A survey of over two million people has found that lesbian, gay and bisexual men and women in England are more likely to report poor health and unfavourable experiences of the National Health Service than their heterosexual counterparts.

We need to ensure both that doctors recognise the needs of sexual minorities, and also that sexual minorities have the same experience of care as other patients

Martin Roland

Previous studies – particularly from the US – have suggested that sexual minorities (gay, lesbian or bisexual) are more likely to suffer from poorer health, including depression and anxiety, than the general population. However, such studies have tended to be limited by sample size and a tendency to combine sexual minority groups that may have quite different experiences of health and health care.

In a study published in the Journal of General Internal Medicine, researchers from the RAND Corporation, the University of Cambridge, and Harvard Medical School, analysed data from over two million respondents to the 2009/2010 English General Practice Patient Survey. The respondents included more than 27,000 people who described themselves as gay, lesbian, or bisexual, making it one of the largest surveys of the healthcare of sexual minorities carried out anywhere.

Sexual minorities were two to three times more likely to report having a longstanding psychological or emotional problem than their heterosexual counterparts. Nearly 11% of gay men and 15% of bisexual men reported such a problem, compared with 5% of heterosexual men; similarly, just over 12% of lesbian women and almost 19% of bisexual women reported problems compared with 6% of heterosexual women. Sexual minorities were also more likely to report fair or poor general health: 22% of gay men and 26% of bisexual men compared with 20% of heterosexual men; and 25% of lesbians and 31% of bisexual women compared with 21% of heterosexual women.

Lesbian, gay and bisexual men and women were also up to 50% more likely than heterosexuals to report negative experiences with primary care services, including trust and confidence with their GP, communication with both doctors and nurses, and overall satisfaction.

Professor Martin Roland, Director of the Cambridge Centre for Health Services Research, says: “The survey shows that sexual minorities suffer both poorer health and have worse experiences when they see their GP.  We need to ensure both that doctors recognise the needs of sexual minorities, and also that sexual minorities have the same experience of care as other patients.”

Dr Marc Elliott, a principle researcher at the RAND Corporation, says: “The English General Practice Patient Survey offers a unique opportunity to survey a large subset of the UK population, giving us a clear picture of the health care experiences facing people from sexual minority groups.

“We know that sexual minorities in the United States have health problems similar to those we see in England and also face stigma, prejudice, and discrimination. It is important to find out whether the US’s health care system also tends to produce worse experiences of care for sexual minorities.”

The researchers speculate that the poorer health reported by sexual minorities may in part be due to potentially hostile and stressful social environments created by the stigma, prejudice and discrimination that they face. It is possible, too, that this hostile environment may carry over into the medical practice, leading to poor healthcare experiences. Fears of discriminatory treatment by a provider may also lead to patients postponing healthcare, which can further impair health.

James Taylor, Head of Policy at Stonewall, the lesbian, gay and bisexual charity, comments: “This research demonstrates how lesbian, gay and bisexual people continue to experience poorer mental health and poorer experiences when accessing primary care than their heterosexual counterparts. It is vital that lesbian, gay and bisexual people are able to access high quality healthcare free from discrimination and action is taken to improve their health.”

The study was funded by the Department of Health (England).

Elliott, MN et al. Sexual Minorities in England Have Poorer Health and Worse Health Care Experiences: A National Survey. Journal of General and Internal Medicine; 5 Sept 2014

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