We need better healthcare for our rainbow communities. It’s time we had a rainbow health strategy that acknowledges that more research, more consultation, and more education is necessary

Opinion: Our rainbow communities are lacking consistent, inclusive, and high-quality healthcare. We’re also lacking comprehensive data about this, but what we do know shows major inequities in health outcomes for our rainbow whānau.

The anecdotal evidence permeates our communities, we’re interconnected by, among many other things, poor healthcare experiences, concerns of potential discrimination, and the wait-and-watch game to see whether new health providers will be safe, supportive, and clued-up about our needs. In a community that already faces challenges from sectors of society that haven’t quite yet embraced diversity, having access to good quality healthcare is even more important.

Our rainbow communities, comprising those with non-heterosexual sexual orientation, or who are transgender, non-binary, or intersex, report and demonstrate challenges in achieving good health. The Human Rights Commission’s Prism report says those of diverse sexual orientation or gender identity report avoiding seeking healthcare because of concerns about being discriminated against. A half of gay and bisexual men report not being ‘out’ to their general practitioner, and reports on mental health and wellbeing (such as the Health Promotion Agency’s Mental Health Monitor) show that our community often experiences poorer mental health outcomes. We don’t know how widely these inequities permeate, but we do know there is vast variability in health status, and differences in access to good quality care.

Where we see these health inequities particularly persist is when we consider intersections of ethnicity, lived experience, socioeconomic status, and how these determinants interact with sexual orientation or gender identity. Our Māori, Takatāpui, and Pasifika rainbow community experience health inequities on many levels, and projects such as the Manalagi Project and Honour Project Aotearoa investigate these experiences, seeking to highlight where these disparities occur, and what they result in.

On the other side, health practitioners are not always well equipped to understand and respond to health issues that are specific to the community. Sixty percent of medical schools in Australasia report having fewer than five hours of rainbow health content in their curriculums. Our clinical courses could be seen to treat rainbow health content as if it were a special topic, and not something that practitioners are likely to encounter in their everyday professional lives. Having a working-level understanding of the rainbow community and knowledge of how health needs may differ, should be expected of all practitioners, as part of our broader goals of providing patient-centred care, and achieving better health equity.

Healthcare is a human right, and our ability to live with good health, to prevent and treat disease, and to advocate for our health affects so much of how we can conduct our lives. The potential to investigate further where failings in the health system are occurring and where our rainbow whānau are not receiving appropriate care, presents an opportunity to then address these inequities and ultimately lessen them. This benefits everyone, because we’re all connected in one way or another to rainbow whānau, and our community’s wellbeing is everyone’s wellbeing.

We’ve seen the importance of health emphasised during the Covid-19 pandemic, but the new normal we’re now creating doesn’t mean we have to resume systems and processes that are failing our community. Now is the time to take stock of our health inequities and ensure the redesigned health system tackles them head on. We could start with a rainbow health strategy that acknowledges that more research, more consultation, and more education is necessary to begin to ensure better health for our rainbow communities.

Cameron Leakey presented on this topic at TEDxUoA.

Cameron Leakey is a master' student in the Faculty of Medical and Health Sciences at the University of Auckland. He works on the Sex and Prevention of Transmission Study, examining discrimination against...

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