Additional databases were excluded to prevent duplication. Systematic searches were carried out using six electronic databases.
3 In total, 57 relevant papers were extracted and reviewed including: systematic reviews (10), narrative reviews (3), reviews of systematic reviews (2), a meta-synthesis (1) and primary research (41). Whilst such a review may not necessarily provide answers to addressing explicit health problems in given settings, it can nevertheless help policy makers, researchers and practitioners address concerns that occur across the data. This design was chosen due to the complex exploratory nature of the review which aimed to establish ‘what is known’ about LGBTI health and healthcare inequalities as well as produce a synthesis of current thinking that cuts across the field offering new perspectives and new areas for further research, training and policy development. rural, younger, older, refugee, those in poverty or disabled)? (iv) What are the potential barriers faced by health professionals when providing care for LGBTI people and how can these barriers be addressed? MethodsĪ narrative synthesis design was used to search global literature systematically. Therefore, this global review was undertaken as part of an EU-funded pilot project that aimed to explore the sources of and modalities for reduction of LGBTI health and healthcare inequalities by determining: (i) what are the causes of LGBTI health inequalities? (ii) What is known about the health inequalities faced by LGBTI people as it relates to healthcare settings? (iii) What is known about the health inequalities of LGBTI people on vulnerable intersections (e.g. 20 Tackling inequalities requires a blended approach by addressing the fundamental causes of inequalities, preventing harmful wider social influences and mitigating against negative effects on individuals. Indeed, in 2016 this journal noted the need for greater international research to inform LGBT public health initiatives.
Moreover, there is a significant lack of research regarding how to address these inequalities. 6, 19Īs health inequalities have multiple root causes, reducing these inequalities is complex and there is no simple solution. 17, 18 This is not only a social justice issue, but growing evidence links these experiences and related minority stress to health inequalities by showing that discriminatory behaviour can impact negatively on both mental health and physical health outcomes. 16 Despite such advances however, social exclusion, stigmatization and discrimination experienced by LGBTI people persist in many healthcare settings.
These rights include legal recognition of gender, non-discrimination in the workplace, freedom of expression and freedom of movement.
However significant obstacles remain to full recognition of LGBTI people’s fundamental rights. 6 Acknowledgement of the need to endorse and exercise the rights of LGBTI people are increasing within the EU where people are broadly protected against discrimination on grounds of sexual orientation (lesbian, gay, bisexual people), gender identity (trans people) and sex characteristics (intersex people).
Major legislative reform in recent years have resulted in significant progress towards achieving equality for LGBT people. 11–13 LGBTI patients can face bias and discrimination in healthcare settings, 13, 14 with trans patients reporting most dissatisfaction resulting in some avoiding medical treatment, including emergency care. 10 Evidence suggests that LGBTI people are more likely than the general population to report unfavourable experiences of healthcare including poor communication from health professionals and dissatisfaction with treatment and care received. 7–9 This emphasis is vital as inequalities impact on both the health outcomes of LGBTI people as well as their experiences of accessing healthcare. 1–6 Reducing health inequalities is a fundamental goal of public health and is regarded by the European Union (EU) as being one of the most important public health challenges facing its Member States. International research increasingly demonstrates that lesbian, gay, bisexual, trans and intersex (LGBTI) people are frequently marginalized and experience significant health inequalities.