Moving forward together: Improving health outcomes for LGBTIQA+ people

Note: For ease and consistency, we have used the acronym LGBTIQA+ in this article, though we acknowledge this does not capture the complexity of lived experience associated with identity, attraction, expression, sex characteristics, and behaviours. When speaking about LGBTIQA+SB Aboriginal and/or Torres Strait Islander we use the expanded acronym to incorporate people who are Sistergirl and Brotherboy.

Australia is one of the best places in the world to live openly as an LGBTIQA+ person. Our pride parades are internationally famous, our queer communities and organisations vibrant, and there is a diversity of identities on our screens and in our media.

Yet LGBTIQA+ people in Australia experience poorer health and wellbeing outcomes than the broader population. For a forward-looking country that values equity of outcomes, this trend is deeply unsettling.

The good news is that there are practical ways to close these gaps and support all Australians to achieve their optimal health and wellbeing. These require governments, health service providers, community-led organisations, and advocates to come to the table and to reflect the needs of LGBTIQA+ people in their work.

In this article, we draw from our experience working to improve LGBTIQA+ health outcomes to identify the particular needs of LGBTIQA+ people, identify innovative programs, describe the root causes of poorer health and wellbeing, and suggest vital actions that can be taken by key stakeholder groups.

LGBTIQA+ people do not constitute a homogenous group. Outcomes and experiences are worse for some people and groups than for others, such as those with specific health needs and those who experience compounding stressors related to intersectionality.

Groups including trans and gender diverse people, people with innate variations of sex characteristics and LGBTIQA+ people who are Aboriginal and/or Torres Strait Islander, from a culturally and linguistically diverse background, or living with a disability report additional challenges accessing inclusive and high-quality healthcare.

Health and wellbeing inequities experienced by LGBTIQA+ people are caused by social, economic, environmental, and structural factors. These include:

• Historic and ongoing practices contribute to more complex and additional health needs, ongoing stress and pain, and fear of accessing services. LGBTIQA+ people are more likely to experience discrimination, persecution, stigma and trauma, including in health and wellbeing settings. As a consequence, they may have more complex health needs and be less likely to seek support.
• The health system is not designed or setup for LGBTIQA+ people, creating intentional and unintentional barriers to care. These include a shortage of capability and comfort within the health and wellbeing workforce to provide services to LGBTIQA+ people, regulatory and policy settings that do not support access to high-quality services, and a lack of investment in the types of services LGBTIQA+ people need and seek.
• We have not focused sufficiently on changing systems to support LGBTIQA+ people achieve their goals. Efforts to drive changes for LGBTIQA+ people have often relied on individuals within government or from sustained community advocacy. Until recently, there has been an absence of cross-government, long term commitment or funding for LGBTIQA+ health and wellbeing despite strong evidence for policy and investment.

While some of the systemic issues that influence health and wellbeing outcomes seem entrenched and insurmountable, there is a way forward. There are many levers available to make improvements and build a stronger, more resilient and equitable Australian community. These include:

The success of any initiative designed to improve health and outcomes for LGBTIQA+ people come down to good co-design and co-delivery. In our experience, there are five keys to success:

• Involve people with lived experience in leadership roles. Teams that embody representation from LGBTIQA+ communities can help focus work on what matters most and add credibility in front of other stakeholders.
• Consult and co-design purposefully. Focus on making sure you understand the needs and preferences of the cohort you are seeking to serve through robust, trauma-informed consultation and co-design activities.
• Don’t over-simplify. LGBTIQA+ is an umbrella term for a diverse set of identities and characteristics, which are further influenced by intersectional factors such as age, location, socioeconomic background, disability, and many other things. Shoehorning the needs of all people into a single persona is rarely useful.
• Focus on links that help meet a person’s needs holistically. It is near impossible to disentangle a person’s health needs from various social determinants, such as education, housing, the justice system, and immigration. Look for opportunities to work across these intersections and develop options that will help a person over multiple dimensions of their life.
• Build on strong foundations. There are already many policies, strategies, models of care, and other initiatives that have been successfully improving experiences and health outcomes for LGBTIQA+ people for decades. Much of this has been driven by highly expert people who are members or allies to the queer community. Use these strengths as launchpads for further work wherever appropriate.

Luckily, there are many examples of good practice to inspire programs targeted for LGBTIQA+ people.

Building a society where everybody, including LGBTIQA+ people, can achieve their own definition of good health is possible if we all play our part. But if we overlook LGBTIQA+ people in policy, legislation, education, program design, and service design, they people will continue to experience worse outcomes than the general population.

For those unsure where to start, try asking yourself: “How can I better consider the needs of LGBTIQA+ people in my work?” Consider the best way to do this. It might be through research, governance, engagement, or expertise.

Whatever you decide, the very fact you are thinking seriously about the question means you are on the path toward improving the health outcomes of LGBTIQA+ people. If we all get on board, this will bring us one step closer to a world of equal health outcomes.

Get in touch to discuss how we can help your organisation contribute to better health outcomes for LGBTIQA+ people.

Connect with Lauren Ware and Steven Hodge on LinkedIn.

Prepared with support from Hannah Dews.