June is Lesbian, Gay, Bisexual, and Transgender (LGBT) Pride Month. Even as a straight cisgender man living in San Francisco, it’s hard not to feel the energy. With a seemingly never-ending swirl of parades, festivals, rallies, fundraisers, and, yes, corporate advertising campaigns, it’s easy to get swept up in celebrating progress towards LGBT equality.
LGBT Patients’ Health Inequities
But from a healthcare standpoint, we still have miles to go. LGBT individuals have higher rates of suicide, substance abuse, and tobacco use. Gay men have higher rates of sexually-transmitted disease (including, but not limited to, HIV). Lesbians are more likely to be overweight or obese. And transgender individuals suffer an array of indignities, from access issues to sexual victimization.
The reasons for these inequities are many. Some are the usual suspects – like income disparities, racial discrimination, and ZIP code variation. Yet the challenge goes well beyond these issues. LGBT individuals often suffer because their unique needs run up against two areas our current healthcare system addresses poorly: mental health and sexual health.
LGBT individuals often suffer because their unique needs run up against two areas our current healthcare system addresses poorly: mental health and sexual health.
Changing the Mental and Sexual Health Dialogue
We’ve written before about the myriad ways in which mental health care must be improved. We need to integrate mental health care into primary care. We need to use technology to solve seemingly-intractable access challenges. And we need to redouble our efforts to eliminate stigma, secure funding, and achieve true mental health parity.
Similarly, we pay woefully little attention to sexual health in the US. The typical physician receives only three to ten hours of training in sexual health issues. Alex Drane, co-founder of companies like Eliza Corporation and Rebel Health, reminded us at the 2016 Oliver Wyman Health Innovation Summit that sexual issues are one of the “unmentionables” consumers care about most regarding their health and happiness. And with ever-shortening primary care visits and growing primary care access issues, few physicians have the time they need with patients to use their limited training to discuss sexual health.
Of course, mental and sexual health aren’t the only big LGBT health issues. LGBT individuals have diabetes, cancer, and asthma, just like anyone else. We can use the same proven population health tools we do with seniors and union workers to help LGBT individuals live better, healthier lives – we just need to invest in these tools (and align incentives accordingly).
A Holistic Approach to Care
But first we must embrace and strive to understand the whole person. Too often in healthcare, in our quest for increased productivity and better measure-based outcomes, we treat patients as standard units. Health plans build engagement strategies based on eight fields of information submitted with an insurance claim, rather than based on the thousands of available consumer data points that really provide insights into people’s motivations. Providers develop care models that segment people based on their conditions rather than their human needs. (I’ve yet to meet someone who identifies primarily as a “diabetic.”) And, as Eric Dishman at the National Institutes of Health reminded us at last year’s Oliver Wyman Health Innovation Summit, whole populations are systematically excluded from pharmaceutical clinical trials.
In addition to reengineering our strategies and systems to support holistic, individualized care, we must replace our temptation for judgement with empathy. At its essence, all of health is behavioral health. Those who can listen – and then connect – at scale with people as people (not just as patients or members) will win in the new healthcare environment. Ultimately it’s what we should aspire to provide for everyone, LGBT and beyond.