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It is important to focus on lesbian, gay, bisexual, transgender, and queer (LGBTQ) health, and the healthcare disparities gap that exist in the LGBTQ community.  Health inequities and poor health outcomes among LBGTQ populations are a result of the adversity experienced by gender and sexually minoritized populations.  For instance, the ways in which LGBTQ health is often conceptualized and measured from a deficit-focused framework can have significant implications for health care access and uptake among LGBTQ populations.  LGBTQ health research has an important role to play in shifting the way that LGBTQ health is understood and measured in health policy and practice, which in turn has significant implications for health promotion strategies targeted at keeping LGBTQ populations healthy across the life course (Colpitts, & Gahagan, 2016).  In the Healthy People 2020, LGBT people are for the first time identified as a United States (U.S.) national health priority, with the Institute of Medicine (2011) concluding that insufficient information exists on the health of LGBT people.  One aspect of social justice is to better understand the social, structural, and institutional elements that create differential access to healthcare and health outcomes in this population.  In fact, there is accumulating evidence of health disparities among LGBT older adults, making LGBT older adults an at-risk population (Emlet, C., A. 2016).  

            Colpitts, & Gahagan, (2016) pointed out that the health needs and experiences of LGBTQ populations have generally been rendered invisible in mainstream health care systems and policies.  This is, in part, because LGBTQ health has traditionally been understood through a heteronormative framework whereby the health needs and experiences of LGBTQ populations are assumed to be similar to those of their age-matched heterosexual and/or cisgender peers.  The invisibility of LGBTQ health needs and experiences has significant implications in terms of the provision of evidence-based, culturally competent health care.  The Virginia Transgender Health Initiative Study found that the health care system was the most commonly cited area where transgender individuals experienced discrimination.  Public health policy and programming interventions have traditionally focused on individual-level indicators of health and on reducing the risk for negative health outcomes by changing individual, ‘lifestyle’ behavior such as diet, exercise, and drug and alcohol use.  Existing LGBTQ health research has demonstrated that social stigma, discrimination and victimization experienced by LGBTQ populations may affect uptake rates of preventative health screening programs and health care services.  It is equally important to note that LGBTQ populations may also experience negative determinants of health such as homelessness, social exclusion and poverty at higher rates than their age-matched heterosexual and/or cisgender peers.  Population-based initiatives that facilitate ‘coming out’ without fear of marginalization or violence are central to promoting the health of LGBTQ populations across the life course (Colpitts, & Gahagan, 2016).  Emlet (2016) stated that there are sub-groups within the LGBT older adult population, including those who identify as bisexual, transgender, older than age 80, and living with HIV infections may be at greatest risk for economic insecurity and a subsequent impact on health and healthcare access, which contributes further to health disparities.  Emlet (2016) added that important disparities have been noted between older and younger adults living with HIV infection as well.   It is said that older adults living with HIV are more likely to live alone and be socially isolated than their younger peers.

            LGBTQ health research has a significant role to play in shifting how LGBTQ health is understood and measured, and, more specifically, the ways in which health research evidence is used to inform health policy and practice.  However, given the longstanding focus on the risks for poor health outcomes among LGBTQ populations, including rates of sexually-transmitted infections (STI) and human immunodeficiency virus (HIV) infection, smoking, obesity and depression/suicidal ideation, a conceptual shift toward health-promoting LGBTQ research approaches is warranted.  According to the World Health Organization, health promotion approaches focus on the “…process of enabling people to increase control over, and improve, their health”, which includes “a wide range of social and environmental interventions”.  It is important to note that health promotion recognizes the significance of both modifiable and non-modifiable determinants of health, and emphasizes upstream, preventative approaches, which include the development of healthy public policy, in contrast to deficit-focused approaches (Colpitts, & Gahagan, 2016).

            People who live in poverty are less healthy than those who are financially better off, regardless of whether the benchmark is mortality, the prevalence of acute or chronic diseases, or mental health.  Approximately 26 percent of adults ages 65 and older in the United States live at or below 200 percent of the federal poverty level.  In contrast, in a national, non-representative sample of LGB older adults (ages 50 and older) Fredriksen-Goldsen and colleagues (2012) found nearly a third of the LGB older adults enrolled in the study lived at or below that economic threshold (Emlet, C., A. 2016).  

            In conclusion, while the needs of this population are receiving additional attention at local, state, and national levels, continued advocacy for improving access to care and working to remove disparities are critical.  An emerging concern for many LGBT older adults is competent and compassionate long-term care.  The future of care and compassionate service delivery for these individuals will require us to learn to identify and build from their naturally emerging strengths (such as community identity, mastery, and social support), improve understanding and competence among providers as to the unique needs and historical consequences of this population, and continually work toward fairness and equity for all older adults (Emlet, C., A. 2016).  Many people do not want the LGBTQ community to have anything because of religious beliefs for instance.  We, as a society, have to do our best in order to close the healthcare disparities gap in the LGBTQ community. 

References

Colpitts, E., & Gahagan, J. (2016). The utility of resilience as a conceptual framework for

            understanding and measuring LGBTQ health. International Journal for Equity in

            Health, 15, 1–8. doi.org/10.1186/s12939-016-0349-1

Emlet, C., A. (2016). Social, Economic, and Health Disparities Among LGBT Older

            Adults. Generations: Journal of the American Society on Aging, 40(2), 16.