Hello everyone. Thank you for joining me today. We're going to take a special look at social determinants of health with a focus on lesbian gay, bisexual, transgender. We're questioning and intersex plus skeleton will be I'm Dr. Sheila smith I use she her pronouns. I'm a clinical professor at the University of Minnesota. In this course we'll be examining strategies to promote LGBTQI Plus inclusivity, health and well being. Our goal is to increase participants LGBT two Q I plus healthcare knowledge and skills for culturally competent practice and identify ways to advance the health of LGBTQ I plus individuals from a specifically social determinants data to action perspective using gender forming approaches. This module is presented in four parts with my colleague Dr. who will be introduced. In this section we address the first objective describe LGBTQ I plus health disparities that can be attributed to social economies both nationally and internationally. Let's get started. Learning activities for this section include the following. Please watch the short video LGBT matters on the YouTube link. We also ask you to familiarize yourself with the very important document from the US Institute of medicine, the health, lesbian gay, bisexual and transgender people. This is an important document as policy for and has been adopted intervention early as well and stands. I would like to policy document sure. As well If you would please see the Fenway institute LGBTQI Class, philosophy of trump's which is listed at the link shown on this page. For those of you who have taken course one in social determinants of health data to action, we'll recognize that our blacks model depicting systems thinking approach used in this course, we're moving from data on social determinants to using that data for making meaning and taking action for groups will change. In this module our content is situated at the person, family, community and socio political levels. To get everyone on the same page and because words matter, here's an important terminology when addressing LGBT Q I plus health needs on social issues. Language and terminology our culture and time dependent and evolved rapidly. It's important to use respectful language and to recognize that not all LGBTQ I persons will feel that the following terms had a representative. Please as well take a link to more complete definitions on the learning activities slide shown previously. Gender is a socio cultural designation as male female gender non conforming gender, non binary, gender queer or questioning. Sex on the other hand, is typically a biologic designation as male, female or intersex, generally based on visible reproductive organs and external genitalia present at group. Transgender are persons whose NATO biologic configuration as male or female does not align with their sense of themselves as male or female. The term trans man or trans woman is used to develop masculine or feminine directionality on the spectrum. This gender male or female refers to persons whose natal biologic gender configuration does align reasonably well with their perceived sense of themselves as male or female. Sex gender spectrum is a concept expressing the full array complexity and sometimes fluidity of sexual orientation and gender identity. Better of sexism is a form of discrimination or prejudice against lesbians, gays, bisexual persons on the assumption of heterosexuality is the quote normal sexual orientation. Sex gender diversity is an umbrella term that encompasses LGBT persons across the spectrum of non heterosexual orientations and nonsense gender identities. Homophobia is a dislike or prejudice against non heterosexual people, transphobia is a dislike or prejudice against non cis gendered people. Microaggressions are statements, actions or behaviors of indirect or big discrimination against members of a marginalized group, they may be intentional or unintentional, conscious or unconscious gender affirming describes interactions or behaviors that support an individual in their pursuit of the alignment between a mental or internal state of being and their physical and social gender presentation. Data on LGBT health demonstrates significant and persistent health disparities for LGBTQ persons and communities, discrimination and bias against sexual gender diverse persons, homophobia and transphobia in particular have led to and sustaining these health disparities. Thus we can say that the health disparities experienced by LGBTQI persons are the direct result of multiple negative social determinants of health directed towards sexual gender diverse persons and communities. Some current demographics for LGBTQI persons in the US are shown here. We can see that it's estimated 4.5 of US adults identify as lesbian, gay, bisexual or transgender. In this in the Washington Dc area of the US we see the highest percentage of LGBT people reported at 9.8% of the population as compared to North Dakota State in the Midwest of the US which has a reported Population of 2.7%. These are wide differences in population, what we don't know is whether these differences are due to an unwillingness to report LGBTQI Identity or to real differences in geographic distribution. We know that closer to 10% of human beings report some level of same sex attraction across all populations. In the USLGBTQI persons tend to be younger and poorer than the population at large. Only 23 percent are age % 50 or older compared to 47% of non LGBT adults and 56 are under age 35, as compared to 28 for the non LGBT population. The SGD Population is also economically disadvantaged and that higher percentages lack access to sufficient nutrition or have household incomes below the poverty line. Additionally, people of color are more highly represented among the LGBTQR Plus persons than in the general population. Unfortunately we don't have similar breakdown of social demographics or LGBTQI communities worldwide, though some countries will have this data and perhaps you can find it for the part of the world. LGBTQI persons have been reported in some European countries population data. Here is some data from the year 2016, showing that percentages have ranged from 1.5% in Hungary to 7.4% In Germany. We have less information about how these data are collected and whether or not in specific regions there would be reasons not to disclose sex, gender diverse identity. So what are the LGBTQI Plus population level health disparities? And how are they associated with social determinants of health? Let's start with the definition of health disparities which can be defined as a particular type of difference in health, in which different disadvantaged social groups systematically experience worse health or greater health risks than more advantaged social groups. Social determinants of health can cause, eliminate, or promote improved health disparities. Healthy people 2020 identifies these five overarching categories of social determinants, the neighborhood and built environment, which includes housing, crime and violence, environmental conditions and access to healthy food, education, which includes high school graduation, higher education, early childhood education and language literacy, economic stability, which addresses poverty, employment, housing stability and food security, health and healthcare access which includes access to health services, access to primary care, and health literacy, and social community context which includes social location discrimination and equity, civic participation and incarceration or an institutionalization. Together with the ION Report, the social determinants model has been applied to the available data on sexual gender diverse persons in the US showing vulnerabilities in many areas. Please include lack of gender and relationship recognition, discrimination, stress and hoping, risk behaviors, poverty, lack of access to health care, homelessness and importantly, an overall lack of data about the population. And in childhood and adolescence disparities are reported as follows. The first is in the area and establishing and accepting and integrating a personal sexual and or gender identity. The second is burdens associated with the coming out process for becoming more public about 1's gender and sexual identity. The third area is the development of gender dysphoria for some gender non binding my children. Particularly with high levels of staying on our discrimination or experience. Among physical health disorders, Adolescent pregnancy is a risk for LGBT issues as well as depression and suicidality. Substance use occurs at higher rates among sexual and gender diverse youth with initiation of youth occurring at younger agents. And HIV and sexual infections occur at significant island levels, particularly among young men who have sex with men. Finally, we see disparities in the areas of obesity and disordered eating and in mood and anxiety disorders. A very serious health risk for LGBTQI risk youth is the risk for suicide In the US our data indicates that 42.8% have seriously considered suicide, 38.2 percent that made a suicide plan, and almost 30 had an active suicide attempt. If you were watching this presentation and have suicidal thoughts or thoughts of taking your own life, please reach out for help immediately. The Nanny suicide hotline number is provided here and is staffed 24 hours a day to assist acute crisis. In addition to the high risk for suicide, homelessness is a signal LGBTQI use with 120% more LGBTQI a young people likely to experience homelessness than their heterosexual peers. Moving on to early and middle adulthood, disparities for LGBTQI persons include mental health disparities and mood disorders, suicidal ideation and behavior eating disorders, breast cancer and obesity, HIV infection and anal cancer and cancer and heart disease risks. Some of these are related to decreased access to care over a lifetime, which by now is leading to increased risks for some of the cancers and heart disease. Other of these risks are related perhaps to the gender reforming hormones used by trans persons and the lifetime effects that they can on the physiology of the body. In later adulthood LGBTQI Health disparities include depression and suicidality. Again breast cancer and cardiovascular disease, long term hormone use risk the effects of alcohol and tobacco use over a lifetime lifetime exposure to violence and discrimination, in the functional assistance and direct care needs that are experienced by all older adults that they become more prominent appropriate general forming services can't be identified. We're coming to the end of this part one in our series and so for reflection we would ask you to think about these questions. What are the LGBTQI demographics and our geographic region and how reliable is the available data? What specific terminology is needed to engage in thinking about social justice and health equity for sexual and gender diverse persons in your geographic region. There is a case study that we would like you to work with. And we'll be coming back to this case study in the next part of this slide set, we'll introduce you to Michael who is a 23 year old Hispanic. Michael identifies as transgender masculine and uses Keith and they pronouns. He is a type one diabetic who has had its own past three days. They are very tired and weak and dehydrated. Michael has been a past injecting drug user and has had unstable housing. Currently they have a new job with health insurance and so they're presenting for healthcare appointment which has been missed for some time. Their blood children today is 319 the designator, which she praised to 22 million mph. This is a dangerously high blood sugar level. They have had a 15 to £20 weight loss, and a new vaginal discharge that they would like to have evaluated. Also, Michael would like to start prep or pre exposure corporal options for HIV infection. This is a question but not one unlike that would be seen, health care clinics or gender normative. For your work on this case study here are a couple of areas of reflection and application for you. What are Michael's care priorities from the perspective of your own health care. And what further information you provided appropriate high quality, culturally competent care for sexual and gender diverse individuals such as Michael with complex health needs in your geographic region. There are some of the social determinants of health components you might want to consider case study. Please think about how some of these social determinants and might affect the quality of care that. This is the end of part one In our module, thank you so much for your attention and your engagement. We invite you to complete the course activities and then proceed to part two of this life. From what?
