The LGBT health research and promotion agenda is not a balanced one. I’ve volunteered with a number of different LGBT groups, and we always had a pile of health promotion leaflets sent to us by local health promotion agencies and by charities.
Probably 80% were targeted towards gay and bisexual male sexual health. We might have a couple on cervical screening and breast checking for women, and a few on alcohol, smoking and substance misuse. We might have a couple of more general ones about mental health or coming out. More recently, there’s started to be more publications targeted at trans people, usually focused on medical transitioning. Very, very recently there have also been some sexual health publications for trans people. And that was about it.
That health promotion literature more or less reflects the state of current LGBT health research. It’s also often reflected in the funding available: one of the groups I volunteered with provided general support to the LGBT community on a wide variety of issues, but it got its funding on the basis of HIV prevention. There’s often also funding for supporting young LGBT people with issues such as coming out, but it typically stops at 18, or 25 if you’re lucky.
But let’s just think about what’s missing in that. The LGBT Public Health Outcomes Framework collects together what evidence exists on LGBT health issues. Here;s a few little excerpts:
- “There are no data on cancer incidence, diagnosis, treatment, survival, morbidity and mortality among LGB&T populations.”
- “… it is reasonable to assume that there will be inequalities in [preventable mortality] affecting the LGB&T community.”
- “… it is reasonable to extrapolate that [the LGBT] community will be potentially more at risk of excess winter deaths.”
- “There is no evidence in relation to lesbian and bisexual women, or trans individuals [with regard diabetes]”
There’s also little or no evidence on heart disease, liver disease, dementia or respiratory disease.
HIV is a serious disease. Suicide is tragic. But most of us are going to die of things like cancer, heart disease and lung disease. Many of us are going to live for many years with conditions like dementia and diabetes. Those are diseases where prevention, survival and quality of life are clearly linked to issues like economic exclusion, social support and trusting your doctor enough to tell them if you think there’s a problem. It’s scarcely a big leap to say that being LGBT is probably relevant. But at the moment, the best we can say is “it is reasonable to assume” that LGBT people may be dying early of diseases that could be prevented. That isn’t good enough
Undoubtedly part of the reason for this is timescale. Mental health, substance abuse and HIV are issues where an intervention can potentially have a measurable effect here and now, and sometimes you can point to the difference made in a specific case. It’s easy to make a financial and moral case for researching that. Whether an intervention has actually prevented heart disease might require thirty years of population data to work out, and even then you might still struggle to disentangle it from wider social trends. But social isolation among older LGBT people is something where it would be pretty easy to carry out an intervention which has an immediate measurable impact, and which would tend to be beneficial for a wide number of health indicators. Ageing, social support and health are huge issues for the NHS right now. Why is there so little out there on older LGBT people.
Another issue is the old “it’s too embarrassing to ask” one. Of course not everyone wants to talk about their identity and everyone should always have the right not to say, but there still seems to be an assumption that simply including the question on an equal opportunities form will lead to patients fainting in shock or storming out of the waiting room in disgust.
It’s hard not to feel that the hidden issue under some of this is due to the interaction between age, sexuality, and gender. The health issues which get highlighted in the LGBT community are those which stand a fair chance of affecting younger people, and especially young men. Ill health, or even death, among the young is shocking. And if someone commits suicide due to hateful bullying, or dies young of AIDS, the cause is clear. It’s harder to work up activist passion about the fact that one group on average gets a chronic disease associated with age a year or two earlier than another. Plus there’s still a sense that our society doesn’t really want to think about older people as having sexual and gender identities, other than very limited stereotypes of grandma and grandpa.
The optimistic view says perhaps it’s just because we’re in a transitional phase. Perhaps now there’s greater equality all these issues will work themselves through, and by the time my generation reaches retirement no-one will be embarrassed to discuss sexual or gender diversity, and there will be few inequalities to identify anyway. Perhaps so. But if we are in a transitional phase, that’s because of the activism and campaigning by the LGBT people who are older now. It doesn’t seem fair to ignore their wellbeing, here and now, while we lie back in the expectation of a glorious future. And if we aren’t in a transitional phase, if the problems aren’t all fixed, we’re going to really regret not acting when we become the older people.