Promoting LGBT health and wellbeing through inclusive policy development

biomed - Jackson , Ross , Mulé , Deeprose Barry , Daley Andrea , Travers Anna , Moore , Moore Dick

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In this paper we argue the importance of including gender and sexually diverse populations in policy development towards a more inclusive form of health promotion. We emphasize the need to address the broad health and wellbeing issues and needs of LGBT people, rather than exclusively using an illness-based focus such as HIV/AIDS. We critically examine the limitations of population health, the social determinants of health (SDOH), and public health goals, in light of the lack of recognition of gender and sexually diverse individuals and communities. By first acknowledging the unique health and social care needs of LGBT people, then employing anti-oppressive, critical and intersectional analyses we offer recommendations for how to make population health perspectives, public health goals, and the design of public health promotion policy more inclusive of gender and sexual diversity. In health promotion research and practice, representation matters. It matters which populations are being targeted for health promotion interventions and for what purposes, and it matters which populations are being overlooked. In Canada, current health promotion policy is informed by population health and social determinants of health (SDOH) perspectives, as demonstrated by Public Health Goals for Canada. With Canada's multicultural makeup comes the challenge of ensuring that diverse populations are equitably and effectively recognized in public health and health promotion policy.

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Publié par	biomed
Publié le	01 janvier 2009
Nombre de lectures	13
Langue	English

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International Journal for Equity in
BioMed CentralHealth
Open AccessResearch
Promoting LGBT health and wellbeing through inclusive policy
development
1 2 3 4Nick J Mulé* , Lori E Ross* , Barry Deeprose* , Beth E Jackson* ,
1 5 6Andrea Daley* , Anna Travers and Dick Moore
1 2Address: School of Social Work, York University, Toronto, Canada, Social Equity & Health Research Section, Centre for Addiction and Mental
3Health (CAMH), Department of Psychiatry, University of Toronto, Toronto, Canada, Ottawa LHIN Representative, Rainbow Health Ontario,
4 5Ottawa, Canada, Coordinator, Social Determinants of Health Stream, Ontario Rainbow Health Partnership Project, Toronto, Canada, Rainbow
6Health Ontario, Sherbourne Health Centre, Toronto, Canada and Seniors Program, 519 Church Street Community Centre, Toronto, Canada
Email: Nick J Mulé* - nickmule@yorku.ca; Lori E Ross* - l.ross@utoronto.ca; Barry Deeprose* - deeprose@cyberus.ca;
Beth E Jackson* - bethjackson@sympatico.ca; Andrea Daley* - adaley@yorku.ca; Anna Travers - atravers@rainbowhealthontario.ca;
Dick Moore - senior@the519.org
* Corresponding authors
Published: 15 May 2009 Received: 4 November 2008
Accepted: 15 May 2009
International Journal for Equity in Health 2009, 8:18 doi:10.1186/1475-9276-8-18
This article is available from: http://www.equityhealthj.com/content/8/1/18
© 2009 Mulé et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
In this paper we argue the importance of including gender and sexually diverse populations in policy
development towards a more inclusive form of health promotion. We emphasize the need to
address the broad health and wellbeing issues and needs of LGBT people, rather than exclusively
using an illness-based focus such as HIV/AIDS. We critically examine the limitations of population
health, the social determinants of health (SDOH), and public health goals, in light of the lack of
recognition of gender and sexually diverse individuals and communities. By first acknowledging the
unique health and social care needs of LGBT people, then employing anti-oppressive, critical and
intersectional analyses we offer recommendations for how to make population health perspectives,
public health goals, and the design of public health promotion policy more inclusive of gender and
sexual diversity. In health promotion research and practice, representation matters. It matters
which populations are being targeted for health promotion interventions and for what purposes,
and it matters which populations are being overlooked. In Canada, current health promotion policy
is informed by population health and social determinants of health (SDOH) perspectives, as
demonstrated by Public Health Goals for Canada. With Canada's multicultural makeup comes the
challenge of ensuring that diverse populations are equitably and effectively recognized in public
health and health promotion policy.
marginalized because of their gender identity and/or sex-Introduction
In this discursive paper we examine the extent of recogni- ual orientation; herein the term 'gender and sexually
tion of gender and sexually diverse populations (LGBTs) diverse populations' is used to address the collective iden-
(The phrase 'gender and sexually diverse populations' and tity of these populations, while 'LGBTs' is used to address
the acronym 'LGBT' both describe the lesbian, gay, bisex- the individuals that make up these communities) in
ual, transsexual, transgender, two-spirit, intersex, queer Canadian public health promotion policy. We review
and questioning individuals and communities who are LGBT health and wellbeing issues, examine limitations of
Page 1 of 11
(page number not for citation purposes)International Journal for Equity in Health 2009, 8:18 http://www.equityhealthj.com/content/8/1/18
existing models such as population health, the SDOH, inals), but have not included sexual minorities [7,8]. Two
and public health goals, in light of the lack of recognition latter reports included lesbians and bisexual women [9]
of gender and sexually diverse individuals and communi- and gay men [10,11]. Yet in the Canadian blueprint report
ties, and provide a critical analysis of the implications of Building on Values: The Future of Health Care in Canada [12]
health disparities. We argue that the gender and sexually LGBT populations are completely neglected in the dis-
diverse populations must be explicitly included in policy course on diversity where other minority groups are
development for a more inclusive form of health promo- addressed (including aging Canadians, those dwelling in
tion. In contrast to an illness-based focus such as HIV/ rural communities, those of lower socio-economic status,
AIDS, we emphasize the broad and unique health and ethnic groups, culturally diverse groups, men and women,
wellbeing needs of LGBT people employing anti-oppres- visible minorities, people with disabilities, and new Cana-
sive, critical and intersectional analyses. Although litera- dians).
ture has been drawn from the most part from Canadian
sources to address the realities of LBGT Canadians, we The Canadian Institute for Advanced Research (CIAR) and
also include literature from Australia, the UK and USA, members of its Population Health Program were highly
societies in which the socio-political-cultural experiences influential in the emergence of the population health
of gender and sexually diverse populations are similar approach in Canada. This perspective considers "proc-
albeit not identical. We then conclude with recommenda- esses by which system-level variables influence the health
tions for a more inclusive approach to recognizing gender of populations" [13]. Health Canada went on to describe
and sexually diverse populations in Canadian public the approach as a means "to maintain and improve the
health promotion models. health of the entire population and to reduce inequalities
in health between population groups" [14]. Despite this,
Public Health Policy in Canada there continues to be a heavy emphasis on targeting the
Historically, Canada has been at the forefront in public 'entire population' with regard to maintaining and
health. This was demonstrated by the contributions of the improving health and less so on reducing "inequalities in
Lalonde Report [1], which introduced the concept of health between population groups" [14]. Critics charge
'health promotion', and the Epp Report [2] which further that the population health approach has been narrowly
expanded Lalonde's concepts and developed the 'popula- focused on individualized characteristics and processes as
tion health' approach. In the Lalonde Report [1], health measured by large-scale surveys (i.e. National Population
determinants comprised four 'health fields' which Health Survey, Canadian Community Health Survey).
included biology, lifestyles, environments and health This approach has tended to position 'risk factors' only as
care. However, the report was ultimately understood to correlates to individualized attributes and behaviours,
champion 'lifestyle' interventions focusing on individual consequently holding to account affected/diseased indi-
rational action and responsibility, while downplaying the viduals [13,15]. Meanwhile qualitative, community-
impact of social structures on health [3]. Although the based research methods and findings are paid very little
Epp Report [2] and the WHO Ottawa Charter for Health attention. Because population health as an approach is
Promotion [4] shifted the focus toward 'healthy public not addressing social/structural determinants, it provides
policy', which acknowledged structural determinants of weak direction on solutions and social change. Popula-
health, community health promotion strategies since that tion health policies are devoid of guiding values that call
time have continued to target individual responsibility for for participation, community development or rectifying
health behaviours (witness HIV/AIDS prevention pro- social injustices [13]. The implications of this are detri-
grams). Thus, a micro level (individualized) lifestyle mental to those seeking the implementation of health
approach continues to dominate and define Canadian equities and policy change (i.e. the gender and sexually
health promotion [5] by targeting 'high risk' populations diverse among other populations) [3,13].
through large scale campaigns in which interventions pro-
mote risk reduction through behaviour change [6]. There- Sexual and Gender Diversity Issues in Canadian Public
fore, illness and behaviour remain central while sexuality Health Policy
and gender identity as social locations in the broader Simultaneous to the development of the public health
social health structures simply do not register. models, the Canadian LGBT communities amassed into a
social movement. Human rights protections based on sex-
Populations marginalized by gender identity and sexual ual orientation were fought for, and won, at the national,
orientation have, for the most part, been excluded from provincial and territ