Eat, Drink, and Be—Less Healthy?
Currently, we have only glimpses into how lesbians’ health compares to that of heterosexual women. That’s because collection of sexual orientation and gender identity data is a recent addition to many research studies and nationally representative surveys. Some of that progress was eroded during the Trump administration, leaving gaps in the data we do have.
But what do those glimpses we do have tell us? Well, lesbians are more likely to report poorer general health, higher numbers of chronic health conditions, and higher rates of asthma, some cancers, and cardiovascular disease than are their heterosexual counterparts.1 Lesbians develop type 2 diabetes at younger ages than heterosexual women.2
It’s not because there’s some unavoidable genetic link between lesbianism and poor health. Rather, lesbians’ poorer health likely derives largely from the combined impact of the “social determinates of health,” and lesbians’ personal health risk behaviors.
The social determinates of health are defined by the CDC as the “…conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of-life risks and outcomes.” The CDC identifies five social determinates as “key”: healthcare access and quality, education access and quality, social and community context, economic stability, and neighborhood/built environment.
But why might these factors disproportionately impact lesbians in ways that result in poorer health? For one, living within a family or community where LGBTQ people are unwelcome or vilified can keep people closeted or—if they emerge—can subject them to ostracism, bullying, or violence. No matter the choice, the situation is very stressful; chronic stress can impact physical health.
Secondly, healthcare access and quality rely on many things, including an adequate supply of healthcare providers and affordability. Many areas of the US have a shortage of healthcare providers. That impacts everyone, regardless of sexual orientation. But it may impact lesbians more, as it adds yet another level of difficulty in the search for a provider who is truly welcoming and knowledgeable.
Healthcare affordability often depends on the availability of health insurance. Before passage of the Affordable Care Act (ACA) and the Supreme Court’s decisions recognizing same-sex marriage, it could be harder for lesbians to obtain good health insurance—e.g., while a heterosexual spouse could be insured under their spouse’s employer-based plan, the same was seldom true of a lesbian partner.
And for a third, economic stability might depend upon a choice between remaining closeted—but employed, and being authentic—but out of a job. Again, a recipe for chronic stress and (if you lost your job) limited or no access to health insurance.
It’s not uncommon for an individual to be challenged across many of the determinates—e.g., to have a non-supportive family; no luck finding a welcoming, knowledgeable healthcare provider; and employer-sponsored health insurance that depends on secrecy. The negative impact on a person’s health can be compounded as the challenges pile up.
The social determinates can and do change in positive ways. But these changes arrive over the long term. So meanwhile, what can a person do to be as healthy as possible?
Reducing personal risk factors—which are largely within an individual’s control—is a good place to start. Those risk factors include tobacco use, excessive drinking, and weight gain. Some are more prevalent among lesbians. A CDC study found that nearly 50 percent of lesbians reported drinking to excess during the past year, compared to 34 percent of heterosexual women. Twenty-five percent of lesbians were current cigarette smokers v. 14 percent of heterosexual women. Seventy percent of lesbians were overweight or obese, compared to 63 percent of heterosexual women.3
Smoking, excessive drinking, and obesity play a role in the development of several cancers and cardiovascular disease. Obesity is a factor in the development of type 2 diabetes, which is also implicated in cardiovascular disease. Since lesbians have higher rates of personal risk factors for developing these diseases than heterosexual women, it’s not surprising they have higher rates of disease.
Societal change most often arrives slowly. But individual change can come in an instant and can yield substantial individual health benefits. There’s that saying about changing the things one can; choosing healthy behaviors is a great place to start.
1Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender Individuals in the US, Kaiser Family Foundation Issue Brief, May 2018
2Roskl of Type 2 Diabetes Among Lesbian, Bisexual, and Heterosexual Women: Finding from the Nurses’ Health Study II, Diabetes Care, July 2018
3Prevalence of Five Health-Related Behaviors for Chronic Disease Prevention Among Sexual and Gender Minority Adults—25 US States and Guam, 2016, CDC Morbidity and Mortality Weekly Report, August 17, 2018