Reducing Health inequalities experienced by LGBTI people

Health4LGBTI Project was a 2 year project (2016-2018) funded by the European Parliament and implemented via the European Commission under its social determinants and health inequalities programme.

The project was a response by the Parliament to growing evidence demonstrating that LGBTI populations across and within EU countries experience significant health inequalities both in terms of poorer health outcomes and barriers/negative experiences of accessing healthcare compared to non-LGBT populations.

These experiences can translate into a risk of depression, suicide and self‐harm, violence, substance misuse and HIV infection. In collaboration with partnerships across six EU countries (Belgium, Bulgaria, Italy, Lithuania, Poland and the UK), Health4LGBTI aimed to improve understandings of how best to reduce specific health inequalities experienced by lesbian, gay, bisexual, trans and intersex (LGBTI) people. It focused on overlapping inequalities stemming from discrimination and unfair treatment on other grounds (e.g. age, status, income). Project activities included:

• Primary research led by Prof Sherriff and his team included a global state-of-the-art scientific review (published in the European Journal of Public Health), a comprehensive scoping review across 27 Member States (published in Health Expectations), and two focus groups studies across the six EU countries into health needs and challenges faced by LGBTI people and key barriers faced by health professionals when providing care for LGBTI people (in Culture, Health and Society).

• Building on UoB’s initial research, development of a comprehensive training programme aimed at increasing the knowledge, attitudes and skills of healthcare professionals when providing healthcare to LGBTI people adaptable to all EU countries.

• Piloting of the training package in 6 EU countries (Belgium, Bulgaria, Italy, Lithuania, Poland and UK).

• A final European conference in Brussels (February 2018) presenting the results of the project to LGBTI communities, the European Commission, European Parliament (MEPs), and Ministers of Health and their equivalents (134 persons registered from 25 EU countries, and health ministry’s officials from 16 EU countries).

The primary research of Health4LGBTI led by the Brighton team is ground breaking in its scope, quality, and reach. The global review of inequalities (Zeeman et al., 2017, 2018) represents one of the largest scientific reviews ever conducted in the field of LGBTI health inequalities.

The research drew attention (inter alia) to the existence of key health inequalities, barriers, and discrimination based on sexual orientation, gender identity, and sex characteristics of LGBTI people.

Similar, the comprehensive scoping review (CSR) conducted by the team (Zeeman et al., 2017) was the first attempt to explore ‘hidden’ grey literature on a truly European scale. The research developed a bespoke rapid-review template and engaged with 27 Member States to conduct reviews of grey literature in national languages which was then translated into English to provide an extensive dataset that has been analysed and recently published by the team (Sherriff et al. , 2018).

The UoB project team conducted two focus groups studies in parallel to the above across six EU countries into health needs and challenges faced by LGBTI people and key barriers faced by health professionals when providing care (see McGlynn et al., 2018). The research showed that discrimination towards LGBTI people often appeared to be underpinned by three related assumptions about LGBTI-related healthcare held by HCPs. First, that patients are heterosexual, cisgender, and non-intersex by default. Second, that LGBTI people do not experience significant problems due to their sexual orientation, gender identity, and/or sex characteristics. Third, that a person’s LGBTI subjectivity is mostly irrelevant for healthcare. The data suggested that it is precisely these assumptions which manifest as significant barriers for LGBTI people seeking healthcare in EU Member States.

Together the core research activities by the UoB team have been used to develop the comprehensive Health4LGBTI training programme for health professionals.
Evaluation data in 6 EU Member States has shown promising results (Donisi et al., 2019); with increases in culturally competent knowledge and skills, attitudinal change, and changes in both day-to-day practices as well as relevant and necessary changes within health systems (e.g. recording mechanisms). Overall, the evaluation shows that the Health4LGBTI training model represents a promising intervention to improve knowledge, attitudes and behaviour/skills of HCPs improving LGBTI cultural competence.