Closets are for Clothes Strategies for Advancing LGBT2SQ Health through Changing Contexts

Presenter Disclosure Presenters: • Cliff Ledwos, Access Alliance • Devon MacFarlane, Rainbow Health Ontario • Catherine Macdonald, Alliance for Healthier Communities

Relationships to commercial interests: • • • •

Grants/Research Support: n/a Speakers Bureau/Honoraria: n/a Consulting Fees: n/a Other: n/a

Health disparities, data, and gaps

Devon MacFarlane, Director, Rainbow Health Ontario Sherbourne Health

About us • Rainbow Health Ontario creates opportunities for the health care system to better serve LGBT2SQ communities • Our mandate is to: • Support policy and program development • Cultivate practice and organizational change • Catalyze LGBT2SQ health research • Foster knowledge dissemination

•Health disparities in LGBT2SQ communities • What do we know?

• Why is this important?

Why is data important? • Evidence based practice & decision making • Understanding issues • Describing alignment with priorities • Identifying needs & opportunities • Designing, implementing & evaluating effective and appropriate interventions • Expressing potential financial impacts and return on investment

Context for disparities •

Disparities rooted in societal context: •

Stigma, discrimination, violence

•

Intersecting forms of oppression, disenfranchisement

•

Disparities, contributing factors, and interventions need to consider specificities of context and within-group differences

•

In discussing disparities, important not to inadvertently stigmatize LGBT2SQ populations

Federal data sources & repositories • Health Inequalities Data Tool

• https://health-infobase.canada.ca/health-inequalities/data-tool/ • Women and Gender Equality: Gender Based Violence Knowledge Centre

https://cfc-swc.gc.ca/violence/knowledge-connaissance/indexen.html • Stats Can: Centre for Gender, Diversity, and Inclusion Statistics Hub

https://www.statcan.gc.ca/eng/topicsstart/gender_diversity_and_inclusion

Strengthening data in Canada • • • •

National surveys and tools Health information management systems Health care administrative data Vital statistics

What we know about…. determinants of health • Childhood experiences: •

Family acceptance and rejection

•

Childhood physical and/or sexual abuse

•

Victimization in schools

• Income and employment: •

Workplace experiences

•

Poverty

• Homelessness

What we know about…. determinants of health • Healthy behaviours & modifiable risk factors •

Tobacco use

•

Alcohol use

•

Physical activity

•

Healthy eating

•

Healthy weights

• Food insecurity • NB: Population level Canadian data available from the Health Inequalities Data Tool

What we know about…. unmet health needs and barriers to care • Access to competent care • Health care providers – pre-licensure training • Disclosure to health care provider • Avoidance of care • Unmet care needs •

Can be higher for racialized LGBT2SQ people

•

Mental health and physical health concerns

•

Cancer screenings

•

Transition-related care

What we know about…. disparities in health conditions and diseases •

Stress-related mental health conditions

•

Suicidal ideation and attempts

•

Problematic substance use

•

Chronic diseases: Arthritis, cardiovascular diseases, respiratory diseases, cancers

•

Dental health

•

HIV, STBBIs, and sexual and reproductive health

Support for program planning • Health Equity Impact Assessment Tool LGBT2SQ Supplement • Overview of considerations for • Planning and evaluation • Programming • Outreach, community engagement, & communications

• Background information on: • SDOH and LGBT2SQ communities • Belonging, heath, culture, & identities • Health outcomes • Considerations for provision of care

Data stories: Ontario CHCs Equity snapshots Data gaps, opportunities 16

Data Snapshot: Sexual Diversity Heterosexual 86.12%

Bisexual 3.99%

Gay 1.35%

Lesbian 0.93% Queer 0.70% Two-Spirit 0.24%

Other 1.06% Do not know 5.61%

Data Snapshot: Gender Diversity Do not know 0.33%

Other 0.27% Two-Spirit 0.12%

Male 39.21%

Intersex 0.06%

Female 59.28% Trans - Male to Female 0.32%

Trans - Female to Male 0.40%

Equity Snapshot: Household Income Chart Title

80% 70% 69%

60%

60% 50%

51%

40% 30% 20%

21% 16% 14% 12%

10%

0%

<25K

12%

25-40K

10% 40-60K

All

LGB

Trans

17% 11%

8% <60K

Equity Snapshot: Household Composition 40% 35%

37%

30% 25% 24%

20% 15%

18%

22%

21%

17%

10%

19%

19% 19%

17%

11% 11% 11%

11%

5%

6%

5%

0% Alone

Housemates

11%

Couple

5%

2-parent family 1-parent family Other biological family All

LGB

Trans

4% 5% Other

7%

Equity Snapshot: Cancer Screening 80% 78% 78%

76%

76%

74%

74%

76%

75%

72% 70%

72%

71%

68% 68%

66%

66%

64% 62% 60%

Breast

Cervical (PAP) All

LGBQ2

Trans

Colorectal

Data Gap: Sexual Orientation Unknown 74%

Known 21%

Prefer not to answer 4%

Undefined 1%

Data Gap: Gender Identity Unknown 74.89% Known 24.31%

Undefined 0.53%

Prefer not to answer 0.28%

Data Gaps: Gender Identity & Sexual Orientation • Gender identity data missing for 75% of clients. • Sexual orientation data missing for 74% of clients.

• 1/3 of CHCs have collected no gender identity or sexual orientation data (100% missing). • 4/5 of CHCs have collected gender identity and sexual orientation data for fewer than half their clients (>50% missing.

Who are we missing? Inequities in data collection We have less information about sexual orientation and gender identity for older adults and seniors than we do for younger adults.

Equity Data Collected by Age

40%

35% 30% 25% 20% 15%

10% 5% 0% Young Adults Gender

Adults Sexual Orientation

Older Adults Gender - Overall

Seniors

Sexual Orientation - Overall

Who are we missing? Charted Gender ≠ Gender Identity Gender is a descriptive client datum recorded in the EMR. However, gender identity (a social construct) is not the same as sex (a biological construct).

Not Male 3%

Male 97%

Male

Gender Identity

Charted as "Female"

Charted as "Male"

Male

Gender

0%

Not Female 4% Female 96%

20%

Female

Female 40%

60%

80%

100%

Someone who is recorded as “Male” or “Female” in the EMR does not necessarily identify this way.

120%

Why does it matter? We need good data to make good decisions. • Individual data to inform care for the individual. • Local data to inform programming. • System-level data to inform policy decisions and advocacy. • Within Ontario: BIRT • Across Canada: CACCH data project

With data on only 25% of our clients, we can’t be sure we’re making good decisions!

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Why does it matter? We need good data to advance health equity. • In this time of health system overhaul, our role is to champion health equity and ensure that a commitment to equity is explicit in legislation, policy, and population health planning (OHTs).

We can’t advocate for our clients if we don’t know who they are. We can’t fight inequity if we can’t see it.

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Why does it matter? Not collecting this data renders our clients invisible. It is effectively “re-closeting” them. • Seniors are particularly at risk of re-closeting as they enter long-term care, see https://www.cbc.ca/news/canada/lgbtq-seniors-long-term-care-homesdiscrimination-1.4721384. Having data on the LGBQ2 and Trans* individuals and populations in our communities can help us advocate for them at transitions.

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Why aren’t we asking? In 2017, Access Alliance conducted a survey of 7 CHCs identified as “equity champions” to measure capacity for equity-informed planning & evaluation. • 6 of 6 identify LGBTQ+ as a client group they serve. • 1 of 6 identify LGBTQ+ as one of top 5 client groups in number of clients. • 0 of 6 identify LGBTQ+ as one of top 5 client groups in terms of priority.

You are not alone! • Connect with peers to share tools, resources, and knowledge. Stay for the networking session after this presentation to get started. Take a rainbow pin and wear it with pride – look for others with the pin to make connections based on a shared commitment to equity for LGBTQ2 clients.

• Get help for FREE online. Check out the tools and resources referenced above and in the handout.

Thank You!

Questions & Discussion

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