Theories and LGBT (Exam Pt.3)

Social epidemiology - focuses on social and structural factors on states of individual and population health

• Determinants like income inequality, education

• Assumes distribution of advantages and disadvantages in society reflex the distribution of health and disease

• Goal is to identify societal characteristics that affect the pattern of disase and health and understand its mechanisms

Link and Phelan (1995)

• Fundamental causes theory explains how SES, race and social capital persist as health disparities

• Even when specific diseases and risk factors change, structural inequalities continue to shape outcomes

  • Resources influenced:

    • Money

    • Knowledge

    • Power

    • Social connections

    • Prestige 

Four elements of fundamental cause

1. Multiple disease outcomes - fundamental causes are linked to multiple diseases and health conditions

2. Multiple risk factors - influence health through a variety of mechanisms, such as access to healthcare, health behaviors, social networks, environmental conditions

3. Access to resources - individuals with more power, money, knowledge, and social connections can leverage these resources to protect their health

4. Reproduces health inequalities over time - those with greater resources will continue to benefit disproportionately

Intersectionality - interconnected systems of social factors (oppression and privilege) which are impossible to detangle since identities do not operate independently

• Identified by Professor Kimberle Crenshaw

• Research reveals multiple marginalized identities (like women of color) experience compounded health inequities

• Ex: black women face higher maternal mortality rates due to combined effects of racism and sexism

• Social identity and social inequality are interdependent, not mutually exclusive

• Intersectional oppression operates at a structural, social, and health care levels, worsening health outcomes over time

  • Ex: gendered racism leads to poorer quality of healthcare for Black women

Minority stress theory - experiences of GSM individuals within the health care system

• Less likely to seek out needed and ongoing health care

• Experuence-based fear and mistrust of medical community

• “Homosexuality” was thought to be a curable disease

• Theory is used as a model for minority oppression in oppression

• Creates a chronic stress through:

  • Prejudice

  • Microagressions

  • Identity rejection

  • Internalized homophobia

  • Hate-based victimization

Gender identity - individuals language for their self-expression as it is placed on the culture’s spectrum

Gender expression - individual’s physical characteristics and behaviors that are traditionally linked to masculine, feminine, or androgyny

• Includes mannerisms, appearance, social interactions

Transgender - describe those who identify different than sex assigned at birth

Non-binary - gender that is not exclusively male or female

Cisgender - identifying with gender assigned at birth

Gender diverse - umbrella term; includes gender identities that demonstrate expressionary framework

Sexual identity - individuals sexuality, sexual attraction and romantic attraction

Sexual orientation - person’s emotional, physical, sexual attraction to other people and expression of that attraction

Romantic orientation - describes preferences a person has towards gender of romantic partners

LGBT

• LGBT are vulnerable population

  • Subject to:

    • Discrimination

    • Scarcity of providers

    • Lack of access to knowledgeable providers

• 2 to 3 times more likely to attempt suicide

• Gay men have higher risk of HIV and other STDs

• LGBT have highest rates of tobacco, alcohol, illicit drug use

• Higher levels of cardiovascular disease; lack of research

Holistic view of GSM health

• Look beyond STDs, substance use, and mental health outcomes

• LGBT health research is limited

• No focus on unique need of LGBT community until emergence of AIDS pandemic

  • CHALLENGES:

    • Inherent evolution of definitions and terminology

    • Community is a hidden population

    • Individuals may be less willing to identify due to history of discrimination

Preventive Care and General Health

• Regular screenings (e.g., cancer screenings tailored for transgender individuals, HPV and STI screenings)

• Vaccinations (e.g., HPV, Hepatitis A & B, Mpox/monkeypox for high-risk individuals)

• Routine wellness checks in an affirming environment

2. Mental Health and Substance Use Support

• Higher rates of depression, anxiety, and suicide risk due to stigma, discrimination, and minority stress

• Increased risk of substance use disorders, including alcohol, tobacco, and illicit drugs

• Need for LGBTQIA+-affirming mental health professionals

3. Gender-Affirming and Sexual Health Care

• Access to gender-affirming hormone therapy and surgeries for transgender and nonbinary individuals

• Safe and affirming reproductive health services, including family planning and fertility preservation

• PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) for HIV prevention

• Culturally competent sexual health education

4. Chronic Disease Management

• Increased risk of cardiovascular disease and metabolic conditions, especially among transgender individuals on hormone therapy

• Higher prevalence of HIV/AIDS, particularly among gay and bisexual men and transgender women

• Need for inclusive care models that address unique risks in an affirming way

5. Social Determinants of Health

• Addressing barriers to healthcare access, including discrimination, lack of insurance, and provider bias

• Housing and employment support, as LGBTQIA+ individuals experience higher rates of homelessness and job discrimination

• Community-based health initiatives to improve outreach and trust in medical systems