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LGBTQ People in Minnesota

 

Common health equity issues for LGBTQ populations

Cultural competence is the ability to recognize and understand the role culture plays in health care and to adapt care strategies to meet patient needs.

Get to know patients on an individual level. Each person’s preferences, practices, and health outcomes are shaped by many factors. Generalizations in this material may not apply to your patients.

About 4% of Minnesotans are LGBTQ. Of those, about 20% are raising children.

LGBTQ in Minnesota

About four percent of Minnesotans identify as lesbian, gay, bi-sexual, transgender, or queer (LGBTQ). A 2017 survey of LGBTQ people in Minnesota indicated that 45 percent live in the Twin Cities metropolitan area, 15 percent live in other cities, and 39 percent live in smaller towns. Respondents primarily identified as White (83%) and 17 percent as people of color, mirroring the state’s population as a whole.

LGBTQ, LGBTQIA and LGBTQ+?

Various acronyms are used to represent the diverse community of lesbian, gay, bisexual, transgender, queer (or questioning), intersex, and asexual (or allied) people. The combination may vary depending on whether the community described is based on gender identity and/or sexual orientation. Queer is an ambiguous, umbrella term used to describe gender expression and sexual orientation. Queer was once considered derogatory and some older LGBTQ adults may not appreciate its use.

Biological sex is the anatomy of an individual’s reproductive system and genetic differences. Assigned sex—female, intersex, male—is a label given at birth based on medical factors, including hormones, chromosomes, and genitals.

Gender expression refers to a person’s characteristics and behaviors such as appearance, dress, mannerisms, and speech patterns that can be described as masculine, feminine, or non-gender conforming.

Gender identity is a person’s inner sense of being male, female, a blend of both, or neither. Transgender people have a gender identity that differs from the sex which they were assigned at birth.

Sexual orientation is a person’s pattern of emotional and sexual attraction to other people. Gay, lesbian, and bisexual are terms that are largely based on who a person is attracted to.

Understanding how someone defines themselves as an individual leads to better care. Ask patients if they have a preferred name and which pronouns they use for themselves.

Health disparities

LGBTQ people suffer from health disparities related to their sexual orientation or gender identity. Compared to heterosexual people:

  • LGBTQ individuals are 2 to 3 times more likely to attempt suicide.
  • LGBTQ populations have the highest rates of tobacco, alcohol, and other drug use.
  • 25.7 percent of LGB adult Minnesotans smoke, compared to the statewide rate of 16.2 percent
  • Men who have sex with men continue to have high rates of new HIV infections in Minnesota.
  • Lesbians are less likely to receive preventive services for cancer.
  • Lesbians and bisexual females are more likely to be overweight or obese.
  • Transgender individuals have a high prevalence of HIV/STIs, victimization, mental health issues, and suicide.
  • Elderly LGBTQ individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers.

More on health care disparities for LGBTQ

  • Voices of Health Reports. An annual survey collecting information on social determinants of health and individual health for LGBTQ in Minnesota. JustUs Health

Social determinant disparities

Social determinants of health are economic and social conditions that influence the health of people and communities. LGBTQ people have a history of being discriminated against in housing, employment, legal status, and suffering from violence and bullying. Bias and discrimination in health care happen as well. Dealing with discrimination is associated with higher reported stress and poorer reported health.

  • While 5.9 percent of the general population makes less than $10,000, 14 percent of LGBTQ individuals are within this income bracket.
  • 7 percent of LGBTQ in Minnesota lacked health insurance in 2017, compared to 4 percent the general population. Lack of health insurance may result in receiving less preventive care and health education.
  • 29 percent of LGBTQ reported having been homeless at least once in their lifetime. LGBTQ youth are 6 times more likely to be homeless than their straight peers.
  • LGBTQ people are the most likely to be targets of hate crimes in America, respective to population size. LGBTQ people of color and transgender people are disproportionally targeted.
  • Up to 41 percent of LGBTQ employees say that they’ve either been physically or verbally abused by their coworkers or had their workplace vandalized. 97 percent of transgender employees surveyed experienced harassment or mistreatment in their workplace, 2009.
  • LGBTQ teens were twice as likely to be bullied, both online and on school property, and were more than twice as likely to stay home from school to avoid violence they felt might befall them on the way there, or on school grounds.
  • Nearly 22 percent of LGBT students reported having been raped—four times the rate of straight students.

Social structure

As a result of the 2015 U.S. Supreme Court decision, same-sex couples can marry nationwide and states must extend all the rights and benefits of marriage to same-sex couples, which includes medical decision-making authority. Minnesota ranks high for having laws and policies in place that help drive equality for LGBT people.

About 20 percent of LBGTQ people in Minnesota are raising biological, adopted, or foster children. In the U.S., an estimated 37 percent of LGBTQ adults have had a child at some time in their lives. They are three to four times less likely to have children than heterosexuals.

Although society’s acceptance of differences in sexual orientation and gender identity has advanced, 39 percent of LGBTQ say that at some point in their lives they were rejected by a family member or close friend because of their sexual orientation or gender identity. About 59 percent of LGBTQ have “come out” (shared their LGBTQ identity) to one or both of their parents, and a majority say most of the people who are important to them know about this aspect of their life. Older LGBTQ are more likely to be “closeted” (not out). Compared to LGBTQ persons under the age of 30, those between the ages of 30 and 54 were at least 16 times more likely to be closeted and those over the age of 55 are 83 times more likely to be closeted. Social isolation is concern for LGBTQ seniors who are twice as likely to live alone, and twice as likely to be single.

Strong social networks are a source of resilience. LBGTQ people estranged from their biological families may have a “family of choice” (friends, current and former partners, and others). These emotionally close groups function as family, although not related by blood or legal ties. Being part of a supportive community fosters good health and can buffer against some disparities. Non-whites are more likely than Whites to say being LGBTQ is extremely or very important to their overall identity (44% versus 34%). LBGTQ people who are also racial/ethnic minorities are “multiply marginalized” and subject to microaggressions associated with both racism and heterosexism.

LGBTQ adults are less religious than the general public. Roughly half (48%) say they have no religious affiliation, compared with 20 percent of the public at large. LGBTQ adults describe many religions as being unfriendly toward people who are LGBTQ.

Medical care

High quality care ensures that LGBTQ patients feel accepted for who they are and feel free to discuss all health issues and concerns with their providers. In some cases, LGBTQ people still experience mistreatment and poor quality care. Only 52 percent of LGBTQ Minnesotans are “out” to their doctor or primary care clinician and 27 percent reported having to teach their clinician about LGBTQ people in order to receive appropriate care. Many health care providers need to adopt processes and behaviors that are not biased against gender identity and sexual orientation. Appropriately asking about sexual orientation or gender identity allows health care providers to tailor care to address health needs.

  • Best practices in LGBT care: A guide for primary care physicians. Basic recommendations for health care providers, such as creating a welcoming environment (signage, intake, EHRs) and screening and immunization guidelines, Cleveland Clinic Journal of Medicine, 2016. (11-page PDF)
  • Learning to Address Implicit Bias Towards LGBTQ Patients: Case Scenarios. Exercises to use for self-learning or to teach health center staff how to identify and address implicit bias related to LGBTQ patients. The National LGBT Health Education Center The Fenway Institute, 2018. (18-page PDF)
  • LGBT Health. A peer reviewed journal dedicated to promoting optimal health care for sexual and gender minority persons and to improving availability and delivery of culturally competent health care services.
  • Minnesota LGBTQ Standards of Inclusion for Health and Human Services. Comprehensive framework to improve systems, policies, and professional development to advance equitable and inclusive health care for LGBTQ Minnesotans. Rainbow Health, 2016. (44-page PDF)
  • MN LGBTQ Provider Directory. Developed by Rainbow Health Initiative.
  • National LGBT Education Center. Offers education resources on a wide range of LGBTQ health issues. The Fenway Institute, one of the world’s largest LGBTQ-focused health centers.
  • To Treat Me You Have to Know Who I Am. Insights into understanding sexual orientation, gender identity, and gender expression. The New York City Hospitals Health Corporation, 2011. (10-minute video)

Mental health

LGBTQ individuals are almost three times more likely than others to experience a mental health condition such as major depression or generalized anxiety disorder. The fear of coming out and being discriminated against for sexual orientation and gender identities can lead to depression, posttraumatic stress disorder, thoughts of suicide, and substance abuse. LGBTQ people must confront stigma and prejudice based on their sexual orientation or gender identity while also dealing with the societal bias against mental health conditions. Some people report having to hide their sexual orientation from those in the mental health system for fear of being ridiculed or rejected. In 2017, 29 percent of LGBTQ people in Minnesota were experiencing severe mental distress and an additional 46 percent were experiencing moderate mental distress.

  • Association of Gay and Lesbian Psychiatrists. A national community of psychiatrists that educates and advocates on LGBTQ mental health issues.
  • The Impact of Discrimination. Stress in American, American Psychological Association, 2015.
  • LGBTQ Mental Health. Discusses common challenges many LGBTQ face in seeking mental health care, so they know how to find help. National Alliance on Mental Illness.
  • MN LGBTQ+ Therapists Network. Minnesota network of mental health professionals with resources for LGBTQ+ people seeking mental health services and continuing education and professional support for mental health professionals.
  • Trevor Project. A national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender, and questioning youth.

End of life

LGBTQ elders are more likely to be single, childless, and estranged from biological family—relying on friends and community members as their chosen family. Only 20 percent of LGBTQ seniors said they are comfortable being open about their sexual orientation with staff in long-term care facilities. Many people have concerns about abuse and/or neglect by staff, isolation from other residents, discrimination by residents, and discrimination by staff.

Additional resources