Awareness of the healthcare disparities experienced by marginalised communities is encouragingly on the rise in recent years. Whether as a result of a person's socioeconomic status or their race, issues are being identified with access to healthcare, increased health risk and discriminatory treatment. However, as we celebrate Pride month around the world, it seems fitting to note that very little conversation takes place around the health and healthcare of people belonging to lesbian, gay, bisexual, transexual, queer or questioning and other sexual identities (LGBTQ+).
It is known that LGBTQ+ people experience disproportionately poorer care and health outcomes (NHS, 2021) including worse cardiovascular health (Caceres et al, 2020) and factors which may result in higher vulnerability to COVID-19 (LGBT Foundation, 2020). Unfortunately, many aspects of health receive little attention in LGBTQ+ populations compared with topics such as HIV and substance use (Caceres et al, 2020). However, evidence shows that adults within these communities have worse cardiovascular health relative to cisgender heterosexual people (Caceres et al, 2020).
For instance, transgender women on gender-affirming hormone therapy experience higher incident myocardial infarction, venous thromboembolism, ischaemic stroke and cardiovascular mortality than cisgender individuals (Caceres et al 2020). This is just one example but various risks and barriers exist within each of these individual groups that fall under the LGBTQ+ umbrella, too complex and numerous to delve into within the space of this short article, and all of which require further attention, research and the subsequent development of culturally appropriate resources, training, interventions and care. In terms of behavioural health, studies have shown that sexual minority people are more likely to engage in less healthy behaviours that are known to increase their cardiovascular risk, in large part as a result of the increased stressors they are faced with (Caceres et al, 2017).
It has been shown that the cardiovascular health of LGBTQ+ adults is compromised by significant psychosocial stressors throughout the life span (Caceres et al, 2020). Discrimination is relatively and unacceptably common, including from health professionals, which can further discourage people within each of these communities from seeking healthcare when symptoms arise.
In the 2017 National LGBT survey, which received more than 108 000 responses, at least 16% of respondents who accessed or attempted to access public health services were discriminated against because of their sexual orientation and 38% because of their gender identity (Government Equalities Office, 2018). Disturbingly, 5% of respondents were offered ‘conversion therapy’ to ‘cure’ them, and 2% had actually undergone it (Government Equalities Office, 2018). For transgender respondents, the numbers were even higher, with 9% of transgender men being offered it and 4% underwent it. In total, 2640 people who responded had received conversion or ‘reparative’ therapy (Government Equalities Office, 2018). Followed by faith organisations, which were responsible for conducting more than half (51%) of these conversion therapies, health professionals were responsible for 19% (Government Equalities Office, 2018).
Each of us naturally holds our own belief systems and values. However, health professionals must not only receive training and support to provide holistic, equal and culturally appropriate care to their LGBTQ+ patients, but they need also become aware of their own beliefs and potential biases in order that these do not inadvertently become barriers to equitable care provision. Furthermore, health professionals may belong to any one of these communities, and may themselves be subject to homophobic or transphobic discrimination from colleagues or patients, or may fear this and therefore keep their sexual identities to themselves.
No person should feel afraid to seek out healthcare and no person should feel uncomfortable going to work or revealing who they are for fear of ill-treatment because of their sexual identity. It is incumbent on each of us to see one another as human beings first, and to treat each other with due respect. It is after all a paramedic's duty to ‘be aware of the impact of culture, equality and diversity on practice’ and ‘be able to practise in a non-discriminatory manner’ (Health and Care Professions Council (HCPC), 2018).
However, refraining from discrimination is only the first step. What happens if you witness it from a colleague for example? Furthermore, how would you as a patient and—more importantly—as a person, want to be treated if receiving care? ‘Passively embracing diversity, inclusion, equality and respect is not enough. On the way to true inclusion, we must not be afraid of challenging discriminating patterns of thought and behaviour and emanate respect and equality’ (British Society for Heart Failure, 2020).