Race and LGBT Health: Coloring in the Gaps

By Michelle Chen Feb 13, 2010

No matter how good your health benefits are, they don’t insure you against discrimination, especially when your racial identity and sexual orientation both stack the odds against your well being. Jeff Krehely of the Center for American Progress writes at The Root that the equality for the LGBT community is also a health issue. According to CAP’s research, “racial and ethnic minorities who are lesbian, gay or bisexual face some of the greatest health care challenges in our country." Lesbian, gay and bisexual people face health inequities like higher cancer rates, more problems with alcoholism and smoking, and greater risk of needing medication for mental health issues (and among youth, suicide attempts). Yet the data cuts in even more nuanced ways when race is factored in, writes Krehely:

For example, lesbian and bisexual black women are the least likely to have had a mammogram in the past two years. Only 35 percent of these women have had mammograms recently, compared to nearly 70 percent of heterosexual African-American, Asian or Pacific Islander, or white women. One out of every five lesbian/gay/bisexual African-American adults has diabetes. Straight African-American and straight, lesbian, gay or bisexual Asian or Pacific Islander, Latino, and white adults are much less likely to have diabetes—fewer than 8 percent of these populations have been diagnosed with the disease. Mental health needs are also a concern. For example, lesbian/gay/bisexual Asian or Pacific Islander adults are more likely than other groups to report experiencing psychological distress. Lesbian/gay/bisexual Latinos are similarly much more likely than all other racial or ethnic groups—gay or straight—to report problems with alcohol abuse and addiction. Data on the general transgender population is notoriously sparse and anecdotal—information on transgender racial and ethnic minorities is even more so. But based on what we do know, people in this population face the largest obstacles to finding and affording high-quality and highly competent health care.

If this is the first time you’re seeing the statistics laid out this way, that’s because medical research has paid astonishingly little attention to the intersection of sexuality, gender, race and health. Each of those aspects of our identities have a distinct bearing on socioeconomic status, access to insurance, and the level of care we can expect in an emergency room or psychiatrist’s office. But researchers nonetheless compartmentalize identity in a way that blinds health institutions to the multifaceted challenges of being well. The CAP study concludes, “For people of color, a lack of affordable health care and insurance and culturally competent service providers—along with persistent racism in society—are some of the largest causes of health disparities. An LGBT person of color faces the combined impact of these barriers, increasing the likelihood of negative health outcomes.” To the extent that communities of color have developed movements around health care equity—advocating for more clinics in underserved areas, for example, or demanding better language access for immigrants—LGBT people of color face the dual political hurdles of alienation from their own racial and ethnic communities, and from a mainstream LGBT rights movement that orients its public image toward middle-class whites. When illness strikes, or a loved one is hospitalized, or you’re struggling with the stigma of a sexually transmitted disease, those tensions create some pretty wide gaps to fall through. The report recommends that the federal government create a special office for monitoring LGBT health that “should first act to ensure that any federally funded health study that collects demographic information—on age, sex, race, ethnicity, primary language, or socioeconomic status—must also include questions about sexual orientation and gender identity.” Outside of government, race and LGBT-related health issues overlap heavily in the public discussion around HIV/AIDS. The Black AIDS Institute has launched the Black Gay Men’s Network initiative to promote dialogue and social support for a constituency that medical disenfranchised and besieged by layers of discrimination. Of course, a holistic social justice movement for LGBT people of color would focus on the individual’s entire life cycle, rather than a single epidemic. Like any other civil rights struggle, it’s about reorienting the public conscience to recognize good health as an entitlement, not a privilege. The failure of modern medicine and American politics to catch up to that reality should prompt a healthy dialogue. Ask your doctor. Image: A scene from "Gen Silent", documentary by Stu Maddox