York Law School, University of York, York, UK
School for Policy Studies, University of Bristol, Bristol, UK.
J Epidemiol Community Health. 2020 May;74(5):408-411. doi: 10.1136/jech-2019-213068. Epub 2020 Feb 21.
Lesbian, gay, bisexual and trans+ (LGBT+) people report poorer health than the general population and worse experiences of healthcare particularly cancer, palliative/end-of-life, dementia and mental health provision. This is attributable to: (a) social inequalities, including 'minority stress'; (b) associated health-risk behaviours (eg, smoking, excessive drug/alcohol use, obesity); (c) loneliness and isolation, affecting physical/mental health and mortality; (d) anticipated/experienced discrimination and (e) inadequate understandings of needs among healthcare providers. Older LGBT+ people are particularly affected, due to the effects of both cumulative disadvantage and ageing. There is a need for greater and more robust research data to support growing international and national government initiatives aimed at addressing these health inequalities. We identify seven key research strategies: (1) Production of large data sets; (2) Comparative data collection; (3) Addressing diversity and intersectionality among LGBT+ older people; (4) Investigation of healthcare services' capacity to deliver LGBT+ affirmative healthcare and associated education and training needs; (5) Identification of effective health promotion and/or treatment interventions for older LGBT+ people, and subgroups within this umbrella category; (6) Development of an (older) LGBT+ health equity model; (7) Utilisation of social justice concepts to ensure meaningful, change-orientated data production which will inform and support government policy, health promotion and healthcare interventions.
女同性恋、男同性恋、双性恋和跨性别者（LGBT+）人群报告称，他们的健康状况比一般人群差，在医疗保健方面的体验也更差，尤其是在癌症、姑息治疗/临终关怀、痴呆症和精神卫生服务方面。这归因于：（a）社会不平等，包括“少数群体压力”；（b）相关的健康风险行为（例如，吸烟、过度使用药物/酒精、肥胖）；（c）孤独和隔离，影响身心健康和死亡率；（d）预期/经历的歧视；（e）医疗保健提供者对需求的理解不足。年长的 LGBT+人群受到的影响尤其大，这是由于累积劣势和老龄化的双重影响。需要更多和更强大的研究数据来支持日益增长的国际和国家政府倡议，以解决这些健康不平等问题。我们确定了七种关键的研究策略：（1）生成大型数据集；（2）进行比较数据收集；（3）解决 LGBT+老年人多样性和交叉性问题；（4）调查医疗保健服务提供 LGBT+友好型医疗保健以及相关教育和培训需求的能力；（5）确定针对年长 LGBT+人群及其伞状类别内各亚组的有效健康促进和/或治疗干预措施；（6）制定（年长）LGBT+健康公平模型；（7）利用社会公正概念确保有意义、以改变为导向的数据生成，从而为政府政策、健康促进和医疗保健干预措施提供信息和支持。
