European-wide monitoring of sexual and gender minority health: a necessary and feasible task for advancing health equity
Year: 2019
Type: editorial
Abstract: The time has arrived for the health of sexual and gender minority (i.e. lesbian, gay, bisexual, and transgender) Europeans to be assessed. It has become increasingly clear that this likely-sizeable proportion of the European population experiences frequent discrimination, harassment and victimization; often conceals its identity and behavior from family members, friends, neighbors and co-workers; and occupies a marginalized existence, contributing to health inequities across the region.1 Yet the specific health needs of the sexual and gender minority population are largely unknown since most national and cross-European health surveys do not assess the population’s sexual orientation and transgender experience. Indeed, by not being monitored, sexual and gender minority individuals remain invisible to those responsible for promoting population health. Researchers and policy makers agree that reducing health disparities and providing equal access to high-quality healthcare represent fundamental goals of public health research and practice and fundamental human rights.2 Studies from the few European countries that do assess sexual orientation in their national health surveys, such as Sweden, the Netherlands and the UK, show that sexual minority individuals represent a disproportionately high-risk population for mental distress, physical health concerns and other indicators of poor life satisfaction.3 While even less is known about the health of transgender populations, existing research suggests that this population is also at very high risk.3 In an effort to encourage more awareness of sexual and gender minority health needs in Europe, a Sexual and Gender Minority Health section was created within the European Public Health Association in 2016 (https://eupha.org/sexual-and-gender-minority-health). The section has organized a number of workshops during recent annual conferences of the European Public Health Association. During the most recent conference in Ljubljana, the section organized a roundtable workshop discussion about strategies for including questions regarding sexual orientation and gender identity in national and cross-European health surveys. An essential next step to improving the health of sexual and gender minority individuals is to adapt representative population-based health surveys to enable the assessment of health in these populations. Such monitoring, requiring the addition of a few questions regarding sexual orientation and gender identity to existing or upcoming national health surveys, can facilitate the allocation of resources to sexual and gender minority health needs, the development of clinical interventions and efficient preventive activities to reduce health disparities affecting this group. Several arguments against including questions on sexual and gender minority status in health surveys are often brought forward, including concerns that: sexual and gender minority individuals are not willing to disclose their identity in surveys, sexual and gender minority populations are too small or not possible to reach in population-based surveys and knowledge is lacking concerning how to ask questions about sexual and gender minority health. Of greater concern is that the national climate surrounding sexual and gender minorities varies greatly across Europe and recent studies have demonstrated that this variation in structural discrimination is directly associated with sexual and gender minority individual’s life satisfaction as well as their ability to openly express their identities.1 Given the great variation in discrimination and sexual and gender minority individuals’ visibility across Europe, it is likely that the resistance among governments to monitoring the health of these groups is much stronger in countries with high degree of structural discrimination. A lack of government trust among sexual and gender minority individuals living in high-stigma countries might also reduce sexual and gender minority individuals’ willingness to disclose their status. Regardless of the structural environment of any given country, public health officials in all European countries need to argue for the importance of monitoring the health of sexual and gender minority individuals and promote the inclusion of brief survey questions and practicable assessment structures regarding sexual and gender minority experiences to national and European-wide agencies with responsibilities for population health monitoring. The inclusion of a few straightforward questions in population health monitoring surveys, with strong guarantees that sensitive personal information will be protected by universal safeguards, is a feasible goal which would vastly increase the public health field’s ability to study and reduce the disproportionate ill health affecting sexual and gender minority individuals across Europe.4,5 We would like to thank Charlotte Deogan (Public Health Agency of Sweden, Sweden), Igor Grabovac (Medizinische Universitat Wien, Department of Social and Preventive Medicine, Austria) and Nicole Rosenhötter (Landeszentrum Gesundheit NRW, Fachgruppe Gesundheitsberichterstattung, Germany) for their participation in the roundtable workshop: ‘Strategies to Monitor the Health and Health Care Needs of LGBT Individuals across Europe’ at the 11th European Public Health Conference in Ljubljana. Conflicts of interest: None declared.
Language: English
Subfield: Social Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: hybrid
Estimated APC paid: $3,181
OpenAlex ID: W2922656102