Awareness of healthcare disparities experienced by marginalised communities is encouragingly on the rise in recent years. Whether as a result of a person's socioeconomic status or their race, issues with access to healthcare, increased health risk and discriminatory treatment are being identified. However, very little conversation takes place around the health and healthcare of people belonging to lesbian, gay, bisexual, transexual, queer or questioning and other sexual identities (LGBTQ+), and how are LGBTQ+ paramedics treated around the world?
In the UK, it is known that LGBTQ+ people experience disproportionately poorer care and health outcomes (NHS, 2021) including worse cardiovascular health (Caceres et al, 2020) and factors which may result in higher vulnerability to COVID-19 (LGBT Foundation, 2020). Unfortunately, many aspects of health receive little attention in LGBTQ+ populations compared with topics such as HIV and substance use (Caceres et al, 2020). However, evidence shows that adults within these communities have worse cardiovascular health relative to cisgender heterosexual people (Caceres et al, 2020). For instance, transgender women on gender-affirming hormone therapy experience higher incident myocardial infarction, venous thromboembolism, ischaemic stroke and cardiovascular mortality than cisgender individuals (Caceres et al 2020). This is just one example of many and further research and development of culturally appropriate resources, training, interventions and care are required.
Studies have also shown that sexual minority people are more likely to engage in less healthy behaviours that are known to increase their cardiovascular risk, in large part as a result of the increased stressors they are faced with (Caceres et al, 2017). The cardiovascular health of LGBTQ+ adults is compromised by significant psychosocial stressors throughout the life span (Caceres et al, 2020). Discrimination is common, including from health professionals, which can further discourage people within these communities from seeking healthcare when symptoms arise.
Health professionals must not only receive training and support to provide holistic, equal and culturally appropriate care to their LGBTQ+ patients, but also to become aware of their own beliefs and potential biases so that these do not inadvertently become barriers to equitable care provision. Furthermore, health professionals may belong to any one of these communities, and may themselves be subject to homophobic or transphobic discrimination from colleagues or patients, or may fear this and therefore keep their sexual identities to themselves. In the current issue of International Paramedic Practice, we hear from paramedics who identify as LGBTQ+ from Ecuador and the UK about their experiences in the workplace.
Refraining from discrimination is only the first step. What happens if you witness a colleague engaging in this behaviour? How would you as a patient and—more importantly—as a person, want to be treated if receiving care? ‘Passively embracing diversity, inclusion, equality and respect is not enough. On the way to true inclusion, we must not be afraid of challenging discriminating patterns of thought and behaviour and emanate respect and equality’ (British Society for Heart Failure, 2020).