1. Supporting and improving the wellbeing of LGBT+ communities
Luis E. Guerra
National Lead Sexual Health, Reproductive Health & HIV
Public Health England
@LguerraC

2. Some of the context
Deficit based narratives drive investment but also perpetuate stereotypes Studies repeatedly show health inequalities affecting LGB&T populations but no routine data and evidence and often evidence base is conflicting Lack of visibility in policy and social marketing perpetuates the marginalisation Men’s health predominates but focus is mainly on HIV and sexually transmitted diseases LGBT specialist voluntary and community sector has shrunk as HIV specific funding has reduced Life expectancy with HIV has expanded
Supporting and improving the wellbeing of LGBT+ communities

3. Life Experiences
Stonewall research into attitudes towards LGB&T staff and patients in the NHS in 2015 found that:
1 in 4 of patient-facing staff have heard their colleagues make negative remarks about lesbian, gay or bisexual people whilst at work in the last 5yrs. 1 in 5 have heard similar remarks about trans people.
1 in 20 patient-facing staff have witnessed other colleagues discriminate against or provide a patient or service user with poorer treatment because they are lesbian, gay or bisexual in the last five years.
1 in 4 of LGB staff say they have personally experienced bullying or poor treatment from colleagues in the last 5yrs.
1 in 4 NHS staff had never received any equality and diversity training and almost 3 in 4 patient-facing staff had not received any training on the health needs of LGBT people, the rights of same-sex partners or how to be inclusive of the LGBT community.
Supporting and improving the wellbeing of LGBT+ communities

4. How many lesbian, gay, bisexual and trans people are there in England?
~ 2.5 to 5.89% of the population in England self-identifying as lesbian, gay, bisexual or other. (PHE 2016) higher proportions of self-identified LGB people live in cities (3.6%<x< 9.9%) There is no national agreed estimate of the proportion of the population who identify as trans A survey in 2012 estimated that 1 in 100 people experience a significant degree of gender non-conformity. (Glen et al 2012)
No trans information because there are no routine questions on gender identity currently included in national surveys.
Supporting and improving the wellbeing of LGBT+ communities

5. Gay, bisexual men & other MSM
PHE led a review of the evidence of health inequalities affecting gay and bisexual men and other men who have sex with men in This highlighted three key areas of significant health inequalities:
Mental health & wellbeing
Alcohol, drugs & tobacco
Sexual health and HIV
Supporting and improving the wellbeing of LGBT+ communities

6. Lesbian, bisexual women and other WSW
Range of inequalities in both physical and mental health areas, including:
Mental health
Pregnancy & reproductive health
Some types of cancer
Alcohol, drugs & tobacco
Intimate partner violence
Musculoskeletal and respiratory conditions
These exist in the context of the communities in which these women live, the policy & legislative landscape and the places and services.
Supporting and improving the wellbeing of LGBT+ communities

7. Trans and non-binary communities
Evidence from primarily population surveys highlights significant inequalities in: Mental health, Alcohol, drugs & tobacco, Violence Although there has been significant progress in the social discourse about trans and non-binary identities, there is still significant discrimination in society. There is very little exploration of non- heterosexual identified trans people’s health. PHE has conducted the first national survey of trans reproductive health and the results will be published in Q1 18/19.
Supporting and improving the wellbeing of LGBT+ communities

8. Minorities within Minorities
Compared to the general LGB&T community and the wider population, minority LGB&T populations have:
Significantly higher rates of suicide, self harm and mental ill health.
Higher rates of reported domestic violence.
Specific evidence has identified:
Higher rates of smoking amongst BME LGB people.
Higher risk of cardiac disease, diabetes and cancer amongst BME lesbian and bisexual women.
Fewer LGB disabled people are accessing health and social care services they think they need, and fewer were out to their GP.
Smoking and drug use was higher amongst disabled LGB men.
58% of trans people in one survey had a disability or chronic health condition.
Bisexual men and women are at increased risk of eating disorders and alcohol abuse and there is some evidence that bisexual men are less likely to test for sexually transmitted diseases.
Supporting and improving the wellbeing of LGBT+ communities

9. Community-centred approaches for health & wellbeing
Strengthening communities
Community development
Asset based approaches
Social network approaches
Volunteer and peer roles
Bridging
Peer interventions
Peer support
Peer education
Peer mentoring
Volunteer health roles
Collaborations & partnerships
Community-Based Participatory Research
Area–based Initiatives
Community engagement in planning
Co-production projects
Access to community resources
Pathways to participation
Community hubs
Community-based commissioning

10. Evidence into Action
Supporting and improving the wellbeing of LGBT+ communities

11. Partnership & co-production
National LGBT Partnership
National LGBT Academic & Research Network
Cross government partnerships
PHE External advisory board
Community advisory boards
Supporting and improving the wellbeing of LGBT+ communities

12. Building the evidence base
Systematic reviews on G/B/L health inequalities
Developed national LGB Prevalence estimate
Black and minority ethnic men who have sex with men project
Gay, Bisexual and other MSM action plan
Improving the health and wellbeing of lesbian and bisexual women and other WSW
Substance abuse and misuse
National LGBT conferences
LGBT data on national reports
Supporting and improving the wellbeing of LGBT+ communities

13. Building the skills & knowledge
Developing healthcare professionals skills
General Medical Council provided specific professional guidelines
Working with Medical Royal Colleges Special Interest Groups
Presentations and posters at national medical conferences
Royal College of Nursing toolkit on LGB&T suicide prevention
Trans screening patient resource
Developing narrative in LGBT communities
Specific LGBT focused resources e.g. trans healthy living fact sheets
Inclusion of LGB people in national social marketing campaigns
Media and event engagement
Visibility at Pride events and national LGBT conferences
Supporting and improving the wellbeing of LGBT+ communities

14. Current Work
Ongoing Sexual health, reproductive health and HIV prevention work with LGBT communities
Publication of Trans Voices: companion document to women voices
Lesbian and bisexual women and other women who have sex with women health inequalities report: Implementation
Working with ClinicQ to develop understanding of gender identity monitoring in sexual health services
Developing e-learning core content on LGBT health inequalities with the National LGBT Partnership
Supporting and improving the wellbeing of LGBT+ communities

15. SH RH & HIV Health Promotion
Supporting and improving the wellbeing of LGBT+ communities

16. Supporting and improving the wellbeing of LGBT+ communities

17. 1 in 3 children who are 5yrs today will live to see their 100th birthday Data is the new oil, it can be mined but it can also be spilled. If it has a plug it is probably collecting data but 90% is unused. Post-tick box generations have more fluid self-identification which creates new challenges for categorisation. Shrinking public/welfare public support focusing on those with the highest needs Value for money Collaborations & community organising
Looking ahead
Supporting and improving the wellbeing of LGBT+ communities

18. Supporting and improving the wellbeing of LGBT+ communities
Thank you: Dr. Justin Varney
Luis E. Guerra
National Lead Sexual Health, Reproductive Health & HIV
Public Health England
@LguerraC