THE HEALTH OF LGBTQIA2 COMMUNITIES IN CANADA Report of the Standing Committee on Health Bill Casey, Chair JUNE 2019 42nd PARLIAMENT, 1st SESSION Published under the authority of the Speaker of the House of Commons SPEAKER’S PERMISSION The proceedings of the House of Commons and its Committees are hereby made available to provide greater public access. The parliamentary privilege of the House of Commons to control the publication and broadcast of the proceedings of the House of Commons and its Committees is nonetheless reserved. All copyrights therein are also reserved. Reproduction of the proceedings of the House of Commons and its Committees, in whole or in part and in any medium, is hereby permitted provided that the reproduction is accurate and is not presented as official. This permission does not extend to reproduction, distribution or use for commercial purpose of financial gain. 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STANDING COMMITTEE ON HEALTH CHAIR Bill Casey VICE-CHAIRS Marilyn Gladu Don Davies MEMBERS Ramez Ayoub Pam Damoff (Parliamentary Secretary – Non-Voting Member) Doug Eyolfson Ben Lobb Ron McKinnon Robert-Falcon Ouellette Sonia Sidhu Len Webber OTHER MEMBERS OF PARLIAMENT WHO PARTICIPATED Leona Alleslev Shaun Chen Gérard Deltell Colin Fraser Iqra Khalid Emmanuella Lambropoulos Blake Richards Don Rusnak Dave Van Kesteren CLERK OF THE COMMITTEE Alexandre Jacques iii LIBRARY OF PARLIAMENT Parliamentary Information and Research Service Nadia Faucher, Analyst Karin Phillips, Analyst iv THE STANDING COMMITTEE ON HEALTH has the honour to present its TWENTY-EIGHTH REPORT Pursuant to its mandate under Standing Order 108(2), the Committee has studied LGBTQIA2 health in Canada and has agreed to report the following: v TABLE OF CONTENTS TABLE OF CONTENTS ........................................................................................................................ VII SUMMARY .................................................................................................................................................. 1 LIST OF RECOMMENDATIONS .......................................................................................................... 3 THE HEALTH OF LGBTQIA2 COMMUNITIES IN CANADA ...................................................... 9 Introduction ....................................................................................................................................... 9 DEFINITIONS AND TERMINOLOGY .............................................................................................. 10 Gender and Sexual Minorities .................................................................................................. 10 Size of the LGBTQIA2 Population in Canada ...................................................................... 11 THE HEALTH OF LGBTQIA2 PEOPLE .......................................................................................... 13 Mental Health ................................................................................................................................. 13 Physical Health .............................................................................................................................. 16 Chronic Diseases .................................................................................................................... 17 Cancer ........................................................................................................................................ 18 Sexual Health .................................................................................................................................. 18 Sexually Transmitted and Blood-Borne Infections .................................................. 18 Use of Alcohol, Tobacco and Other Substances ................................................................ 22 Availability of Data on The Health of LGBTQIA2 Communities in Canada ............. 23 FACTORS CONTRIBUTING TO HEALTH INEQUITIES IN LGBTQIA2 COMMUNITIES ...................................................................................................................................... 25 Social Factors ................................................................................................................................. 25 Minority Stress ....................................................................................................................... 26 Legal Factors .................................................................................................................................. 27 Intersectionality ............................................................................................................................ 28 vii Housing ...................................................................................................................................... 29 Income and Employment ................................................................................................... 30 Food Insecurity ...................................................................................................................... 31 Age ............................................................................................................................................... 31 Indigenous People ................................................................................................................. 32 Access to Health Care ........................................................................................................... 32 Access to Health Care for Trans People ................................................................. 33 Racialized People and Newcomers ................................................................................. 35 Place of Residence ................................................................................................................. 36 WAYS TO PROMOTE HEALTH EQUITY FOR LGBTQIA2 COMMUNITIES ....................... 37 Sex Education ................................................................................................................................. 37 Family and School Support for Youth ................................................................................... 38 Social Connections ....................................................................................................................... 38 Digital Health .................................................................................................................................. 39 Legal Amendments ...................................................................................................................... 39 Non-disclosure HIV Status ................................................................................................. 39 Surgery on Intersex Children ............................................................................................ 39 Health Provider Training ........................................................................................................... 40 CONCLUSION ......................................................................................................................................... 41 APPENDIX A GENDER AND SEXUAL DIVERSITY GLOSSARY ............................................. 47 APPENDIX B MAP OF PUBLICLY FUNDED GENDER AFFIRMING MEDICAL CARE IN CANADA ............................................................................................................................................. 49 APPENDIX C LIST OF WITNESSES ................................................................................................ 51 APPENDIX D LIST OF BRIEFS.........................................................................................................