4.2 When Health Care Hurts:
Prescriptions for the Cure of BC's Health Care System

This was the second year that the Rainbow BC Conference organized a health stream. The health stream participants built on the work that was done last year -- the identification of LGBT health issues and concerns -- and moved to an examination of solutions for addressing our health issues and concerns. Given the mandate of the larger conference, participants from the health stream focused both on health care issues in general and health issues related specifically to relationship and street violence.

The World Health Organization recognizes health is a universal right for everyone. Queers contribute towards health care, work within the health care system, and rely on the system. The health care we are seeking is one which is sensitive and respectful. Currently, the system is designed with basic assumptions of patient and family heterosexuality and assumptions around gender. This leads to disrespect, lack of accessibility, intimidation, phobias, and insensitive treatment from providers when members of the LGBT communities and our families seek medical treatment. It leads also to the denial of our existence. This invisibility of our lives further perpetuates a lack of resources, and a lack of knowledge and understanding of what LGBT health issues and concerns are and what culturally sensitive care is for LGBT people.

The experiences of members of the LGBT communities and our families, when we seek medical assistance as a result of relationship or street violence, is symptomatic of the inability of the health care system to adequately and sensitively address our needs. When we seek to meet health needs as a result of violence, we are met with more of the same. That is, victimization continues as ambulance workers, hospital staff, victim assistance programs respond to the victim in a negative way because of his or her perceived or actual sexual orientation. The victim's same-sex partner, family and friends can be victimized by being denied access to the hospital or not recognized as key supports. The potential for this form of victimization occurs not just with bashing/ violence, but in any encounter with the health care system.

The delivery of health care services must be changed to accommodate LGBT issues and health emergencies. At this moment in time, health care hurts.

  • My partner died 1.5 years ago. Some health care workers were very supportive, others were awful. It was often very hard work and constant battle. I did not need to be educating others while in crisis.
  • Health care workers need to learn about Female to Male Transgender. Potentially life-threatening lumps and other danger signals especially in breast and cervical tissue routinely go unchecked in order to avoid the extreme discomfort of facing an uninformed health care worker.
  • My mother is in a health care residence - causes me to ask what will happen to me at her age if I need to move into a facility? I feel quite desperate as a lesbian with no children, and am likely to need more support than my partner (who has children).
  • On admission, the hospital wouldn't accept my partner's name in the system. The only way my partner could have visiting rights and decision making authority was if I said my parents were dead.
  • When I called the hospital about my partner's mom they said I wasn't family.
  • Lack of information to and from all levels of professionals including general practitioners of Transgender treatments and issues.
  • Poverty is possibly the single greatest barrier to health promoting behavior among youth. Making services and medications accessible through subsidization would help to enable youth to meet their own health needs.
  • The medical system doesn't provide the structure or safety for us to provide a complete picture of ourselves.
  • I (a transgendered woman) presented at the office of a health professional, for a service which any other woman might take for granted. I was told by the receptionist, "We don't treat your type." She might as well have chopped my legs off at the knees.

Definitions

Violence is: the perpetuation of abuse (physical, emotional, mental, intellectual, social, sexual, spiritual), discrimination, oppression, or denial by individuals or institutions against LGBT people.

Safety is: freedom from violence as defined above; culturally appropriate and sensitive health care which is inclusive, welcoming, respectful, and educated about our communities; and, freedom from re-abuse by the health care systems, other programs and institutions. Examples of safety:

  • to walk down the street without being in fight or flight mode
  • to know that the "next taunt" is no longer coming
  • to know that the institution will intervene on our behalf if violence does occur
  • to feel secure that job performance will be judged/rated on its merits
  • to be able to come out in a rural community without ostracism; to be able to live where we want without social exclusion
  • to be able to conduct social conversations without self-censorship or danger
  • to be able to find a job; to be "out" on our resumes
  • to be able to consult with doctors without being asked about marital status, and other assumptions
  • to have our lives visible on health care forms (e.g. admitting forms, patient assessments) otherwise we are ignored and our lives not acknowledged
  • to not feel fear of being apprehended into a prison or psychiatry ward because something is misinterpreted, or because of old attitudes viewing queers as having mental illnesses, and the system failing to adequately address this.

Summary of LGBT Health Issues and Concerns

As discussed at both Rainbow BC Conferences, and as outlined in the report,
A Population Health Framework for Addressing the Health Issues and Concerns of the Lesbian, Gay, Bisexual and Transgendered Communities (Perchal and Brooke, 1995), the LGBT communities have a number of health issues and concerns, which have been summarized in the following section.

LGBT communities have a higher incidence of some diseases

  • 1 out of 3 lesbians is likely to get breast cancer as opposed to 1 out of 9 heterosexual women
  • typical life span for a 20 year old gay or bisexual urban male is 54-66 years
  • 77% of the known AIDS cases in Canada are amongst gay men
  • 2 out of 10 persons in the transgendered community in BC may be HIV+

We face considerable barriers in accessing the health care system and in service delivery

  • negative attitudes and actions of health care providers
  • insufficient education and training of providers on our health issues
  • members of the LGBT communities not accessing or delaying treatment for fear of discrimination
  • information on our communities health concerns is not well known or well communicated
  • lack of understanding of the complexity and diversity within the LGBT communities (creates barriers both within and outside the LGBT community)

LGBT health determinants are not being fully addressed

  • discrimination related to heterosexism, homophobia, bi-phobia, and transphobia
  • stress related to systemic/personal abuse /discrimination
  • inadequate housing
  • poverty
  • lack of coping skills to address health determinants

Studies also cite a range of other health concerns, including

  • domestic abuse
  • childhood sexual abuse
  • substance use
  • depression
  • suicide

Recommendations

Based on discussions during the conference, the health stream developed a number of recommendations for addressing LGBT health issues in general and issues arising from violence and bashing. These recommendations include both an education and information focus, as well as a number of recommendations that focus on broader systemic change.

We recommend:

1. That the Ministry of the Attorney General, and the Ministry of Health, conduct mandatory training of health care providers, mental health communities, physicians, police and law enforcement agencies on LGBT health issues, and relationship and street violence.

2. That the Ministry of the Attorney General, and the Ministry of Health, provide funding to assist in the development and implementation of a strategy for distributing information on LGBT health issues to LGBT communities and to BC health care providers (e.g. pamphlets on our health issues). As part of this, an update would be needed of the Perchal and Brooke, 1995 report: A Population Health Framework for Addressing the Health Issues and Concerns of the Lesbian, Gay, Bisexual and Transgendered Communities.

3. That the Ministry of the Attorney General provide core funding to support and expand the Prideline, including training for employees and volunteers, and resources to keep information current and relevant to each community throughout BC. The Prideline could then serve as a province wide information and support service for the LGBT communities.

4. That the Ministry of Health and the Ministry of the Attorney General provide funding to conduct a project which develops health care protocols for victims of LGBT bashing and violence (e.g. ambulances, hospital emergency rooms, victim assistance programs, general practitioners). Information could then be disseminated throughout the province.

5. That the Ministry of Health review and eliminate discriminatory policies related to health care coverage for our communities, in particular those that affect the transgendered (e.g. electrolysis is available through Medicare for hirsute women but not for transitioning women) and immigrant and refugee communities.

6. That the Ministry of Health encourage Health Boards, hospitals, research organizations and groups to conduct research (e.g. LGBT issues in care homes) and collect incidence data on LGBT health concerns (e.g. breast cancer, suicide rates, immune disorders).

7. That the Ministry of the Attorney General conduct a province wide media campaign (e.g. 'homo/bi/transphobia hurts') on violence against LGBT communities.

8. That each Health Region in the Province create a structure for an LGBT advisory body (e.g. LGBT Population Health Advisory Committee - Vancouver/Richmond Health Board).

9. That the Ministries seek, on an ongoing basis, LGBT communities' involvement, input and collaborations.

10. That LGBT communities and various Ministries recognize that the determinants of health, in particular, poverty, are a health care issue.

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