As we begin the New Year, we need to both reflect on what we accomplished in 2015 and look ahead to new goals in 2016. The LGBTQI community counted remarkable successes in the past year; marriage equality became nationwide law in the United States and Ireland; public figures like Laverne Cox and Caitlyn Jenner created astounding visibility for the trans communities; and public awareness and acceptance of LGBTQI people continued to grow, one person and one family at a time, at an almost unbelievable rate! On a local scale, the UC Davis Medical Center earned designation as a “Leader in Healthcare Equality” by the Human Rights Campaign for the 5th consecutive year. Despite these wonderful successes, we know there is a great deal more work to be done if we want to eliminate health disparities for LGBTQI patients.
We know that LGBTQI health disparities often start within our own homes, are nurtured within our own schools and community centers, and are maintained by our shared U.S. culture despite all the gains that have been made by LGBTQI and ally activists in the past 50 years. Perhaps most critically, our health care is too often provided by providers who fail to recognize us and our unique needs.
This overwhelming challenge in health care is the pervasiveness of heteronormativity –the assumption that normal people are heterosexual and cisgender – a lingering, toxic side effect of a “don’t ask, don’t tell” culture that goes far beyond military law. Heterosexuality is the attraction of a person of one gender to a person of the opposite gender: a man sexually attracted to a woman or a woman sexually attracted to a man. Just writing that definition requires the assumption that there are two distinct, mutually exclusive genders – male and female – and that normal people feel at home in the gender they were assigned at birth based on their genitals (cisgender).
The assumption of cisgender identity leaves no room for people who do not feel at home in the gender to which they were assigned at birth. When toddlers insist that they are not a boy but a girl, or not a girl but a boy, they are making a clear statement that they are not cisgender. They are also making a statement that their health will be at real risk unless they have a loving family that can adapt to them as they are instead of how they had been expected to be.
The assumption of heteronormativity means there is no room for people who are attracted to members of their own gender or to those who express a gender identity other than male or female. Just as toddlers can articulate a non-cisgender identity by age 2 or 3, many other children speak of being gay, lesbian, bisexual or queer before puberty. A parent’s instinct may be to shake them out of it, but recent data suggests that a loving and supportive family makes the difference between a life-long string of health disparities and a normal, healthy but non-heterosexual life.
What do LGBTQI patients, like the children described above, need in health care? Perhaps the greatest single need is to be accepted for who they are. That acceptance creates a safe space in which the patient can be healthy and supported.
Who can provide that safe space? It can be provided by anyone regardless of sexual orientation and gender identity, so long as that provider recognizes that there is normal biological variability among people on both sexual orientation and gender identity. This variability makes a patient different from, but not less than, a patient who is heterosexual and cisgender. A safe, caregiving space simply accepts the person for who they are, accepts that they may love someone of their own gender, may love both males and females, may identify with a gender not assigned at birth and may express gender in any form. In short, LGBTQI patients make all their health providers a little richer, when the provider is open to challenging their own assumptions about sexual orientation and gender identity and expression. This is why we are bringing the Improving OUTcomes Conference back to UC Davis for a second year in 2016. Last year, we reached more than 125 healthcare providers and students of all specialties from all over California and the United States with the goal of increasing awareness and compassion for LGBTQI health needs. This year, we hope to reach 150 or more. We hope you can be one of them!
We are proud of what we’ve accomplished, but we also know how much work lies ahead. We’re excited for the upcoming challenge, and we hope that you’ll join us in enriching your openness to and knowledge of variability in sexual orientation and gender identity at Improving OUTcomes 2016! Stay tuned to our website, where we’ll publish a new blog every week on a different topic in LGBTQI health. We are also opening registration now with the hope that we’ll see you April 8-9!
Happy New Year!
Edward J. Callahan, PhD
University of California, Davis Health System
Associate Vice Chancellor for Academic Personnel
Professor of Family and Community Medicine
Chair, Vice Chancellor’s LGBTQI Advisory Committee