Reya Sankar

Sexual orientation and health disparities have always been linked. Studies show that sexual minorities (e.g., gay, lesbian, bisexual) experience larger extents of discrimination, shame, and tension causing a higher risk of poor health outcomes and behaviors when compared to their heterosexual counterparts. Most of all, these individuals are found to have a lower prevalence of access to health insurance as well as healthcare.

All people who are in need to medical care should be able to go to the hospital without the worry of being mistreated, harassed, or out rightly denied of service. However, discrimination in health care environments endangers the lives of LGBTQ people through denials of necessary care. One example of this discrimination was after one patient with HIV disclosed to have interactions with other men, the hospital staff spurned to supply his HIV medication. In another case, a transgender teenager in the hospital for self-inflicted injuries due to suicide attempts was repeatedly disrespected and misgendered. Moreover, he was discharged from the hospital early causing him to later commit suicide. 

Despite current protections of LGBTQ people, they continue to face health care discrimination from harassment to humiliation by providers. According to a survey conducted by the CAP, it shows the several types of discrimination this community has had to face when seeking health care. Among LGBQ patients, 8% said that a doctor or other provider refused to see them because of their perceived sexual orientation, 6% said that a doctor or provider refused to give them health care related to their perceived sexual orientation, 9% said that a doctor or other provider used harsh or abusive language when being treated, and 7% said that they experienced unwanted physical contact from a doctor or other provider. Among transgender patients, 12% said a doctor or other provider refused to give them health care related to the gender transition, 23% said a doctor or other provider intentionally misgendered them, 21% said a doctor or other provider used harsh and abusive language when being treated, and 29% said that they experienced unwanted physical contact from a doctor or other provider.

It is important to create a safer environment for LGBTQ people discrimination ultimately discourages LGBTQ people from seeking health care. According to a survey conducted by the CAP, 14% of those who experienced this discrimination avoided or postponed needed medical care because of the disrespect and inequity from the health care staff. Avoiding medical care may result in late detection of disease, reduced survival, and potentially preventable human suffering.

Health equity is an economic issue as well as a social issue. Several disparities are determined by ethnic groups, socioeconomic classes, and the location of the region. The causes of these inequalities are shown through an increase in infant mortality rates, and a decrease in life expectancy and rates of preventable disease. The main factors of these inequalities are the smoking rates, access to care, nutrition, and physical activity. Health and healthcare inequities result in the inferiority of healthcare, worse health outcomes for minority populations and those of low status, decreased productivity, and varying use of corporate healthcare profits. These health disparities are a reflection of the persistent inequities that exist in American society. 

One way to improve health equity is for employers to ensure that their resources are received by diverse populations in the highest quality possible. This can be done by choosing health plans that offer cultural proficiency. This is a crucial step to reduce racial stereotyping and ensures equal services to all populations.

Healthcare organizations can also employ a more diverse workforce of healthcare providers. This is important because ethnic minorities are underrepresented in the healthcare industry. This is also a crucial addition as minorities are often more comfortable seeing a provider of a similar ethnic background which allows for better communication and patient-provider relationship. This causes biased care, judgments, and assumptions to occur less. In addition, this allows for healthcare and public health organizations to collect and use data on these groups to improve the quality of care for their diverse populations as well as point out specific health needs and help plan targeted involvement. 

Health plans and insurance companies can reduce health disparities by using innovative and wide-ranging strategies. One example of this was when the National Health Plan Collaborative brought together 11 leading health plans, including Aetna, Kaiser Permanente, Humana, and UnitedHealth Group among others, to create a toolkit that combined case studies, sample tools, policies, and other resources to help reduce health disparities within their memberships. One way this was done was by using geographic information system mapping to identify the most optimal areas for targeted intercessions. This tool can make it possible to closely examine social and health factors at the neighborhood level, which can help with analyzing the health plan market area for specific health conditions, such as people with skin conditions who have not received recommended care in a particular region.

Health begins in the environments in which we are born, live, and work. Engaging with the social and economic conditions of health is a critical component of any inclusive health equity strategy to improve the health of people throughout the nation and decrease healthcare costs. Improving community environments by supporting programs and policies that address these health inequalities ensures that the root causes are addressed.