Rural gays + Americans face health disparities, but societies reveal their strengths

Rural gays + Americans face health disparities, but societies reveal their strengths

There is little research on rural LGBTQ+ health

Rural Lesbian, Gay, Bisexual, and Transgender (LGBTQ+) Population Range Estimated Number Three to four million people And live in every corner of the country. However, despite the growing recognition of the importance of examining intersections of demographic characteristics in public health research and health services, insufficient attention has been paid to the health and health care of rural LGBTQ populations.

To be clear, there is a large body of research that documents health inequalities separately by sexual orientation, gender identity, and bribery. In short, members of the LGBTQ+ community experience weaker health And the Worse access to care from heterosexual and gender-conforming peers, likely as a result of discrimination, stigma, and minority tension. Rural people are also experienced weaker health And the Worse access to care than their urban counterparts due to issues including provider shortages, hospital closures, and limited access to healthy foods and economic resources in rural areas. We argue that understanding what is happening at this intersection has never been more important. Amid ongoing discussions about how best to promote health equality including spirituality, sexual orientation, and gender identity, rural LGBTI people deserve to focus on healthcare and health equity research.

What did our research do?

Using a combination of secondary data analyses, key informant interviews, and case studies, our team, made up of researchers at the University of Minnesota and Vanderbilt University, set out to understand the health disparities affecting LGBT people in rural areas across the United States. Research summaries and comprehensive descriptions of our team’s work are publicly available at University of Minnesota Rural Health Research Center website. Unsurprisingly, our studies revealed health disparities that paint a bleak picture for many residents of rural LGBTQ+ communities in terms of health and access to care.

Equally important, we highlight success stories and promising models supporting rural LGBTQ+ health based on what communities share with us in key informant interviews. Research in this large and diverse community cannot and should not focus exclusively on disability. There are painful disparities, resilience, creativity, and hope at the intersections between rurality and LGBTQ+ health. Both are worth our time and attention. As such, we present here LGBTQ+ rural health disparities and strength markers.

What our research found

Our analyzes using Centers for Disease Control and Prevention (CDC) data from 2019 and 2020 National Health Interview Survey (NHIS) found inequality in chronic diseasesAnd the self-categorized healthAnd the Psychological healthAnd the Social and emotional support Among rural LGBTQ+ adults. The prevalence of chronic conditions can reveal inequities in health and health care at the population level, where the management of chronic conditions requires reliable access to routine health care. We found that lesbian, gay, and bisexual adults in rural areas had more chronic conditions overall when compared to urban adults from the LGBT and heterosexual populations in both rural and urban settings, with more than Two out of five LGBTI adults in rural areas report three or more chronic conditions. This is in addition to adults in rural areas of the LGB who report Highest prevalence of living with both depression and anxiety disorders.

Social contact is an essential aspect of healthy living, yet LGB adults in rural areas reported the lowest levels to meet their social and emotional needs. We found that the COVID-19 pandemic has exacerbated inequalities in social and emotional support, with rural LGBT adults reporting the largest decrease in social and emotional support compared to the year prior to the COVID-19 pandemic.

We also learned through NHIS that rural LGB adults reported worse self-rating validity compared to their urban peers and heterosexual people. Approximately one in three Rural LGBT adults described their health as poor or fair rather than excellent, very good, or good, compared to one in five heterosexual rural adults. Further analyzes using CDC data from Behavioral Risk Factor Monitoring System confirmed Disparities in self-rating of health. Because these analyzes of two large, nationally representative data sets revealed worse self-rating validity of rural adults from LGB than urban and heterosexual adults, our studies provide strong evidence that the intersection of LGBTQ+ identities and rurality can compound health disparities.

However, secondary data analysis can only reveal so much. To add a nuance, we conducted a series of 14 Key informants interviews with experts from LGBTQ+ advocacy organizations. We asked key informants for their views on rural health and well-being issues. Through these interviews, respondents identified the two health challenges most common to LGBT residents in rural areas, namely lack of resources, limited cultural awareness, and modesty among service providers and health care staff. Limited resources include lack of funding, lack of transportation, and lack of access to broadband Internet services. In addition to describing these barriers, the interviewees also recommended changes to improve health and well-being among LGBT people in rural areas. These responses highlighted the importance of education for service providers and community members, as well as the necessity of non-discrimination policies to address existing inequalities and protect LGBT residents from discrimination in both rural and urban areas.

Currently, there is no federal law prohibiting discrimination based on sexual orientation and gender identity. Instead, state legislation creates scope protection mixtureSome prohibit discrimination on the basis of sexual orientation or gender identity only, but not both. Less than half of all states currently have laws explicitly prohibiting discrimination on the basis of both sexual orientation and gender identity, and very rural states are Not well represented among that group. Furthermore, 18 countries do not have explicit protections for discrimination based on sexual orientation or gender identity. These disparities exist at the state level in protecting LGBTQ+ residents while basic rights, such as the right to same-sex marriage, are being discussed again at the federal level in the wake of the US Supreme Court in June 2022 Dobbs vs Women’s Health Jackson resolution. Given the aforementioned inequalities in health and access to health care, rural LGBTI residents may face the greatest risks from this lack of equal protection.

Research that focuses solely on deficits has its limits, and can do damage, if not combined with studies that acknowledge the work that is being done to confront inequality and uncover strengths in rural LGBTQ+ communities. To this end, we conducted a series of case studies that focused on success stories and promising models in rural LGBTQ areas. They are drawn from across the country and represent organizations with varying levels of capacity and access to resources.

For example, we spoke to representatives of organizations working in Improve access To LGBTQ+ rural health care confirmation. Initiatives ranged in scope and form, but broadly included education and training in cultural humility for rural health care providers and all clinic staff. Respondents also emphasized that LGBTQ+ patients’ personal experiences in a hospital or clinic are influenced by more than just the doctor they see. It remains important for front desk staff, support staff, and clinical assistants to receive training and be competent in LGBTQ+ health.

We also spoke to leaders of three organizations in Rural communities build inclusive spaces for LGBTQ+ residents. Whether through educational events, local advocacy, or simply offering a social space, these rural community organizations work to make LGBTQ+ residents feel connected. These organizations made it clear that feeling cared for and included is vital to the health and well-being of everyone in their communities. Using a broad definition of health to include social bonds and a sense of belonging, we also highlighted Two Celebrations of Pride in Small Country Towns. Both festivals (held in Pine, Minnesota, and Hastings, Nebraska) have grown since their inception and are proud of the work they have done to increase the visibility and acceptance of LGBTQ+ residents in their communities. Across these examples, organizations and community members have drawn on the strengths of their rural areas to create inclusive and healthy environments for LGBT residents in rural areas.

to go forward

Many advances in LGBTQ+ rights and equality have been made in recent decades, but more work is needed to ensure healthy representation and equality for Americans from the LGBTQ+ community. First, an extensive data collection process that includes nuances of spirituality, sexual orientation, and gender identity is essential for research and health policy intervention for this large, growing, and diverse population. Throughout this commentary, we use “LGBTQ+” to refer broadly to the population studied in our research and to highlight the power and interdependence of the work to advance rights and improve health for both sexual and gender minorities. However, most national health surveys collect minimal data on gender identity, which limits their usefulness in studying transgender populations, which face unique challenges and disparities in addition to those of their LGB peers. Increasing data collection on rural LGBTQ+ individuals, but particularly on rural transgender and gender non-conforming people, is critical to increasing visibility and reducing the disparities affecting everyone in the LGBTQ+ community. Such data must be collected Follow best practices It is conducted with and reported to rural LGBTQ+ communities. The 2022 Trans US SurveyWhich explicitly asks for rural representation, is a step in the right direction and will provide the information urgently needed.

There is also an urgent need to pay attention to the health of LGBT people in rural areas, especially in light of the increasing number of homophobic and transphobic bills being introduced in state legislatures. according to human rights campaign, 36 states introduced or passed anti-LGBTQ+ bills in 2022 alone. These laws range from direct goals around health care access for the transgender population to restrictions on discussion of sexual orientation in public education. Rural people have more limited choices for education And the Health Care previously; These laws will further restrict appropriate choices for rural LGBTQ+ residents, fueling anger in rural areas over LGBTQ+ health inequalities.

Meanwhile, public policy must continue to promote health and access to care for all rural communities across the country, particularly as rural residents continue to experiment. Inequality in health and mortality As a result of the COVID-19 pandemic. Such policies may include subsidies for rural health care providers or Medicaid expansion in states that have not yet expanded Medicaid—many of which have large rural populations. This is especially important for LGBTQ+ residents in rural areas, such as Rural people are less likely to have health insurance of urban residents—particularly in states that have not expanded Medicaid—and at the national level, LGBTQ+ adults are more likely to use Medicaid than their heterosexual and gender compatible counterparts.

In parallel, policymakers should consider enacting non-discriminatory protections for LGBT people to reduce exposure to interpersonal discrimination. With these legal protections, including prohibitions against discrimination included in Equality Law, local rural community organizers may feel more comfortable celebrating pride events and sponsoring LGBTQ+ events in their communities. Meanwhile, Congress has the opportunity to entrench marriage equality in federal law through Respecting the law of marriage, which would have major repercussions for the public health of LGBTI Americans. Both bills were approved in the House of Representatives but not voted on in the Senate. Ultimately, as LGBTQ+ rights and research continue to evolve, the health and well-being of members of the rural LGBTQ+ community must not be left behind.

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