You might consider yourself a relatively healthy person. I know I do (and I'm not trying to brag – there's a wider point here). I live on a mostly vegan diet, drink my two and a half litres of water per day and generally avoid things that make me feel stressed. Or at least that’s the story I tell myself. Until I remember that I am also a smoker (even when the tobacco packets have a photo of someone’s gangrenous foot slapped across them), never actually exercise properly (the last time I stepped foot in a gym was when I could still get a “youth” membership) and drink tequila more than any regular person should drink tequila.
I’m also a queer woman. And while this fact shouldn’t be relevant to my health, rising evidence would beg to differ. Numerous studies have shown that lesbian and bi women have worse self-reported health than our straight counterparts. We're at a higher risk of developing type 2 diabetes at a younger age than straight women, are more likely to be overweight and may be at an increased risk for breast, cervical and ovarian cancer. Lesbian women have higher rates of polycystic ovaries, too, while those in same-sex couples have higher rates of asthma. And that’s without even going into the stats around our mental health, which don’t look good either. In 2014, for example, 12 percent of lesbian women and 21 percent of bisexual women in England reported a long-term mental health problem, compared to 4 percent of heterosexual women.
So what gives? Queer women aren’t unhealthy just because we’re queer – that would be ridiculous. But as with anything relating to health disparities among certain sections of society, the answer boils down to a number of complex and interconnected factors. As Public Health England puts it: “Some burdens come directly from adult lifestyle behaviours, but many come from the wider determinants in our lives such as housing, employment and the impact from the families, communities and society in which we live.”
For starters, queer women don’t always have the most seamless relationship with health practitioners, which obviously isn't ideal when it comes to... our literal health. Queer women frequently report negative experiences with GPs – whether that be direct or indirect discrimination, or a feeling of distrust in relation to our specific health concerns (36 percent of lesbian and bi women have said a doctor or nurse had wrongly assumed they were straight). And that means a lot of us might avoid going to the doctor. This can have dire consequences. Fifteen percent of lesbian and bi women over 25 have never had a cervical screening test, for example, compared to 7 percent of women in general. With that in mind, if we're sick, we're more likely to go untreated.
But that's not the only barrier queer women face. Harri Weeks, who works at the National LGB&T Partnership – an organisation which works to reduce health inequalities and challenge homophobia, biphobia and transphobia within public services – tells me over the phone that it’s really hard to pinpoint one single factor without speaking about another when it comes to health disparities. “We look at what the environmental factors are, how they might influence behaviours and then what that means for LGBTQ people’s health outcomes,” they explain.
“There’s the fact that LGBTQ people are more often clustered in cities, for example, which can have a knock-on effect on things, like being around air pollution, or access to physical activity. There’s the fact that the safest space for these communities have for a long time been bars and clubs, which normalises things like smoking, drinking and to some extent drug use,” they continue. “And then of course there’s the mental health repercussions of living with hate crime, low level discrimination, minority stress and exclusion. The health community is beginning to recognise isolation as a big trigger for a lot of health concerns.”
Harri also points out that “homelessness, austerity and unemployment” impact marginalised communities more heavily than the general population. “When you're worrying about whether you can keep your job, or whether you can be 'out' at your job... all of those things are going to mean that healthcare and looking after yourself aren't going to be at the top of your agenda,” they explain. “And we know that accessing GPs and primary care is harder for people from LGBTQ communities. So it's coming at it from a lot of different angles.”
It would be simplistic to claim that all queer women have worse health than all straight women. Being a woman of colour, differently abled, transgender, from lower income socio-economic backgrounds and/or bisexual are all factors that are worth taking into consideration when it comes to LGBTQ women's health. If you are a trans woman receiving hormone therapy, for instance, you are at an elevated risk for cardiovascular events. “Bisexual women are more likely to have poor mental health, for example,” adds Harri, “And we also know that disabled LGBTQ women are more likely to have greater health inequalities compared to non-disabled LGBTQ women.” In other words: none of this is straight-forward. Everything is intersectional.
So what can be done about these bleak statistics? Dr Michael Brady, the NHS’ National Advisor for LGBT Health, tells me that the NHS is aware of the mental health disparities (although he does not comment on the physical health disparities, even though I ask the press office several times). “We know from a number of studies that LGBT women have higher rates of mental health issues than the general population,” he says over email, explaining that the NHS has made a renewed commitment that mental health services will grow faster than the overall NHS budget, creating a new ring-fenced local investment fund worth at least £2.3 billion a year by 2023/24. He continues: ”As part of our long-term plan the NHS is investing in mental health services, particularly for children and young people, and ensuring staff have the information and training they need to help them deliver the personalised care people need.”
That's all well and good, but what about our physical health? Or are we just all destined to breathe in air pollution and be miserable until the end of time? Well, as Harri tells me, the first thing that needs to happen is real, population-level data collection, because at the moment we are mainly relying on small and sporadic amounts of research, which doesn't make much of an impact if we want to improve services. “If we're not counted we don't count,” says Harri. “So we need to have that data collected so that we can make cases.”
But more than that, the health services around us need to pay attention to our specific health needs – whether that be mental, physical or anything in between. Because if the LGBTQ community has worse health than our straight peers, then this fact needs to be taken into consideration when it comes to treatment. “We need both specialised and targeted services – many of which will be being delivered by the LGBTQ sector, and therefore will need greater attention given to their funding and sustainability,” Harri explains, “and we simultaneously need to make the mainstream services more inclusive, and also more appropriate.”