Dr Justin Varney, National Lead for Adult Health and Wellbeing, and Gul Root, Lead Public Health Pharmacist, both of Public Health England, consider the opportunity presented by this year’s Pride Festival for health professionals to focus on the needs of the LGBT community.
Tackling health inequalities cannot be achieved if we ignore the needs of lesbian, gay, bisexual and trans people, yet too often we, as public health professionals, fail to think beyond the shopping list of diversity to consider how we can better support this specific population and meet their needs.
Health professionals including pharmacy teams, allied health professionals and the wider workforce need to be aware of and sensitive to the needs of people from the LGBT community.
When it comes to meeting the needs of the LGBT community there is significant evidence of inequalities in:
- 52% of young LGBT people reported self-harm either recently or in the past compared to 25% of heterosexual non-trans young people and 44% of young LGBT people have considered suicide compared to 26% of heterosexual non-trans young people
- The Gay Men’s Health Survey (2013) found that in the last year, 3% of gay men have attempted to take their own life. This increases to 5% of black and minority ethnic men, 5% of bisexual men and 7% of gay and bisexual men with a disability. In the same period, 0.4% of all men attempted to take their own life
- Prescription for Change (2008) found that in the last year, 5% of lesbians and bisexual women say they have attempted to take their own life. This increases to 7% of bisexual women, 7% of black and minority ethnic women and 10% of lesbians and bisexual women with a disability
- The Trans Mental Health Study (2012) found that 11% of trans people had thought about ending their lives at some point in the last year and 33% had attempted to take their life more than once in their lifetime, 3% attempting suicide more than 10 times
- 17.7% of gay & lesbian and 24.7% of bisexual 15yrs are currently smokers, compared to 7.5% of straight identified 15yr olds
Alcohol and substance misuse
- 35% of LGB people in one large national survey had taken at least one illicit drug in the last month. This figure is 7 times higher than that reported by the British Crime Survey (2010/11) for the general population, and among LGB people aged 16-24 use of any drug in the last month is more than 2.5 times higher and more than a fifth of respondents aged 41-50yrs had taken one drug in the last month
Sexual health and HIV
- HIV and sexually transmitted diseases remain significant issues for gay and bisexual men. Between 2014 and 2016 there was a 10% increase in STI infections in gay, bisexual and other men who have sex with men. In 2015 an estimated 2,800 gay and bisexual men acquired HIV, the majority of them acquiring the infection in the UK
Many of these inequalities are even greater for LGBT people from ethnic minority groups, bisexuals and LGBT people living with disabilities, perhaps reflecting the compounding impacts of marginalisation and discrimination.
But it’s not just about meeting these needs, it is also about informing communities that you see them and want to engage and work with them.
The Stonewall Report Unhealthy Attitudes highlighted that about a quarter of LGBT staff working in the NHS have witnessed colleagues in patient facing roles being homophobic, biphobic or transphobic and almost a quarter had directly experienced discrimination from colleagues themselves. Sadly this experience is not restricted to the health sector but it does highlight that we still have a way to go in becoming a more inclusive society.
An individual’s journey towards self-awareness and self-identification of their sexual orientation or gender identity can happen at different stages of life. Some people will know early on as young people that they feel ‘other’ from the heterosexual and gender binary norms of society and some may take decades to find their natural identity as they work through societal and life pressures to find a way to be their true selves.
There are many opportunities to make every contact count for LGBT people and this starts with having a strong emphasis on equality and diversity training for all staff alongside engagement with local LGBT community organisations to co-produce the approach and share learning.
Within specific health improvement programmes such as the Healthy Living Pharmacy initiative there are really great opportunities to move faster and deeper in meeting the needs of these communities and an opportunity for HLP pharmacies to become safe healthcare settings for LGBT people to get support, signposting and access services from trained professionals.
But supporting LGBT people isn’t just about the services we provide, it is also about how we treat each other. Being yourself at work is key to being able to achieve both your personal and professional potential. The evidence base that demonstrates the value to business of colleagues at all levels of the organisation being able to bring their authentic selves to work is building every day.
Public Health England, like many other employers, is committed to becoming an inclusive and compassionate employer that supports our diverse and talented workforce to truly be their authentic selves at work. For us this has been about supporting our LGBT staff through inclusive policies, visible statements of inclusion, ensuring all staff undertake diversity and inclusion training, supporting training and development opportunities for LGBT staff and ensuring that our approach to inclusion is accessible for all of our diverse and talented workforce.
The inequalities affecting LGBT people are too great to ignore and we should all step up and take pride in tackling them together.
There are a range of resources available to support organisations of all sizes to do more to tackle LGBT health inequalities, these include:
- NHS Choices Gay, Lesbian & bisexual health pages
- NHS Choices Trans people
- The LGBT Public Health Outcomes Framework Companion Document
- PHE Promoting the health and wellbeing of gay and bisexual men and other men who have sex with men
- PHE Prevention suicide: lesbian, gay, bisexual and trans young people
- GMC Protecting patients your rights as LGB people
- Sexual orientation – a practical guide for the NHS
- Stonewall research on LGB Health Issues
- Pride in Practice
- RCGP LGB Issues in Primary Care E-learning (search for gay to find the module)
- RCGP Gender Variance E-learning (search for trans to find the module)
- E-Learning for Health Gender Variance E-learning
- NHS Employers LGB&T inclusion pages
- Stonewall Workplace inclusion resources