The Canadian Medical Association (CMAJ) is making a case for LGBT+ medical education in Canada. In a published analysis by Miranda Schreiber, Tehmina Ahmad, Michael Scott, Kevin Imrie, and Saleem Razack, the CMAJ is looking at how two-spirit, lesbian, gay, bisexual, transgender, queer, intersex, and asexual (2SLGBTQIA+) Canadians experience disproportionately poor health outcomes, and how the proper education in our society can change that. Schreiber says the inequality in healthcare comes from persisting structural oppression that has been passed down from the last century. “In the 19th century, Western medicine classified homosexuality as a medical condition. The Diagnostic and Statistical Manual of Mental Disorders (DSM) explicitly pathologized homosexuality until the early 1970s and continues to characterize gender dysphoria as a mental health diagnosis,” she stated.
Negative experiences with healthcare professionals have caused LGBT+ people to avoid visiting them altogether. According to the CMAJ report, many physicians often feel unqualified to treat 2SLGBTQIA+ patients – and medical educators agree this can only change through the right education. However, the correct information on LGBT+ healthcare seems to be scarce and inconsistent. Through this analysis, the CMAJ considered the obstacles of integrating 2SLGBTQIA+ information into Canadian medical education, and it says there should be a standard for it.
It’s not just about making changes for the future. It’s also about understanding the past. In addition to being pegged ‘mentally ill’ in the past, LGBT+ health issues were often completely ignored in Canada and the United States. “The AIDS crisis, which surged in the 1980s, was met with governmental negligence on both sides of the US–Canada border. The Reagan administration was reluctant to fund AIDS research, taking until 1985 to even acknowledge the AIDS epidemic. Although elected in 1984, then–Canadian Prime Minister Brian Mulroney did not acknowledge the existence of AIDS until 1989, and 2SLGBTQIA+ community groups and Canadian researchers had to work to provide people with experimental medications without government support,” stated the CMAJ report.
Those systemic wrongs continue in 2021, often resulting in LGBT+ patients feeling like they have to educate their healthcare professionals. Surveys taken in the past five years have shown unmet health needs for the trans community and inconsistent knowledge gaps about LGBT+ health. “Two-Spirit People’s barriers to health care are compounded by colonialism, racism, and cultural insensitivity, along with homophobia and heterosexism. Community-based qualitative research shows that gay Black men in Canada also encounter unique and substantial barriers to health care, and 2SLGBTQIA+ people who migrate from Africa and the Caribbean experience disproportionate trauma and mental illness,” the CMAJ analysis stated. This proves that each LGBT+ subgroup has particular health vulnerabilities, and intersection is needed.
In comparison to heterosexual, cisgender people, training and education about 2SLGBTQIA+ health to healthcare professionals is significantly disproportionate, causing disappointing experiences. Although integrating LGBT+ health information into medical curricula has challenges, the report by CMAJ says it has proven to be a beneficial step toward improving on this issue. Some of the barriers in developing a curriculum that offers LGBT+ medical education include a lack of health data, knowing which methodologies best serve students and patients, and a limited distribution of comprehensive resources, making collaboration and research challenging. “The Canadian Census will first collect multidimensional 2SLGBTQIA+ data in May 2021, and the exact number of 2SLGBTQIA+ people in Canada is not known with certitude,” the CMAJ report pointed out.
The CMAJ report says experts, community members, researchers, and learners have recommended incorporating LGBT+ health content into the medical curriculum. “The House of Commons Committee, in its recommendations for action to reduce the gap in health care for 2SLGBTQIA+ people, proposed improving education about the health needs of 2SLGBTQIA+ people for all health care providers,” said the report. A national standardization that mandates the inclusion of the 2SLGBTQIA+ curricula for undergraduate and postgraduate education will create better healthcare and better experiences for this community.