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LGTB Health Matters LGTB Health Matters An Education & Training Resource for Health and Social Service Sectors The Centre: A Community Centre Serving and Supporting Lesbian, Gay, Transgender, Bisexual People and Their Allies 1170 Bute Street Vancouver BC V6E 1Z6 www.lgtbcentrevancouver.com Project Coordinator ● Brian Dunn Design & Layout ● Britt Permien © January 2006 1 Acknowledgements This document has been developed with the assistance of many people. People who have given time, shared their ideas, enthusiasm, experiences and resources so that health and social service providers might be better informed about the needs and capacity of LGTB people, families and communities. The LGTB Health Matters Project gratefully acknowledges the support of the Canadian Rainbow Health Coalition (CRHC) as project partner. Throughout the project and the development of this document I have had the opportunity to discuss the importance of LGTB-inclusion in health and social services with a variety of organisations. These ranged from universities and colleges to providers of health and social services, unions, government and community agencies, far too many to list individually, so I thank them all. I specifically want to thank the individuals within these organizations who facilitated these contacts and who supported the project. As a part of fact-finding a number of small group discussions were conducted with LGTB community mem- bers. These groups included; lesbian, bi and trans women 55 years plus, LGTB youth, queer staff of Vancouver Coastal Health, community members in Kamloops, two-spirit people, queer families and the Chronically Queer group (queer people with a disability). Thank you to the people who attended and shared their experiences and ideas. I hope that you will see some of what you shared reflected in this document. The LGTB Health Matters Working Group has been integral to the defining and guiding of this document. I am grateful to all of the participants for their time, energy and critical reflections. I hope that you will reap the benefits of your commitment to this work when you use this resource in your setting. The working group members were: Donna Wilson, chair— The Centre Devon MacFarlane— Vancouver Coastal Health Elizabeth Stanger— Vancouver Coastal Health Michel (Mike) Tarko, Dept of Psychiatric Nursing— Douglas College Silvia Wilson, Faculty of Health Sciences— Douglas College Brian O’Neill, School of Social Work and Family Studies— University of British Columbia Heidi Walker— Community member & Registered Nurse Paula Tognazzini, School of Nursing— University of British Columbia Doug Yochim, Dept of Nursing— Langara College Emily Falk, Fulbright Scholar— BC Centre of Excellence for Women’s Health (until May 2005) Jill Cory— BC Women’s Hospital and Health Centre (until March 2005) I particularly want to thank Mike Tarko and Heidi Walker. Mike co-authored module one and provided detailed editing advice throughout. Heidi wrote the section on Lesbian Health in module three. Last but not least to the management and staff of The Centre; to Donna Wilson for her vision and guidance, my peers for their support and encouragement and the many volunteers who helped with photocopying and administrative tasks. Brian Dunn, LGTB Health Matters Project, January 2006 2 able of Contents Introduction Module one Introduction to Heterosexism and LGTB-phobia and Their Impact on the Health and Well-being of the Lesbian, Gay, Trans and Bisexual Populations Knowledge Assessment - Pre and Post Module two Understanding LGTB Diversity and the Factors Which Determine LGTB Health and Well-being Knowledge Assessment - Pre and Post Module three Delivering Accessible and Inclusive Health and Social Services to LGTB Individuals, Families and Communities Knowledge Assessment - Pre and Post Module four The Health and Social Service Provider as an Advocate for LGTB Inclusion Knowledge Assessment - Pre and Post Appendices Appendix A Glossary of Terms Appendix B Critical Moments in the History of Lesbian, Gay, Transgender, and Bisexual (LGTB) Persons. Appendix C Suggested Answers for Knowledge Assessments Pre and Post 3 Introduction The LGTB Health Matters: An Education & Training Resource for Health and Social Service Sectors has been developed as a convenient and practical resource for educators of health and social services personnel. It is a tool which can be used in part or its entirety. Constructed as four independent but inter-related modules, it uses a variety of methods to help the educator and learner to better understand LGTB communities, their experiences and their interaction with health and social service sectors. This material has been developed in response to a deficit in the education of many health and social service professionals relating to the recognition and needs of LGTB people and communities. During preparation of this document, a number of professional schools for health and social services personnel from around the province were contacted to determine what LGTB-specific content was covered in their teaching. The scan indicated that most included none or what was included related predominantly to sexual health or HIV/AIDs. It was, however, heartening to speak with those colleges and universities that did feature some content specif- ic to issues such as heterosexism and homophobia. The need for this material goes beyond the knowledge and skill deficit within the service sector. The real issue is the health and well-being of LGTB people. Available health statistics indicate that LGTB Canadians are dying younger and experiencing poorer health than heterosexual and non-trans people. Excluding HIV/AIDs - which predominantly impacts gay and bisexual men - there is not a great deal to account for these epidemio- logical discrepancies. The fact that LGTB people experience higher rates of depression, smoke more cigarettes and possibly consume greater amounts of alcohol points to other causes, causes that might be socially or politically founded. Heterosexism and homophobia, transphobia and biphobia (LGTB-phobia) have a profound impact on individuals, families and communities and are, as a result, costing money and lives. The material in this document attempts to make connections between how society and systems are constructed to exclude LGTB people, what impact these exclusions have on their health and well-being and what needs to be done, particularly in the health and social service systems, to redress this. Module one introduces the learner to terms, while exploring attitudes and knowledge the learner may possess relating to LGTB people and communities. Reference is also made to the historical background that has shaped LGTB people and communities. Finally, this module considers the various stages of life from youth to older adult, demonstrating how heterosexism and LGTB-phobia impacts on the lives of LGTB people. Module two considers the diversity within LGTB communities and the factors which determine health. Using determinants developed by the World Health Organization and Health Canada, the author explores what these might mean for LGTB people and communities. Examining issues from social support through to housing, disability and employment the module attempts to demonstrate the unique experience of LGTB people within each of these determinants. In module three, there is a move to more practical applications. The learner is introduced to materials which will assist them in better understanding LGTB communities and ways to facilitate greater LGTB inclusion within health and social service settings. Specific recognition has been given to individual components: lesbian, gay, transgender, bisexual and two-spirit health. These summaries are intended to alert the educator and learner to some of the health conditions, strengths and service considerations specific to each group. The fourth and final module encourages the learner to consider their role as advocate. It proposes that health and social service personnel at all levels have some capacity to create more LGTB-inclusive service because of their positions within powerful and respected social institutions. It also explores practical actions which would assist with systemic changes and community engagement. 4 Using LGTB Health Matters: An Education & Training Resource for Health and Social Service Sectors Terminology and language use can vary significantly within LGTB communities. What is accepted in one community as inclusive may not be so for another. For this reason it is important to clarify how some of these terms have been used within this document. Detailed definitions for most terms used can be found in the glossary attached as Appendix A. The abbreviation LGTB has been used (in preference to some of the extended options such as LGTBTTSQQI) as it is the standard format used organisationally by The Centre. It is not intended to be exclusive and can be read as inclusive of the other communities which comprise the non-heterosexual and gender diverse communities. The underlying premise presupposes a common factor for each of these groups or communities: the experience of oppression and discrimination because of their minority status, whether it relates to their sexual orientation and/or gender identity. Where there are distinct issues - for example, under the law - they will be identified separately as LGB and trans. The term trans has been used in place of trans- gender or transgendered. Variations to the LGTB combination may be found in some quotes, i.e. GLBT. The term two-spirit is also
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