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Year : 2021  |  Volume : 34  |  Issue : 1  |  Page : 19-21

LGBTQ population health policy advocacy

Ringwood, NJ 07456, USA

Date of Submission01-Oct-2018
Date of Decision19-Jul-2019
Date of Acceptance20-Jan-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Christina Iannucci Moran
Christina Iannucci Moran, 41 James Dr, Ringwood, NJ07456
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/efh.EfH_243_18

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Introduction: Members of the lesbian, gay, bisexual, transsexual, and queer/questioning (LGBTQ) community have specific health-care needs that are often overlooked by health-care providers due to education gaps and discrimination. Health-care inequality for this population has been researched and found to negatively contribute to poorer health outcomes for LGBTQ individuals. Background: There exists a critical need for LGBTQ health education at the undergraduate level for future health-care providers. Additionally, policy reform that establishes an LGBTQ-inclusive code of conduct and educates health-care workers on LGBTQ-specific health needs aims to reshape organizational culture. Recommendations: Curriculum-based education on LGBTQ health for students in health-care professions opens up conversations about the unique needs of this population and paves the way for improved provision of care and better relationships between providers and patients. Education and inclusive policy reform within organizations are critical for improving health outcomes for LGBTQ individuals. Conclusion: Increasing health-care providers' knowledge of this population's specific health needs and learning how to deliver culturally appropriate and sensitive care will lead to improved health outcomes for members of the LGBTQ community.

Keywords: Acceptance, culture, education, health care, inclusive, LGBTQ, policy reform

How to cite this article:
Moran CI. LGBTQ population health policy advocacy. Educ Health 2021;34:19-21

How to cite this URL:
Moran CI. LGBTQ population health policy advocacy. Educ Health [serial online] 2021 [cited 2022 May 19];34:19-21. Available from:

  Introduction Top

All over the world, members of the lesbian, gay, bisexual, transsexual, and queer/questioning (LGBTQ) community face implicit and explicit discrimination in health care, significantly affecting the health outcomes of these individuals.[1],[2],[3],[4] The inequitable provision of health-care and health outcomes for this population is a public health issue and the result of cultural misconceptions, hetero-normative attitudes and assumptions of health-care providers, and a general lack of knowledge regarding this population's specific health needs.[1] Due to the author's limited knowledge of international health-care policy, the following paper will discuss the need for LGBTQ health education and health-care policy reform within the context of the United States.

The pervasiveness of an exclusive health-care culture that struggles or refuses to meet the needs of the LGBTQ community allows for this population to experience abuse, discrimination, subsequent avoidance, and inequitable care.[3] Health-care policies that permit health practitioners to refuse care of an LGBTQ individual on the basis of the practitioner's religious/ethical beliefs exist and promote a deleterious relationship between individuals and health-care providers; negatively impacting the health outcomes of LGBTQ communitymembers.[3]

This type of health-care culture demonstrates limited knowledge of the individual health-care needs of LGBTQ persons and the outright refusal of care. Consequently, the relationship between health-care workers and this population is full of mistrust and fear.[2],[3] Research supports integrating education and LGBTQ-inclusive policies into the health-care system to foster a culture of acceptance and aid in lessening the health-care disparity experienced by these individuals.[3],[4]

  Background Top

Inequitable care for the LGBTQ community

When compared to heterosexual peers, members of the LGBTQ community tend to suffer higher rates of anxiety, depression, substance abuse, and suicide.[2] Feelings of mistrust and discrimination from health-care providers discourage timely medical treatment, resulting in poorer health outcomes.[3],[4] Differences in health-care provision and experiences with health-care providers between heterosexual individuals and LGBTQ individuals demonstrate an absolute need for quality improvement.[1],[3]

The Human Rights Campaign (HRC) Health-care Equality Index (HEI) was created in 2007 and serves to guide health-care facilities toward LGBTQ-inclusive policy reform as well as creating benchmarks for participating organizations.[5] The HEI is based on four fundamental elements of LGBTQ patient-centered care: LGBTQ-inclusive patient nondiscrimination policy, LGBTQ-inclusive visitation policy, LGBTQ-inclusive employee nondiscrimination policy, and LGBTQ patient care training for staff.[5]

Data in the 2018 HEI report reflect an increase in the number of facilities participating in the United States, as well as an increase in policy reform and patient outcomes amongst the participating facilities.[5] Seventy percent of participating facilities have a plan to decrease health disparities of LGBTQ patients, and 63% of these facilities have reviewed clinical services in order to recognize potential LGBTQ-related gaps in care.[5]

The number of organizations participating in the HEI continues to grow nation wide, but there remains considerable work to be done to improve the care and health of LGBTQ individuals.[5] When discussing discrimination, 70% of transgender or gender-nonconforming individuals and 56% of lesbian, gay, or bisexual individuals state they have experienced some type of discrimination in health care.[5] These numbers are staggering and highlight the importance of LGBTQ education and training for health-care students and providers.

LGBTQ health-care policy development and advocacy

Fear of discrimination leads to delays in health-care treatment and poorer health outcomes.[3] Members of the LGBTQ community have individual and specific health-care needs that are often overlooked by health-care providers due to lack of knowledge.[2],[6]

The HRC's HEI has laid a solid foundation for minimizing the gaps in care for LGBTQ individuals. Policy development addressing LGBTQ patient care training for medical staff would bolster the HRC's efforts and improve health outcomes for this population.

Many studies show education specific to LGBTQ health-care needs and sensitivity training improve patient experiences with health-care providers and patient outcomes.[7],[8] Continued advocacy for indiscriminate, equitable care of LGBTQ individuals is necessary to overcome the health-care disparities facing this population.

  Recommendations Top

Improving care for the LGBTQ population

To promote optimal health-care delivery and health outcomes for individuals in the LGBTQ community, education should being at the undergraduate level. Research and literature reviews show the need for curriculum-based education specific to LGBTQ health for students pursuing a profession in health care.[9],[10],[11] Inclusion of an LGBTQ health curriculum should be mandated by all accredited schools and supported by professional organizations.[10] Understanding the health-care needs of this population equips health-care providers with the knowledge to deliver competent clinical care.

Continuing medical education (CEU) for practicing health-care professionals should address LGBTQ-related terminology, specific health issues, and stigmas and discrimination affecting this population, as well as consequential health disparities.[10] Innovative knowledge of the needs and concerns of LGBTQ individuals allows health-care professionals to better serve this population.The use of education to improve LGBTQ health outcomes has been an effective intervention in health-care facilities; helping to reduce stigmas that negatively affect members of the LGBTQ community.[7] Subsequently, improvements in patient care, patient experience, and health outcomes for LGBTQ individuals have been noted.[8] Education-based policies that have been implemented by health-care organizations have resulted in improved patient care, patient experience, and health outcomes for LGBTQ individuals.[8]

To further mitigate knowledge and health-care deficits of the LGBTQ population, a concentrated effort needs to be made to incorporate LGBTQ-specific education in medical school curriculums; as studies show such education at this level is lacking.[9] Undergraduate education focused on the specific health-care needs of LGBTQ individuals would aid in improving health-care and patient outcomes of this population by increasing health literacy of new physicians.[9]

Improving the delivery of competent care and increasing knowledge related to the LGBTQ community will lead to myriad improvements. Understanding the unique needs of LGBTQ individuals promotes relevant health conversations, improves the provision of care, and builds trust between individuals and health-care providers.[7] Trust between these groups improves timely access to health-care and health outcomes.

LGBTQ policy across the health-care spectrum

Equality and indiscriminant health care should be the expected norm. The HRC's HEI makes note of this and includes a policy for LGBTQ-inclusive employee non-discrimination.[5] Extending LGBTQ-inclusive policy beyond patients and encompassing families and employees fosters an accepting, culturally sensitive environment. Bridging this policy to include facilities outside the health-care setting, such as businesses and schools aids in furthering a culture of acceptance and optimal outcomes for the LGBTQ community.

Inter professional support for LGBTQ policy reform

It is imperative to include all health-care team members in LGBTQ education in order to improve patient satisfaction and health outcomes.[8] Health-care organizations should mandate and provide education to all staff, focusing on how to address members of the LGBTQ community and provide indiscriminate and culturally sensitive care. The success of the proposed policy rests on the compliance of all health-care providers and organizational employees, as each professional has the chance to affect the health-care experience for every patient.

  Conclusion Top

The pervasive culture of LGBTQ discrimination is reflected in health-care and organizational policy, making it critically important to provide education and policy revision in order to deliver all-inclusive health-care services. Individuals in the LGBTQ community suffer poorer health outcomes as a result of delays in care, provider's refusal of care, and the lack of knowledge of care providers when compared to heterosexual peers.

Reshaping organizational culture to include all patient populations will help lower gaps in care and health disparities. Education and policy reform are essential elements of this cultural shift. Undergraduate education and continuing medical education focused on the needs of the LGBTQ community have an integral role in changing the culture of health care for this population. Educating health-care professionals about the unique needs of LGBTQ individuals leads to improved patient care and better relationships between care providers and individuals.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Knight RE, Shoveller JA, Carson AM, Contreras-Whitney JG. Examining clinicians' experiences providing sexual health services for LGBTQ youth: Considering social and structural determinants of health in clinical practice. Health Educ Res 2014;29:662-70.  Back to cited text no. 1
McNair RP, Hughes TL. Coming out: Is the Mardi Gras still needed? Med J Aust 2012;196:224.  Back to cited text no. 2
Lambda Legal. Creating Equal Access to Quality Health Care for Transgender Patients; Transgender Affirming Hospital Policies; 2016. Available from: [Last accessed on 2018 Sep 05].  Back to cited text no. 3
Quinn GP, Sutton SK, Winfield B, Breen S, Canales J, Shetty G, et al. Lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) perceptions and health care experiences. J Gay Lesbian Soc Serv 2015;27:246-61.  Back to cited text no. 4
Human Rights Campaign Foundation. Healthcare Equality Index 2018: Rising to the Standard of Promoting Equitable and Inclusive care for Lesbian, Gay, Bisexual, Transgender & Queer Patients and their Families; 2018. p. 1-88. Available from: [Last accessed on 2018 Sep 05].  Back to cited text no. 5
Lim F, Johnson M, Eliason M. A national survey of faculty knowledge, experience, and readiness for teaching lesbian, gay, bisexual, and transgender health in baccalaureate nursing programs. Nurs Educ Perspect 2015;36:144-152.  Back to cited text no. 6
Hyatt J. Improving LGBT healthcare communication. J Hosp Ethics 2015;4:17-21.  Back to cited text no. 7
Newsome C, Colip L, Sharon N, Conklin J. Incorporating a pharmacist into an interprofessional team providing transgender care under a medical home model. Am J Health Syst Pharm 2017;74:135-9.  Back to cited text no. 8
Dubin SN, Nolan IT, Streed CG Jr, Greene RE, Radix AE, Morrison SD. Transgender health care: Improving medical students' and residents' training and awareness. Adv Med Educ Pract 2018;9:377-91.  Back to cited text no. 9
McCann E, Brown M. The inclusion of LGBT+health issues within undergraduate healthcare education and professional training programmes: A systematic review. Nurse Educ Today 2018;64;204-14.  Back to cited text no. 10
McDowell A, Bower KM. Transgender health care for nurses: An innovative approach to diversifying nursing curricula to address health inequities. J Nurs Educ 2016;55:476-9.  Back to cited text no. 11


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