Applying a Capabilities Approach to Understanding Older LGBT People's Disclosures of Identity in Community Primary Care.

Michael Toze,Kathryn Almack,Trish Hafford-Letchfield,Julie Fish

doi:10.3390/ijerph17207614

Abstract

Internationally, there is increasing recognition that lesbian, gay, bisexual and trans (LGBT) populations experience substantial public health inequalities and require interventions to address these inequalities, yet data on this population is often not routinely collected. This paper considers the case study of the UK, where there are proposals to improve government and health data collection on LGBT populations, but also a degree of apparent uncertainty over the purpose and relevance of information about LGBT status in healthcare. This paper applies a health capabilities framework, arguing that the value of health information about LGBT status should be assessed according to whether it improves LGBT people’s capability to achieve good health. We draw upon 36 older LGBT people’s qualitative accounts of disclosing LGBT status within UK general practice healthcare. Participants’ accounts of the benefits and risks of disclosure could be mapped against multiple domains of capability, including those that closely align with biomedical accounts (e.g., longevity and physical health), but also more holistic considerations (e.g., emotion and affiliation). However, across all domains, individuals tend to assess capabilities at an individual level, with relatively little reference to population-level impact of disclosure. Clearer articulation of the benefits of disclosure and data collection for the collective capabilities of LGBT populations may be a beneficial strategy for improving the quality of information on LGBT populations.

Highlights

There has been growing recognition that sexual orientation and gender identity is associated with inequalities within public health, and that this requires proactive action by governments and international agencies [1,2,3,4]
Focusing on how disclosure may enhance capabilities develops the analysis away from establishing what is considered to be ‘relevant’, and instead addresses what disclosure of LGBT status allows LGBT people to achieve within healthcare
It provides context for exploring different mechanisms LGBT people may use to enhance their health capabilities: for example that some individuals who want options to address difficult feelings about sexuality may do so through talking to their GP, while others may seek out dedicated LGBT services

Summary

Introduction

There has been growing recognition that sexual orientation and gender identity is associated with inequalities within public health, and that this requires proactive action by governments and international agencies [1,2,3,4]. Public health relies on the availability of large-scale population data in order to assess the needs of populations and the impact of interventions. Sexual orientation and gender identity are often not consistently recorded in key datasets such as censuses, patient records and mortality registries. This has resulted in a lack of large-scale data on key later-life morbidity and mortality outcomes in LGBT populations, such as cardiovascular disease, diabetes, cancer and other long-term conditions and conditions of ageing [5,6,7,8]. Public Health 2020, 17, 7614; doi:10.3390/ijerph17207614 www.mdpi.com/journal/ijerph

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