Stonewall Inn, and ordered all the “crossdressers” to be arrested. At that time, it was illegal for a person to wear more than three “gender inappropriate” items, and while these types of raids were common at the time, this was the first-time patrons decided to fight back, led by a black transgender woman by the name of Marsha P. Johnson. Their actions resulted in more than six days of protests across the country.
Terms
LGBTQ+: Lesbian, Gay, Bisexual, Transgender, Queer
Heterosexuality: The quality or characteristic of being sexually attracted solely to people of the opposite sex
Homosexuality: The quality or characteristic of being sexually attracted solely to people of the same sex
Bisexuality: This term is highly debated within the LGBTQ+ community as the prefix “bi” refers to two, however according to the Oxford Dictionary, bisexuality is defined as the “quality or characteristic of being sexually attracted not exclusively to people of one particular gender”.
Pansexuality: The quality or characteristic of being attracted to all genders. Historically, the term pansexuality arose out of frustration, when people felt that the term “bisexuality” promoted a gender binary and referred to a person’s biological sex rather than gender identity; however, now that the definition of bisexuality has changed from using “male” and “female” to using “the same gender as me” and “not the same gender as me”, the two terms are sometimes used interchangeably.
Asexuality: The lack of sexual attraction to others, or low or absent interest in or desire for sexual activity
Transgender: Term used to describe people whose gender identity differs from the sex they were assigned at birth. May also include non-binary and genderqueer individuals.
Queer: A word that describes sexual and gender identities other than straight and cisgender.
A Brief History of Issues Affecting LGBTQ+ People in Canada
By The Numbers
While the exact number of people who self-identify as belonging to the LGBTQ+ community is not known, recent data suggests it is upwards of 13% of the population, or ~4 million Canadians
1 in 4 Gen Z and millennials identify as LGBTQ+ compared to 1 in 10 Gen X
32% of LGBTQ+ members identify as being bisexual and 29% as pansexual with homosexuals comprising 25%
Compared to men, women are more than twice as likely to identify as bisexual and half as likely to identify as homosexual
The Current State of Health Affairs
Despite the large number of LGBTQ+ people in Canada, their needs are often overlooked, or are grouped with heterosexual peoples’ needs. Data from the Canadian Government shows that lesbian/ gay people are nearly twice as likely, and bisexuals are three and a half times more likely to report having poor mental health compared to heterosexuals. There are a number of factors contributing to these statistics, including stigma. In fact, nearly half of minority sexualities have experienced bullying on the basis of their sexuality, and this concept of “minority stress” has been linked to higher rates of suicidal ideation and earlier onset of chronic illness in this population. One statistic that strikes me the most, however, is in relation to the rates of food insecurity among minority sexualities. The risk of lesbian/ gay people becoming food insecure is similar to that of heterosexuals, however for unknown reasons, bisexuals are at a 3x higher risk.
More often than not, LGBTQ+ members will not disclose their sexuality to their healthcare providers and are less likely to be tested for HIV, despite being at a far higher risk. There are several reasons for this non-disclosure, and several sexual/ gender minorities report having to actually educate their healthcare providers on their risk factors or health needs. In terms of transgender individuals, more than half who visited a hospital for emergency services reported a negative experience.
I would also be remiss if I did not take this opportunity to discuss how the COVID-19 pandemic has affected the LGBTQ+ community. Peer-reviewed research in the United States has revealed that the well-being of bisexuals was most negatively impacted by the pandemic in terms of stress, loneliness, and psychological distress with that of homosexuals following not too far behind. Given the higher prevalence of chronic and immunosuppressive illness among sexual minorities, it’s not surprising that they have been hit disproportionately harder than the general population.
These alarming facts form the basis of why it is crucial for pharmacists and other health care providers to be aware of these disparities and take active steps to close the healthcare gap between heterosexuals and members of the LGBTQ+ community.
What can we do better as healthcare professionals?
There is still a lot of work to be done when it comes to supporting LGBTQ+ people, including within the LGBTQ+ community itself! To this day, nearly a third of sexual minorities and more than half of bisexuals do not feel a sense of belonging within the LGBTQ+ community. As health care professionals, we can do a number of things to help create a more inclusive space and provide more optimal patient-centered care.
1) First and foremost is awareness & education
A lot of healthcare professionals don’t learn about sexual minorities and their health needs in school, so it is our job as lifelong learners to educate ourselves on these topics. For more information, pharmacists are encouraged to consult their provincial pharmacy association, as many offer continuing education courses on diversity and inclusion, transgender health needs, etc.
2) Discussion
In order to end the stigma, we need to be discussing these issues on a day-to-day basis. Most of us in the LGBTQ+ community are more than happy to answer questions! As pharmacists, for example, one thing we could do is be asking every patient for their current gender and preferred pronouns when doing initial patient interviews. You can also offer to speak with the patient in a private counselling room if that makes them feel more comfortable.
3) Take the time to build relationships with sexual minority patients
As mentioned, most won’t disclose their orientation to healthcare providers, but as pharmacists, we are uniquely situated to develop long-term relationships with patients, making them more likely to open up to us and discuss their specific health needs.
4) Create a welcoming environment
If store rules allow it, don’t be afraid to show material that demonstrates your store is a safe space for LGBTQ+ people, such as flags or posters. As another example, I personally wear a pin on my white coat showing my preferred pronouns to encourage discussion and put patients at ease.
5) Be understanding
It's important for us to remember that peoples’ attitudes tend to come from a place of ignorance rather than hatred. For example, when my dad was a kid, homosexuality was still a crime and gay marriage was illegal until his 40s.
Takeaway Messages
As a pharmacy student and LGBTQ+ member, my main goals of this article were to:
Provide some context to the history of LGBTQ+ rights in Canada
Demonstrate how prevalent sexual minorities are in the community as well as some of their unique risk factors
Provide suggestions that can be implemented in practice to create a more inclusive environment and establish better relationships with patients
About the Author
This article was written by a cis-gendered, bisexual male who is also the vice president of an LGBTQ+ advocacy society. The views presented here are my own and the data is derived from peer-reviewed research and government documents. I can be reached at carter.v@dal.ca if you have any questions about implementing inclusivity in practice or just general questions about the LGBTQ+ community in healthcare.
References
Casey B. The health of LGBTQIA2 communities in Canada: Report of the Standing Committee on Health. Published 2019. Accessed June 2, 2021. www.ourcommons.ca
Fish JN, Salerno J, Williams ND, et al. Sexual minority disparities in health and well-being as a consequence of the COVID-19 pandemic differ by sexual identity. LGBT Heal. 2021;8(4):263-272. doi:10.1089/lgbt.2020.0489
Fondation Jasmin Roy. The values, needs and realities of LGBT people in Canada in 2017. Published 2017. Accessed June 2, 2021. https://fondationjasminroy.com/en/initiative/lgbt-realities-survey/
United Nations. Report to the UN General Assembly: The impact of the COVID-19 pandemic on the human rights of LGBT persons. Published 2021. Accessed June 2, 2021. https://www.ohchr.org/Documents/Issues/SexualOrientation/ImpactCOVID19LGBTpersons.pdf