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GLBT Health Inequalities The evidence

Associate Professor Anne MitchellGay and Lesbian Health Victoria

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ABS Survey of Mental Health and Wellbeing 2007

• more likely to have had a chronic condition in the last 12 months (51.3% v. 46.9%)

• 9.2% have a disability or long-term health condition

• 69.9% of ‘homosexual/bisexual’ people have a sedentary/low level of exercise

• 40.3% are overweight or obese

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ABS Survey of Mental Health and Wellbeing 2007

• more likely to be a current smoker (35.7% v.22%)

• twice as likely to have used illicit drugs (64.6% v. 33.2%)

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ABS Survey of Mental Health and Wellbeing 2007

• twice as likely to have a high/very high level of psychological distress (18.2% v. 9.2%)

• almost 3 times as likely to have had suicidal thoughts (34.7% v. 12.9%)

• 5 times as likely to have had suicidal plans (17.1% v. 3.7%)

• 4 times as likely to have attempted suicide (12.6% v. 3.1%)

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ABS Survey of Mental Health and Wellbeing 2007

• 4 times more likely to have ever been homeless (12% ‘homosexual/bisexual’ v. 2.9% ‘heterosexual’)

• twice as likely to have no contact with family or no family to rely on for serious problems (11.8% v. 5.9%)

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What makes GLBT people sick?

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Lesbian/Gay

Transgender

Intersex

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Young people who have been abused are more likely to self-harm

(WTIA, 2005)

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no abuse verbal abuse physical abuse

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How to Close the LGBT Health Disparities Gap

A paper by Jeff Krehely for the Centre for American Progress. December 2009 identifies 18 health disparities

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How to Close the LGBT Health Disparities Gap

• Access to health care and health insurance

• Impact of societal biases on physical health and wellbeing

• Impact of societal biases on mental health and wellbeing

• Impact of societal biases on engaging in risky behaviour

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Private Lives 2006

• 5476 GLBTI people, from all over Australia

• On the SF36 Scale which has a mean of 71.9 all PL participants scored lower (68.6)

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Rural vs Metro

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Good or excellent self-rated health

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National Preventative Health Priorities

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Obesity

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Private Lives

• Women were more likely to be overweight (49%) than all women in the ABS 2001 National Health Survey (38%)

• Private Lives men were less likely (43%) to be overweight than ABS men (54%)

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Eating disorders

• There is good USA evidence to confirm that gay men have a higher prevalence of eating disorders (Meyer et al, 2007)

• It has been postulated that 80% of males with eating disorders in the USA are male

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Women’s Health Australia

Analysis of the same sex attracted women in the younger cohort of the study (22 – 27 in 2000) showed that:

• Lesbians were not generally heavier than other women but were significantly less likely to be dissatisfied with their body shape compared with exclusively heterosexual women.Compared to lesbians, bisexual and heterosexual women were more likely to weight cycle, and engage in unhealthy weight control practices such as smoking, cutting meals, vomiting and using laxatives

(Polimeni et al, 2003)

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Come out to play (Symons, 2010)

• Nearly half (46.0%) of respondents involved in mainstream sport were NOT OUT as LGBT to anyone.

• 33.0% of respondents were OUT to some and 21.0% were OUT to all

• 41.5 % of respondents reported experiencing verbal homophobia at sometime during their sports involvement

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Come out to play

26.0% of males and 9.9% of females reported there were sports that they would like to play but did not because of their sexuality, and 58.3% of transgender respondents reported there were sports that they did not play because of their gender identity.

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Alcohol, tobacco and other drug use

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Smoking• A study conducted by the Australian Drug

Foundation (2000) in the gay, lesbian, bisexual and queer communities found drug use two to four times higher than in the general population.It also found higher rates of smoking than in the general population.

• The 2004 Sydney Women and Sexual Health Survey found rates of 34% for smoking compared to and ABS figure of 24% for Australian women generally. (Richters et al 2000)

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Smoking• Tobacco use was higher in all groups in the

Private Lives study than in the population generally (National Health Survey) and was the most commonly used substance by this group (Pitts, 2006)

• Of the HIV Futures 6 sample 42% smoked (which is more than double the rate in the general population) and 76% used alcohol(Grierson,2009)

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Women’s Health Australia

Analysis of the same sex attracted women in the younger cohort of the study (22 – 27 in 2000) showed that these women were significantly more likely to report:

• Risky alcohol use (7% compared to 3.9%)

• Marijuana use (58.2% compared to 21.5%)

• Other illicit drugs (40.7% compared to 10.2)

• Injecting drug use (10.8% compared to 1.2%)(Hillier et al, 2003)

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National study of same sex attracted young people, n = 1800

• 7% males, 14% females injected drugs; 15% weekly (vs. 1%-2% in general pop’n).

• 95% were using alcohol, usually at risky levels with more young women than young men drinking

• 53% of the sample smoked, again more young women than men.

Hillier et al, 2003

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Reasons for alcohol and drug use

• Sociability

• Self medication

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Relationship between levels of homophobic abuse and drug and alcohol use among

SSAYP

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no abuseverbal abusephysical abuse

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Hillier, 2005

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Mental Health

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Women’s Health AustraliaLongitudinal study of the health of Australian

women (n 40,000)

Analysis of the same sex attracted women in the younger cohort of the study (22 – 27 in 2000) showed that these women were significantly more likely to report:

Being depressed (38% vs 19%) Higher levels of anxiety (17.1% vs 7.9%) Having tried to harm or kill themselves in the last 6 months (12.6

vs 2.7%)McNair et al.2003

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Suicide attempts528 young adults – up to 30yrs (m=21yrs)

• Heterosexual female 8.3%• Heterosexual male 5.4%• Lesbian female 28%• Gay male 20.8%• Bisexual/undecided female 34.9% • Bisexual/undecided male 29.4%

Nicholas and Howard 2001

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Australian Study of Health and Relationships 2003

Out of the 20,000 participants, those who are same sex attracted were to found to report higher levels of psychosocial distress

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Private LivesHave you ever been depressed?

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Private Lives

• 42% of males and 62% of females had seen a counsellor or psychiatrist in the previous five years

• Nearly two thirds had done so for issues relating to depression/anxiety

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TranZnation(2007)

• Participants experienced depression at much higher rates than the population in general

• Those assigned male at birth experienced higher rates than those assigned female.

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Service Use

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Health Service Use

• It has been demonstrated that GLBT health service use is less than that of the population generally (Diamont, 200; McNair & Medland, 2002)

• In the WHA data non-heterosexual women were less satisfied with health service delivery and more likely to shop around (Pitts & Horsley, 2005)

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Health Service Use

• Private Lives participants used a wide range of services and mostly found them satisfactory, probably as a result of not disclosing

• Same sex attracted young people did not generally use health services for support and if they did, often found them unsupportive (Hillier,2005)

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Health Service Use

TranZnation participants were high users of health services but had both positive and extremely negative experiences (Couch, 2007)

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Barriers to service use for GLBTI clients

• GLBTI peoples’ fears of discrimination (or actual experience of discrimination) cause them to use health services less, and they are likely to present later with a problem which is therefore less amenable to treatment.

• GLBT patients are likely to be especially conscious of protecting their privacy in medical records.

• The potential disclosure of their sexual orientation on medical records may be a factor in their willingness to discuss it openly (Mulligan EA & Braunack-Mayer A, 2004)

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Barriers for service provision• Lack of confidence in their own knowledge

and understanding of the issues

• Belief that its not relevant to health care/service provision

• Sense that it is “private” and none of their business

• Fear of offending or upsetting patient/client

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Barriers for service provision

Belief that it is unnecessary to know about sexual or gender identity because “we treat everyone the same”

Treating people the same usually means treating everybody as if they are heterosexual

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Well proud: A guide to gay,lesbian,bisexual, transgender and intersex inclusive practice for health and human services (2009)

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Conclusions

• Some of our health issues coincide with the priorities of the National Preventative Health Task Force

• In order to get equitable outcomes we need different solutions

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