Confronting health disparities in LGBTQ+ communities

For many people in LGBTQ+ communities, access to health care can be elusive. These unique groups of people seem to face greater barriers to care, disparities in health outcomes, and difficulty finding specific services for their mental and physical well-being.

“Health disparities are often rooted in discrimination, stigma, and healthcare industries that still have much to learn about the unique health needs of LGBTQ+ communities,” says Atlantic Health System nurse practitioner Catherine Trossello, DNP, FNP-BC. “Children and adults are disproportionately affected by four key social determinants of health—non-medical factors, for example, like the zip code where they’re born, live, and work.”

4 key social determinants of health

1. Discrimination and stigma: Many LGBTQ+ individuals experience a bias in health care, which causes them to mistrust or become reluctant to seek care. It often stems from the provider misgendering or making assumptions about sexuality.
2. Lack of provider training: Few healthcare providers receive formal education in LGBTQ+ health issues. This leads to a gap in culturally competent care, from mental health treatment to gender and sexual health.
3. Economic limitations: LGBTQ+ people—particularly transgender and those of color—are more likely to face poverty, unemployment, and housing instability. These can become daily struggles, all which negatively affect health.
4. Insurance barriers: Some health insurance companies deny specific services for LGBTQ+ people. They also do not recognize non-traditional family structures, which can limit health services and insurance coverage.

Understanding 5 key LGBTQ+ health disparities

1. Mental health: LGBTQ+ people are at a higher risk for depression, anxiety, and suicidal ideation. According to the CDC, more than 40% of LGBTQ+ youth have considered suicide—more than double the rate of their non-LGBTQ+ peers.
2. HIV/AIDS and sexual health: Gay and bisexual men, particularly those of color, are disproportionately affected by HIV. Transgender women also face an elevated risk of HIV, along with barriers to preventive services.
3. Substance use: Higher rates of tobacco, alcohol, and drug use are reported among LGBTQ+ communities. These substances are targeted toward LGBTQ+ folks and can therefor become relied on as coping mechanisms to deal with the stress and discrimination they experience on a regular basis.
4. Gender-affirming care: Transgender or nonbinary people have trouble accessing hormone therapy, surgeries, or mental health care. These services are often costly, excluded by insurance, or are simply not understood by health care providers.
5. Chronic health conditions: Lesbian and bisexual women face higher risks for chronic health conditions such as obesity, breast cancer, and cardiovascular disease. This is likely because they avoid routine screenings.

Moving toward health equity

“Reducing health disparities for LGBTQ+ youth and adults requires systemic change,” says Catherine. “The health disparities that exist are diverse and complex, requiring unique training for health care teams.”

She explains that legal protections are addressing health care discrimination and improving insurance coverage for specific services. A new emphasis on education and cultural training for healthcare providers is another exciting development. And health care systems are making mental health care for marginalized youth a priority.

“This is forward progress,” says Catherine. “The LGBTQ+ communities deserve acceptance and understanding, and we’re working to close the health gap with increased awareness, greater inclusivity and a new level of accountability for more equitable care.”