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LGBTTIQQ2SA and Cultural and Religious Competencies in Healthcare
By: Nataliya Zlotnikov, HBSc, MSc


The world is reopening: Clinics across Canada, the United States, and many other nations of the world are in varying states of once again opening their doors as the majority of the world watches the first wave of COVID-19 subside. 

It’s also June, a month in which people of LGBTTIQQ2SA communities celebrate Pride. This year, due to COVID-19, Pride Toronto, has opted to celebrate Pride virtually, with Virtual Pride. 

Here at Embodia, we understand that persons in LGBTQ+ communities often face considerably more obstacles, discrimination, as well as physical and mental health consequences when attempting to seek out, and see health care practitioners (HCPs); these issues can be further amplified based on socioeconomic status and ethnicity. As the writer of this blog, I understand that in writing this, I am writing on behalf of other people, therefore, I do not truly understand their experience. It is important to remember that we cannot truly understand another’s experience and we must try to avoid colonization. 

We invite you, the HCP, to join us in this thorough course from Pelvic Health Solutions. It is truly a wonderful and informative course which taught me a great deal. Whether you identify as one of the letters of LGBTTIQQ2SA, would like to obtain a deeper understanding of the unique health care needs of the LGBTQ+ communities in order to provide better care, or simply would like to become more informed and competent on issues of gender, sex, orientation as well as the multitude of ways in which age, race, ethnicity, cultural beliefs and faith systems tie in to healthcare, and more specifically to pelvic health, please take a look at Pelvic Health Solutions’ course: Cultural Competencies in Pelvic Health

In This Online Physiotherapy Course, You’ll Learn:

  • How to develop an understanding of specific traditions/faith systems and their cultural expression of sex and intimacy.
  • How to develop the knowledge and skills to improve the health care experience of individuals with different cultures/faith systems than your own. Christian, Muslim, Jewish and Hindu faith systems will be explored. Aboriginal culture as it pertains to sexual identity, roles and function will also be explored.
  • How to develop an understanding of the health care needs of LGBTQ individuals, which will enable them to implement and to advocate for LGBTQ positive change.
  • How to develop the knowledge and skills to understand and improve LGBTQ health care delivery at a systemic level and at a clinical level.
  • What all the letters in LGBTTIQQ2SA stand for!

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As we mentioned, this course is quite thorough, so it would be naive to try to package all of the extensive information discussed in it into one short blog. Instead, we will briefly touch on just a few of the topics examined in the course:

Homophobia, Heterosexism and Heteronormativity:

Although I certainly hope that we all know what homophobia is, heterosexism and heteronormativity may be terms with which we are less familiar, so let us define all three here:

  • Homophobia: A fear or disdain held towards homosexuals. This can happen at a micro level (interpersonal relations), or at a macro level (legislation and policy formation).
  • Heteronormativity: The assumption that heterosexuality is the preferred, natural, and assumed way to be. It is the assumption that anyone you meet is straight, unless you know that they are not, as well as the assumption that homosexuality is unnatural. 
  • Heterosexism: How we use heteronormativity to organize society, i.e. assuming that heterosexuality is natural and is the only way to be, therefore, only straight people are allowed to get married. Heterosexism is often undetected, .e.g. in healthcare, assuming that a person’s partner is of a certain sex. 

We live in societies in which heterosexism, heteronormativity, and homophobia are all present and create significant barriers for LGBTQ+ identified persons to receive quality health care. Heterosexism, heteronormativity, and homophobia within our societies open the door to discrimination and violence towards LGBTQ+ people. These three H’s, along with social determinants of health (discussed below), are barriers to healthcare for LGBTQ+ populations and increase their vulnerability to ill health.

Social Determinants of Health:

Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national, and local levels. The SDOH are mostly responsible for health inequities (World Health Organization, 2020). A few examples of SDOH include: Do you have: physical health, social support, economic stability/work security, access to healthcare, access to education?

Now, based on the previous section above, we understand that laws in our societies give preferential treatment to cis-gendered heterosexual persons. And since we now also understand that SDOH are shaped by numerous things including power. And since I don’t think that anyone will contest that those who make the laws have the power. We can therefore safely assume that current social organization will inevitably result in health inequities (and consequently decreased mental and physical health and well-being) for LGBTQ+ persons. But, we actually don’t have to assume, literature is rife with studies indicating precisely this. 

Here are just a few examples:

Shocking? Here are a few more statistics specifically regarding transdenger or gender non-conforming people for the United States/Canada:

If you are appalled and offended at this data, you are quite justified in your sentiments; this is simply unacceptable.

As we mentioned, the information we have just discussed is the tip of the iceberg in a constantly evolving conversation. Oftentimes, LGBTQ+ persons do not seek HCPs even when they need to due to fear of some of these aforementioned issues. Imagine having to see your doctor and your doctor having no idea how to treat or assess your even most basic concerns. We’ve said it in previous blogs and it stands true here as well: It is our responsibility as HCPs to inform ourselves about these issues so that we may provide equitable and respectful care to all our patients, and so that our patients have no reservations about coming to see us. We urge you to become more educated by signing up for this course. To facilitate this educaction, we’ve also included another brief video from the course below, discussing some LGBTQ community resources so that you may provide them to current patients if they require them. The health of one is the health of all. 

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