Double-Minority: More on How Intersectional Identities Impact Health Care.

Abstract

To the Editor: We thank Turpin and colleagues 1 for bringing attention to the influence of intersectional race/ethnic and sexual minority status on health care access and satisfaction. So often health care professionals focus on these social identities as isolated variables and miss the reality of the patient experience. Turpin and colleagues’ article expands on the traditional lens of diversity and focuses on the intersectional perspective. We would like the authors to expand on the article’s findings and discussion. Their article finds that patients who identify as both a racial and sexual minority face greater barriers to health care access compared with their non-Hispanic White heterosexual counterparts even after adjusting for sociodemographic factors. The authors suggest that while racial barriers to health care are primarily driven by socioeconomic factors, for sexual minorities, these barriers may have a different root cause. Turpin and colleagues’ overall findings in this study are significant to clinical practice as they highlight an area in which health care can take direct action in improving patient satisfaction and access. Although this article brings forward a novel understanding of how intersectionality is affecting our patients, it does not answer why barriers to health care access are greatest among those with overlapping identities as racial/ethnic and sexual minorities. Perhaps the authors can use their large dataset to deepen the understanding of specific causative factors for the barriers these patients face, thus allowing for more targeted meaningful interventions in health care. In their discussion, Turpin and colleagues recommend incorporating intersectional frameworks in training activities for health care professionals and placing a greater emphasis on understanding the context of minority experiences. Their discussion should also consider the importance of visibility, recruitment, and retention of sexual minorities within academic medicine as a primary means of fostering the culturally competent care the authors refer to in this article. Medical educators have used this recruitment model to increase racial/ethnic diversity throughout the medical training process. Further diversifying the workforce is considered a driving force for creating a medical community prepared to take care of an increasingly diverse nation. However, medicine often fails to consider the increasing sexual and gender diversity in the United States when implementing these diversity efforts.