Creating Public Health-Based Interventions to
Address Sexuality as a Determinant of Health Disparities
Mailman School of Public Health, USA
Submission: October 02, 2018; Published: October 29, 2018
*Corresponding author: Kittu Pannu, Mailman School of Public Health, USA.
How to cite this article: Kittu Pannu. Creating Public Health-Based Interventions to Address Sexuality as a Determinant of Health Disparities. JOJ Pub
Health. 2018; 4(2): 555634. DOI: 10.19080/JOJPH.2018.04.555634
Health disparities amongst sexual minorities are not a new phenomenon – research institutes have been calling for researchers to fill in the gaps in available materials for years. The list of diseases that disproportionately affect sexual minorities compared to their heterosexual counterparts increases as more research delves into this new area of study, including heart conditions, mental illnesses, substance abuse issues, and suicide  Evidence points to access, mistrust, stigma, and overall chronic stress as major contributors to these discrepancies in health outcomes. Studies have already linked the LG and B identities to higher levels of mental health issues, smoking, and activity limitation. Researchers believe that these issues may be due to an overall increase in stress experience for people identifying with these sexualities, a lack of healthy coping mechanisms, social isolation, and a lower overall quality of life  As public health practitioners, it is our duty to address and alleviate these issues in order to develop a higher quality of life for this vulnerable population. We can do so by directing more funding toward research efforts that delve into understanding which intervention styles can decrease these disparities and increase positive health outcomes for this vulnerable population.
Stigma is a major contributing factor to health disparities observed in minority populations, including sexual minorities. [2,3] Through its chronic nature, stigma can increase one’s daily psychological stress, leading to deleterious physical and mental health effects. Stigma impacts from a variety of areas including from within, from others, and from one’s own environment and community. Researchers have concluded that sexual minorities who live in communities that are known to create higher-stigmatizing environments tend to live shorter lives when compared to their peers in lower stigma-creating areas. Discrimination, prejudice, and marginalization within communities have the ability to shape stress levels and, ultimately, health outcomes for sexual minorities. Researchers have stated that these findings are in line with health outcomes due to minority stress experienced through race in the South  Minority groups within the umbrella of sexual minorities, such as those who identify as bisexual or who engage in homosexual activity without self-identifying as LGBT are at
an elevated risk for negative health outcomes than their other LGBT counterparts, much of which researchers expect is due to a heightened level of stress surrounding that person’s identity. In other words, if a person is a part of an even more marginalized group of a marginalized community, they tend to experience more negative health outcomes. Issues of hegemonic masculinity, or when men refuse to seek out medical care for their ailments as a means to remain self-sufficient, can further drive disparities amongst these already-marginalized groups.
Many of these disparities hinge on access and utilization issues, including timely utilization when issues arise [2,3] Sexual minorities have less access to healthcare services, which translates to fewer opportunities to take care of their overall health. Currently, researchers are trying to observe if specific sexual identity may further exacerbate these differences. Sexual minorities have reported higher levels of expected/experienced stress and barriers to healthcare, especially when they consider the expected and experienced discrimination felt from disclosing a homosexual identity to a healthcare professional. After interviewing healthcare staff members and patients, Everett and Mollborn correlate this negative reaction to a lack of cultural competency trainings available to staff members .
Everett and Mollborn have shown that sexual minorities are, like other minorities, not immune to hate crimes and other discriminating acts  Nearly 20 percent of sexual minorities stated that they had experienced criminal activity as a result of their orientation. Focusing on a perceived disparity between the genders, Everett and Mollborn attribute these findings to how men are victims of violent crime more so than women and how most perpetrators of these attacks are heterosexual men. This stigma can confer onto sexual minorities higher levels of psychological distress, opening them up to higher levels of mental health issues . Increasing mental health outcomes in sexual minorities has been linked to help reduce healthcare needs, self-esteem, and confidence in the medical system to treat their physical ailments  Other interventionists have pointed to a lack of education-based interventions as a possible way to improve health outcomes for this population. Hatzenbuehler highlighted
how many LGBT population-targeting public health interventions
focus on gay and bisexual men only, leaving out a substantial part
of this underserved population. The authors recommend a focus
on education to encourage potential patients to receive the care
they need . Unfortunately, current policy and governmental
action have not made things any easier for sexual minorities.
Whether they deny equal protections on a national level for
LGBT people through the introduction of numerous religious
exemption bills or those that prevent municipalities or counties
from passing nondiscrimination protections, many politicians
have attempted (and succeeded) to roll back protections through
the law targeting this particular minority group. The issue athand
is how we as public health practitioners can alleviate some
of these issues and create an environment that is more hospitable
to sexual minorities.
Based on this, I propose the following steps to alleviate some
of the issues facing sexual minorities:
a) Increase the amount of effective cultural competency
trainings for healthcare workers that will engage and shape
their behaviors. Doing so will help to educate and familiarize
healthcare workers on a culture they may not understand and
can help in humanizing these patients. Cultural competency
programs can also aid in teaching these workers how to provide
healthcare to people whose lifestyles they may not agree with
while still behaving in a professional and helpful manner.
By doing so, we can help displace some of the stigmatizing
behaviors in which some healthcare workers may engage and
increase sexual minority trust in the healthcare system.
b) Introduce positive discussion on sexuality and related
topics through sexual education curricula in middle and high
schools and create mandatory training programs for sexual
education instructors that address how to remove stigma from
nontraditional sexual identities. By introducing this to teens
and young adults, we can ensure that these topics will receive
exposure. Addressing it in a positive manner can help to begin
the process of dismantling certain aspects of structural stigma
associated with being a sexual minority. Creating training
programs can work to ensure that instructors are exposed to
de-stigmatizing language that we would encourage them to
use with their students.
c) Create more public health campaigns to target the
minority groups within the sexual minority population. Focus
on educating lesbians and bisexual women on the benefits of
engaging the healthcare system. By doing so, public health
interventionists can educate these vulnerable groups on the
benefits of health screenings and proactive healthcare action.
This can decrease health disparities between heterosexual
and homosexual women.
d) Increase the amount of research projects dealing with
these topics. This can help with understanding the extent to
which stress, stigma, sexuality, healthcare access, mistrust of
the medical system, and other related topics all contribute to
health outcomes for sexual minorities.
As stated above, it is up to us to do something about these
health disparities. We need to delve into this branch of research
to expand and learn more about how these issues affect overall
health outcomes, create evidence-based interventions to alleviate
these issues, and then implement and continually evaluate them
in the real world. Change may not occur immediately, but we
can create the foundation for change that can shape the health
outcomes of generations of sexual minorities to come.