Despite growing acceptance of same-sex sexuality in western
countries (Costa, Pereira & Leal 2014) and recent political and
legislative changes in many of them - such as laws allowing
same-sex couples to marry and adopt or joint-adopt children,
lesbian, gay and bisexual (LGB) individuals still face prejudice
in society mostly due to religious conservatism and right-wing
political positioning (Commissioner for Human Rights 2011;
Costa et al. 2014; Costa et al. 2015). Consequently, the identity
development of LGB individuals is restricted by these negative
societal attitudes, which may perpetuate the experience of
stigmatization and social discrimination (Rankin et al. 2010).
Minority stress theory suggests that stigma and interpersonal
discrimination are risk factors for physical and mental health
problems among sexual minorities (Pereira & Costa 2016;
Lyons & Hosking 2014; Woodford et al. 2014).
LGB Health Disparities
Consistent with the minority stress theory, research
generally finds a positive association between interpersonal
discrimination and poor physical and mental health outcomes
among sexual minorities including: HIV risk and infection, and
sexually transmitted infections (Ayala et al. 2012; Beyrer et al.
2012; Lyons, Pitts & Grierson 2012; Pereira 2014; Wolitski &
Fenton 2011); higher rates of tobacco smoking and illicit drug
use (Rivers 2001; Willoughby et al. 2008; Drabble et al. 2005);
use of methamphetamine and other ‘‘party drugs’’ (Gonzales,
Mooney & Rawson, 2010; Halkitis, Palamar & Mukherjee
2007; Lyons, Pitts & Grierson, 2013), and asthma, diabetes,
cardiovascular disease, or disability (Dilley et al. 2010; Kim et
al. 2012; Fredriksen-Goldsen et al. 2013; Farmer et al. 2013).
In addition, rates of depression and anxiety are well above
those of the heterosexual population (Bostwick et al. 2014;
Chakraborty et al. 2011; Morrison 2011; Pereira & Rodrigues
2015), as well as emotional distress (Almeida et al. 2009;
Choi et al. 2013), self-esteem (Huebner, Rebchook & Kegeles
2004), panic disorder (Mays & Cochran 2001), suicide and
suicide risk (Semp & Read 2015; Haas et al. 2010; Pereira &
Rodrigues 2015; Thoma & Huebner 2013), and this could be
particularly the case for more vulnerable LGB people such as
older LGB individuals (Addis et al. 2009; Harper & Scheineder
2003; Jackson, Johnson & Roberts 2008). Therefore, there are
accumulating data indicating that health problems are more
prevalent among sexual minorities than among heterosexuals.
The growing number of studies that have found clear
disparities among sexual minority groups and straight populations
raises public health concerns for the LGB community and the
wider population (Campbell 2013). Also it is becoming more
evident that, in many countries, LGB individuals are not able to exercise fully their rights to health care and service utilization
because of discriminatory laws or anticipation of rejection by
their health care providers (Conron et al. 2010; Boehmer 2012).
Health Care access
LGB individuals often face challenges and barriers to
accessing needed health services and, as a result, can experience
worse health outcomes. Lower rates of primary care utilization
among LGB populations may be founded on expectations and
experiences of stigma based on sexual orientation (Whitehead
et al. 2016). The prevalence of measures of health care service
utilization and access varies across categories of sexual
orientation (Ward et al. 2014), translating into having less
health insurances and having more irregular health providers
(Conron et al. 2010; Gonzales & Blewett 2014) or limitations
on procreation and access to assisted reproductive technologies
(Kissil & Davey 2012). A continuum of five discourses that
characterize the health services access by LGB people and
equity literature were identified by Daley & MacDonnell (2014)
including two dominant discourses: 1) multicultural discourse,
and 2) diversity discourse; and three counter discourses: 3)
social determinants of health discourse; 4) anti-oppression
discourse; and 5) citizen/social rights discourse.
In addition to the same health concerns as the general
population, sexual minorities face higher rates of illness and
health challenges, hence being more likely to experience
obstacles in obtaining care. Barriers to care include the lack of
advertisement of LGB-affirming providers, gaps in coverage,
cost-related hurdles, poor treatment from health care providers
(Kates et al. 2015), lack of information and negative attitudes of
health-care providers (Blondeel et al. 2016; Sabin et al. 2015).
Understanding these barriers and the additional health risks
they impose is crucial to improving the health status of LGB
Promoting Health Equity
The primary focus in LGB health has been on disparities
and the negative experiences LGB people may encounter.
Glaringly absent in previous studies of LGB health has been
attention to health equity and the more positive aspects of LGB
health. A health-equity approach aims to reduce disparities and
maximize efforts to reach full health capacity. Through a health
equity perspective, our attention shifts to how LGB individuals
can achieve a sense of well-being, enhanced quality of life,
and attain their full health potential (Fredriksen-Goldsen et al.
In this paper, I have illustrated the importance of connecting
to the health and wellbeing issues affecting sexually diverse
people. Such connections now need to be acknowledged and applied in the development and implementation of public health
policy. To date, many western states have failed to capture
sexually diverse populations in health and social service public
policies, despite evidence for numerous structurally-driven,
population-based health disparities.
LGB people cross all socio-economic, ethno-racial,
age, gender, (dis)ability, religious, geographical location,
educational, and relationship status lines. Consequently, for
many in these communities, their existence is made up of
multiple intersecting social identities. These identities intersect
and are affected by societal power dynamics that can result
in oppressions and/or privileges that play out structurally or
individually and interpersonally (Moosa-Mitha et al. 2005).
Recognition of oppressions and how they affect LGB
populations and their social identities and health and wellbeing
requires us to reframe population health, and public health goals
to provide a stronger foundation for inclusive health promotion
policies and initiatives that capture sexual diversity.
An important body of research using a variety of
methodologies has consistently documented high levels of
discrimination against LGB people (Fundamental Rights
Agency 2014; Sears & Mallory 2011), and demonstrates a
consistent pattern: sexual orientation-based discrimination is
common in many health settings. Furthermore, research shows
that discrimination has negative impacts on LGB people in
terms of physical and emotional health. Therefore, positive
measures to promote respect for the human rights of lesbian,
gay and bisexual people should be adopted and implemented
There must be recognition of the unique and specific health
and well-being issues affecting LGB people, substantiated with
knowledge guided by a critical/structural analysis followed
by implementation of funding, programming, and services, in
which LGB individuals and communities can be represented in
health policy (Mulé et al. 2009), prioritizing them in order to
address their health and well-being concerns, implicating the
diverse communities' voices and experiences; the health care
and social service systems, that must reshape how they provide
service delivery; and the broader society that needs to become
knowledgeable and sensitized to these issues via public health
education campaigns in order to combat homophobia and
heterosexism directed at these populations.
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