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Putting more care into health care for LGBTQ+ individuals

Michelle Marie Garrido, MD, Physician, Family Medicine, Optum, California
Gina Debogovich, Senior Director, Community and Social Media, UnitedHealth Group  

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Individuals identifying as lesbian, gay, bisexual, and transgender, queer/questioning (LGBTQ) and other gender identities/sexual orientations, collectively referred to as LGBTQ+, face significant challenges and barriers to accessing health care services and that needs to change.1,2

Stigma, discrimination, inadequate or outright denial of needed health care services, and a lack of appropriate and adequate training for health care providers and affiliated professionals on LGBTQ+–specific health care needs contribute to these substantial health disparities.2,3

A recent estimate showed an increase in the overall proportion of U.S. adults self-identifying as LGBT, from 4.5% in 2017 to 5.6% in 2021; the proportion is even higher in younger adults, with one in six (15.6%) adults of Generation Z considering themselves LGBT.4

The vast health care and outcome disparities, along with the increasing population of LGBTQ+ individuals, highlight an urgent need to identify and implement meaningful strategies to close these care gaps.

The challenge of LGBTQ+ health care disparities and inequities

While increasing visibility, social acceptance and policy changes have had positive effects on the lives of LGBTQ+ individuals, discriminatory attitudes and practices persist, including in health care.3

The formal designation of sexual and gender minorities as a health disparity population by the National Institutes of Health in 2016 underscores the gravity of the current state of LGBTQ+ health care.

LGBTQ individuals are 2.5–times more likely to experience depression, anxiety and substance misuse compared with heterosexual individuals.5 The rate of suicide attempts is four and two times greater for LGB and Q youth, respectively, compared to heterosexual counterparts.5

Older LGBTQ adults also face unique challenges, with nearly one-third reporting depressive symptoms.5

The Centers for Disease Control and Prevention recently reported elevated health risks for LGBTQ+ individuals, including higher rates of chronic conditions, such as asthma, kidney disease and heart disease, associated with serious COVID-19 illness.6

As members of the LGBTQ+ community, our first-hand experiences reflect the barriers and challenges to competent, compassionate and respectful health care for LGBTQ+ individuals.

For example, due to the antiquated forms used for recording births, many married same-sex partners struggle to be identified as co-parents of their newborn child, unlike heterosexual couples.

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Partners may be referred to as “friend” in health care settings, without acknowledging the importance of the relationship or even the partner’s role as caregiver in specific medical scenarios.

These powerful personal experiences, acute awareness of the limited exposure to basic aspects of LGBTQ+ health issues in medical school and beyond, and a commitment to treating every health care recipient with dignity and respect has laid the groundwork for Optum’s LGBTQ+ care-focused programs.

Launching LGBTQ+ health equity and cultural competency education

The challenge of providing equitable and sensitive LGBTQ+ health care is immense. As a result, we started at the foundation– education. LGBTQ+ health-specific instruction for medical students, residents, and other clinicians has been limited, if any.1

Appropriate education focused on LGBTQ+ health can empower clinicians and support staff to identify and modify practices, thereby improving the patient experience and care outcomes.

To achieve this goal, Optum launched two initiatives to help advance LGBTQ+ health equity and cultural competency within and outside our organization – an accredited CME course focused on LGBTQ+ health issues and an online resource hub for LGBTQ+ members and their allies.

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LGBTQ+ health equity and cultural competency education

OptumHealth Education is offering Caring for the LGBTQ+ Community: An Introduction to all providers at no cost.

This educational module is in an accredited webcast series to inform participants about the unique needs of and health disparities experienced by the LGBTQ+ community.

The webcast will also discuss appropriate use of pronouns and terminology and explore how to create environments in which LGBTQ+ individuals can feel validated, safe, and welcome.

Future modules will offer more in-depth provider-focused education around the unique health care needs of specific populations within the LGBTQ+ community, such as caring for transgender patients.

PRIDE365+ – a toolkit for care recipients and their allies

In addition to no-cost training, Optum launched PRIDE365+, a website that provides resources to educate and support LGBTQ+ community members and allies in creating open, safe, and respectful working and living environments. Visit PRIDE365+.

PRIDE365+ includes an LGBTQ+ fact sheet, a resource guide, an LGBTQ+ terminology and pronoun guide, a transgender support guide, and a “How to be an Ally” guide, along with informational content from our partner Trans Lifeline.

Optum committed $25,000 to both Trans Lifeline and the Trevor Project, organizations focused on supporting transgender individuals. These donations and partnerships and the PRIDE365+ program cement our pledge to helping our LGBTQ+ members live their healthiest lives.

Making an impact

Optum has a critical responsibility in leading the charge in addressing LGBTQ+ health disparities. Our initiatives are important steps in realizing mindful, compassionate, and competent health care for the LGBTQ+ community.

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  1. Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. National Academies Press (US); 2011. Accessed May 30, 2021. http://www.ncbi.nlm.nih.gov/books/NBK64806
  2. Healthy People 2020. Lesbian, Gay, Bisexual, and Transgender Health. Accessed May 30, 2021. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health
  3. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on Population; Committee on Understanding the Well-Being of Sexual and Gender Diverse Populations. Understanding the Well-Being of LGBTQI+ Populations. (White J, Sepúlveda M-J, Patterson CJ, eds.). National Academies Press (US); 2020. Accessed May 30, 2021. http://www.ncbi.nlm.nih.gov/books/NBK563325
  4. Gallup. LGBT Identification Rises to 5.6% in Latest U.S. Estimate. Gallup.com. Published February 24, 2021. Accessed May 29, 2021. https://news.gallup.com/poll/329708/lgbt-identification-rises-latest-estimate.aspx
  5. American Psychiatric Association. Mental Health Disparities: LGBTQ. Published online 2017. https://www.psychiatry.org/psychiatrists/cultural-competency/education/lgbtq-patients
  6. Heslin KC. Sexual Orientation Disparities in Risk Factors for Adverse COVID-19–Related Outcomes, by Race/Ethnicity — Behavioral Risk Factor Surveillance System, United States, 2017–2019. MMWR Morb Mortal Wkly Rep. 2021;70. doi:10.15585/mmwr.mm7005a1

This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of Optum Care. The views and opinions expressed may change without notice. 

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