{"id":27443,"date":"2023-06-21T18:51:12","date_gmt":"2023-06-21T18:51:12","guid":{"rendered":"https:\/\/updates-www.mccdn.io\/vitals\/?p=27443"},"modified":"2025-04-28T23:43:13","modified_gmt":"2025-04-28T23:43:13","slug":"lgbtq-health-equity-should-be-the-rule-not-the-exception","status":"publish","type":"post","link":"https:\/\/updates-www.mccdn.io\/vitals\/lgbtq-health-equity-should-be-the-rule-not-the-exception\/","title":{"rendered":"LGBTQ+ health equity should be the rule, not the exception","gt_translate_keys":[{"key":"rendered","format":"text"}]},"content":{"rendered":"

At MultiCare, we are committed to working toward health equity \u2014 ensuring all people have access to quality health care regardless of age, race, ethnicity, gender identity, religion, sexual orientation, ability, socioeconomic status or location.<\/em><\/p>\n

But we also recognize the reality that longstanding biases and barriers embedded in the health care system, and our society, can prevent people from accessing the care they need.<\/em><\/p>\n

In this series \u2014 inspired in part by society\u2019s growing awareness that not everyone has the same chance to be healthy \u2014 we take a deeper look at the disparities that impact our patients and how we as health care providers and community members can reduce those disparities and improve the health and well-being of all.<\/em><\/p>\n

Maternity care for bisexual women of color<\/strong><\/h2>\n

Bisexual women and women of color have long experienced challenges in maternal and perinatal health care.<\/p>\n

From bi negativity and bisexual erasure to racial stereotypes and adverse health outcomes, this is a reality Deana Williams, (she\/her), PhD, MPH, has found in her work as a research investigator at the MultiCare Institute for Research and Innovation<\/a>.<\/p>\n

What she doesn\u2019t know, though, is what bisexual women of color experience when seeking and accessing this type of care. And that\u2019s largely because the research community isn\u2019t doing enough to accurately represent them.<\/p>\n

\u201cIn current research, bisexual women of color are vastly underrepresented and often aggregated with other sexual minority women,\u201d Williams says. \u201cWomen of color who are bisexual are experiencing disparities at even greater levels than their white queer counterparts.\u201d<\/p>\n

Dr. Williams is leading a study funded by the National Institutes of Health to capture the voices and lived experiences of these patients. She hopes to spark changes that will result in affirming, culturally conscious care for all birthing people.<\/p>\n

Health care disparities come in many forms<\/strong><\/h2>\n

This case study is just one example of the health disparities faced by the LGBTQ+ community. Discrimination based on gender identity and sexual orientation \u2014 especially when coupled with race, age and socio-economic status \u2014 can play a significant role in equitable access to care.<\/p>\n

For example, LGBTQ+ adolescents are more likely to experience bullying, and without access to affirming and culturally competent intervention and treatment, the risk of suicide increases, according to the U.S. Department of Health and Human Services.<\/p>\n

The Trevor Project<\/a> reports LGBTQ+ youth are more than four times likely to attempt suicide than their peers.<\/p>\n

\u201cQueer people don\u2019t genetically have predispositions that lead to things like substance abuse or suicidality,\u201d says Joseph Angel, MD, (he\/him)<\/a>, a family medicine\/obstetrics and LGBTQ+ care provider at MultiCare Tacoma Family Medicine<\/a>. \u201cIt stems from society and the unwelcoming spaces.\u201d<\/p>\n

Sometimes these health disparities come from simpler things, such as patient forms with only two gender options, a receptionist refusing to use a chosen name, or a health care provider making assumptions about a patient\u2019s sexual health.<\/p>\n

Other times, disparities are based on decades-long systemic issues that have been ingrained in health care education and operations.<\/p>\n

\u201cWe are skin before we are gender, and skin changes so much over a lifetime. If that\u2019s always shifting, we should have the ability to shift in other ways.\u201d<\/p><\/blockquote>\n

LGBTQ+ health care has long been dictated by gay white men and focused on sexual health. Although it\u2019s a necessary group to care for, others have been left out, Dr. Angel explains.<\/p>\n

Women who have sex with women, for example, have higher rates of reproductive cancer, he says. They\u2019re more likely to miss cancer screenings and less likely to be pregnant and\/or breastfeed, which is thought to provide beneficial hormones that reduce the risk of many cancers.<\/p>\n

Gay men also have higher rates of HPV-related cancers, which they don\u2019t typically get screened for, Dr. Angel adds.<\/p>\n

Many of these challenges come from a lack of LGBTQ+ competency, says Esteban Herevia (he\/him), former Spokane Pride<\/a> president\/CEO. Doctors and other health care providers have good intentions, but may not understand the impact enough.<\/p>\n

An organization could update its intake process to gather sexual orientation, gender identity and pronoun (SOGI-P) information but may not do so in a respectful manner, such as asking in front of others in the waiting room. It\u2019s not meant to be intrusive, but it doesn\u2019t create a respectful space, Herevia says.<\/p>\n

Unique issues for older LGBTQ+ adults and youth<\/strong><\/h2>\n

Health disparities are a longstanding issue for the LGBTQ+ community.<\/p>\n

As a group, older LGBTQ+ patients experience unique economic and health disparities, including poverty and physical and mental health conditions from a lifetime of stressors. They\u2019re less open with providers about their sexual and gender identity because they feel unsafe, and are more likely to live in isolation, according to the American Psychological Association.<\/p>\n

Queer youth face mental health challenges not only from discrimination and societal pressure \u2014 but also the struggle to receive affirming and appropriate care due to a lack of transportation, financial resources or parental support.<\/p>\n

\u201cIn general, there are misconceptions that queer youth are confused,\u201d says Daniel Ensley (he\/him), development and partnerships specialist at Oasis Youth Center<\/a> in Tacoma.<\/p>\n

It\u2019s easy for people to focus on struggles like suicidal ideation, substance use and sexual assault, he explains.<\/p>\n

\u201cIt\u2019s extremely sexualized because when people think about those who are not straight, for some reason all they can focus on is that single difference and kind of forget we are whole people,\u201d Ensley says. \u201c(Sex education) is not talking about consent, boundaries and communication enough, so when youth are put in situations because of discrimination, stigma and lack of support, they\u2019re at risk for victimization.\u201d<\/p>\n

Room for improvement in LGBTQ+ care<\/strong><\/h2>\n

Health care organizations should be engaging in diversity, equity and inclusion (DEI) work, says Dr. Angel. On a social level, we should all work to break down our biases. But providers often want to believe they have no biases without putting in the work, he adds.<\/p>\n

\u201cIt\u2019s really the responsibility of the provider to educate themselves on the disparities that exist in different populations,\u201d he says. \u201cSometimes they expect their patients to do that for them, but that\u2019s not their role.\u201d<\/p>\n

The LGBTQ+ community has made great strides in equality over the past few decades, so it\u2019s easy for people to assume the work is done, Dr. Angel says. With that mindset, patients can struggle to find affirming, reliable providers. Plus, many LGBTQ+ individuals distrust health care spaces and hesitate to seek care because of negative experiences they\u2019d had.<\/p>\n

During Herevia\u2019s time with Spokane Pride, he was brought into the Washington State University College of Medicine to lead a competency course with second-year medical students and faculty. The most productive conversation that day came out of a disagreement.<\/p>\n

People mistakenly think LGBTQ+ health care providers are trying to change a person\u2019s genetic makeup, he explains. But that\u2019s not possible and isn\u2019t necessary to affirm someone\u2019s gender identity.<\/p>\n

\u201cWe are skin before we are gender, and skin changes so much over a lifetime,\u201d Herevia says. \u201cIf that\u2019s always shifting, we should have the ability to shift in other ways.\u201d<\/p>\n

What MultiCare is doing for the LGBTQ+ community<\/strong><\/h2>\n

While we have more to do, MultiCare has made strides in improving the care and experience<\/a> of LGBTQ+ patients.<\/p>\n

In 2019, MultiCare began collecting SOGI-P information during intake, says Jennifer Vigil (she\/her), MultiCare Inland Northwest health equity and outreach program manager.<\/p>\n

Staff are still perfecting the process, she says, such as when and where to ask such questions, and addressing some people\u2019s frustration about why they or their children are being asked.<\/p>\n

\u201cBeing an LGBTQ+ competent provider should be the rule, not the exception. Every single person who is interacting with patients should understand a queer or gender-expansive person might be in the room.\u201d<\/p><\/blockquote>\n

It’s important to acknowledge those feelings, Vigil says, but also teach people that these questions go beyond a federal mandate \u2014 they\u2019re rooted in providing an affirming space, especially for those at higher risk for suicide.<\/p>\n

MultiCare is also developing a directory of LGBTQ+ affirming doctors and other health care providers so patients can more easily identify those who specialize in their specific health needs.<\/p>\n

MultiCare has also:<\/p>\n