Health Disparities in the LGBTQ Community: Providing Culturally Competent Care Julia M. Applegate, MA Planning and Evaluation Program Manager LGBTQ Health Initiative, Columbus Public Health

Check in Question Why does talking about this population matter to the work you are doing?

Introduction Goals 1.) Introduce the concept of the Genderbread Person. 2.) Describe specific health disparities experienced by the LGBTQ Community. 3.) Discuss how to provide culturally competent care and services.

Decoding the L, G, B, T & Q Sexual Orientation –Homosexuality –Heterosexuality –Bisexuality Gender Identity (Sex vs. Gender) –Cisgender –Transgender –Transsexual Fluidity:Queer/Questioning

The Heterosexual Questionnaire Developed by Martin Rochlin, 1972 –Pioneering gay affirming psychologist Examining the implications of heterosexism, heterosexual privilege Same lens can be applied to gender identity/gender expression

Why Cultural Competence? Important tool for tackling larger issues of Health Inequity/Health Disparity –Health inequity Differences in health which are unnecessary and avoidable but, in addition, are also considered unfair and unjust.

Health Inequity explained Systematic: Inequities and their consequences are not ‘random’ but follow a ‘pattern.’ Socially produced: The ‘patterns’ produced by inequities can be traced back to the social determinants of health (neighborhood, education, social norms, access to care, food security, etc.) In this case homophobia, heterosexism. Unfair: Inequity has an ethical and moral connotation, which is embodied in a sense of ‘injustice.’

Striving for Health Equity Health Equity is: –Fairness in the distribution of resources between groups with differing levels of social advantage –Creating an environment where everyone has a good chance to be healthy

Cultural Competency Defined Culture –Refers to language, thoughts, behaviors specific to one’s race, class, ethnicity, religious affiliation, sexual orientation, etc. Competence –Implies the ability to function within the context of diverse beliefs, behaviors, etc. of the population to be served.

Cultural Competency Defined Cultural Competency – continuous learning process that builds knowledge, awareness, skills and capacity to identify, understand, and respect the unique beliefs, values, customs, languages, abilities and traditions of all people in order to provide effective programs and services. –cultural humility

LGBTQ in Columbus LGBTQ Columbus stats –68,300 1 –Extrapolate from limited national data –United Way survey –Lack of local data 1. “Same Sex Couples and the Gay, Lesbian, Bisexual Population: New Estimates from the American Community Survey,” The Williams Institute.

Impact of Stigma Tie in with heterosexual questionnaire Relationship to social determinants of health –Complex, integrated, overlapping social structures and economic systems that include the social environment –Shaped by the distribution of money, power and resources at global, national and local levels Microaggressions

Health Disparities Experienced by LGBTQ Community 2 Suicide (LGBT youth 2-3 mores times likely to attempt) Homelessness (40% youth homeless are LGBTQ) Breast and Cervical Cancer HIV (65% MSM) Obesity Alcoholism, tobacco use (WSW smoke 200% more) Mental Health challenges (response to trauma/stigma) Increased numbers of all for trans community “Report on Lesbian, Gay, Bisexual and Transgender Health,” Healthy People.gov

2009 Lambda Legal Survey*: Discrimination and Barriers to Care in LGBT Community 56 % LGB and 70% Trans and GNC report at least one experience of: Being refused care Health care professionals refusing to touch patient or using excessive precautions Health care professionals using harsh or abusive language Being blamed for their health status Health care professionals being physically rough or abusive * When Health Care Isn’t Caring: Lambda Legal’s Survey of Discrimination Against LGBT People and People with HIV (New York: Lambda Legal, 2010)

Intersectionality In the Lambda Legal survey, all of these discriminatory behaviors were worse among LGBT respondents of color and/or low-income. These health care refusals further exacerbate stigma and discrimination already experienced by a vulnerable population. Fear of discrimination prevents LGBTQ people from seeking needed medical care.

Health Disparities Experienced by LGBTQ Community 2 Suicide Homelessness Breast and Cervical Cancer HIV Domestic Violence Obesity Alcoholism, tobacco use Mental Health challenges Increased numbers of all for trans community 2. “Report on Lesbian, Gay, Bisexual and Transgender Health,” Healthy People.gov

Case Study 1994 (24 yrs) Birth control Planned Parenthood 2004 (34 yrs) Fertility/family planning/OBGYN 2010 (40 yrs) birth of child/CPH 2013 (42 yrs) partner relationship/James Cancer

How to Provide Culturally Competent Care & Services Recognize one’s own bias. Refrain from making assumptions. Use inclusive language. Know community resources. Identify oneself as an ally.

Impact of Providing Culturally Competent Care Closing health disparities. Achieving health equity. Improving health outcomes. Increasing “community trust” of health care establishments. Decrease in ability of stigma to function as a barrier to care.

Thank you Questions?