What does the future of LGBTQ health care look like? LGBTQ individuals' mental and physical health needs are largely shaped by society and culture. As society changes, health disparities in the LGBTQ community will change, too. Here's a bit about the current state of LGBTQ health care and how it might change in the future.
LGBTQ individuals have secured greater rights and are enjoying increasingly positive views from the public, but health disparities still exist, often a result of persisting stigmas and discrimination. Experiencing discrimination can lead to substance abuse and increased risk of suicide, and members of the LGBTQ community are still often victims of violence, as well.
LGBTQ health disparities include youth being two to three times more likely to commit suicide; lesbians being less likely to get preventive cancer services; gay men being at higher risk for HIV and other sexually transmitted infections (STIs); and transgender individuals being at higher risk of HIV, victimization, and suicide. LGBTQ communities also have higher rates of tobacco use and substance abuse. This is disheartening, but not insurmountable.
The source of depression and anxiety for LGBTQ individuals — especially transgender people — is typically not their gender identity or sexual orientation, but the degree to which they are accepted. Many health disparities boil down to whether or not an individual feels safe and accepted.
"Transgender folks aren't really having a lot of psychological issues based on just their transgender status," Christopher Swales, MD, a family medicine doctor with Dignity Health Medical Foundation – Woodland and Davis explained. "A significant portion of that depression and anxiety comes from their worry about the response from the community."
This means that the LGBTQ community's higher rate of suicide or depression can likely be attributed to concern about how society is going to treat them. Unfortunately, acceptance is still an issue for many in the LGBTQ community, Dr. Swales said. There are still acts of violence, and many still do not feel safe. "Even here in California, there are still people who are harmed because of their transgender status," he said. "There's still room for a lot more progress."
In addition, there simply aren't enough doctors who understand the cultural competency of LGBTQ care. Dr. Swales said that when he looked at a list of doctors in Sacramento, only three were listed in the transgender section — including himself. "When compared to other specialties, there are definitely not enough doctors who have the education and are open to caring for transgender patients," he said. As you look for the right provider, remember that you can see any doctor and the key is to find someone you're comfortable with.
LGBTQ health could look very different in five, 10, or 20 years from now, but it all comes down to increased care and acceptance. If society becomes less tolerant of discrimination and bullying, members of the LGBTQ community might feel less anxious about being themselves. This could lead to increased mental well-being and confidence, which might lower substance abuse rates. But that means we can't be lax about acceptance — we must continually take a stand against discrimination.
When LGBTQ individuals feel more secure, they may be more likely to visit doctors because they won't worry about feeling embarrassed or misunderstood. They'll be more likely to seek preventive care, be treated for STIs, and receive mental health treatment, too.
Of course, physicians need to play their part. It's important for more and more doctors to study the unique needs of the LGBTQ culture and promote themselves as LGBTQ-friendly. For example, doctors who are better educated about LGBTQ needs will be more willing to prescribe pre-exposure prophylaxis when appropriate, which could help society eventually become HIV-free, Dr. Swales said. The Office of Disease Prevention and Health Promotion agrees that physician education is critical. In a report from the organization, "providing medical students with training to increase provision of culturally competent care," is listed as an important effort toward improving LGBTQ health.
We're already seeing evidence of positive change. More and more medical schools are including courses and training focused on treating LGBTQ patients, and an increasing number of hospitals are incorporating diversity and cultural competency training for personnel. If trends like these continue, then in five to 20 years, LGBTQ individuals may not feel any additional anxiety about visiting a doctor, and their overall health will improve significantly as a result.
Of course, improving LGBTQ health care in the future won't be easy, but it also isn't an insurmountable goal. It all begins with education, acceptance, and care. This can start with doctors who provide LGBTQ-friendly services and stand up for the rights of their LGBTQ peers.
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