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