There is strong evidence that lesbian, gay, bisexual and transgender (LGBT) people experience considerable health inequalities that affect both their health outcomes and experiences of the healthcare system.
The LGBT Companion Document (2013) has been developed by a group of volunteer experts from across the LGBT community and the Department of Health. It provides national data and evidence on LGBT communities for each indicator and domain, and is designed to increase our understanding of LGB&T health. This should ensure that the public health system can challenge inequality related to sexual orientation and gender identity, which will improve the commissioning and provision of services for the LGBT community.
The life expectancy of the LGBT population has not been modelled in the UK. However, it is possible to infer that from evidence of significantly higher levels of smoking, drug and alcohol misuse, they will have an increased risk of cancer, coronary heart disease and suicide. This ultimately suggests a shorter life expectancy than the heterosexual and non-transgender community. Self-reported wellbeing appears to vary across each of the LGBT orientations. The national Integrated Household Survey (2010) found that self-reported health was slightly better among lesbians and gay men than heterosexuals, but much worse amongst bisexuals and those identifying with another non-heterosexual identity.
Improving the wider determinants of health
Individuals from the LGBT community often experience prejudice and marginalisation that affects wider factors such as education, experiences of crime and housing stability. This is likely to lead to significant health inequalities and difficulties in accessing targeted services. For example, child poverty is more likely to affect LGB couple households. Sickness absence is another significant factor due to the increased risk of stress and anxiety associated with discrimination and harassment in the workplace. National evidence demonstrates that nearly 1in 5 lesbian and gay people have experienced homophobic bullying in the workplace during the last five years.
Local and national research indicates that LGB&T individuals have higher levels of health risk behaviours such as smoking and alcohol use. They are also less likely to engage with health interventions and screening programmes if they are not explicitly recognised by the service. Self-harm is a particular concern amongst this group, since previous research shows that 1 in 5 lesbian and bisexual women have deliberately harmed themselves compared to 0.5% of women overall. LGB people are also less likely to meet the recommended guidelines around fruit and vegetable consumption. Data from the Lesbian and Gay Foundation shows that 13% of LGB people said they eat the recommended five or more portions of fruit and vegetables daily compared to general findings from the 2010 Health Survey for England, which found that 25% of men and 27% of women meet the ‘5-a-day’ recommendation. Additional concerns revolve around eating disorders, physical inactivity and smoking.
The health protection indicators focus on protecting the population’s health from major incidents and threats whilst reducing health inequalities. There is currently a lack of evidence on LGBT communities in relation to many of the indicators in this domain. However, the available evidence indicates that this group are likely to be experiencing health inequalities in relation to health protection. For example, men who have sex with men (MSM) are 11 times more likely to have chlamydia than their heterosexual peers. HIV treatment and care has developed significantly over the last few years, yet remains a key issue for gay and bisexual men. Nationally, 1 in 10 men who have sex with men (MSM) are living with HIV, and 1 in 3 HIV positive men have an undiagnosed HIV infection.
Healthcare public health and preventing premature mortality
There is evidence that LGBT communities are more likely to experience health inequalities in relation to preventable ill health. For instance, the evidence for greater levels of risky behaviour such as smoking and drinking suggests higher mortality rates from causes considered preventable. This applies to a range of disorders such as cancer, liver disease and respiratory diseases. There is also evidence for an increased prevalence of suicide, self-harm and poorer mental health outcomes amongst LGBT people. For example, a systematic literature review commissioned by the Department of Health in 2008 revealed a two-fold increase in suicide attempts in LGB people compared to the heterosexual population. Meta-analyses also demonstrated that the risk of depression and anxiety disorders was at least 1.5 times higher in LGB people. The health-related quality of life for LGBT older people is also likely to be poorer than the wider population. Previous research shows that this cohort is more likely to live alone and experience a greater level of social isolation than their heterosexual peers.