LGBT Health and Public Policy
There is a growing body of academic and community-based research that identifies specific health disparities between LGBT communities and the general population in Canada. It is important that this information about the health needs of LGBT people is included within public health policy in Ontario. Rainbow Health Ontario facilitates the sharing of research data to ensure that government and voluntary sector decision makers are equipped to develop sensitive, progressive health and social policies.
Internationally, public health policy and practice are increasingly addressing LGBT health issues. Already some regional, provincial and national governments have developed comprehensive policy frameworks and focused resources to address inequities in health care access and poorer health outcomes among LGBT populations:
• In both Scotland and England, where health care is administered nationally, there are now government directives aimed at ensuring access to knowledgeable and welcoming care for sexual and gender minorities (Fair for All INCLUSION Project, UK Department of Health Equality and Human Rights)
• In Australia, the Department of Human Services for the state of Victoria committed to a health and wellbeing action plan for gay, lesbian, bisexual, transgender and Intersex Victorians in 2003. Their Gay and Lesbian Health Victoria website provides public information on a wealth of topics, describes strategies for improvement in health services and health status.
• After the closure of the Gender Identity Clinic in Vancouver, British Columbia, the Vancouver Coastal Health Authority worked closely with community groups to establish decentralized, respectful, accessible care for trans communities in the lower mainland. They offer free provider training and a comprehensive website.
• In Nova Scotia, the Capital Health District has established a Gay, Lesbian, Bisexual, Transgender and Intersex Initiative which aims to improve access to comprehensive and coordinated primary health care for GLBTI people.
The government of Ontario is committed to the health and well-being of LGBT people in the province. With the funding of RHO, Ontario too has taken up the challenge of ensuring more equitable respectful health services for LGBT people.
LGBT Health Policy Issues
Rainbow Health Ontario works with community members and other partners to assist with the development of healthy public policy that supports our communities. We have begun to identify public policy issues that affect the health and well-being of LGBT communities. Here is a brief overview of some of the issues that we already working on:
• Funding for sex reassignment surgery in Ontario
In June 2008, the government of Ontario re-instated sex reassignment surgery (SRS) on the Ontario Health Insurance Plan (OHIP) formulary. Trans-activists in the province have been advocating for this move since funding was removed a decade earlier. Rainbow Health Ontario is currently working with Trans community activists, the LGBTT Program at Sherbourne Health Centre, the Ministry of Health and Long Term Care, as well as CAMH (Centre for Addiction and Mental Health) to review current policies and procedures for approving OHIP-funded SRS in the province. It is our position that such a process should be client-centred, timely, accessible and grounded in a more comprehensive set of primary care services for general and trans-specific health care.
• Increased Visibility of LGBT People in Health Promotion Strategies
Many of the health issues that are of concern to LGBT communities are issues that lend themselves to health promotion strategies such as educational campaigns and community mobilization. We know that the success of such efforts is greatly enhanced by approaches that carefully target their audiences and speak to their specific concerns. Yet health education messages about issues such as substance use, obesity, smoking, cancer awareness, or heart health are rarely aimed at Ontario’s LGBT communities or their health care providers. Rainbow Health Ontario is interested in providing information, consultation or in forming partnerships with other organizations to help create informative and culturally appropriate health promotion strategies and materials.
• Assisted Human Reproduction Act and LGBTQ Communities
The LGBTQ Parenting Network (Sherbourne Health Centre) provides resources, information and support to LGBTQ parents, prospective parents and their families. One of its recent advocacy initiatives involves lobbying on behalf of LGBTQ communities with regards to the Assisted Human Reproduction Act, an Act that became law in 2004 and which regulates the activities of fertility clinics and sperm banks. Rainbow Health Ontario is a member of the AHRA/LGBTQ Working Group, a group made up of physicians, nurses, fertility counselors, midwives, community development workers, lawyers, researchers and consumers of reproductive technologies. This Working Group has prepared a report which outlines the key concerns and recommendations of LGBTQ communities in relation to the Act. These include
• Culturally competent counselling that addresses specific concerns of LGBTQ populations
• Reassurance that the intent of the Act is not to criminalize home insemination
• The right to take sperm home
• Insemination with a known donor who is not a sexual partner
• Use of gay men as sperm donors
• Consistency and transparency of costs
• Awareness of LGBTQ issues and concerns reflected in all documents and practices related to the operation of fertility clinics and sperm banks
As a result of the report, the AHRA/LGBTQ Working Group has been invited to Ottawa to address both the staff and the board of the AHR Agency, LGBTQ content is being incorporated into their website, and we anticipate ongoing dialogue with the AHR Agency with regards to the concerns of LGBTQ communities.
• Changes to Questions on Statistics Canada Surveys
In 2003, Statistic Canada added a question about Sexual identity to the Canadian Community Health Survey (CCHS). This single question is being added to all Statistics Canada surveys, and this is an important first step in describing the health and social needs of LGB Canadians. The next urgent step is to include questions about:
• Same-sex behaviour (sex of sex partners, past-year and lifetime)
• Same-sex attraction (for those over age 20), and
• Gender identity
By including these measures, our knowledge about LGBT health in Canada would increase substantially. Rainbow Health Ontario is currently working in partnership with a network of Ontario-based LGBT researchers to advocate for these changes.