How Discrimination Impacts LGBTQ Healthcare

LGBTQ people face barriers to healthcare. Learn about what students, providers, and healthcare leaders can do to address LGBTQ discrimination in healthcare.
St. Kate's campus in fall, seen from above

All people need medical care. Yet for lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) individuals, basic and essential healthcare services can be difficult to access. What is LGBTQ health discrimination? Stigma, bias, and systemic inequalities in healthcare settings combine to hinder LGBTQ people from receiving the support and care every patient deserves. 

Educating caregivers and the public on the challenges facing the LGBTQ community can make healthcare more equitable and inclusive for people of all sexes, sexual orientations, gender identities, and gender expressions. 

LGBTQ Health Disparities: Trends and Statistics

To improve the safety and well-being of LGBTQ people, the healthcare system must recognize the unique challenges LGBTQ people face before and while seeking medical treatment.

LGBTQ Populations Tend to Be At-Risk

According to the U.S. Office of Disease Prevention and Health Promotion, LGBTQ people face significant health challenges as a result of social stigma, discrimination, and violence. 

Stigma, Bullying, and Family Rejection

In a heteronormative culture — a culture in which heterosexuality is the default and the norm — LGBTQ individuals often endure shame and stigma. 

Biases against LGBTQ people from their family, religious community, work, and school affect their mental health and personal safety. LGBTQ youth are more likely to be bullied in school than other students. This has serious health repercussions, as peer victimization is a leading cause of high-risk sexual behaviors in middle and high school students. 

Additionally, disclosing one’s gender or sexual identity can cause significant interpersonal challenges at home when parents or guardians fail to accept and support their child. Because of family rejection, LGBTQ youth are overrepresented in foster care and are more likely to become homeless than others their age. Tragically, LGBTQ youth are two to three times more likely to attempt suicide than their heterosexual peers. 

Discrimination

Discrimination against LGBTQ individuals has been associated with high rates of psychiatric disorders, substance abuse, and suicide. LGBTQ populations have the highest rates of drug use, including the use of tobacco and alcohol. Elderly LGBTQ people face additional barriers to health, especially because of isolation and a lack of culturally competent providers. Examples of discrimination that negatively affects the health of LGBTQ individuals include:

  • Legal discrimination in access to health insurance, employment, housing, adoption, and retirement benefits
  • Financial barriers
  • Lack of social programs that are inclusive for LGBTQ people of all ages
  • Shortage of healthcare providers who are knowledgeable and culturally competent in LGBTQ health (which can discourage LGBTQ people from seeking care)
  • Negative provider attitudes

Furthermore, barriers to healthcare related to sexual and transgender stigma worsen when combined with systemic racism and xenophobia. LGBTQ people who are immigrants or have limited English proficiency are especially vulnerable in the healthcare system. Many individuals who need care forgo it out of fear and distrust of the system.

Medical Transition Struggles

The experience of living as a sexed and gendered being is clearly diverse. Yet babies are typically assigned a single sex at birth (male or female) by a healthcare professional. Then, according to societal norms, children are expected to fit neatly into a corresponding gender identity (boy or girl) and embrace the preferred activities and values that have been codified as “masculine” or “feminine.” 

Transgender and gender nonconforming youth face particular mental health challenges as they reckon with this binary sex/gender system. Some, though not all, transgender people experience gender dysphoria (a feeling of distress that can occur when a person’s sex as assigned at birth does not align with their gender identity).

Many medical clinicians do not support transition services for transgender youth. Few insurance programs cover transition treatments, and transgender people are less likely to have health insurance than heterosexual people. 

Violence

Experiences of violence and victimization are frequent for LGBTQ individuals. They have long-lasting effects. According to the National Center for Transgender Equality, over 25% of transgender people have been victims of transphobic assault, and the percentage is even higher for trans women of color. 

Medical providers must educate themselves about the pervasive violence that LGBTQ — especially transgender — people face, and offer culturally competent care. 

Diversity in the LGBTQ Community

LGBTQ people demonstrate resilience in the face of public health systems that were traditionally designed to exclude them. 

The Entire Rainbow . . . for Good Reason

The LGBTQ community celebrates diversity. LGBTQ people encompass all races and ethnicities, social classes, and religions. For the healthcare system to serve all people, practitioners, clinicians, and researchers alike must start with acknowledging the diverse individuals and communities who comprise the population. 

Inclusion Is Key

The acronym “LGBTQ” is a useful (though sometimes limited) shorthand term for referring to a diverse and ever-evolving community. People of many sexes, genders, identities, and expressions have existed long before labels. 

Labels and language matter. To serve all people, healthcare professionals and researchers must continually educate themselves on emerging understandings of sex, gender, and sexuality. In the present day, that means including individuals whose gender identities, gender expressions, and sexual orientations are not directly referenced within the LGBTQ acronym.

For example, the LGBTQ community also includes: nonbinary people (individuals who identify as neither a man nor a woman), asexual and demisexual people (individuals who do not experience sexual attraction, or who experience sexual attraction only after persistent emotional bonding), and intersex people (individuals with a combination of male and female sex characteristics, such as chromosomes, hormones, or sex organs). 

Learn How to Be an Advocate in Nursing and Public Health

LGBTQ people face numerous barriers to healthcare. Stigma and social shaming can deter LGBTQ people from seeking care. The scarcity of competent healthcare for LGBTQ people can discourage patients. And LGBTQ people face discrimination on a daily basis. 

Further research and education on LGBTQ individuals’ health and experiences navigating the healthcare system can work to produce better outcomes for all patients.

Healthcare Research Must Include LGBTQ People 

Medical research must be inclusive of LGBTQ people. Healthcare professionals need ongoing education about the challenges that the LGBTQ community faces today. Most national and state studies do not ask questions regarding sexual orientation and gender identity. This makes understanding the number of LGBTQ individuals in the population and their specific health needs difficult. 

Educating Healthcare Professionals About LGBTQ Barriers to Healthcare

Healthcare should work for all patients, regardless of gender or identity. Homophobia and transphobia diminish health outcomes for LGBTQ people. With education and further research on vulnerable populations in healthcare, the dismantling of the structures of oppression that prevent some individuals from accessing the treatment and care they deserve can begin.

Want to know more about what educators and students are doing today to promote the health and well-being of all patients? Visit St. Catherine University’s Nursing programs and public health programs to learn more about healthcare education that is committed to justice and diversity.


Sources:

American Psychological Association, “How Does Implicit Bias by Physicians Affect Patients’ Health Care?”

BMC Medical Ethics, “Implicit Bias in Healthcare Professionals: A Systematic Review”

Centers for Disease Control and Prevention, Health Disparities Among LGBTQ Youth

The Forum (with NPR), “Health in the LGBTQ Community Improving Care and Confronting Discrimination”

Human Rights Campaign, “Fatal Violence Against the Transgender and Gender Non-Conforming Community in 2021”

Human Rights Watch, “‘You Don’t Want Second Best’: Anti-LGBT Discrimination in US Health Care”

National Center for Transgender Equality, Anti-Violence 

National Institutes of Health, “The Health of Lesbian, Gay, Bisexual, and Transgender People

National Institute for Health Care Management, “Addressing Health Disparities in the LGBTQ Community”

Office of Disease Prevention and Health Promotion, Lesbian, Gay, Bisexual, and Transgender Health

The Trevor Project, Health Care