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Research agenda
Older LGBT+ health inequalities in the UK: setting a research agenda
  1. Sue Westwood1,
  2. Paul Willis2,
  3. Julie Fish3,
  4. Trish Hafford-Letchfield4,5,
  5. Joanna Semlyen6,
  6. Andrew King7,
  7. Brian Beach8,
  8. Kathryn Almack9,
  9. Dylan Kneale10,
  10. Michael Toze11,
  11. Laia Becares12
  1. 1 York Law School, University of York, York, UK
  2. 2 School for Policy Studies, University of Bristol, Bristol, UK
  3. 3 School of Applied Social Sciences, De Montfort University - City Campus, Leicester, Leicestershire, UK
  4. 4 School of Health & Education, Middlesex University, London, UK
  5. 5 School of Social Work & Social Policy, University of Strathclyde, Glasgow, UK
  6. 6 Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
  7. 7 Department of Sociology, University of Surrey, Guildford, Surrey, UK
  8. 8 International Longevity Centre UK, London, UK
  9. 9 School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
  10. 10 UCL Institute of Education, University College London, London, UK
  11. 11 Lincoln Medical School, University of Lincoln, Lincoln, Lincolnshire, UK
  12. 12 Social Work and Social Care, University of Sussex, Brighton, Sussex, UK
  1. Correspondence to Dr Sue Westwood, York Law School, University of York, York YO10 5GD, UK; sue.westwood{at}york.ac.uk

Abstract

Lesbian, gay, bisexual and trans+ (LGBT+) people report poorer health than the general population and worse experiences of healthcare particularly cancer, palliative/end-of-life, dementia and mental health provision. This is attributable to: (a) social inequalities, including ‘minority stress’; (b) associated health-risk behaviours (eg, smoking, excessive drug/alcohol use, obesity); (c) loneliness and isolation, affecting physical/mental health and mortality; (d) anticipated/experienced discrimination and (e) inadequate understandings of needs among healthcare providers. Older LGBT+ people are particularly affected, due to the effects of both cumulative disadvantage and ageing. There is a need for greater and more robust research data to support growing international and national government initiatives aimed at addressing these health inequalities. We identify seven key research strategies: (1) Production of large data sets; (2) Comparative data collection; (3) Addressing diversity and intersectionality among LGBT+ older people; (4) Investigation of healthcare services’ capacity to deliver LGBT+ affirmative healthcare and associated education and training needs; (5) Identification of effective health promotion and/or treatment interventions for older LGBT+ people, and subgroups within this umbrella category; (6) Development of an (older) LGBT+ health equity model; (7) Utilisation of social justice concepts to ensure meaningful, change-orientated data production which will inform and support government policy, health promotion and healthcare interventions.

  • ageing
  • health inequalities
  • social inequalities

https://doi.org/10.1136/jech-2019-213068

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    Footnotes

    • Twitter Sue Westwood @Woman4Equality

    • Contributors This article is informed by extensive collaborative work involving all of the co-authors for a research grant application submitted to the Wellcome Trust, funded by a Research Pump Priming Award from the University of York. The award supported a literature review and networking conference, the focus of which was older LGBT+ health inequalities in the UK. The co-authors each attended the conference and presented papers at it. The lead author then drafted the first version of the article submitted here. It was circulated to all of the co-authors, each of whom provided extensive feedback both generic and on issues specific to their areas of expertise. Subsequent drafts were re-circulated on multiple occasions, further feedback was provided by all of the co-authors, and the final draft (submitted) was approved by all authors. The co-authors contributed as follows: PW: substantial contributions to the conception of the article and thematic analysis; feedback on drafting and re-drafting. Made a particular contribution about health and social care provision about which he has published previously. JF: substantial contributions to the conception of the article and thematic analysis; feedback on drafting and re-drafting. Made a particular contribution about heteronormative healthcare about which she has published extensively. THF: substantial contributions to the conception of the article and thematic analysis; feedback on drafting and re-drafting; made a particular contribution about social care provision about which she has published previously. JS: substantial contributions to the conception of the article and thematic analysis; feedback on drafting and re-drafting; made a particular contribution about secondary data analysis in LGBT+ health research about which she has published previously. AK: substantial contributions to the conception of the article and thematic analysis; feedback on drafting and re-drafting; made a particular contribution about LGBT+ ageing about which he is a leading UK expert. BB: substantial contributions to the conception of the article and thematic analysis; feedback on drafting and re-drafting; made a particular contribution about policy implications. KA: substantial contributions to the conception of the article and thematic analysis; feedback on drafting and re-drafting; made a particular contribution about both LGBT+ end of life carer and LGBT+ ageing about which she is a leading UK expert. DK: substantial contributions to the conception of the article and thematic analysis; feedback on drafting and re-drafting; made a particular contribution about methodology having recently led a UK systematic literature review. MT: substantial contributions to the conception of the article and thematic analysis; feedback on drafting and re-drafting; made a particular contribution in relation to older transgender health issues, in which field he is an emerging scholar. LB: substantial contributions to the conception of the article and thematic analysis; feedback on drafting and re-drafting; made particular contribution on big data analysis.

    • Funding This article was funded by a University of York (UK) Research Priming grant, Feb 2019 – July 2019 Westwood, S., Fish, J., Willis, P., Birks, Y. Older LGBTQ Health and Care Inequalities in the UK - Developing a collaborative research network.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.