Lesbian Health Care Lesbian Health Issues in a Heterosexual Society

The additional burdens placed on the lives of minorities as a result of social exclusion can lead to health disparities. Social exclusion theory has been used in previous research to investigate the health disparities that exist between socioeconomic classes and individuals of different ethnic backgrounds living in the United States, but it has not yet been applied to another important minority group: sexual minorities. This review of the literature has sought to apply social exclusion theory to the examination of health issues and health disparities within the lesbian community. Lesbian women face the health concerns common to all women, but also face a number of additional health care related challenges as a result of their sexual minority status living in a predominantly heterosexual society. Many of the challenges that they face with respect to their access to health care, the health care risks specific to their community and their health status are a result of their stigmatized social status. This review of the literature has sought to examine what is presently known concerning lesbian health status, their health risk behaviors, as well as their utilization and access to health care. The review also examines issues of relevance to the future of health care within this community by examining the specific and unique needs of aging lesbians.

Table of Contents

Abstract 3

Lesbian Health in Heterosexual Society 6

Social Exclusion Theory 7

Overview of Topics Covered 8

Literature Review 10

Social Exclusion Theory 10

Social exclusion from society through legal sanctions. 13

Failure to provide for the needs of particular groups. 15

Exclusion from social production. 16

Economic exclusion from social consumption. 17

Social exclusion and health outcomes. 18

Methodological Issues in Studying Lesbian Health 20

Definition & Measurement of Sexual Orientation & Identity. 20

Studying a Marginalized Population. 23

Funding for Research. 26

Current Health Status of Lesbians 27

Health Risks and Health Behaviors. 28

Weight. 29

Smoking. 31

Alcohol Use & Abuse. 33

Substance Use. 33

Cancer & Major Illnesses. 34

Reproductive Cancers. 34

Chronic Illnesses. 38

Sexual Health. 40

Mental health. 42

Minority Stress & Health 45

Stress associated with hiding sexual identity. 46

Experiences of prejudice and victimization. 48

Social support and minority stress. 50

Social Support, Relationships & Health 53

Access to & Experiences with Health Care Services 56

Unequal access to health benefits. 57

Misinformation. 58

Negative experiences and disclosure of sexual orientation. 61

Social exclusion. 63

The Experience of Aging for Lesbians 65

Summary & Conclusions 73

Summary 73

Recommendations for Future Research 76

Conclusion 79

References 81

Lesbian Health in Heterosexual Society

North American society is based upon the ideals of equality and opportunity, despite the long history of failing to provide these ideals to all members of society. Throughout various times in history, different minority groups have been restricted in their access to the rights and opportunities afforded to the majority. African-Americans in the U.S.A. have had a long struggle for equality, and similarly, Jewish-Americans and Japanese-Americans have faced periods of blatant discrimination and unequal treatment. Today, these transgressions are generally looked upon with the benefit of hindsight, offering apologies and recognizing these 'past' situations as being unjust, unfair, and immoral. Despite the common acknowledgement that differential treatment based on race, ethnicity, or gender is wrong and contrary to the ideals upon which our society is founded, discrimination continues for a number of minority groups. Sexual minorities, generally considered anyone who is not heterosexual, are at the forefront of their own 'civil rights' movement in the U.S.A. today, battling for equal rights within a country that has found far too many ways to curtail the rights and opportunities of...

While progress has been made, with the decriminalization of same-sex sexual activity (2003), the recognition of same-sex relationships and marriages in some states, and the federal repeal of the Don't Ask Don't Tell policy banning gay men and lesbians from serving openly in the military (2010), the playing field is far from even and there are many battles still to be fought. In challenging the courts and legislatures to provide equal rights, an important issue that must be addressed is the examination of the consequences of inaction. Failure to move forward in providing equal rights to sexual minorities is not just a matter of failing to make changes to the law, it is also a failure to provide for and protect sexual minorities. When that status of a particular group of individuals is set below the status of another, the demoted, or marginalized group suffers in a variety of ways, not least of which include mental and physical health deficits. Marginalization can restrict access to health care, restrict access to rights under the law that can impact an individual's health, and can create psychological consequences that can reduce an individual's ability to function to their potential and to adequately care for themselves. The focus of the present research examines how systematic social exclusion impacts the health care needs and behaviors of lesbian women. What are the specific health care deficits, both psychological and physical, faced by lesbians living in a heterosexual society? What is the status of knowledge concerning lesbian health and what specific methodological issues impede research on sexual minorities and health care issues? How do the mechanisms of social exclusion, discrimination and minority stress impact the quality of life for lesbians as compared to heterosexual women and what do we know about relative mortality rates for these two groups? These questions have guided this research towards a goal of greater understanding concerning the current health status of lesbians as a marginalized group. The highlighting of the current health deficits and obstacles to health care access is intended to serve as a catalyst for those working to promote positive change and meaningful progress with respect to the creation of equality in the healthcare field.
Social Exclusion Theory

Elements of social exclusion theory, as it can be applied to health and social inequalities, will be used as a guiding framework for analyzing the current health status of lesbians and the challenges and deficits this group faces as a whole with respect to health care. According to White (1998), there are four aspects of social exclusion that relate to and diminish health status in marginalized groups, such as sexual minorities. This theory has predominantly been applied to racialized groups, but it is equally applicable to the study of other marginalized groups, such as sexual minorities, and lesbians in particular. The four aspects relevant to the current analysis of lesbian health and access to health care are: 1) Social exclusion from society through legal sanctions; 2) Failure to provide for the needs of particular groups; 3) Exclusion from social production and the denial of opportunity to contribute to and participate actively in society's social and cultural activities; and 4) Economic exclusion from social consumption. These four aspects of social exclusion theory will be applied to the various topics explored in this review of the existing literature concerning lesbian health and lesbian access to health care. In some cases, only a selection of these points will be relevant for a given topic, but more often than not, all four aspects will prove fruitful in analyzing the topics at hand.

Overview of Topics Covered

One of the key challenges to understanding lesbian health and issues surrounding access to health care among lesbians as a group relates to methodology and the ability of researchers to accurately and effectively study lesbians. The first challenge in this area is the ability of researchers (and sexual minorities themselves) to agree upon and utilize a shared definition of the term lesbian. Sexual identity itself is a fluid and complicated concept, and thus it can only be expected that the term would be defined differently between individuals and groups for whom the term holds relevancy (Diamond, 2000). Beyond the challenges of finding and operationalizing the terms required to actively pursue research in this area, researchers must also overcome the challenges associated with studying a group that, by its very definition, is often marginalized and hidden from mainstream society. As such, there can be difficulties in reaching adequate numbers of participants when conducting a study, and when participants are found, there are additional challenges related to the expectations of participants (Rothblum et al., 2002). Given psychology's tumultuous history with its treatment of sexual minorities, many sexual minorities are skeptical of the research being conducted and are eager to determine the motives of researchers prior to committing their time and efforts to participate in ongoing research (Fish, 2009). Finally, effective research requires funding, and funding for sexual minority research fluctuates as a function of the politics involved in the agencies providing funding. As a result, given the varying political climates, funding for sexual minority research can often be sparse and researchers are often required to use funding from more mainstream research projects to fund fringe projects related to sexual minority issues. The final consequence of such circumstances is that the research quality and generalizability is sacrificed in the face of affordability. Despite these challenges, researchers have indeed conducted fruitful and important research on the health status and experiences of sexual minorities, allowing for a thorough review of the literature…