By Rod Knight
With another Pride upon us, we have many reasons to celebrate: over the decades, we have decriminalized homosexuality, amended the Canadian Human Rights Act to include sexual orientation, and seen same-sex marriage officially recognized by the state.
Advances in human rights for LGBTQ2S people in Canada have been profound. And yet, for many, these advances have not led to improved health and social well-being.
Despite this history of progress, we continue to see serious social and health inequities among LGBTQ2S people. From chronic diseases to addictions to sexually transmitted and blood-borne infections to depression and suicide, LGBTQ2S people consistently experience worse outcomes when compared to heterosexual and cisgender people.
These inequities are particularly pronounced among Indigenous LGBTQ2S people, people of colour, and those experiencing poverty. Why is this happening, and what can be done to improve the health and social well-being of LGBTQ2S people?
It’s important to point out that these health outcomes are not the result of individual choices or so-called lifestyle risk factors. These outcomes are heavily rooted in the social conditions that continue to systematically disadvantage and marginalize LGBTQ2S people. Many LGBTQ2S young people I’ve encountered as a public-health researcher have described complex histories of loneliness, isolation, and other forms of trauma resulting from violence, discrimination, and stigma that they experience in various facets of their lives.
As a result, LGBTQ2S people with these experiences often must deal with multiple and sometimes complex health outcomes. Unfortunately, the health-care service-delivery system tends to be designed in ways that silo sexual health, substance-use care, mental health, and other health issues—which means LGBTQ2S people aren’t able to receive the type of care they need.
In my research with LGBTQ2S young people, for example, we continue to see that their substance-use, mental-health, and sexual/reproductive-health needs are not only going unmet but. in many cases when they do seek or engage with care, significant harms can occur. For instance, many of the research participants in my studies report they are less likely to access care due, in part, to negative interactions with health-care services that are not well-equipped to address the needs of them as LGBTQ2S individuals. Unfortunately, care providers often lack the skills and competencies to navigate conversations about gender and sexual identity with their LGBTQ2S clients.
Health services need to be designed in ways that are welcoming to LGBTQ2S people: evidence-informed, client-centred, safe, reflexive, and nonjudgmental. They also need to be designed in a way that services are integrated—that is, services that can manage a variety of different health-related needs.
Furthermore, health-care organizations need to provide opportunities for care providers to cultivate skills in order to provide care in ways that promote dignity and safety. Here in Vancouver, the Foundry and Health Initiative for Men provide examples for how to deliver this type of health care. They must become the example for other communities.
Another problem that continues to present barriers to responding to the needs of LGBTQ2S people is the availability of good data. For example, we do not currently have high-quality, population-level data on how substance use-related harms are occurring within and across LGBTQ2S populations—a particularly salient issue given both the magnitude of the current overdose crisis and the fact that we know LGBTQ2S people experience higher rates of substance use-related harms. This is due, in large part, to the fact that many surveillance systems do not systematically collect information on sexual and gender identity.
Research funding and public health agencies should promote strategies that require all large-scale health studies and surveillance systems to adopt standard metrics of sexual and gender identity so we will have a better understanding of how outcomes like drug overdoses (e.g., opioid and meth overdoses) are affecting different subpopulations of LGBTQ2S people.
Ultimately, if we do not measure these kinds of differential effects, addressing inequities becomes increasingly challenging.
In order to address the social and health well-being gaps still experienced by LGBTQ2S people, we must continue to fight for advances in protecting human rights. For example, sexual-orientation and gender-identity change efforts (often referred to as “conversion therapy”) continues in Canada to this day, despite numerous health professional bodies unequivocally denouncing this practice. Such practices must be banned through the Criminal Code and resources invested to support and heal survivors of conversion therapy while also supporting research to further develop evidence-based strategies to decrease the mental-health harms resulting from exposures to conversion therapy.
Although LGBTQ2S people are underserved in almost all areas of health care, it is critically important to remember that particular segments of the LGBTQ2S community are especially disadvantaged. Aligning our efforts with movements, institutions, and individuals who are working toward improving racial equity, accessibility, and poverty eradication is something we should all be championing.
We have seen progress, but a lot more work remains. Happy Pride.