The Journey Toward Healthcare Equity
Achieving a standard of equal access, educated caregivers, and respectful treatment of LGBTQ+ patients in American healthcare has been, and still is, a journey.
One of the first steps forward was the Human Rights Campaign Foundation’s Healthcare Equality Index, which began transforming healthcare for LGBTQ+ people in 2007. The first report contained 10 recommendations for healthcare facilities. Those recommendations included four foundational elements: an LGBTQ+ inclusive patient non-discrimination policy, an LGBTQ+ inclusive visitation policy, an LGBTQ+ inclusive employment non-discrimination policy, and staff training in LGBTQ+ patient-centered care.
The stakes are high. According to Do Ask, Do Tell, a project of Fenway Health in Boston, “by learning to avoid discrimination, stigmatization, and simple mistakes due to inexperience, front-line health care workers can help LGBT people avoid the ‘double whammy’ of experiencing these health problems in their daily lives, and then being discouraged from seeking the care they need.”
LGBTQ+ Health Challenges
• LGBTQ+ youth are at higher risk for HIV and other STIs and are more likely to attempt suicide.
• Gay men are at higher risk of HIV and STIs, especially within communities of color.
• LGBTQ+ populations have higher rates of smoking, alcoholism, drug use, depression, anxiety, and suicide.
• Lesbians are less likely to get mammograms and Pap tests and have higher rates of breast cancer.
• Transgender populations have a high prevalence of HIV and STIs and are less likely to have health insurance.
On the Local Level
Elizabeth Campbell, JD, is Beebe Healthcare’s first Director of Diversity, Equity, Inclusion & Belonging. Healthcare equity is a key goal for her. “Equity is providing services that someone needs,” says Campbell. “It’s not the same as equality. Equality is applying the same thing to everybody, without regard to their needs. And so, understanding what the needs may be and then providing the services that meet those needs—that’s delivering equitable care.”
Dr. William M. Chasanov, Beebe’s Vice President and Chief Population Health Officer, says, “It’s hardwired into our organization that as a patient comes into our hospital, they have an option to recognize how they would like to be identified, with he/him, she/her, they/them, and then we obviously have the companion training for our team members to understand what that means.”
Campbell adds, “This is where our team members really need to understand the why. It’s not a check-the-box exercise. This is about respect of our patients and building trust. And my research tells me that when our patients trust our medical providers more, the patient is more likely to have better outcomes…and calling someone by the wrong name or using the wrong pronoun is a very early indicator that I’m not listening to you…you’re invisible to me.”
According to Chasanov, the COVID pandemic put a spotlight on marginalized communities and inequities, which led to initiatives for testing, screening, education, prevention, and treatment. “What that did, under the guidance of Dr. Tam, our CEO,” says Chasanov, “it really put a spark underneath Beebe Healthcare to understand.” Beebe expanded its community outreach and behavioral health services. “We have, for the first time, hired psychiatrists and behavioral medicine specialists in our community, in our ambulatory practices, expanding our acute care hospital services.”
Preventive care is an essential part of health equity. “I would like to think that one of the preventive wins that occurred within the last year was the monkeypox vaccination,” says Chasanov. “We reached out to our partners such as CAMP Rehoboth and others to say we want to meet you where you are to say how can we get vaccinations to your community to try to keep you as safe as possible.”
Bayhealth, which has facilities in Milford, also trains their staff and physicians in LGBTQ+ cultural competency and in the unique health needs of the LGBTQ+ community. Their website has a page, “LGBTQ+ Inclusion at Bayhealth,” that includes a list of clinicians who specialize in LGBTQ+ services.
Recent political attacks have specifically targeted LGBTQ+ healthcare. Campbell is not deterred. “We exist to provide patient care to all of our community. That is why we are here…. We serve people who live in Sussex County, people who work in Sussex County, and people who come to visit and vacation in Sussex County…it would trouble me immensely if that ever were to be the case, that we were restricting access or falling prey to political pressure. We are professionals.… I will stand up for our community. We will provide the services that our community needs.”
There is still work to be done. Campbell acknowledges, “we’re human; people make mistakes…but the idea is to show up human, with compassion.” Chasanov adds, “As a healthcare organization leader in the community, we are on a journey. Our success in our journey is the community’s success in their journey.” ▼
Nancy Sakaduski is an award-winning writer and editor who owns Cat & Mouse Press in Lewes, Delaware.