What are LGBT+ inequalities in health and social support—why should we tackle them?

Fish, Julie and Almack, Kathyrn and Hafford-Letchfield, Trish and Toze, Michael (2021) What are LGBT+ inequalities in health and social support—why should we tackle them? International Journal of Environmental Research and Public Health, 18 (7). 3612. ISSN 1660-4601 (https://doi.org/10.3390/ijerph18073612)

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There are a number of obstacles to the inclusion of research in LGBT+ health inequalities and social support in national and international policy initiatives including attitudinal (ranging from disbelief that differences exist to discriminatory views [5]), the relative dearth of robust data (due to lack of measures about SOGI in existing data-sets), and the lack of large-scale data-sets (due to challenges in random sampling). Of concern at a global level, is the unequal provision of rights for LGBT+ people. In six UN member states, the death penalty can be imposed for consensual same-sex sexual behavior and in 26 countries a penalty of 10 years to life imprisonment can be imposed [6,7]. Some jurisdictions separately penalize diverse gender expression and many countries have no framework for allowing trans people to access ID documents or state recognition; further, they impose requirements that are a breach of human rights, such as sterilization (https://www.humandignitytrust.org; accessed 30 March 2021). The Office of the High Commissioner for Human Rights (OHCHR) has noted the violation of the human rights of intersex people in many jurisdictions, e.g., non-urgent sterilizing surgeries performed on children without capacity to consent. By contrast, protections for sexual orientation and gender identity are explicitly included by nine jurisdictions; moreover, in the constitutions of 123 UN member states consensual same sex acts are legal. Several international jurisdictions have implemented legislative ordinances to protect the rights of their LGBT+ citizens, there is increasing recognition by governments of the need to understand and address LGBT+ health and social care inequalities and a number are implementing policy initiatives to promote well-being including adoption, equal marriage, protections in employment, housing and access to and use of health and social care. Globally, (although important omissions remain) there are legal frameworks to support the implementation of evidence-based policy to embed these legislative developments in everyday life. In this Special Issue, we aim to contribute to the substantive field of LGBT+ research, highlight methodological developments and new approaches to evaluation and implementation to support the work of Governmental and Non-Governmental Organizations (NGOs) and other bodies across the world in their LGBT+ equality work.This Special Issue is partly shaped by a recent agenda-setting paper which called for greater and more robust data to inform international policy developments. To this end, the authors advocated seven criteria on which to build a robust field of research to support international and national government initiatives aimed at tackling LGBT+ health inequalities. We endeavored to include studies which meet these criteria in the following ways: (1) large datasets (Li, Hickson, Kattari, Tan); (2) comparative data collection (Hickson); (3) addressing diversity and intersectionality among LGBT+ people (Daly, Hickson, Levin, Kattari, O'Shea, Toze); (4) investigating the delivery of healthcare services capacity o deliver LGBT+ affirmative healthcare (Levin); (5) identification of effective health promotion and/or treatment interventions and for sub-groups (Li, Toze); (6) development of a health equity model (Daly, Henrickson); (7) utilization of social justice concepts to ensure change-oriented data (Kattari, Mulé, McDermott).