Minority Health and Health Disparities

Have you ever watched Japanese movie called “Monster” directed by Hirokazu Koreeda? When I first saw the title of the movie, I literally thought it’s a typical spine chilling horror story. However, little did I know that monster implicits the anti-LGBTQIA+ attitudes/policies, or systemic ingrained heteronormativity by showing deep rooted societal and cultural discrimination, homophobias, and stigmatization towards individuals of LGBTQIA+. A popular dialogue from the movie “I have pig’s brain not human being’s brain”, in real it’s parents, and society’s perspectives and remarks that made them weird, not because they are wired that way. I belief not all the things can be fixed as per standard of an individual or society’s policy because they are not meant to be and if you insist then be a prisoner to things that you cannot change.

You know around the world till March of 2024, 65 countries criminalize private, consensual, same sex sexual activity, 12 countries have jurisdictions that can impose the death penalty for private, consensual same-sex activity, and 14 countries criminalize the gender identity and expression of trans people. [4]

However, the disparities and level of minority stress are non-homogenenous within the LGBTQIA+. Adolescence and youth, racial/ethnic minorities, socio-economic disadvantaged, and older adults suffer the most. Adolescence and youth tends to become a subject of bullying, risky sexual behaviours, suicide, and family rejection or homeless.[3] While LGBTQ+ older adults have higher likelihood of depression, anxiety disorders, and multiple health risk behaviors with higher rates of social isolation and loneliness due to lack of familial support, anti-LGBTQIA+ attitudes and policies limiting them from marriage and family formation. The fear of experiencing medical neglect, mistreatment, and discrimination in aged care settings is undeniable from chronic minority stress over lifetime. [1]

Countries which support the inclusion and visbility of LGBTQIA+, and prohibition of  anti-LGBTQIA+ discrimination, however, they still suffer from increased risk of certain physical and mental health conditions. Among the ten most common mental health conditions in USA namely anxiety, attention deficit hyperactivity disorder[ADHD], autism spectrum disorder[ASD], bipolar disorder, eating disorder, depression, obsessive compulsive disorder[OCD], personality disorder, post traumatic stress disorder[PTSD], and schizophrenia. The subgroups of Sexual and Gender Minorties[SGM] had significantly higher chances of diagnosing at least 4 out of 10 conditions in comparison to non-SGM counterparts, which marked the presence of mental health disparities in the SGM with respect to non SGM. If we delve deeper into these subgroups, cisgender sexual minority men had higher probability of diagnosing 9 of 10 conditions excluding schizophrenia. However, cisgender sexual minority women had higher likelyhood of all 10 conditions. Gender diverse people of any sexual orientation and assigned female or male sex at birth shown higher chances of diagnosing of 9 of 10 conditions excluding schizophrenia. Similarly, cisgender heterosexual women had higher odds for 9 of 10 conditions apart from eating disorders. When compared with cisgender heterosexual women, they shown higher chances for ADHD, ASD, bipolar disorder, OCD, personality disorder, and PTSD.  [2] Anti-LGBTQIA+ attitudes and minority stress along with social barriers of stigma and cis-heteronormativity, are some of the underlying factors for poor mental health among the SGM.

In terms of physical health conditions, there is significant prevalence of osteoporosis, colon, liver, breast, ovarian, or cervical cancers and a greater rate of overweight or obese among the lesbian and bisexual women, and a higher rates of transmission of the HIV, viral hepatitis, and other STIs, anal, prostate, testicle, and colon cancers, in addition to body image and eating disorders among gay and bisexual men. The rates of self-harm and suicide were higher in trans people because they experience significant discrimination and higher rates of interpersonal violence. Exclusion from the breast cancer screenings or gynaecological care particularly the trans and non binary individuals who are capable of pregnacy . Moreover exclusion from the labour and poverty leads many trans women into prostitution, violence, STIs, and drug abuse. Within the category, black and Latin American trans women are worstly affected with exclusion and often becomes victims of physical and sexual assault, even  murder.[3]

While analysing the global health policies’ inclusion of LGBTQIA+ communities, some prominent factors for having health and healthcare inequities are the criminalization of sexual and gender diversity, anti-LGBTQIA+ legislation, and lack of legal protections for LGBTQIA+ individuals along with lack of research material. While some framed blame on their “non-conforming sexual orientation or gender identity” instead of changing the deep rooted discrimination in societal and cultural system. Along with cases of HIV/AIDS infections as often described as risky behaviours voluntarily engaged by them without utilitizing precautionary measures. Within the LGBTQIA+ people, Men who have sex with men (MSM) garnered much more focus than others in terms of sexually transmitted infections, in contrast, the bisexual community was rarely mentioned independently especially the bisexual women. [4]

Whether we play blame games or break the systemic heteronormativity, gaps need to be reduced with appropriate measures by considering their unique and LGBTQIA+ centered needs with open mind and arms to make them accessible to healthcare needs without discrimination, bias and fear of rejection. I belief as a healthcare worker, sometimes being kind, considerate and respectful towards your patients/clients play equal role as a bottle of sleeping pill.

To my dearest readers, these questions are for you to ponder and feel free to share your thoughts and ideas which are more than appreciated and gladly receive to enrich my perspective.

• What do you think about LGBTQIA+ communities ?
• Are you a part of this communities? [ If so, does it implicate to you or what’s your thoughts?]
• Do you support anti-LGBTQIA+ attitude/policies? [If so why?]

References

1. Lampe, N. M., Barbee, H., Tran, N. M., Bastow, S., & McKay, T. (2023). Health Disparities Among Lesbian, Gay, Bisexual, Transgender, and Queer Older Adults: A Structural Competency Approach. The International Journal of Aging and Human Development, 98(1), 39–55. https://doi.org/10.1177/00914150231171838
2. Lu, J. A., Soltani, S., Austin, S. B., Rehkopf, D. H., Lunn, M. R., & Langston, M. E. (2025). Mental Health Disparities by Sexual Orientation and Gender Identity in the All of Us Research Program. JAMA Network Open, 8(1), e2456264. https://doi.org/10.1001/jamanetworkopen.2024.56264
3. Medina-Martínez, J., Saus-Ortega, C., Sánchez-Lorente, M. M., Sosa-Palanca, E. M., García-Martínez, P., & Mármol-López, M. I. (2021). Health Inequities in LGBT People and Nursing Interventions to Reduce Them: A Systematic Review. International Journal of Environmental Research and Public Health, 18(22), 11801. https://doi.org/10.3390/ijerph182211801
4. Rosa, W. E., Weiss Goitiandia, S., Braybrook, D., Metheny, N., Roberts, K. E., McDarby, M., Behrens, M., Berkman, C., Stein, G. L., Adedimeji, A., Wakefield, D., Harding, R., Spence, D., & Bristowe, K. (2024). LGBTQIA+ inclusion in the global health policy agenda: A critical discourse analysis of the Lancet Commission report archive. PLOS ONE, 19(10), e0311506. https://doi.org/10.1371/journal.pone.0311506