Equitable care for All: The LGBTQ+ healthcare evolution

To coincide with LGBTQ+ History Month, our colleague Terry Starr has taken the time to reflect on this year’s theme of medicine, exploring historical discrimination in healthcare, and current efforts for equitable healthcare provision.

The focus of the 2024 LGBTQ+ History Month is “Medicine – Under the Scope” and will look, in the words of the national organising committee, “at the amazing work of LGBTQ+ staff across the NHS and in other healthcare settings, in providing healthcare, especially during the pandemic.” At the same time, they note the need to “shine a light on the history of the LGBTQ+ community’s experience of receiving healthcare which has been extremely complicated leaving LGBTQ+ people still facing health inequalities even today.”

It should come as no surprise to any student of history that LGBTQ+ people would have mixed experiences of the health care services. Whilst there are many hundreds of thousands of LGBTQ+ staff who dedicate their lives to the service of others, the nineteenth century pathologisation of homosexuality and transgenderism (to use old terminology), casts a long shadow over the following two hundred years of medicine. LGBTQ+ people are not special in this respect: disproven ideas on health, race and class led to all manner of bizarre theories about white and aristocratic superiority in the past.

Prejudices and assumptions

In the broad post- Second World War era, many prejudices and assumptions were challenged. As early as 1948, Doctor Evelyn Hooker compiled evidence that scientifically, there was no difference between the cognitive performances of gay men vis a vis heterosexual men, and the same results were soon also evidenced for lesbian women. But mental health professions change slowly, and it was only in 1974 that the American Psychiatric Association ratified in a popular vote of professionals, the decision to declassify homosexuality as an apparent mental health disorder. But as late as 1984, the London Gay Teenage Group (an organisation that has since merged with others) reported that a significant minority of its members had been pressured by NHS workers to have some kind of treatment designed to turn them into heterosexuals. In the 1990’s the direct action groups OutRage! and Lesbian Avengers campaigned for an apology from the Health Service.

Minority stress and mental health

Well, that is the past. However, even today people who are in a minority group might experience health services differently. LGBTQ+ current affairs site News is Out quotes a new report from the American Cancer Society, and says “Many members of the LGBTQ+ community experience ‘minority stress’, which can elevate risk factors. Coined in 2003, the term ‘minority stress’ is the discrepancy and conflict that arise between the values of a historically minoritised group and the dominant culture or society.”  The report goes on to analyse how race, class and other issues can impact health outcomes.

Can we apply this understanding of minority stress to mental health services as well?  A 2017 report for the Greater London Assembly summarised: “Being lesbian, gay, bisexual, transgender (or non-binary, intersex, queer or gender fluid) is not in itself a mental health issue. But the extent to which people are accepted and included in society for who they are can have a profound effect on mental health and wellbeing. One is six LGBTQ+ people experience homophobic, biphobic or transphobic hate crime at some point in their lives. Experience or fear of hate crime can have a lasting, cumulative negative effect on mental health. And LGBTQ+ people are more likely to experience homelessness, unemployment, abuse and violence, all of which increase the risk of mental health problems“.  At the same time, the report found that many service providers were ill prepared to “demonstrate commitment to more inclusive service provision right across the public sector.

A healthier future

You may be wondering where LGBTQ+ History Month 2024 fits in to all this. It is after all, not at all universally supported within the LGBTQIA+ communities themselves, with some people feeling that it is tokenistic. These criticisms come from both the right of the LGBTQ+ movements (where people argue that there is no need for a celebration that might provoke homophobes) and the left too (where people argue for a general queering of history generally). Nevertheless, the 2024 History Month gives us an opportunity to reflect on the challenges to equitable health provision and to mark achievements.

And these achievements have been built by grassroots organisations upward. LGBTQ+ healthcare groups have heavily influenced the development of patient-centred healthcare across the globe. Many lesbian women were inspired by the women’s liberation movement of the seventies to create healthcare networks. When the AIDS crisis hit during the eighties, many of these activists worked with a newly politicised generation of gay men to build grassroots service organisations such as Terrence Higgins Trust, delivering, educating and lobbying. In 1986, AIDS:  A Guide to Survival was published by Peter Tatchell, presenting a holistic vision of healthcare that contradicted the negative messaging from the newspapers and even parts of the NHS. In the nineties, the self-organised and grassroots approach to health was adopted by more and more charities and networks working in the fields of cancer and mental health, and groups working with refugees and asylum seekers, to cite just a few.

And it is worth celebrating the fabulous work currently being done in the health and care sectors by LGBTQIA+ people. Anecdotal and staff profile evidence suggests that women, individuals of Black, African, Caribbean and Asian descent, and LGBTQ+ people are more likely to work in the often overlooked but nonetheless vital roles such as care work, nursing, support work and various ancillary positions. Their contribution to society is immeasurable, delivering frontline services despite dwindling resources.

So, this LGBTQ+ History Month, spare a thought for the many people who are striving for equity in care and services, as well as the many people who have helped create change in the past, and whose contribution is sometimes overlooked. Our NHS and care services are the better for the combined efforts of many individuals and groups. Bravo!

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