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Increasing the cultural competence of health care providers serving Minnesota's diverse populations
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Common health equity issues for LGBTQ populations
Cultural competence is the ability to recognize and understand the role culture plays in health care and to adapt care strategies to meet patient needs.
Get to know patients on an individual level. Each person’s preferences, practices, and health outcomes are shaped by many factors. Generalizations in this material may not apply to your patients.
About 4% of Minnesotans are LGBTQ. Of those, about 20% are raising children.
LGBTQ in Minnesota
About four percent of Minnesotans identify as lesbian, gay, bi-sexual, transgender, or queer (LGBTQ). A 2017 survey of LGBTQ people in Minnesota indicated that 45 percent live in the Twin Cities metropolitan area, 15 percent live in other cities, and 39 percent live in smaller towns. Respondents primarily identified as White (83%) and 17 percent as people of color, mirroring the state’s population as a whole.
LGBTQ, LGBTQIA and LGBTQ+?
Various acronyms are used to represent the diverse community of lesbian, gay, bisexual, transgender, queer (or questioning), intersex, and asexual (or allied) people. The combination may vary depending on whether the community described is based on gender identity and/or sexual orientation. Queer is an ambiguous, umbrella term used to describe gender expression and sexual orientation. Queer was once considered derogatory and some older LGBTQ adults may not appreciate its use.
Biological sex is the anatomy of an individual’s reproductive system and genetic differences. Assigned sex—female, intersex, male—is a label given at birth based on medical factors, including hormones, chromosomes, and genitals.
Gender expression refers to a person’s characteristics and behaviors such as appearance, dress, mannerisms, and speech patterns that can be described as masculine, feminine, or non-gender conforming.
Gender identity is a person’s inner sense of being male, female, a blend of both, or neither. Transgender people have a gender identity that differs from the sex which they were assigned at birth.
Sexual orientation is a person’s pattern of emotional and sexual attraction to other people. Gay, lesbian, and bisexual are terms that are largely based on who a person is attracted to.
Understanding how someone defines themselves as an individual leads to better care. Ask patients if they have a preferred name and which pronouns they use for themselves.
LGBTQ people suffer from health disparities related to their sexual orientation or gender identity. Compared to heterosexual people:
More on health care disparities for LGBTQ
Social determinant disparities
Social determinants of health are economic and social conditions that influence the health of people and communities. LGBTQ people have a history of being discriminated against in housing, employment, legal status, and suffering from violence and bullying. Bias and discrimination in health care happen as well. Dealing with discrimination is associated with higher reported stress and poorer reported health.
As a result of the 2015 U.S. Supreme Court decision, same-sex couples can marry nationwide and states must extend all the rights and benefits of marriage to same-sex couples, which includes medical decision-making authority. Minnesota ranks high for having laws and policies in place that help drive equality for LGBT people.
About 20 percent of LBGTQ people in Minnesota are raising biological, adopted, or foster children. In the U.S., an estimated 37 percent of LGBTQ adults have had a child at some time in their lives. They are three to four times less likely to have children than heterosexuals.
Although society’s acceptance of differences in sexual orientation and gender identity has advanced, 39 percent of LGBTQ say that at some point in their lives they were rejected by a family member or close friend because of their sexual orientation or gender identity. About 59 percent of LGBTQ have “come out” (shared their LGBTQ identity) to one or both of their parents, and a majority say most of the people who are important to them know about this aspect of their life. Older LGBTQ are more likely to be “closeted” (not out). Compared to LGBTQ persons under the age of 30, those between the ages of 30 and 54 were at least 16 times more likely to be closeted and those over the age of 55 are 83 times more likely to be closeted. Social isolation is concern for LGBTQ seniors who are twice as likely to live alone, and twice as likely to be single.
Strong social networks are a source of resilience. LBGTQ people estranged from their biological families may have a “family of choice” (friends, current and former partners, and others). These emotionally close groups function as family, although not related by blood or legal ties. Being part of a supportive community fosters good health and can buffer against some disparities. Non-whites are more likely than Whites to say being LGBTQ is extremely or very important to their overall identity (44% versus 34%). LBGTQ people who are also racial/ethnic minorities are “multiply marginalized” and subject to microaggressions associated with both racism and heterosexism.
LGBTQ adults are less religious than the general public. Roughly half (48%) say they have no religious affiliation, compared with 20 percent of the public at large. LGBTQ adults describe many religions as being unfriendly toward people who are LGBTQ.
High quality care ensures that LGBTQ patients feel accepted for who they are and feel free to discuss all health issues and concerns with their providers. In some cases, LGBTQ people still experience mistreatment and poor quality care. Only 52 percent of LGBTQ Minnesotans are “out” to their doctor or primary care clinician and 27 percent reported having to teach their clinician about LGBTQ people in order to receive appropriate care. Many health care providers need to adopt processes and behaviors that are not biased against gender identity and sexual orientation. Appropriately asking about sexual orientation or gender identity allows health care providers to tailor care to address health needs.
LGBTQ individuals are almost three times more likely than others to experience a mental health condition such as major depression or generalized anxiety disorder. The fear of coming out and being discriminated against for sexual orientation and gender identities can lead to depression, posttraumatic stress disorder, thoughts of suicide, and substance abuse. LGBTQ people must confront stigma and prejudice based on their sexual orientation or gender identity while also dealing with the societal bias against mental health conditions. Some people report having to hide their sexual orientation from those in the mental health system for fear of being ridiculed or rejected. In 2017, 29 percent of LGBTQ people in Minnesota were experiencing severe mental distress and an additional 46 percent were experiencing moderate mental distress.
End of life
LGBTQ elders are more likely to be single, childless, and estranged from biological family—relying on friends and community members as their chosen family. Only 20 percent of LGBTQ seniors said they are comfortable being open about their sexual orientation with staff in long-term care facilities. Many people have concerns about abuse and/or neglect by staff, isolation from other residents, discrimination by residents, and discrimination by staff.
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