We all deserve the right to be who we are without fear of discrimination or physical harm. But for the LGBTQ community, these rights aren’t guaranteed. It’s important to understand how systemic prejudice against sexual minorities takes a huge human toll, leading to disparities in LGBTQ health and well-being.
First, it’s useful to remember that LGBTQ is just a shorthand way to reference a diverse community of people who identify as lesbian, gay, bisexual, transgender, and queer. This represents a broad range of identities and expressions of gender, sexual orientation, and presentation.
The impact of LGBTQ health disparities
LGBTQ health disparities are preventable gaps in physical and mental health that stem from social stigma, discrimination, and denial of civil and human rights based on sexual orientation and gender identity.
The persistence of these problems can be hard to fathom after all the progress made toward LGBTQ equality in the last 20 years. Same-sex couples can legally get married and adopt children nationwide. LGBTQ individuals can serve openly in the military.
But in over 25 states, it’s still legal to deny housing, employment and business services to people identifying as LGBTQ. No matter where they live, many LGBTQ Americans continue to face discrimination and social stigma in their daily lives.
Research shows how this constant struggle directly and indirectly affects LGBTQ health and well-being, leading to worse outcomes than the general population.
3 types of health disparities in the LGBTQ community
A mountain of evidence shows discrimination increases physical and mental health risks for LGBTQ people. The What We Know project at Cornell University concluded that 95% of 300 peer-reviewed studies found a link between LGBTQ discrimination and health disparities. The types of LGBTQ health disparity also interconnect, compounding other factors.
Physical health
- Gay men have higher rates of HIV and other sexually transmitted infections (STIs), especially among communities of color.
- LGBTQ people are more likely to experience heart disease. Researchers trace this to the elevated stress hormones triggered by discrimination, social rejection, and the fear of violence.
- Lesbians are less likely to seek or receive preventive health services for cancer.
- Lesbians and bisexual females are more likely to be overweight or obese, which can lead to other health problems such as heart disease and diabetes.
Increased risk of violence
Mental health
Being part of the LGBTQ community can be a source of strength and bring a sense of acceptance and belonging. It also can bring special mental health challenges. The National Alliance on Mental Illness (NAMI) provides a summary of the mental health risks and disparities in the LGBTQ community drawn from recent research.
- The risk of experiencing a mental health condition is more than twice as high for LGB adults and nearly four times as high for transgender individuals.
- The risk of suicide is 2 times as high for LGB adults and nearly 8 times as high for transgender individuals.
- Substance misuse or overuse often starts as a way to cope or self-medicate with psychological trauma. This risk is nearly twice as high for LGB adults and almost four times as high for transgender individuals.
The longer-term effects of mental health disparities show up across individual’s lives, often having cumulative effects. For example, lower well-being and serious mental health issues have a financial impact, both in costs of care and ability to maintain good employment and other structures for financial stability.
What causes LGBTQ health disparities?
It helps to consider the history of legal oppression, hate, and discrimination to understand why LGBTQ people experience higher health risks. Colonization spread bigotry and homophobic legislation criminalizing LGBTQ behavior across the globe centuries ago. And while it has been decriminalized in the US and much of the world, same-sex sexual activity is still illegal in 71 countries, according to Human Dignity Trust.
Public acceptance has significantly improved, with 72% of Americans saying homosexuality should be accepted by society, according to Pew Research Center. That leaves a large, often vocal, minority of nearly 30% who disagree. As a result, many LGBTQ individuals face prejudice and rejection from their families, coworkers, and in society at large.
Social determinants
A public health term, social determinants, are systemic factors that affect health and well-being that are largely outside a person’s control. We all experience social determinants – like financial wellness, access to education, and the amount of pollution where we live. Depending on our circumstances, these factors can be positive. But for minorities, these outside forces tend to be like headwinds working against them.
Examples of social determinants affecting LGBTQ people include:
- Legal discrimination in access to healthcare and insurance, employment, housing, marriage, adoption, and retirement benefits
- Lack of laws protecting against bullying in schools
- Higher rates of poverty, making it more difficult to afford health insurance or care, housing, and higher education
- Inadequate social programs geared to meet the needs of LGBTQ youth, adults, and elders
- Inequities in benefits programs, including disparities between reproductive treatments and adoption programs, which create a higher financial burden, or limit the financial benefits, for LGBTQ workers
Within healthcare systems, social determinants can affect health outcomes for individuals. This means that based on these factors outside of a person’s control, they may be less likely to receive a correct diagnosis, be offered preventative care, or be given an effective treatment protocol.
Social determinants mean that an individual in the LGBTQ community may experience worse health outcomes for common conditions unrelated to their gender or orientation.
Healthcare disparities and barriers to care
Quality healthcare without discrimination is considered a basic human right. But this isn’t a given for many minorities, including LGBTQ people.
The last decade shows how quickly sexual and gender minorities can lose hard-won healthcare rights depending on who controls the White House and state government where they live.
For example, several states recently passed laws that deny evidence-based, gender-affirming healthcare for transgender youth, with some laws threatening parents with separation from their children by state child protective services. While these laws are being challenged in court, transgender youth and their families face fear and uncertainty in getting the care they need.
On the federal level, President Donald Trump rolled back newly granted provisions in the Affordable Care Act (ACA) that protected LGBTQ people from insurance discrimination and exclusions of care related to gender identity. These rights are being restored under the direction of President Joseph Biden, but it’s clear the protection is tenuous.
Aside from the very real risk of gaps in continuity of care when these rights get rolled back, these political battles can add chronic and damaging stress to the lives of LGBTQ people, regardless of their health status. The impermanence of these provisions serves as a reminder that their ability to plan for the future or make family and financial decisions is at risk.
Systemic loss of agency may make some LGBTQ people less likely to seek out health services or prioritize healthy behaviors and contributes to increased risk for poor physical health and mental health.
Beyond legal barriers, research shows LGBTQ individuals may be less likely to access quality healthcare for several interconnected reasons:
- Lack of culturally competent providers with knowledge of LGBTQ health or health issues unique to transgender
- Fear of stigma, discrimination, or poor treatment, and/or prior negative experiences with health providers
- Difficulty affording health insurance or care
- Refusal of care due to gender identity, sexual orientation, or gender presentation
Minority stress
Day-to-day experiences of discrimination, rejection, and the fear of violence grind away at LGBTQ people. This hostile legal and social climate leads to “minority stress,” which researchers and mental health professionals say can depress an individual’s coping mechanisms and ability to build resilience.
Dr. Katie Imborek, a co-founder of the University of Iowa LGBTQ Clinic, explains how minority stress is linked to internalized stigma and trauma, low self-esteem, and expectations of rejection.
“It’s really their experience living in a world that treats them as somewhat less than,” said Dr. Imborek during a Share Public Health podcast aired by the Midwestern Public Health Training Center. “The systemic injustice and discrimination … from having a challenging time with employment … to housing … to healthcare, to feeling at times that they may be estranged from friends or family or from their place of worship.”
It’s never easy when you feel like you don’t fit society’s mold and still feel the pressure to be what society expects. These external pressures can lead to a lack of self-acceptance and internal contradictions that take a toll on mental and behavioral health. This can cause cognitive dissonance, a conflict between our feelings and beliefs about who we are and the identity we feel safe in projecting to others.
Diversity and intersectionality
Sexuality and gender identity and presentation are far more complex than scientists, and society, might have thought. Researchers now describe a sexuality spectrum that doesn’t easily fit into binary, either-or categories.
Even the acronym LGBTQ continues to evolve as our scientific and social understanding of sexuality rapidly changes. For example, some organizations add “I” or + to be more inclusive of intersex or nonbinary people.
According to the Intersex Society of North America, intersex is a general term describing a wide range of natural variations that occur when a person is born with reproductive or sexual anatomy that doesn’t fit the typical definitions of female or male. Though once thought to be extremely rare, intersex people are estimated to represent nearly 2% of the general population, which is roughly the same percentage as redheads.
Sexuality and gender are also just one part of a person’s identity. Race, religion, ethnicity, nationality, socioeconomic class and our experiences all play a role in who we are.
This diversity and intersectionality can complicate the experience of being LGBTQ. Belonging to more than one marginalized group can compound the challenges and risks for an individual.
For example, research shows that risks of violence, homelessness, and suicide are much higher for black LGBTQ individuals. Consider how different the life of a cisgender white gay man raised by an accepting, middle-class family compared to a transgender Black woman who is experiencing homelessness because her family disowned her as a teen.
This also leads to challenges for LGBTQ people in finding qualified health professionals who can help them with their unique needs. They will want to look for someone with both cultural competence and the cultural humility to want to learn.
LGBTQ health across generations
All age groups experience health disparities, but there is special concern for youth and older adults in the LGBTQ community. Here's a closer look at some of the generational differences.
Being young and LGBTQ
The teen years can be risky for everyone. Depending on their family, school, and social environments, LGBTQ adolescents face higher risks than their heterosexual counterparts.
In his advice to parents on raising a happy and healthy LGBTQ child, journalist and Washington Post columnist Steven Petrow writes about the experience of growing up gay and the importance of positive parental support.
“When many LGBTQ people look back on their childhood, we remember a mixture of confusingly feeling different; being harassed for our sexual identities; and realizing how important our parents, teachers, and other authority figures were in either helping us through those years — or making our lives worse,” writes Petrow. “Experts say research shows that how parents respond can be fundamental to their children’s mental health and well-being, now and in the future.”
LGBTQ and aging
Reports estimate there are around 3 million LGBTQ Americans over age 50. With that number expected to grow to around 7 million by 2030, researchers and policymakers have identified LGBTQ older adults as a vulnerable and underserved population. Research from the National Center on LGBT aging and Sage Advocacy for LGBT Elders indicates that LGBTQ adults face special health challenges as they age:
- Older LGBTQ adults are twice as likely to be single and live alone and are four times less likely to have children.
- Half of all Americans living with HIV are over 50 years old.
- A study across 10 states showed that 48% of same-sex couples experienced adverse treatment when seeking senior housing.
- As with other aging people, LGBTQ people face an increased risk of infirmity, disability, and death. But their lives are further complicated by less dependable acceptance of their rights around legal decision-making, benefits, communal property, and inheritance among other factors.
How to be an ally for LGBTQ health
There are many ways for family members, friends, coworkers, health professionals, and concerned citizens, to be a supportive and effective ally.
Check-in with your intentions
Remember that the goal of standing up against LGBTQ health disparities is ultimately to improve the health and well-being of other humans, including some you know. Maybe including you.
Maintaining that focus and checking yourself against it regularly can help you choose where to put your efforts. What starts as good intention can become self-satisfied and performative if you lose sight of the goal.
Check for unconscious bias
Even when we have good intentions, unconscious biases and attitudes can affect our behavior, judgments, and the language we use without realizing what’s going on.
For example, using a person’s preferred gender pronouns is an important way to validate their identity. At first, changing old habits in the way we speak may feel confusing and uncomfortable. If we experience a lot of internal resistance, we may want to explore our feelings to see if there are some old beliefs and stereotypes that may need updating.
Better than an ally, be an advocate
One of the best ways to support health equality is to spread awareness about organizations focused on serving the LGBTQ community. Here’s a list of some of these groups and resources:
- Centerlink, The Community of LGBTQ Centers. They provide an international directory of local centers serving LGBTQ health, social, cultural, and political advocacy needs.
- Health Professionals Advancing LGBTQ Equality. In addition to providing educational resources for professionals, this organization offers a directory of LGBTQ-welcoming healthcare providers.
- Healthcare Equality Index. The Human Rights Campaign LGBTQ advocacy group conducts an annual survey of healthcare facilities on policies and practices dedicated to equitable treatment and inclusion for LGBTQ patients, visitors, and employees. The HEI 2022 report provides the survey results and education about improving healthcare inclusiveness for the LGBTQ community. This tool helps find facilities that complete the survey.
- NAMI. The alliance offers information about LGBTQ mental health for individuals, families and healthcare professionals.
- LGBT National Help Center. This organization operates three national hotlines that provide peer-support for youth, adults and older adults in the lesbian, gay, bisexual, transgender, queer and questioning community.
- PFLAG. With nearly 250,000 members and 400 chapters across the country, PFLAG focuses on providing support, information and resources for LGBTQ people, their parents, families, and allies.
- The Trevor Project. This organization provides information and support to LGBTQ young people, including 24/7 access to trained crisis counselors by chat, text or phone.
- The American Psychological Association.They provide educational and support resources on a range of LGBTQ topics, including guidance for practitioners.
Fighting stigma
The stigma and discrimination affecting LGBTQ people isn’t going away easily. Besides advocating in the political arena, we can make progress each day in one-on-one conversations at home, with friends, and at work.
The good news: many people, particularly in younger generations, are aware and committed to moving past discrimination. The bad news: that might not feel very comforting if you are currently experiencing the negative disparities.
Serving LGBTQ people in healthcare, therapeutic, and mental health settings requires education, awareness, and a willingness to learn. For many LGBTQ people, asking for help takes courage to overcome fear of rejection and judgment. Building our mental health awareness can help us broach difficult subjects and even save lives.
