Wholistic Health Equity Determinants and the LGBTQIA++ Community:

This blog post first appeared in Ellen’s Interprofessional Insights, and is published with explicit permission of the author

With PRIDE in full stride, the dire needs of the LGBTQIA++ community will receive prime attention today, and for my next several blog posts. Too little emphasis has historically been placed on this population’s challenges in addressing these determinants and continues to be the norm. The community still struggles in accessing quality concordant health and behavioral health care, managing their psychosocial health and reflective resource needs, and activating action to mitigate their abysmal health outcomes. Systemic racism further perpetuates each of these disparities. It triggers trauma that further exacerbates physical and behavioral health, while also compromising individual safety. Time to shift this trend.

Recent Realities

The recent article in Health Affairs by Auerbach & Fox nailed it: “significant evidence suggests that virtually all LGBTQ++ populations are at elevated risk of preventable illness, injury, and death.” This article and previous works by the Kaiser Family Foundation, University of Wisconsin’s Institute for Research and Poverty, and HRC arm us with considerable data to advance action!

Poverty and Food Insecurity

An increasing incidence of the LGBTQIA+ community live close to the federal poverty level:

• 34% have incomes below 200% (of the FPL) vs. 25% of non-LGBTQIA++ people.
• 39% earn $30,000 a year or less annually. 
  • 28% of lesbian and bisexual women compared to 21% of heterosexual women.
  • 23% of gay and bisexual men compared to 15% of heterosexual men.
• 32% of transgender persons earned an annual income of under $10,000 compared to 23% of heterosexual persons.
• Lesbian couples have the highest poverty rates followed by heterosexual couples and male same sex couples.

In general, across the community:

• 30% are unable to pay their bills.
• 67% used all or most of their savings for healthcare expenses.
• 52% had trouble paying medical bills in the past 12 months or had difficulty paying for necessities (e.g., food, heat, or housing)
• 41% borrowed money from family or friends.
• 2x as likely to experience food insecurity than other populations at rates upwards of 30% of the population. One recent study reported female sexual minorities as: 
  • 52% more likely to experience nutrition obstacles, and
  44% more likely to report household SNAP assistance than their heterosexual counterparts.

Unemployment

Unemployment rates loom large for the community:

• 22% of adults vs. 16% of straight and cisgender counterparts
• 29% of transgender adults, 30% of bisexual women

Amid the pandemic these numbers soared with surveys revealing as high as:

• 28% of LGBTQIA+ report that they, or another member of their household experienced a job loss vs. 23% of the rest of the population, and
• Close to 50% report their work hours reduced.
• 45% of the population reported challenges paying their rent or mortgage vs. 32% of the remaining population.

Quality of and Access to Necessary and Concordant Care

The Kaiser Family Foundation yielded concerning results in the context of chronic illness management:

• 47% have an ongoing health condition that requires regular monitoring, medical care, or medication.
• 21% have a disability or chronic disease that keeps them from participating fully in work, school or housework.
• 34% of those on Medicaid with a disability or limiting chronic disease report the following experiences with providers:
  • Not believe they were telling the truth (16% )
  • Suggest they were personally to blame for a health problem (13%)
  • Assume something about them without asking (21%)
  • Dismiss their concerns (29%)

Trauma and Chronic Illness Exacerbation

The community’s higher rates of exposure to psychosocial stressors contribute to higher rates of chronic and autoimmune illnesses. The higher incidence of poverty, unemployment, homelessness, interpersonal violence, as well as family and peer abandonment take their toll across LGBTQIA++ populations.

Research notes intense onset and exacerbation of migraines, respiratory issues, HIV/STIs, diabetes, heart attacks, hypertension, arthritis, visual/hearing impairment, and stomach/gall bladder trouble, along with substance use and addiction. Neurological symptoms can be especially fierce in response to the expansive psychosocial stressors faced by individuals.

But Wait, There’s More

The pervasive WHED struggles of the community contribute to higher rates of discrimination, trauma, and, ultimately, more intense behavioral health conditions and mental illness. The incidence of suicidal ideation, gestures, and completed actions are at record levels, and for the youngest members of the LGBTQIA++ community. This topic deserves its own blog post and where I’ll go next time.

In addition, there must be defined recommendations for industry action. Reports have noted a variety of recommendations that ensure protective factors are in place for members of the community; these may include having healthcare providers and practitioners promote inclusion and belongingness, as well as expanding access to concordant treatment specialists. Emphasis has also been placed on individuals reducing isolation, leaving rural areas and residing in more urban areas, seeking higher levels of education, being employed, being married, not growing up in poverty or becoming a parent at a young age.

These factors make for a nice wish list but may not directly eliminate the immense disparities that have plagued the community for centuries. More can and must be done. Stay tuned for my next bi-weekly post.

Bio: Ellen Fink-Samnick is an award-winning industry entrepreneur whose focus is on interprofessional ethics, wholistic health equity quality, trauma-informed leadership, and competency-based case management. She is a content-developer, professional speaker, author, and educator with academic appointments at Cummings Graduate Institute of Behavioral Health Studies, George Mason University, and the University of Buffalo School of Social Work; her latest book is The Ethical Case Manager, and available on Amazon. Ellen serves in national leadership and consultant roles across the industry.