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LGBT Health in Contemporary Society

Balight-from-lecture-twoWe’re celebrating National Public Health Week by featuring stories that highlight public health efforts across the University of Pennsylvania.

One such initiative is the Penn Medicine Program for LGBT Health, founded by Baligh R. Yehia, MD, MPP, MSHP, an assistant professor in the division of Infectious Diseases and director of the program.

For part three of Penn’s Diversity Lecture series, Yehia delivered a talk last month at the Penn Bookstore on “Lesbian, Gay, Bisexual, and Transgender (LGBT) Health in Contemporary Society.”

The Penn Medicine Program for LGBT Health is an interdisciplinary effort across the Perelman School of Medicine, School of Nursing, School of Dental Medicine, and Center for Public Health Initiatives as well as other areas of Penn Medicine, the Children’s Hospital of Philadelphia, and the Veteran’s Affairs Medical Center in Philadelphia. Yehia and his team focus on climate and visibility, health education, research, patient care, and community outreach to serve as leaders both locally and nationally in efforts to eliminate disparities in care for LGBT patients.

Yehia’s talk came at a critical time, as the LGBT community faces higher rates of smoking, depression, substance and alcohol abuse, sexually transmitted diseases, and certain cancers compared to their heterosexual counterparts. At the same time, LGBT patients face numerous barriers when seeking medical care, including decreased access to health services, lack of awareness among many health professionals of the health needs of these populations, and inequitable health system policies and practices across the United States.

While there is increasing awareness of LGBT issues in pop culture and in the increasing number of legal provisions to provide equality to LGBT individuals, advocates says homophobia, discrimination, bullying and hate crimes are still prevalent in many areas of the country. Yehia and his colleagues with the Penn Program for LGBT Health aim to make health care a safe space for all patients, no matter their sexual orientation or gender identity.

“If you are an LGBT individual, sometimes you don’t know which of these environments you are walking into,” said Yehia. “If you’re coming in as a patient, you may wonder, is this a hospital that is going to be welcoming and accepting of who I am or not”?

Part of problem is lack of training in medical school and beyond. Yehia cited a study that reported an average of less than five hours of U.S. medical school instruction is dedicated to LGBT health, and a third of medical schools have allocated no time at all to these topics.  Yehia commended the Association of American Medical Colleges for recent efforts to support the curricular and climate changes needed during medical training to better train future physicians and researchers in caring for individuals who identify as LGBT, gender nonconforming, and/or born with differences in sex development.

He noted some ways to improve medical education, including supporting faculty who are willing and able to provide LGBT health education and mentorship, integrating LGBT content into medical training, working to identify and eliminate bias against LGBT individuals, and making sure national exams include LGBT health content.

“Education plays a key role in building a culturally sensitive workforce. Embedding these concepts early in training and reinforcing them throughout residency and practice is critical,” Yehia said.

Very few health systems and medical research studies collect data on sexual orientation and gender identify beyond male or female, thus adding to challenges facing those striving to improve care for these groups.

“If it remains invisible, it’s hard to address,” said Yehia, adding that fear of discrimination and stigma may lower individuals comfort disclosing this information. “We need to encourage academic institutions and funding bodies to promote LGBT research, starting with the collection of sexual orientation and gender identity data in medical records and research studies.”

Closing his talk on an optimistic note, Yehia sees progress in many areas, including an increased focus by national organizations on LGBT research and care.

The Agency for Healthcare Research and Quality’s National Healthcare Disparities Report included the LGBT community for the first time in 2011, marking a step forward for researchers and clinicians seeking backing from a respected federal agency. The Department of Health and Human Services’ Healthy People 2020 (published in 2010 and setting goals for 2020), included the LGBT community. The Joint Commission, which accredits hospitals and medical programs, published a handbook in 2011, “Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care,” for LGBT individuals. All Penn Medicine hospitals were named as a 2014 LGBT Healthcare Equality Leader from Human Rights Campaign, earning top marks in meeting non-discrimination and training criteria that demonstrate commitment to equitable, inclusive care for LGBT patients and their families. 

To bolster this progress, Yehia urged support for the development and standardization of questions used to collect data to improve the information gathered. This can include how to ask the questions best, who in medical teams should ask the questions, and when in the process should these questions be asked.

This ongoing movement is expanding attention for LGBT health, and there is reason to be optimistic and hopeful of valuable progress to come.

“As we continue to progress as a society and LGBT identify becomes more normalized, we’ll be able to get a better understanding of health needs and experiences of LGBT populations,” he said.



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