Queer Health: Cultural Intervention Project
Kelly Klebaum, Alana Rabby, Kelsey Smart & Paige Stewart
Rachel L. Walker
University of Saskatchewan
WGST 220: Queering the Terrain
March 21st, 2013
The Canadian health care system offers a multitude of benefits such as subsidized prescriptions, free access to emergency services, and social resources. We have become increasingly aware through personal and scholastic experience that the queer community faces major prejudices when accessing our health care system. For our cultural intervention project, we have chosen to focus on these discrepancies as they directly relate to the queer community. We hope to gain insight and understanding of the health care system as it pertains to the queer community in Saskatoon, from the perspectives of both those providing health care and those receiving it. Our research was conducted in the form of anonymous surveys, identifying subjects only by age and self declared gender identification. Our questionnaires for health care providers focused on issues of their own feelings of comfort working with queer clients and the training or education they received regarding the treatment of the queer population. We asked health care recipients about the ease of access to health care services, their personal experiences within the health care system, and what they see as major issues relating to queer health. Our goal within this project was to: examine the quality of health care being provided to the queer community; the competency and comfort levels of the doctors, nurses and other health care providers working within the queer community; and to identify issues faced in the assessment and treatment of the queer community. We hope to provide viable solutions and avenues of discussion regarding the future of health care within this community.
The World Health Organization (2007) defines mental health as “a state of wellbeing in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”. Through our research, both academic and interpersonal, we have seen first-hand, the inextricable link between physical health care and mental health. One of the main concerns our research highlighted is the generally heteronormative framework that exists within the health care system. Due to this bias, many times questions pertaining specifically to queer health issues are simply not asked. In essence, “Heterosexist biases, assumptions and policies contribute to feelings of invisibility and marginalization, and ultimately, can lead to reluctance on behalf of LGBQITT persons to utilize health care services” (Arnold & de Peuter, 2007, pg 29). We know that the queer population is at an increased risk of depression, substance abuse, suicidal ideation and attempts, as well as the physical concerns of STI’s, HIV/AIDS, HPV, sexual assault and violence, harassment and assault, and discrimination. (“Rho fact sheet:,” 2012)Throughout our research, we have become aware of the many barriers which exist between the queer community and the health care system. One of the most significant barriers we identified is the general lack of education and/or training health care providers had received. Exclusionary language and assumptive misconceptions about the queer community only exacerbate issues of mistrust between health care providers and the queer community. We recognize that the willingness of health care providers to utilize more neutral and inclusive language could create a more open environment conducive to patient honesty and comfort.
In conducting our research we received thirteen surveys; five from health care recipients and eight from health care providers. Given that our survey was qualitative, we felt that this was a satisfying number of surveys to review for data collection and analysis. One main theme that became clear as we analysed our data was that a majority of health care provider’s competence regarding issues related to gender and sexual diversity arose from personal experience. Their ability to draw on resources was made available through interdisciplinary action and communication. There were also notable differences in the data we received between licensed health care professionals and what we gathered from social outreach workers. We received a greater number of responses and interest in completing the survey from social outreach workers than licensed professionals. For example, none of the licensed professionals from the Sexual Health Centre (SHC) completed our survey and various other nurses within the health care region who were asked to participate either did not respond or declined. One nurse we spoke to verbalized his feelings of incompetence on the issues; he admitted that he did not know what queer health specifically entailed, and he did not complete the survey. We think this gap in participation is complicit with the range of knowledge held by our interview participants on the subject. Many of the health care providers responded as feeling capable of addressing queer issues. However, when social outreach workers responded, they submitted longer responses addressing more of the relevant queer health issues, as evidenced by our research. Licensed professionals spoke to ‘a lack of queer health problems’ or felt that there simply was no difference in regards to care between heterosexual and queer people. We feel that this ignorance stems from both a lack of knowledge on the subject of queer-centric health concerns as well as a general lack of awareness of the queer population. Both providers and recipients commented that an increase in education and training about queer health issues was needed, and health care providers felt the area was largely ignored in their career training. Licensed providers also expressed minimal experience actually working with queer people, and at times gave assumptive and stereotypical responses. Social outreach workers recognized more of the evidenced queer health issues such as mental health problems, the need for social support, and a greater need for access to community health resources.
Health care recipients responded to our survey with general enthusiasm and an optimistic attitude towards the health care they are receiving. They reported less negative experiences than positive ones. Often the recipients reported accessing the health care system for reasons not directly related to their sexuality. They expressed some concerns, and took issue especially with the discourse employed in direct relation to their sexual identity. Health care providers made heteronormative assumptions and sexuality was not always addressed. Some of the health care recipients we interviewed shared what they feel are barriers to good health service in Saskatoon. One individual identified as Metis and felt subject to racism when accessing services. They also admitted self-doubt about particular health practices relating to uncertainty about accurate information and a definite lack of relevant and offered information. Their hope was that, at the very least, health care professionals could address patient’s health care issues on a patient to patient basis and in an objective and dignified manner.
Throughout the course of our research, we were struck by the common theme of a lack of education, illustrated by both our interviews with health care providers as well as our personal experiences within the education system. Sexual health education is an often overlooked subject within the context of Saskatoon’s school system, particularly in regards to alternative sexualities. We feel that “cultural competence in health care environments increases access, but also enhances practitioner-client communication and rapport” (Arnold & de Peuter, 2007, pg 43), and the ramifications of cultural competence would only serve to bolster confidence in health care providers. We also feel that increased awareness of community resources should be made a priority by health care providers working within the queer community. The relationship between medical practitioners and community outreach centers should be fostered and strengthened with raised awareness and communication between all branches of health care service, including knowledge of resources available within the community to provide appropriate and timely referrals. We feel that the dismantling of the restrictive and often times judgemental discourse associated with the health care system’s heteronormative biases would be one of the most positive changes that could occur within the health care system. One of the comments that stuck out in our research regarded the importance of inquiry about self-identification of gender and sexual-orientation during clinical assessment. Self-identification would improve individualized care, rather than expecting all people to identify within a heteronormative binary. Continuing education in all aspects of health care is vital for providing current and topical patient care. In an area as evolving as queer health, this becomes especially important. The de-stigmatization of mental health issues within the queer community is an area that we see as supremely important for the furthering of positive health care provisions. By addressing mental health issues more openly, raising awareness with fact based discussion of mental health, and using inclusionary language we feel that this stigma could be greatly reduced. The advocation and creation of equal treatment policies within the health care system is another avenue that we see as pertinent to issues of queer health.
Our initial interest in queer health issues was only strengthened as we researched and experienced first-hand the clear discrepancies within the health care system. We have touched on many of the inequalities we discovered in our research, as well as attempted to create viable solutions and avenues of discussion pertinent to major issues in the area of queer health. As we created our questionnaires, we focused on the heteronormative framework that structures the current medical model; exclusionary discourse, the stigma still related to queerness, and the general lack of knowledge and awareness of queer health concerns. While there has been some academic research conducted on the subject, it will take interdisciplinary activism to create effective change in the health care system. The next generation of health care professionals have the ability and obligation to raise public awareness and make a positive difference in queer health outcomes. The future of queer health care is ripe for change with the visibility of queer issues rising, as we work towards decreasing the stigma associated with the queer community.
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