LGBTI health care: challenging and improving the inequality in care for LGBTI communities

Historically, LGBTI populations across Europe have experienced significant health inequalities both in terms of poorer health outcomes and negative experiences of accessing healthcare compared to non-LGBTI populations. For some, these experiences have translated into a risk of depression, suicide and self-harm, violence, substance misuse and HIV infection.  

Research led by the 91¶¶Òõ has tackled these health inequalities within the LGBTI community, generating changes in policy and health education at local, national and European levels. A series of major projects investigated both structural and causal effects of inequalities in healthcare and services for LGBTI citizens, uncovering and dealing with barriers including access to health care, health inequalities, definitions, healthcare systems and classification methods as well as adequate awareness of needs amongst healthcare professionals.  

These projects aimed to improve understanding of how best to reduce specific health inequalities experienced by LGBTI people. Using mixed methods approaches and co-production with end-users and partners across Europe, researchers examined interactions between lived experience, policy and clinical practice and how these affect physical and mental health and well-being of individuals identifying as LGBTI in the UK and Europe.  

Find out more about our research with and for LGBTI communities at our Centre for Transforming Sexuality and Gender

Health4LGBTI - the first-ever global analysis of LGBTI health inequalities

As a result of a successful tender, 91¶¶Òõ researchers led two of five research work packages for the European Parliament’s Health4LGBTI project – a two-year EU-funded project in collaboration with partners in six EU countries (Belgium, Bulgaria, Italy, Lithuania, Poland and the UK).  Health4LGBTI completed the first-ever global analysis of LGBTI health inequalities in LGBTI scientific literature, highlighting the existence of key barriers and discrimination based on sexual orientation, gender identity, and sex characteristics of LGBTI people.

The review found that LGBTI people are more likely to experience health inequalities due to heteronormativity or heterosexism, minority stress, experiences of victimisation and discrimination, compounded by stigma. Inequalities pertaining to LGBTI health(care) vary depending on gender, age, income and disability as well as between LGBTI groupings. Gaps in the literature remain around how these factors intersect to influence health, with further large-scale research needed particularly regarding trans and intersex people. 

The study also focused on the barriers faced by health professionals when providing care and uncovered a lack of cultural competence concerning the needs of LGBTI people, a lack of awareness relating to gender identity, and a lack of specialist mental health and counselling services. This was supported by focus groups across the six EU partner countries and showed that three assumptions about LGBTI-related healthcare held by HCPs underpinned discrimination. Firstly, that patients are heterosexual, cisgender, and non-intersex by default; secondly that LGBTI people do not experience significant problems due to their sexual orientation, gender identity, and/or sex characteristics; and, thirdly that a person’s LGBTI subjectivity is mostly irrelevant for healthcare.  

These projects recognised that a key structural challenge and primary reason that LGBTI people experience inequalities in health is due to invisibility in health systems including poor data or no data. It consequently advocates for better data collection by health professionals including how systems can record more appropriate recognition of sexual orientation and gender identity. This can help ensure LGBTI people are afforded dignity, respect, and appropriate care. 

The project has subsequently led to further, significant improvements in training programmes for health professionals. The Health4LGBTI project team developed a comprehensive training programme that focuses on knowledge, attitudes and skills of healthcare professionals when providing healthcare to LGBTI people and accounted for the needs of diverse European settings. 

The results of the Health4LGBTI research have been used by the UK Parliament’s Women and Equalities Committee inquiry into health care provisions for LGBT communities in October 2018 and subsequently fed into the LGBT Action Plan 2018 from the Government Office. In July 2020, the Ministry of Health in Portugal launched a National Health Strategy for LGBTI people with an inaugural programme dedicated to Health promotion of transgender and intersex people underpinned by Health4LGBTI including a national roll out of the training materials developed by the project.