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Understanding and Improving the Social Determinants of Health for the LGBT+ Community

Updated: Mar 10, 2023

​​By Leah Bowers and Catherine Smith, Lead Consultants of Data-Driven Strategy, Sangfroid Strategy

You may be wondering, what are social determinants of health? Maybe you’ve heard that term before, but never really understood how they affect your life.

Our team has recently been diving into the research around measuring outcomes related to the social determinants of health and how they affect various populations, such as the LGBT+ community.

Social Determinants of Health Disparities in the LGBT+ Community

The social determinants of health (SDOH) are the environmental conditions where we live, work, and play that affect a wide range of not only health, but also basic functioning, and quality-of-life outcomes and risks. There are five main categories of SDOH:

Each of us moves around this world based on our identities and societal conditions. We find and settle into communities based on this movement. Each community experiences different environmental conditions as a result.

For the LGBT+ community, societal conditions significantly marginalize how individuals interact within their neighborhoods, education spaces, healthcare access, and food security. These SDOH disparities may be further compounded when looking at LGBT+ communities through a lens of intersectional identities such as race, and nationality, leading to greater health inequities & risks to the quality of life.

We focus here on research related to how the Social Determinants of Health uniquely affect the LGBT+ population. This research also highlights examples of organizations that work to measure and improve the SDOH for both LGBT+ individuals and the broader community, and the tools used to do so. LGBT+ community-focused SDOH Disparities primarily center around behavioral health and well-being (i.e. psychological distress, sense of belonging, etc.) and physical health and well-being (i.e. access to gender-affirming services, gender/sexuality-based violence, accurate health care information, etc.). Understanding these disparities help us to start identifying possible interventions.

One way of thinking about SDOH interventions is from an ecosystem perspective. In this perspective, activities and interventions at different levels lead to greater health outcomes:

  • Upstream: work that relates to public health, prevention, partnerships, and policy;

  • Midstream: human services work addressing individuals’ social needs (including health and human service integration, barrier-breaking, and referrals);

  • Downstream: work related to individual healthcare needs.

These levels of interventions serve as ‘Protective Factors’, or things that help minimize greater risk to health, behavioral health, or wellbeing. For example, many organizations have identified groups such as Gay-Straight Alliances, training for physicians, and ally/parents/guardians sessions for awareness as beneficial in addressing SDOH.

Measuring Effects of the SDOH

Because this research is quite new, there are multiple methods for measuring the effects of various factors on one’s well-being. However, measuring the SDOH typically looks at these categories to understand a person’s quality of life and potential health risks:

  • Demographics

  • Economic Stability

  • Employment

  • Education

  • Food

  • Environment

  • Health and Healthcare

  • Housing

  • Neighborhood and Built Environment

  • Physical Activity

  • Lifestyle

  • Safety, Social, and Community Context

  • Transportation and Infrastructure

Asking screening questions in these areas can help you both understand the overall well-being of clients and their needs. Also due to this work being newer, very few examples exist that specifically demonstrate how the SDOH are measured in the LGBT+ community. However, The LGBT Center of Greater Cleveland, in partnership with Sangfroid Strategy, and local LGBT+ advisory leaders are working to change that!

The LGBT Center is building off research and data collection standards from various national organizations and lessons from others measuring the SDOH to better understand the holistic health and well-being of their membership.

Gulnar Feeresta, an Atlantic Fellow focusing on Health Equity and Senior Director of Programs at the LGBT Center, says "We are excited to strengthen our data practices to provide the most useful interventions and supports for the local LGBT Community."

Stay tuned for more updates from this work in the coming months!


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