Natural Health Equity with Anna-Liza Badaloo is a monthly opinion column that examines disproportionate health impacts on equity-deserving communities. Learn more about Anna-Liza and her work here. The opinions expressed in this piece are the author’s own and do not necessarily represent the opinions of INM.
Every October, I celebrate LGBTQ History Month and reflect on the struggles queer activists endured to give us the freedoms we enjoy today. But this year is different. On June 5, 2023, the Human Rights Campaign declared a state of emergency for all LGBTQ+ Americans, with good reason. Of the 525 state-level bills targeting LGBTQ+ people in the United States, 75 have become law.1Rosa WE, Metheny N, Shook AG, Adedimeji AA. Safeguarding LGBTQ+ lives in an epoch of abandonment. Lancet Glob Health. 2023;11(9):e1329-e1330. https://doi.org/10.1016/S2214-109X(23)00353-4
How do these policies affect LGBTQ+ health care? Here’s a snapshot:
- Prevents teachers from discussing LGBTQ+ issues
- Stops mental health workers from providing gender-affirming care to people under 18 with gender dysphoria
- Criminalizes parents seeking medical care they believe will support their children’s well-being
Some states have taken their interpretations of the legislation even further. In Florida, for example, the Protections of Medical Conscience Act permits healthcare workers to deny LGBTQ+ people health services if they feel providing them violates their moral, ethical, or religious beliefs.2Rosa WE, Metheny N, Shook AG, Adedimeji AA. Safeguarding LGBTQ+ lives in an epoch of abandonment. Lancet Glob Health. 2023;11(9):e1329-e1330. https://doi.org/10.1016/S2214-109X(23)00353-4
Let me take you back to the early 1980s. I have fond memories of attending the Pride Parade with my mother’s friends every year. Some were renowned artists who invited me to swanky photography and art exhibits. This circle of queer folks became our family’s greatest support. But things changed. During the AIDS crisis, many of my mother’s friends passed away. One after the other, I watched their faces become gaunt, their skins grow sallow, and their bodies wither. Hardly a month went by without someone dying.
On the playground, calling someone “gay” was the greatest insult, and “gaylord” became the ultimate taunt. But I had no idea what gay meant. When I asked my mother, she laughed heartily. “You’ve known what gay means since you were born — you just didn’t know it!” Sure, I’d seen some of my mom’s friends with romantic partners of the same gender and some of a different gender. But why would anyone care about the gender of someone else’s partner? And even more perplexing: how could there be so much hatred toward queer people when my experiences were always loving and kind?
Forty years later, one thing is clear: the fight for equality is far from over. What is old is new again, and the pendulum of public opinion has swung back around. Extensive research3Marchi M, Travascio A, Uberti D, et al. Post-traumatic stress disorder among LGBTQ people: A systematic review and meta-analysis. Epidemiol Psychiatr Sci. 2023;32:e44. https://doi.org/10.1017/S2045796023000586 points to a significantly higher risk of mental health difficulties and suicide for queer people. This new wave of anti-queer sentiment adds another layer of stress, anxiety, and safety concerns. Consequently, the effects of LGBTQ+ discrimination permeate our healthcare system.
Naturopathic doctors Arlie Millyard and Cyndi Gilbert are the co-founders of Heal All Consulting, which aims to improve 2SLGBTQIA+ inclusion among health and wellness practitioners. I had the pleasure of speaking with Dr. Millyard on the ND Will See You Now Podcast in 2022. Millyard and Gilbert identify as queer, and Gilbert was raised by a lesbian mom. Motivated by personal negative experiences with the healthcare system and armed with knowledge from their queer patients, they resolved to mend the gaps in clinical practice.
“I’ve personally experienced going to a practitioner who you think [will] be super-inclusive because they’ve marketed themselves that way,” Millyard says. “Then you find out they haven’t done anything to make their practice inclusive. It’s really disappointing, and it often happens because practitioners who aren’t queer don’t know much about identities they don’t share. They don’t realize the full scope of what’s needed to be a good practitioner to these populations.”
Negative healthcare experiences among queer people often start with administration. To make a new appointment, Millyard notes, you can call their office or book online. “You might worry, is the receptionist trained to be inclusive? Does the online booking software require you to [enter] a title like ‘Mr.’ or ‘Mrs.’? Is the intake form inclusive?” Without inclusive systems, queer patients may conclude the healthcare practitioner is unsafe for them and end the booking process then and there.
Let’s say the appointment moves forward. The patient walks into the office, and what do they see? “Is that space physically and emotionally safe for LGBTQSIA+ clients?” asks Millyard. “Are there safe bathroom options for trans patients? Do the media and decor around the clinic represent us? Do they show diverse people? Do they show families that look like our families? Even before the appointment begins, patients may feel unwelcome and unsafe.”
Then there’s the appointment itself, where non-judgemental language and active listening come into play, notes Millyard. “Has the practitioner challenged their biases? Are they making assumptions that patients are straight and cisgender unless they’re proven otherwise? This is probably the most common issue I have experienced, and [there are] deeper consequences than most practitioners realize. If assumptions are made about us, it can be demoralizing.”
Millyard frequently hears from her queer patients that practitioners don’t have the clinical knowledge and skills to serve them properly. For example, Millyard explains, “Many practitioners are not aware that asexuality is a normal thing. Not all patients with low libido need treatment for it. Patients get pathologized and pushed into unwanted treatments, which can also lead them to avoid healthcare.”
Heal All Consulting uses an intersectional lens to benefit patients and practitioners. “You can be the most LGBTQSIA+ inclusive practitioner. But if you haven’t addressed racism in your practice, you won’t be inclusive to black queer patients,”4Apodaca C, Casanova-Perez R, Bascom E, et al. Maybe they had a bad day: How LGBTQ and BIPOC patients react to bias in healthcare and struggle to speak out. J Am Med Inform Assoc. 2022;29(12):2075-2082. https://doi.org/10.1093/jamia/ocac142 Millyard explains. “If you don’t work toward decolonizing your practice, you won’t be inclusive to Two Spirit patients. If you don’t make your practice accessible, you won’t be inclusive to queer disabled patients. Inclusive systems, safer spaces, challenging our biases, and updating our clinical knowledge and skills are things practitioners can do to create safer practices for LGBTQSIA+ clients.” And this is just the tip of the intersectionality iceberg. Queer youth, seniors, veterans, and neurodiverse people all have unique healthcare challenges, not to mention people with multiple intersections.
Heal All Consulting offers practitioners several courses, including Foundations of LGBTQ+ inclusive wellness, which lays the groundwork for their advanced courses, and provides Inclusive Messaging packages to help practitioners create inclusive forms, websites, and social media. According to a 2023 study on the importance of LGBTQ+ cultural competency for healthcare practitioners, this training is more vital than ever. “The increasing number of state and federal policies restricting LGBTQ+ health services highlight the urgency of equipping health professionals with culturally responsive training,” says Millyard. “Health systems must prioritize organizational-level changes to provide access to safe and affirming healthcare services.”5Yu H, Flores DD, Bonett S, Bauermeister JA. LGBTQ + cultural competency training for health professionals: A systematic review. BMC Med Educ. 2023;23(1):558. https://doi.org/10.1186/s12909-023-04373-3
What message does Millyard have for queer people considering a naturopathic doctor? “We often face so many issues in health care because practitioners don’t see us as individuals, which is why there are so many assumptions and stereotypes. That’s less likely to happen with a naturopathic doctor because we always use an individualized approach. We want to understand your whole lifestyle, your individual factors, and who you are as a person.”
- 1Rosa WE, Metheny N, Shook AG, Adedimeji AA. Safeguarding LGBTQ+ lives in an epoch of abandonment. Lancet Glob Health. 2023;11(9):e1329-e1330. https://doi.org/10.1016/S2214-109X(23)00353-4
- 2Rosa WE, Metheny N, Shook AG, Adedimeji AA. Safeguarding LGBTQ+ lives in an epoch of abandonment. Lancet Glob Health. 2023;11(9):e1329-e1330. https://doi.org/10.1016/S2214-109X(23)00353-4
- 3Marchi M, Travascio A, Uberti D, et al. Post-traumatic stress disorder among LGBTQ people: A systematic review and meta-analysis. Epidemiol Psychiatr Sci. 2023;32:e44. https://doi.org/10.1017/S2045796023000586
- 4Apodaca C, Casanova-Perez R, Bascom E, et al. Maybe they had a bad day: How LGBTQ and BIPOC patients react to bias in healthcare and struggle to speak out. J Am Med Inform Assoc. 2022;29(12):2075-2082. https://doi.org/10.1093/jamia/ocac142
- 5Yu H, Flores DD, Bonett S, Bauermeister JA. LGBTQ + cultural competency training for health professionals: A systematic review. BMC Med Educ. 2023;23(1):558. https://doi.org/10.1186/s12909-023-04373-3