Canada’s health-care system is failing 2SLGBTQ+ people, new study finds

More than two in three queer Canadians are unsatisfied with their mental healthcare, a new national study has found, and the issues with equality in healthcare services don’t stop there.

A whopping 39 per cent of 2SLGBTQ+ Canadians have experienced discrimination directed at their sexual orientation, gender identity and/or gender expression in the previous five years, including but not limited to verbal abuse, physical violence, and online harassment, 2023 data shows. So, it should come as no surprise that many members of this community have experienced discrimination within health care.

Data from the Pink Paper on Health, a new report published by Pink Triangle Press (PTP), looks at health care experiences across the country and found some alarming disparities between 2SLGBTQ+ communities and their cisgender/heterosexual counterparts. Researchers surveyed more than 2,100 people nationwide, half of whom identify as 2SLGBTQIA+, finding that queer communities experience poorer health outcomes, reduced access to care, and higher levels of discrimination than non-queer respondents.

HIGHER RATES OF CANCER, CHRONIC PAIN

The study, funded by Women and Gender Equality Canada (WAGE) and conducted by Environics Research, was the first-ever national, bilingual, comparative study on 2SLGBTQIA+ health and health care experiences in the country. 

And the data paints a stark picture: mental and physical health disparities are not just talking points or numbers on a report, but lived realities for countless 2SLGBTQ+ Canadians. Meanwhile, from chronic pain conditions to cancer, queer communities reported higher levels of diagnosis, magnifying the urgency for equitable care.

For instance, the report shows that cancer diagnoses were alarmingly high among asexual (15 per cent) and gay (11 per cent) people, while just five per cent of non-2SLGBTQIA+ participants had been diagnosed with cancer.

Chronic pain was alarmingly more prevalent among queer people, with 28 per cent of queer and 27 per cent of Two-Spirit respondents experiencing the issue, compared to five per cent of non-2SLGBTQIA+ respondents.

While mental health is something that should be on everyone’s mind, the findings underscore the disproportionate mental health burden experienced by members of queer communities. 

Of queer respondents, 40 per cent reported a diagnosed mental health condition, twice the rate of non-2SLGBTQIA+ participants. Meanwhile, 50 per cent of queer people said their mental health was their top concern, compared to 31 per cent of straight/cisgender respondents. 

The study found that depression severity was highest among pansexual (47 per cent) and asexual (45 per cent) respondents, more than double that of their heterosexual/cisgender counterparts. Anxiety is also a major issue, affecting 50 per cent of pansexual people, 45 per cent of respondents who identify as queer, 47 per cent of asexual people, and 45 per cent of Two-Spirit people. That’s compared to just 24 per cent of non-2SLGBTQIA+ respondents. 

ACCESS, TRUST AND DISCRIMINATION

There are several reasons for the poor health care outcomes reported by queer respondents, including a lack of doctors and other health care professionals trained on 2SLGBTQIA+ health, a lack of inclusive communication, and the absence of culturally safe care. 

For many queer Canadians, a routine visit to the doctor can feel like navigating a minefield, where even simple questions about identity risk misunderstanding or hostility. Many people shared that they have had to conceal their queer identity, explain basic aspects of their existence to providers, or lie about their gender or sexual orientation to avoid being dismissed, misgendered, denied care, or treated with hostility. Unsurprisingly, discrimination was more common among racialized and rural respondents. For instance, 77 per cent of Two-Spirit respondents experienced discrimination in health care settings. 

When it came to health care-related concerns for queer people, 43 per cent worried about the competency of health-care professionals, 32 per cent were concerned with receiving respectful health care, and 36 per cent shared concerns about feeling safe and understood in health care settings.

2SLGBTQ+ people also report some major trust issues when it comes to doctors and service delivery, with 56 per cent of queer people getting their health care through online platforms, compared to 40 per cent of cisgender and straight people. This is due to a lack of access to care and widespread mistrust in the system.

Researchers found that the services most important to the queer people they spoke with were also the least accessible and least satisfying. For instance, overall, less than 30 per cent of 2SLGBTQIA+ respondents said they were happy with their mental health care. But breaking it down by group, some groups had really low rates of satisfaction: 12 per cent of asexual, 11 per cent of queer, three per cent of genderfluid and three per cent of Two-Spirit people reported satisfaction with their care.

SUGGESTIONS FOR IMPROVEMENT

The study doesn’t just highlight problems; it also lays out a roadmap toward care that is inclusive, affirming, and accessible to everyone. This includes integrating 2SLGBTQ+ health into health care training, expanding inclusive mental health services at federal, provincial, and institutional levels, and conducting a national environmental scan of available 2SLGBTQIA+ health care services. 

The report also calls for the standardization of inclusive sex and gender data collection, improvements to access for health services in rural and remote communities, and for health-care institutions to be made safer for queer people by centring 2SLGBTQIA+ voices. Additionally, researchers are calling for a national environmental scan of available 2SLGBTQIA+ health care services.

Additionally, taking matters into their own hands, PTP has launched a new platform dedicated to 2SLGBTQ+ health information. An accessible, one-stop destination for credible health information for queer communities, Script is a new tool that aims to address gaps in reliable, affirming health resources for 2SLGBTQ+ communities, publishing evidence-based stories that reflect the perspectives and diverse health care needs of the community. More information can be found on Script’s website.