Health Problems, Economic And Social Aspects Of Marginalized Groups In America

The word “marginalized” is used to delineate the experiences of the population who live on the periphery of mainstream America. These groups lack the power to improve their life situation, since they are usually alienated from complete participation in the American dream. In fact, this term has been stretched from the original version to minorities. One of the examples of a marginalized group is “lesbians”. There has been a lot of research done on the increased risk of health problems on lesbian women and, as a result, evidence-based practices’ emphasis on the knowledge about risk and occurrence of health problems requiring special awareness and attention. These researchers also address some of the ethical challenges based on the assumptions underlining the analysis. This paper will address some of the health problems of this marginalized group and economic aspects, as well as social justice and its relationship to health disparities. The paper will also discuss incidence and prevalence statistics in the state of New Jersey, in terms of local and national data related to the problem. In the end, the author will also address some of the actions which she will take as a future practitioner for this marginalized group.

Background

Approximately 1.1%-3.5% of U.S. adults identify themselves as lesbian. Prior to 1961, homosexuality in the United States was mostly invisible, due to the reasons linked with shame and unnaturalness. Being a lesbian was against the law and it was also considered a crime in all 50 states. Due to the epidemic of the acquired immunodeficiency syndrome, there has been a high awareness of health problem among females who have sex with same sex partners. A physician must be knowledgeable about the health issues of lesbians. Biases about lesbians in healthcare have been shaping health seeking behavior and access to care for lesbians even with increased social acceptance. It is reported that approximately 600,000 households are made by same-sex couples in United States. The health care providers are seeing these patients even if they are aware of their sexual orientation and gender identities. However, health disparities are still at a height due to the prejudice and stigma attached to this group. Studies have reported high incidents of suicide attempts, especially in teenagers due to the burden of marginalization. Majority of women do not open up about their sexual orientation to their physicians and as a result, lesbians are screened at the rate of 5% to 18% lower than heterosexual women. It has been reported that lifetime lesbians (2.2%) are at a higher risk of cervical cancer than bisexual women. The rate of colon cancer is approximately 4.5% in lesbian women. They are also at a high risk for breast cancer than heterosexual women since they have a decreased rate of breast cancer screening and nulliparity. The HIV impact and its risk of female-to-female transmission still remains under research. Due to these disparities, the health care of this group is gaining increased attention in terms of understanding morbidity and mortality in Western countries. A problem of intimate partner violence presents a public health concern for lesbians which at times result in assault and repeated injuries. Health care providers at times are unaware of these issues and are ignorant of violence in these kinds of relationships. Lesbian or young girls are also found to be at risk for tobacco use and eating disorders. Young lesbians, who may not be sure about their sexual orientation, can utilize some counseling which will help them cope with difficulties at home, school, or in their community.

Economic Issues

In 2015, the Supreme Court of the United States extended marriage equality to same sex couples. However, till now, there is still implied discrimination in getting jobs, housing, and public accommodations based on sexual orientation. Studies have reported that about 23% of lesbians are living in poverty, compared to heterosexuals. In NJ, lesbian couples with children have a lower median income than heterosexual couples with children ($59,200 vs. $75,380). Young lesbians tend to leave their homes and live on the street due to not being accepted by families. As a result, homeless lesbians are more prone to mental health problems such as major depression. Workplace discrimination against lesbians is a big factor in socioeconomic difference for Lesbian population.

Social Justice

Even though the Supreme Court has made same sex marriage legal, there are many times when a lesbian gets married and goes back to their jobs, they get fired the next week because of now being openly “lesbians”. There are still some states which lack anti-discriminatory laws to address sexual orientation or gender identity. They lack any federal law protection for access to employment, housing, or public accommodations. Mississippi State received a lot of criticism due to a law which allowed business owners to refuse to serve gay men and lesbians based on the owners’ religious beliefs. A case was filed against this discrimination but the owner’s religious belief was later upheld by the Supreme Court. Due to the existence of many health disparities faced by this minority group, they are exposed to various stressors resulting in many mental health problems such as mood and anxiety disorders, depression, substance abuse, and suicide. They also show lower levels of psychological and social well-being as well as a higher rate of physical health problems, such as unsafe sex. Lesbians are also not utilizing preventive health care for routine check-ups and screenings for pap smear and cervical cancer due to the perceived discrimination by the health care providers. They also face barriers in getting health insurance. Data reported 20% and 30% of lesbians do not have health insurance.

Ethical Issues

The disparities faced by this marginalized group get more exacerbated when health care providers refuse to treat them due to their own personal or religious beliefs. These refusals to treat and providing necessary care can result in serious emotional, physical, and financial problems for lesbians. Studies have reported health care workers using harsh words for lesbians; there have been reports of them at times refusing to touch them or of them using extra precautions and would sometimes blame them for their health issues. Studies have reported that lesbians are denied infertility treatment, claiming religious belief prevents them from performing a procedure, even though the clinic is accepting their health insurance. Although the attitudes of health care workers has improved, some physicians are still not comfortable in caring for lesbian patients.

Plan of Action

]As we know, there are no gay or lesbian specific diseases. However, the health care provider must be aware of their health issues due to many health disparities affecting some of them. For the first time in Healthy People 2020, lesbians and gays are recognized as an at-risk population and their health disparities have been highlighted. Recently, there has been a tremendous improvement in the social environment of lesbian and LGBT minority individuals but the effect of these changes may not be widely positive. It still has to be determined if these changes have decreased the stigma and prejudice against this group at an interpersonal level. In addition, there may be a need for new measures to assess such experiences. Due to some of the cultures within our society still being homophobic, this group still requires a lot of courage to come out in the open. Many young lesbians use the term “queer” as a blanket for their community. However, as a future practitioner, it is my social responsibility to be non-judgmental and have an open mind when seeing these patients in clinical setting.

As a future practitioner, I would like to take few steps in improving the care of this minority group. First, I would create a welcoming atmosphere within the clinic and examination room by posting a rainbow flag or any other sign. It is very important to be open and non-judgmental during history taking about their sexual identity in terms of building trust and not making any assumptions based on their appearance. This change will build a level of trust among physicians and their patients, which will lead to an increase of their routine checkups, screenings, and for future care in a timely manner. Secondly, I would set up my office with a staff that will welcome all patients in spite of their gender and sexual orientation, and who will treat all patients with the same respect. The patient information forms will be modified with details that will identify their relationships status to get more accurate information by using terms, such as, “relationship status” instead of marital status, using “partner” rather than spouse or husband/wife. I would make sure to inform the patients that their information would be kept confidential and their response to these questions is optional. I would like to have my clinic provide educational material on health information regarding sexual orientation and gender issues for my clients and their families. I would also provide a list of community resources to encourage any counseling for themselves or their families. The outcome of the above actions will be visible in the reduction of any mental health illness medication usage or change in mood and behavior of the patient.

I believe becoming aware of their issues and making resources and referrals available specifically addressing their issues will convey that I care for them and that I am making efforts to be familiar of their needs.

Conclusion

To conclude, I would say that in talking about any marginalized group, we should remember that their problems are mutually inclusive to the society as a whole and not exclusive; such as, any health care issues with lesbians may be women’s health issues in general. Health disparities in any minority group not only interfere with their ability to get optimal care but it also creates mental and health problems for them. Biases in the society affects the socioeconomic and mental growth of that population and raises a lot of ethical issues in health care. In our conversation about equality, we should talk about equality in all aspects of life for everyone. Health care providers must look at their own biases, identify them, and work on them to improve accessibility of care for all. We should train our professionals to help them in gaining the necessary knowledge, expertise, and sensitivity. We must refine our attitude towards sexuality to promote positive environment without becoming awkward or uncomfortable.