The Systemic Barriers Minority Populations Face in Healthcare

While most people believe that the healthcare system provides quality care for all patients, this is not necessarily the case. Minority patients, including people of the LGBTQI+ community, have a difficult time communicating health issues and feeling safe when being treated by unknowledgeable professionals. The lack of education and resources in the healthcare system leads to poor health and more health problems such as PTSD and depression in minorities. Few actions are being taken to combat this discrimination and failure of quality in care, and education is of the utmost importance when creating an inclusive healthcare system for all minority groups.


One of the largest barriers to healthcare that people from minority communities experience is lack of access due to the professionals having insufficient knowledge of their experience [1]. There are many people of color and of the LGBTQI+ community who report discrimination in the doctor’s office. Across the country, providers tend to demonstrate a lack of cultural competence towards their patients, especially transgender people of color. With regards to transgender medical care, this lack of knowledge about transgender health issues is mainly rooted in the medical training given to these professionals, which is catered to the cis, white, and male communities. This lack of knowledge and, more importantly, familiarity when it comes to treating transgender patients prevents members of the LGBTQI+ community, especially transgender members, from receiving proper care. For some people with intersex variance, interventions may have lifelong consequences such as surgical scarring, continued surgeries, or the effects of trauma linked to surgery due to the emotional impact of discrimination and stigma [2].


A member of the community recalls a specific discriminatory instance when they first received an intersex diagnosis at the age of sixteen. They had gone to a general practitioner to find out why they had not begun to menstruate. After multiple visits, bloodwork, and trips to specialists, they were told that they would not be able to have children and that their body needed a bit of a push if it were going to more adequately “feminize” [2]. This instance is not only handled poorly but also left the sixteen-year old with emotional trauma and scarring. To reduce this barrier in the minority community experience, which is created by poor education, educational material about treating members of the LGBTQI+ community should be implemented into medical school curriculums. Biases towards minorities need to be assessed to improve the care and knowledge that providers provide and possess. This knowledge includes learning about the medical and emotional issues minorities face and how to treat them in an affirmative manner.


With this lack of knowledge comes fear and stigma against minority groups; and since the healthcare system primarily caters cisgender people of Caucasian descent, most minorities are marginalized even further [1]. This leads to discrimination in hospitals and clinics and causes many women, people of color, and members of the LGBTQI+ community to refuse or postpone care to avoid this aggression [3]. From 2012 to 2013, studies that surveyed about 200 participants determined that transgender participants were more likely to delay seeking care and report negative effects of disclosing their identity to their provider when compared to their cisgender counterparts [3]. Women were also more likely to get delayed treatment and less comprehensive care when compared with their male counterparts because of physician biases [4]. For example, orthopedic surgeons are 22 times more likely to recommend total knee replacement to a male patient than a female patient despite exhibiting similar symptoms. Women also fail to receive further diagnoses for the same symptoms when taken to the hospital, leading to higher chances of misdiagnoses or no diagnosis at all, and thus, worse health overall [4]. This also applies to the LGBTQI+ community. The PROMIS Global Short Form, which is a carefully standardized psychometric instrument that measures the individuals’ global health, showed that their overall physical and mental health status was deemed lower than the average person due to delayed care.


Many members of the LGBTQI+ community face major depressive disorder (MDD) or posttraumatic stress disorder (PTSD) due to stress from the prejudice, social stigma, and discrimination they face [5]. This stress can also exhibit in physical forms, which is usually ignored or pushed off since going to the professionals causes extra stress due to their minority status. To cope with the mental and emotional stress that many minorities experience, about 30% of transgender participants in a nationwide survey noted that they resorted to the use of drugs and alcohol [6]. Male participants had an easier time receiving help for their addiction and other issues while minorities, especially transgender participants, were denied services or postponed medical treatment due to LGBTQ-related discrimination. Addictions tend to have a greater effect on minority communities as the resources and education related to these issues are limited [6]. Unfortunately, there has been no meaningful attempt to educate or alter the workforce to cater to the needs of different minority groups including transgender individuals [1]. Due to these limited efforts, it is more difficult for minority groups to feel comfortable and reach out for help from healthcare professionals, which only puts them at a disadvantage mentally and physically. This also leads to postponing medical services leading to health issues worsening at a faster rate in minority groups compared to others [5].


A few different courses of action are helping to actively combat discrimination against minorities in the healthcare system, from individual action to broader change influencing healthcare systems. There are many transgender patients who decide to take matters into their own hands and personally educate their providers on their specific needs [5]. This results in catered care for the individuals if the professionals are willing to cooperate, but does not create institutional change. For a wide-encompassing change, the Gay and Lesbian Medical Association produced Guidelines for Care of Lesbian, Gay, Bisexual and Transgender Patients in 2014 [5]. These guidelines are meant to be used by primary care health care providers and include recommendations for staff sensitivity training. As of now, there is no current information on the efficacy of these guidelines. However, with the implementation of this and other similar programs, nation-wide change can occur, providing a safer and more inclusive space for minorities, especially transgender patients.


Minority populations, in general, have limited access to healthcare services. Subgroups such as transgender and queer populations within the LGBTQI+ community are especially vulnerable to experiencing discrimination and microaggressions based on their identity. These issues inflate the health disparities that minority communities experience and act as a hurdle towards optimizing their health and well-being. Creating a safer space for minority patients is of utmost importance, but requires comprehensive education of the healthcare workforce.


References:

1) Safer, Joshua D., et al. “Barriers to Health Care for Transgender Individuals.” Current Opinion in Endocrinology, Diabetes, and Obesity, vol. 23, no. 2, Apr. 2016, pp. 168–71. PubMed Central, doi:10.1097/MED.0000000000000227.

2) Zeeman, Laetitia, and Kay Aranda. “A Systematic Review of the Health and Healthcare Inequalities for People with Intersex Variance.” International Journal of Environmental Research and Public Health, MDPI, 8 Sept. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7559554/.

3) Macapagal, Kathryn, et al. “Differences in Healthcare Access, Use, and Experiences Within a Community Sample of Racially Diverse Lesbian, Gay, Bisexual, Transgender, and Questioning Emerging Adults.” LGBT Health, vol. 3, no. 6, Dec. 2016, pp. 434–42. PubMed Central, doi:10.1089/lgbt.2015.0124.

4) Kent, Jennifer A., et al. “Gender Disparities in Health Care.” Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, vol. 79, no. 5, 2012, pp. 555–59. Wiley Online Library, doi:https://doi.org/10.1002/msj.21336.

5) Baptiste-Roberts, Kesha, et al. “Addressing Healthcare Disparities among Sexual Minorities.” Obstetrics and Gynecology Clinics of North America, vol. 44, no. 1, Mar. 2017, pp. 71–80. PubMed Central, doi:10.1016/j.ogc.2016.11.003.

6) “Data Dictionary.” National Institutes of Health, U.S. Department of Health and Human Services, cdrns.nih.gov/data/data-dictionary


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