1. www.stonewall.org.uk/international ILGA-Europe Roundtable on LGBTI Health in Europe: Social Health Determinants November 2014

2. www.stonewall.org.uk/international Stonewall’s health research Specific health briefings on Bisexuality, Disability, Domestic Abuse, Ethnicity, Experiences of Healthcare, and Mental Health. Stonewall Health Briefings (2012) 6,861 respondents from across Britain: largest survey ever on gay and bisexual men’s health needs in the world. Gay and Bisexual Men’s Health Survey (2012) Guide to supporting LGB patients and staff. Based on Stonewall’s ongoing work with dozens of NHS organisations. Sexual Orientation: A guide for the NHS (2012) Stonewall commissioned YouGov to survey 1,050 heterosexual and 1,036 LGB people over the age of 55 across Britain. Lesbian, Gay and Bisexual People in Later Life (2011) Over 6,000 women completed the survey, making this the largest survey of L&B women's health needs outside the US. Prescription for Change: Lesbian and bisexual women’s health check (2008)

3. www.stonewall.org.uk/international Prescription for Change: Lesbian and bisexual women’s health check (2008) In 2007, Stonewall invited lesbians and bisexual women to complete a survey about their health needs and experiences of the health sector. We were overwhelmed with the response. Over 6,000 women completed the survey, making this the largest survey of lesbians' and bisexual women's health needs outside the US. The picture they paint should disturb any healthcare practitioner. Key findings Lesbians are more likely to have smoked and to drink heavily than women in general. At various ages they are less likely to have had a smear test and more likely to have had breast cancer. Levels of self harm and suicide are significantly higher than in the wider population. Half have had negative experience of healthcare within the last year alone and a similar number feel unable to be open about their sexual orientation to their GP.

4. www.stonewall.org.uk/international Findings in focus Smoking, alcohol and drugs - Two thirds of lesbian and bisexual women have smoked compared to half of women in general. - Just over a quarter currently smoke. - Nine in ten lesbian and bisexual women drink and 40 per cent drink three times a week compared to a quarter of women in general. - Lesbian and bisexual women are five times more likely to have taken drugs. - Over one in ten have taken cocaine, compared to three per cent of women in general. Cancer screening - Fifteen per cent of lesbian and bisexual women over 25 have never had a cervical smear test, compared to seven per cent of women in general. - One in five who have not had a test have been told they are not at risk. - One in twelve lesbian and bisexual women aged between 50 and 79 have been diagnosed with breast cancer, compared to one in twenty women in general. Sexual health - Less than half of lesbian and bisexual women have ever been screened for sexually transmitted infections. - Half of those who have been screened had an STI and a quarter of those with STIs have only had sex with women in the last five years. Mental health - One in five lesbian and bisexual women have deliberately harmed themselves in the last year. - Half of women under 20 have self-harmed. - Five per cent have attempted to take their life in the last year and sixteen per cent of women under 20 have attempted to take their life.

5. www.stonewall.org.uk/international Gay and Bisexual Men’s Health Survey (2012) With 6,861 respondents from across Britain, this is the largest survey ever conducted of gay and bisexual men’s health needs in the world. However, it demonstrates that many of the needs of gay and bisexual men are not being met and that there are areas of significant concern – most particularly in mental health and drug use – that have been overlooked by health services which too often focus solely on gay men’s sexual health. The survey covers eight areas: Smoking alcohol and drugs; General fitness and exercise; Mental health; Eating disorders and body image; Domestic abuse; Cancer and common male health problems; Sexual health and HIV; Discrimination in healthcare. Key findings The report provides clear evidence that gay and bisexual men nationwide are more likely to attempt suicide, self-harm and have depression than their straight peers. They are also more likely to smoke, drink and take illegal drugs. It ill-serves our gay and bisexual communities when these uncomfortable truths are ignored.

6. www.stonewall.org.uk/international Findings in focus Mental health and well-being - In the last year, three per cent of gay men and five per cent of bisexual men have attempted to take their own life. - One in sixteen (six per cent) gay and bisexual men aged 16 to 24 have attempted to take their own life in the last year. - One in fourteen gay and bisexual men deliberately harmed themselves in the last year. - One in six (15 per cent) gay and bisexual men aged 16 to 24 have harmed themselves in the last year. Smoking, alcohol and drug use - While smoking and alcohol consumption among gay and bisexual men is broadly similar and/or slightly higher than men in general, illegal drug use is much higher. - Two thirds (67 per cent) of gay and bisexual men have smoked at some time in their life compared to half of men in general who have smoked. - Eight in ten (78 per cent) gay and bisexual men had a drink in the last week compared to seven in ten (68 per cent) in general. - Half (51 per cent) of gay and bisexual men have taken drugs in the last year compared to just 12 per cent of men in general.

7. www.stonewall.org.uk/international Social inequalities Gender & LGBT health As the reports demonstrate, lesbian and bisexual women may experience health problems which are driven by their gender as well as sexuality. Healthcare discrimination A third of gay and bisexual men are not out to their GP, and a third have had a negative experience related to their sexual orientation in the last year. For lesbian and bisexual women those figures are both half. Mental health One in fourteen gay and bisexual men have deliberately harmed themselves in the last year. For lesbian and bisexual women that figure is one in five. Ten per cent of gay and bisexual men aged 16-19 have attempted to take their own life in the last year, compared with sixteen per cent of lesbian and bisexual women aged under 20. Gender, ethnicity & LGBT health Black and minority ethnic LGB people are more likely to have self-harmed, attempted suicide, and taken drugs than LGB men and women in general. Of black and minority ethnic lesbian and bisexual women 55 per cent are not out to their GP or other healthcare professionals and 54 per cent have had negative experiences in the past year. Seven per cent have attempted to take their life in the past year. 12 per cent said their healthcare professional acknowledged they were lesbian or bisexual after they’d come out (26 per cent of white lesbian and bisexual women). Of black and minority ethnic gay and bisexual men 55 per cent have experienced at least one incident of domestic abuse from a family member or partner since the age of 16 (17 per cent for men; 50 per cent for gay/bi men in general). 37 per cent have had a negative experience related to their sexual orientation in the past year in a healthcare setting.

8. www.stonewall.org.uk/international Social inequalities LGB people in later life We know from YouGov polling of 1,036 older lesbian, gay and bisexual people and 1,050 heterosexual older people, comissioned by Stonewall, that a significant proportion of older gay people are: More likely to live alone. 41 per cent of LGB older people, compared to 28 per cent of heterosexual older people. Have limited family support. LGB older people are less likely to have children and less likely to see biological family members on a regular basis. Rely on formal services for help in the future. 50 per cent of LGB older people are uncomfortable being out to care home staff, 33 per cent to a housing provider, and 20 per cent to a GP. Gender identity Our 2014 YouGov Polling of 100 trans people found that health and social care inequalities was the number one priority. Stonewall’s consultation with around 500 trans and gender non- conforming people has so far included the following recurring themes: GPs often lack understanding of the gender reassignment care pathway, and automatically refer to mental health services. Often trans status is the focus of every healthcare interaction, even when seeking routine medical treatment. NHS staff across the board lack training in sensitive treatment of trans patients (e.g. proper use of pronouns, sensitivity to the language people prefer to use to describe their bodies etc.)

9. www.stonewall.org.uk/international Summary Complexity of people’s identities and situations; LGBT people are many other things, as well as LGBT. Importance of understanding how social inequalities might interact with and compound one another. Social as opposed to biological or physical drivers. Various areas of concern already marked by stigma and discrimination. Wide areas of health (and social policy) are involved. Isolation from health and social care services is a general feature. Misrepresentation within healthcare settings (e.g. use of stereotypes, assumptions, incorrect language) is also a general experience.

10. www.stonewall.org.uk/international What can be done? Reduce violence, discrimination, stigma and social exclusion against/of LGBT people, and against all, in general. Promote widening of what we understand by LGBT health to beyond a focus on MSM and sexual health (also, inclusion of ‘social’ issues – bullying and domestic abuse). Destigmatising approach – both of LGBT communities and, importantly, of those areas of health marked by stigma and discrimination for anyone. More research (e.g. longitudinal studies, T* and I*, social class, cross-country). Also SOGI data collection. Training of healthcare providers – especially more systematic training which is embedded into practice (e.g. Stonewall’s pilot study with Cardiff Medical School), and focus on delivery. Proactive approach from healthcare providers to reach out to affected communities, and to actively demonstrate that services are for them. Develop programmes to help make this happen (e.g. Stonewall’s Health Equality Index and Health Champions Programmes).

11. www.stonewall.org.uk/international For more information: www.healthylives.stonewall.org.uk Thank you!