The literature has repeatedly shown the presence of health inequalities in the lesbian, gay and bisexual (LGB) population compared to the heterosexual population. For example, Statistics Canada reported in 2020 that people from the LGB community were three times more likely to have experienced acts of physical or sexual violence in their lifetime. They would also be more likely to suffer from depression, to experience anxiety, to have suicidal thoughts and to abuse substances than their heterosexual counterparts.
However, few studies have focused on mortality in this community, more specifically on deaths whose causes are easier to prevent.
A pan-Canadian research team looked into the question and compared avoidable mortality estimates for lesbian, gay and bisexual adults with those of heterosexual individuals in Canada.
“Respondents from the LGB community had a higher risk of all-cause mortality, and these risks were higher specifically for heart disease, accidents, HIV and suicide,” says Olivier Ferlatte, professor at the ‘School of Public Health of the University of Montreal and researcher at the Center for Public Health Research who participated in thestudy.
Social and economic causes
Olivier Ferlatte, professor at the School of Public Health at the University of Montreal
For the research team, this higher mortality among lesbian, gay and bisexual people can be partly explained by the phenomenon of “minority stress”. This theory predicts that an accumulation of external threats, real and perceived, towards sexual minorities (e.g. violence, discrimination or social exclusion), coupled with internalized notions of shame and concealment of sexual identity, leads to psychological, physiological and behavioral responses.
“Because of this stress, many LGB people perceive or anticipate that healthcare providers will stigmatize their minority sexual orientation or have directly experienced discrimination or stigma, and therefore delay or avoid medical consultations. », specifies Olivier Ferlatte.
The increased mortality could also be explained by the fact that LGB people have more difficulty accessing social resources (they are less in a couple, therefore less surrounded by family and have a less extensive support network) and material resources (their income is lower).
Structural interventions needed
For Olivier Ferlatte, the solution to correct this gap would be to facilitate access to primary and preventive health care adapted to LGB people, where “openness, benevolence and acceptance take precedence”.
In this regard, he insists on the fact that the health of members of the LGB community is a global issue that goes far beyond sexual health, hence the importance of investing more in front-line care, which promotes the diagnosis early onset of several conditions, including cardiovascular disease.
Olivier Ferlatte also deplores the lack of funding for mental health in the country and recalls that Canada is one of the only G7 countries not to have a national strategy for suicide prevention. “This context leads to significant barriers to access to mental health care, not to mention that you have to wait several months and pay large sums to undertake psychotherapy,” he says.
Finally, the researcher believes that we should also invest more in research concerning the LGB community to better understand its needs and particularities. “We are the first research group to describe preventable mortality in this portion of the population,” he says. We need to monitor this reality closely and then determine what types of interventions could reduce health inequalities among sexual and gender minorities.