Catherine Meads, Michael P Kelly, Chris Carmona
Much has been written about the general relationship between social position and health. Far less is available on this relationship as it applies to the health of lesbian, gay, bisexual and transgender (LGB&T) people. Whether the health of LGBT people is similar, better or worse in general than that of other members of the population, and the degree to which being LGBT contributes to health inequalities and inequities or intersects with other dimensions of social stratification and difference, is not well understood. As possibly as many as 6% of the UK population identify as LGBT, there could be important health consequences. This paper considers the theoretical aspects of social stratification, sexual orientation and health. It also reports the findings of a systematic review of physical and mental health research about LGBT people in the UK. This was analysed in the context of the relationship between health and social position. For the systematic review, MEDLINE, MEDLINE Inprocess, EMBASE, PsycINFO, Web of Science and Cochrane Library databases were searched between January 2000 andMay 2008. References were searched and experts were contacted. Included were UK studies enrolling LGBT participants with any physical or mental health measures, but not HIV/AIDS, sexually transmitted diseases, sexual behaviour or health related to transitioning. Unpublished surveys involving more than 1000 participants were included. Inclusion decisions, data extraction and quality assessment were undertaken in duplicate. Quality assessment used established checklists appropriate to each study design. The results were tabulated and assessed narratively. From a total of2603 citations, five unpublished surveys and nine published papers were included. Studies were on transgender people’s health was available. The general trend of results for LGB people suggested worse health, particularly mental health and health behaviours. The lack of good-quality empirical information means that the interaction between the social position of LGBT people, other dimensions of social difference and the intersections between these dimensions and health outcomes is very difficult to describe. LGBT health needs are rarely highlighted beyond sexual health and HIV prevention, and adequate equity audit is not possible. This systematic review initiates improved consideration of the specific health needs of LGBT people and the th eoretical and empirical research that is needed to understand the health of LGBT people in the context of health inequalities.
