Getting It Out In The Open - Lesbian, Gay and Bisexual People
Reducing Health Inequalities!

Sometimes as a society we tend to avoid issues that we do not feel comfortable with or perhaps do not understand and we may even falsely assume that everyone has the same health needs.  As a result, some people who are perceived as the most vulnerable and most in need of help, either get side stepped or fall through the net.  The Public Health White Paper Healthy Lives Healthy People, advocates a new approach to "reach across and reach out" to address the root causes of poor health to the people who need the most support.  With a particular emphasis on tackling health inequalities, high alcohol levels, smoking, mental health, sexual transmitted infections (STIs) and obesity.  We therefore have a responsibility to ensure people who experience health inequalities and are likely to be the most susceptible to the above, are not isolated or discriminated against, but are brought to the forefront of public health.

Lesbian, gay and bisexual (LGB) people tend to be vulnerable to a number of health risks because of people's reactions to their identity.  This can leave them feeling stigmatised and they are often unrecognised in health and social care settings.  Healthcare and other professionals have a misconception that LGB people's health needs are the same as those of heterosexual people, unless their health needs are related to sexual health.

A briefing written in 2007 by Dr Julie Fish as part of the Department of Health's Sexual Orientation and Gender Identity Advisory Group's work programme entitled "Reducing health inequalities for lesbian, gay, bisexual and trans people - briefings for health and social care staff" sought to highlight that LGB people can be younger, older, bisexual, lesbians, gay men, trans, from black and minority ethnic (BME) communities and disabled, and to dispel assumptions that they form a homogeneous group. 

Health Issues: What We Don’t know
Many young people know they are lesbian, gay or bisexual by the age of 11 or 12, but do not come out until they are 15 or 16 years of age.  The period between 11-16 years, has been described as the isolation years and has been identified as the time when young LGB’s need the most support and information.  During these critical “isolation years” LGB's may feel alone, confused and stigmatised particularly as it is also the period where they may encounter homophobic bullying in schools.  Evidence suggests that between 30% to 50% of young people in secondary schools, attracted to people of the same sex, would have experienced homophobic bullying, and that "gay" is the most frequent term of abuse in the playgrounds.  Young LGB people are also at risk of violence and victimisation and are likely to face verbal abuse, teasing, physical assault both in schools and on the streets. 

Feelings of isolation, fear of being unable to talk about their sexual orientation and the consequences of homophobic bullying can have an impact on a young person's mental health and which could have negative repercussions during their adult life.  The evidence taken from the briefing into young lesbian, gay and bisexual people, highlights that these young people are at increased risk of mental problems, are more likely to suffer from depression, to have attempted suicide (as a result of family denial, self loathing and leaving home) and lead unhealthier lifestyles than their heterosexual peers.  The statistics reveal that compared to their heterosexual peers, lesbian and bisexual girls are more likely to smoke and binge drink.  There is also an increased risk that young gay and bisexual men may take illicit drugs and may not be aware of  health risks from unprotected sex.  

The unhealthy lifestyles experienced by young LGB people can follow them into adult life.  Researchers have pointed out that LGB’s may use drugs, alcohol and tobacco as coping mechanisms in dealing with their homophobia.  However, they have also argued that the lack of social spaces for LGB’s means they are more likely to congregate in clubs and pubs and hence are more obliged to use the "scene" and fit in with a drinking culture. 

The Statistics:

Smoking: Young lesbian and bisexual women were almost 10 times more likely to smoke at least weekly compared with heterosexual women.
- 25% of lesbians are smokers compared with 15% of heterosexual women.
- 33% of gay men are smokers compared with 21% heterosexual men

Alcohol: Lesbian and bisexual women aged 20-30 years reported higher weekly alcohol consumption and less abstinence compared with heterosexual women

Drugs: In comparison with young heterosexual people, young LGB’s are:
- 3 times more likely to use MBMA/ecstasy
- 8 times more likely to use ketamine
- 26 times more likely to use crystal methamphetamine. 

Eating disorders:
- Gay men are more likely to engage in recurrent binge eating and purging which is often linked to aspirations to the ideal gay male body shape (slim and muscular).
- Lesbians are believed to have a higher body mass index than heterosexual women and may be more at risk of obesity. 

Good health should include everyone and that means reaching out to all segments of the population and understanding that different groups have different needs and requirements.  The rising levels of STIs and the fact that LGB people still feel discriminated against and continue to experience a number of health inequalities, signifies that more needs to be done to support them.  This may include how commissioners and providers deliver their services and how they are perceived by LGB service users.    

What Can You Do?
Training Solutions are offering a programme on Addressing Health Inequalities Experienced by Lesbian, Gay and Bisexual People on the 7th April.  The one-day course aims to raise awareness of the health and social care needs of lesbian, gay and bisexual (LGB) people, who are disproportionately affected by health and social inequalities. It will identify key research findings that affect LGB communities specifically, and examine how these relate to the statutory obligations for services. As the public health agenda broadens in the light of the forthcoming Equality Act, it is essential that health and social care services are accessible and meet the needs of all potential service users.

For further information please click here or contact Nicolette Smith 

Health and Wellbeing Conference – the 21st Century Agenda

Book now to receive your early bird discount!

There are only a few days left to take advantage of the early bird booking rate or submit a poster for consideration for oral and speed presentations at 'Health and Wellbeing- the 21st Agenda', the second International conference from the journal Public Health.

The journal Public Health is holding its second international conference in September 2011. Taking as its theme health and wellbeing, the conference will explore the relationships between health, wellbeing and the factors which influence them in a global environment. Come and join us in refocusing the agenda on
health and wellbeing as we move forward into the second decade of the 21st century. Over the two days we will be covering a wide variety of topics including men’s health, workplace health, sustainability and population ageing.

Speakers include: Professor Sir Michael Marmot, Jonathon Porritt, Professor Sir Andy Haines, Professor Richard Horton, Professor Dame Carol Black and Lord Hunt of Kings Heath. The conference also features master classes from Dr Ian Banks, Dr Steve Boorman, Professor Tim Lang and Dr John Beard, among others.

The conference is being held on Thursday 8^th and Friday 9^th September 2011 at Friends House in Euston, London.

We are also inviting poster submissions for oral, speed and poster presentations. The deadline for submissions is also fast approaching; all posters must be submitted by Friday April 1^st to be considered.

For more information regarding conference booking and poster submissions please visit www.rsph.org.uk/healthandwellbeing or contact Claire Robins at crobins@rsph.org.uk.  

Loneliness – A Public Health Issue?

“Friendship is a lot like food. We need it to survive” –  Hara Estroff Marano, Psychology Today.

We humans have an inherent need to be part of a group, to form friendships, to interact and to socialise with people.  Evidence suggests that these are all necessary in order for us to maintain good health and wellbeing.  However, what happens when we only have part or none of the above, when we are unable to socialise, when we don’t feel like interacting, when we loose touch with friends and family?  It is likely that we will feel a sense of loneliness, and this, the experts say, can be detrimental to our health.

Since the 1990’s an increasing number of studies measuring the impact of loneliness suggest it is an important public health concern.  The evidence reveals that the risk of developing and dying from heart disease can depend on the strength of one’s social network of friends and family.

What is Loneliness and how does it arise?

Loneliness, although easy to describe is harder to define because of its many dimensions.  Wikipedia defines loneliness as an unpleasant feeling in which a person experiences a strong sense of emptiness and solitude resulting from inadequate levels of social relationships.  Loneliness is however a subjective experience, in that, if a person thinks they are lonely, then they are lonely whether they are in solitude or in the middle of a crowd. 

The mental Health Charity MIND, believe that loneliness is a very intense feeling and "to feel lonely is to be overwhelmed by an unbearable feeling of separateness, at a deep level”. 

It is likely that many of us will have experienced loneliness at some point in our lives.  For some it may be a temporary feeling, resulting from certain events, while for others, it could feel like a permanent part of life. 

Loneliness can occur for a number of reasons and as highlighted above can depend on a persons state of mind.  However, feelings of loneliness may arise from losing connection with others through death, breakup of a relationship, moving away, being immobile or ill and working longer hours, or from being unable to form new connections due to shyness or lack of confidence.

A report called The Lonely Society? commissioned by the Mental Health Foundation, found that the way in which people now live is impacting on their ability to connect with others. More people live alone: the percentage of households occupied by one person doubled from 6% in 1972 to 12% in 2008. The divorce rate has almost doubled in the past 50 years and the number of lone parent households is rising. People are living longer but many older people are doing so alone. Because of people pursuing careers and education opportunities, many now live further away from their families and the communities they grew up in. 

The Health Implications of Loneliness

Loneliness, although a natural emotion, can be detrimental to our physical and mental health.  One of the main reasons why loneliness has negative implications is because it makes it harder for us to control our habits and behaviour.  A book written by John T Cacioppo and William Patrick entitled "Loneliness: Human Nature and the Need for Social Connection" suggests that loneliness leads to self destructive habits, such as overeating, relying on alcohol and avoiding physical exercise.

In their numerous studies, they reported that not only do lonely people tend to withdraw from society (becoming further isolated) but they express higher levels of stress and difficulties sleeping, leading to diminished restorative processes.  Tests also show that loneliness affects the immune and cardiovascular systems and that there is a strong correlation between loneliness and depression.  The Lonely Society report? found that four in ten people (42%) have felt depressed because they felt alone.

James J Lynch, loneliness expert and writer of  "A Cry Unheard: New Insights into the Medical Consequences of Loneliness" describes loneliness as a silent epidemic that is harming public health, leading to depression and early death.  He proposes that causes of death are notably higher for “divorced, single, and widowed individuals of both sexes and all races."

Cacioppo points out that, “being connected with others is so necessary to survival, that human brains have become hard-wired to seek regular social contact”. 

How Lonely are We - The Statistics

The UK report by The Lonely Society? reveled that 48% of us believe people are getting lonelier in general.  Only 22% of us never feel lonely and one in ten (11%) of us feel lonely often.  A third of us (37%) have a close friend or family member who we think is very lonely and over half of us (57%) who have experienced depression or anxiety isolated ourselves from friends and family.

The pain of loneliness is the sharp end of a milder feeling of social disconnection that research suggests is widespread: a recent Emotional Needs Audit of the UK by the Human Givens Institute, which involved 4,600 online respondents, reported that 24.1% of people did not feel emotionally connected to others; 34.8% did not feel connected to the wider community and 35.4% felt they did not receive enough attention.  The lonelier our society, the more likely we are to experience loneliness.

Coping with Loneliness

Loneliness is clearly a health concern, and we need to seek ways of overcoming it.  Making the effort to spend time with a friend or family can have a two way effect.  It will allow you to socialise and feel good as well as having a positive impact on the other person.

The UK mental health charity MIND, offers several suggestions on how to overcome loneliness.  Some of these include; learning to be with others, joining a class, a local interest group or volunteering for something.  For further information on dealing with loneliness click here to go to the MIND website.

We are interested to hear your opinions.  Are we becoming a lonely society? Has technology played a part or is it the changes in our lifestyles?  How else can we tackle the lonely issue? 

Women Smoking their way to Lung Cancer

This week is particularly important for public health for two reasons;  firstly, today is International Women's Day and secondly, tomorrow, Wednesday 9th March, is National No Smoking Day.  Consequently, many charities are using this opportunity to flag up important health issues, so as to raise awareness and discuss ways of overcoming them. 

Yesterday, Cancer Research UK (CRUK) revealed their latest figures showing that rates of lung cancer have more than doubled for women over the age of 60 since the 1970's.   The statistics show a notable rise from 88 per 100,000 in 1975 to 190 per 100,000 in 2008.  For women over the age of 80 the picture is even more alarming, with lung cancer rates tripling from 84 per 100,000 in 1975 to 273 cases diagnosed for every 100,000 women in 2008. 
 
Although lung cancer for men is still considerably high, the data demonstrates that there has been a slight decrease in recent years and CRUK believe this is a result of changes in smoking patterns.  While the proportion of male smokers peaked before 1960, women smokers on the other hand, increased during the 1960's and 1970's, which would now effect those over the age of 60.  Overall, the number of women diagnosed with lung cancer has risen from 7,800 cases in 1975 to more than 17,500 in 2008.  Whereas in 1975 the rates for men over 60 fell from 23,400 to 19,400 in 2008. 

Lung Cancer: The Facts

• Lung cancer is the second most common cancer diagnosed in the UK after breast cancer.
• Around 41, 000 were diagnosed with lung cancer in 2008 - equivalent to 112 people every day.
• In the 1950s, for every lung cancer case diagnosed in women in the UK, there were 6 in men.  That ratio is now 3 cases in women for every 4 in men.
• More than 8 out of 10 cases of lung cancer occur in people over 60 years of age.
• Rates of lung cancer in Scotland are among the highest in the world, reflecting their history of high smoking prevalence.
• Lung cancer is the most common cancer in the world with an estimated 1.61 million new cases diagnosed in 2008.
• In the UK it is the most common cause of cancer death - accounting for more than 1 in 5 deaths.
• Around 35,000 people died from lung cancer in the UK in 2008 - which is 95 people every day.

What Causes Lung Cancer

• The link between tobacco and cancer was established more than 50 years.
• Smoking causes almost 90% of lung cancer deaths.
• It is estimated that exposure to passive smoke in the home causes around 11,000 deaths every year.
• A small proportion of lung cancer cases are caused by heavy exposure to industrial carcinogens and air pollutants, including diesel exhaust, asbestos and non-ferrous metals.

For further information visit the CRUK official website by clicking here.

Nonetheless, CRUK do point out that successful anti-smoking measures - such as the tobacco advertising ban and the legislation making public places smoke free - have meant the number of smokers has continued to drop.
Jean King, Cancer Research UK’s director of tobacco control, said: “These figures highlight how important tobacco control measures are in helping people to stop smoking. With the lung cancer rate rising among women we would like the government to introduce a comprehensive and well funded tobacco control strategy that targets at risk groups and stops young people from beginning an addiction that kills half of all long term smokers”
“Around nine in ten cases of lung cancer are caused by smoking and one in five people still smoke, so it’s vital that work continues to support smokers to quit and protect young people from being recruited into an addiction that kills half of all long term smokers. In particular we want displays in shops covered up so that young people are no longer being exposed to this form of tobacco marketing.”

What Can You Do?
Get Involved and Help Raise Awareness for Women's Health!
In aid of International Women’s Day this year, the Royal Society for Public Health is running a "Women's Health and Well Being" programme on 12th May.  The event will seek to raise awareness of interrelationship between lifestyle and health, while educating participants about the steps they can take to empower women to improve their physical and mental health.  For further information or to download our flyer please click here or please contact Nicolette Smith 020 3177 1625.