Better Health For All

practFebruary is Lesbian, Gay, Bisexual and Trans History Month, an annual opportunity to celebrate the contribution of LGBT+ people in history and reflect on how society can become more inclusive of diverse sexual orientations and gender identities. For public health professionals it is a reminder to reflect on how well we service this community in our daily professional practice.

In the last five years we have seen rapid evolution in the language surrounding gender and sexual identity, alongside this a more nuanced understanding from the media and the public of the diversity within the LGBT community.

Sadly the evidence suggests we still have a way to go in terms of community acceptance and inclusion.  The UK Government National LGBT Survey 2017, an online survey which gathered responses from over 108,000 LGBT+ people living in the UK, found that:

• more than two thirds of LGBT+ respondents said they avoid holding hands with a same-sex partner for fear of a negative reaction from others.

• 23% had experienced a negative or mixed reaction from others in the workplace due to being LGBT+ or being thought to be LGBT+.
• At least two in five respondents had experienced an incident because they were LGBT+, such as verbal harassment or physical violence, in the 12 months preceding the survey. However, more than nine in ten of the most serious incidents went unreported, often because respondents thought ‘it happens all the time’.
• 2% of respondents had undergone conversion or reparative therapy in an attempt to ‘cure’ them of being LGBT+, and a further 5% had been offered it.

For public health colleagues these findings shouldn’t come as a surprise. For over two decades the body of evidence, demonstrating significant and persistent health inequalities across physical and mental health affecting LGBT+ people in the UK as well as internationally, has grown in breadth and depth.

Public Health England has consolidated some of the evidence into reports on improving the health of gay and bisexual men, and the health of lesbian and bisexual women, in addition to the reporting of sexual health  and HIV affecting men who have sex with men and a specific guide on screening for trans and non-binary individuals.

There have also been an increasing number of local authorities doing specific LGBT needs assessments, including Stockport, Devon, Reading,  Manchester, Brighton & Hove, which provides a great foundation for action.

The National LGBT Companion Document to the Public Health Outcomes Framework (2013) set out four key recommendations for action which remain relevant today for public health professionals, further strengthened by the growing evidence base:

Recognition

This is more than just specific LGBT needs assessments, it is about recognition of LGBT people in all needs assessments and annual DPH reports, in the same way we routinely consider gender, ethnicity and age.

There are also many areas where intersectionality between different minority identities such as sexual orientation and ethnicity create compounded inequalities, as well as creating opportunities for bridging and collaborative solutions across communities.

It is also important to recognise that LGBT represents four different groups of individuals who share some inequalities but also who experience specific and different levels of inequality.

Engagement

Working with communities is at the core of public health practice, we are professionals for whom engagement is a core skill, yet we don’t always think about specific and targeted engagement with the diversity of the LGBT community.  Being conscious and aware of this may help approach engagement differently, and LGBT history month provides a great way to become more aware of local groups, networks and community organisations who can help you strengthen your conversations with local LGBT people.

Monitoring

Evidence and data are at the core of public health practice, especially when it comes to focusing resources where they are most needed. With the ONS, NHS and local government integrating sexual orientation data collection into routine datasets there is now a stronger body of data to draw upon for the local and national picture. However data is only useful if it’s analysed and it’s incumbent on us as public health practitioners, and commissioners, to ask for this data to look at what is happening to our local LGBT communities.

Service Provision

Finally where public health professionals are engaged in commissioning or providing services it is important to think about how service provision is meeting the needs of LGBT individuals and communities. There is lots of support now available to providers to support them to provide more inclusive and culturally competent services for LGBT people, such as the Pride in Practice Programme and resources from NHS Employers. The concept of progressive universalism can work for LGBT people but only if universal services are culturally competent to meet their needs, and that requires explicit commissioning and monitoring of service use to ensure that LGBT communities are not being left behind.

Across public health we have a duty to address health inequalities and we can only do that effectively if we talk about, and think about, the needs of minority communities and take specific action to address them. LGBT history month is just one month, but it can provide an important prompt for reflection on whether you are doing enough in your daily practice to close the gaps in LGBT health. 

Written by Dr Justin Varney, Fellow of the Faculty of Public Health, HonFOM, and Interim Strategy and Policy Lead, Business in the Community and National Strategic Advisor at Public Health England.