Documenting the Need for Cultural Competence

Kaiser Family Foundation Establishes the Need

Lesbian, gay, bisexual, and transgender (LGBT) individuals often face challenges and barriers to accessing needed health services and, as a result, can experience worse health outcomes. These challenges can include stigma, discrimination, violence, and rejection by families and communities, as well as other barriers, such as inequality in the workplace and health insurance sectors, the provision of substandard care, and outright denial of care because of an individual’s sexual orientation or gender identity.

While sexual and gender minorities have many of the same health concerns as the general population, they experience certain health challenges at higher rates, and also face several unique health challenges. In particular, research suggests that some subgroups of the LGBT community have more chronic conditions as well as higher prevalence and earlier onset of disabilities than heterosexuals. Other major health concerns include HIV/AIDS, mental illness, substance use, and sexual and physical violence. In addition to the higher rates of illness and health challenges, some LGBT individuals are more likely to experience challenges obtaining care. Barriers include gaps in coverage, cost-related hurdles, and poor treatment from health care providers.

Medical education does not routinely encompass LGBT health issues. More than half of medical schools and public health school curricula lack instruction about the health concerns of LGBT people beyond work related to HIV/AIDS. However, the medical community’s awareness of LGBT health needs has grown. Several professional medical societies have formed policies and guidance that advocate on behalf of fair treatment and access for LGBT patients and health providers. For example, the American Medical Association (AMA) has issued an explicit nondiscrimination policy as well as numerous other statements that recognize prior discriminatory practices in the medical setting, the importance of better understanding and addressing LGBT health needs, the impact of discrimination on health and well-being, and the need to include sexual orientation in research.

The World Professional Association for Transgender Health also maintains a set of standards and principles to guide health care professionals in providing health care to transgender people. Additionally, in 2011, the Joint Commission, an independent non-profit national organization that accredits and certifies more than 20,000 health care organizations and programs in the U.S., began to require that hospitals prohibit discrimination based on sexual orientation, gender identity and gender expression in order to be accredited.

Association of American Medical Colleges Issues the Call

Recent literature has documented a gap in health care for patients who are or may be gay, lesbian, bisexual, transgender (LGBT), genderqueer, gender nonconforming, or born with differences of sex development (DSD). These groups … face health disparities caused by decreased access to needed care, bias and discrimination both in society and in the health care setting, lack of provider knowledge and/or comfort in providing care; absent or suboptimal risk factor assessment, and medical management that is not grounded in the current best evidence. These disparities can lead to preventable harms …

In order to develop competencies specifically to address the needs of the populations described in this publication … committee members created a total of 30 competencies to address the specific needs of these populations … These 30 competencies are designed for use in undergraduate medical education. However, because these competencies and their respective objectives are based on the Reference List of General Physician Competencies and thus the combined ACGME/ABMS framework, they are designed to be easily adapted for use in graduate and continuing medical education.