Pride Month is a welcome opportunity to celebrate the LGBTQ community’s diversity and unyielding spirit. But the community needs more than parades and rainbow flags.
Ongoing discrimination and an unprecedented wave of legal, political, and societal threats are inflicting damage on the mental and physical health of LGBTQ people. The public needs need more research funding to document the resulting health inequities, more training for health professionals to recognize and address the unique needs of the LGBTQ community, and more policies to support the equality, dignity, and humanity of every human being.
In the first half of this year alone, more than 500 discriminatory anti-LGBTQ bills have been introduced in state legislatures. Among many other goals, these bills would ban access to life-saving health care for transgender individuals and criminalize teachers for discussing the existence of LGBTQ people. (Seven out of 10 LGBTQ youth surveyed report the existence of these bills adversely impacted their mental health, even when the bills do not become law.) On top of this, there has been an unparalleled, coordinated attack on clinicians providing gender-affirming care as well as LGBTQ researchers, legislators, and many others.
I’m an epidemiologist who focuses on health inequities affecting LGBTQ communities. Colleagues and I have spent decades documenting how discrimination impacts LGBTQ people through a process we call “minority stress.” The thesis is simple and intuitive: Stress caused by experiencing bias, rejection, hostility, and marginalization takes a toll on the body and mind. The data bear that out.
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Health care providers don’t routinely collect information on patients’ sexual orientation or gender identity, so data on health inequities is incomplete. But we do have evidence that LGBTQ people are burdened with disproportionate rates of mental health conditions, such as depression and suicide among adolescents, as well as physical health conditions like cancer. LGBTQ people are more likely to develop hypertension during their pregnancies and have their babies born preterm. Notably, they are more likely to die prematurely. Colleagues and I recently published a landmark study in JAMA based on 40 years of data with more than 90,000 participants. We found that lesbian and bisexual women die 26 percent earlier than their heterosexual peers.
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The National Institutes of Health has designated LGBTQ individuals as a health disparities population, thereby opening new avenues for research funding. As recently as the 1990s, just a handful of peer-reviewed studies were published on LGBTQ health each year. Now it’s several thousand each year. Even so, LGBTQ communities remain dramatically understudied and underfunded. Just 1 percent of NIH-funded research focuses on LGBTQ health, even though almost 1 in 10 people in the United States are LGBTQ, and that number is twice as high among young people, who may feel less stigma in self-identifying as LGBTQ.
Public health and medical professionals have critical roles in addressing the health crises facing LGBTQ communities. Yet even elite institutions aren’t giving future leaders the skills and understanding they need to do their part.
For example, medical school students are not routinely trained to take a social history that’s inclusive of LGBTQ experiences. Public health students are not trained on how, or even why, they should collect sexual orientation and gender identity data along with other demographic data like age, race, ethnicity, and income. These gaps hamper our ability to document inequities, develop policies to address those inequities, and appropriately screen and treat patients who may be more vulnerable to certain health conditions due to minority stress.
This is undoubtedly a moment of adversity for LGBTQ communities. Yet it’s also an opportunity to demand and drive change. This month, colleagues and I are launching the LGBTQ Health Center of Excellence, a joint venture between the Harvard T.H. Chan School of Public Health and Harvard Pilgrim Health Care Institute. Our mission is to advance health equity for LGBTQ communities with a focus on training to prepare the next generation of LGBTQ health leaders; research to expand the evidence base of LGBTQ health; and dissemination to inform policy makers, health care providers, and the larger public about how to improve LGBTQ health most effectively. I’m hopeful that our center can serve as a model for change, but we need other institutions to follow suit.
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Leaders in public health and medicine must raise our voices loudly and clearly to demand increased support and protections for the LGBTQ community. Our call to action cannot wait — we must secure dedicated research funding from NIH and philanthropists, train the next generation of leaders, conduct empirically grounded research, and translate our work into change.
Through solidarity and science, we can ensure that everyone — regardless of their sexual orientation or gender identity — has the chance to live a long and healthy life.
Dr. Brittany Charlton is the founding director of the LGBTQ Health Center of Excellence at the Harvard T.H. Chan School of Public Health and Harvard Pilgrim Health Care Institute.
