Gender, sexuality and the discursive representation of access and equity in health services literature: implications for LGBT communities

Abstract

BackgroundThis article considers how health services access and equity documents represent the problem of access to health services and what the effects of that representation might be for lesbian, gay, bisexual and transgender (LGBT) communities. We conducted a critical discourse analysis on selected access and equity documents using a gender-based diversity framework as determined by two objectives: 1) to identify dominant and counter discourses in health services access and equity literature; and 2) to develop understanding of how particular discourses impact the inclusion, or not, of LGBT communities in health services access and equity frameworks.The analysis was conducted in response to public health and clinical research that has documented barriers to health services access for LGBT communities including institutionalized heterosexism, biphobia, and transphobia, invisibility and lack of health provider knowledge and comfort. The analysis was also conducted as the first step of exploring LGBT access issues in home care services for LGBT populations in Ontario, Canada.MethodsA critical discourse analysis of selected health services access and equity documents, using a gender-based diversity framework, was conducted to offer insight into dominant and counter discourses underlying health services access and equity initiatives.ResultsA continuum of five discourses that characterize the health services access and equity literature were identified including two dominant discourses: 1) multicultural discourse, and 2) diversity discourse; and three counter discourses: 3) social determinants of health (SDOH) discourse; 4) anti-oppression (AOP) discourse; and 5) citizen/social rights discourse.ConclusionsThe analysis offers a continuum of dominant and counter discourses on health services access and equity as determined from a gender-based diversity perspective. The continuum of discourses offers a framework to identify and redress organizational assumptions about, and ideological commitments to, sexual and gender diversity and health services access and equity. Thus, the continuum of discourses may serve as an important element of a health care organization's access and equity framework for the evaluation of access to good quality care for diverse LGBT populations. More specfically, the analysis offers four important points of consideration in relation to the development of a health services access and equity framework.

Examining the Development of Positive Space in Health and Social Service Organizations: A Canadian Exploratory Study

“…Nevertheless, while LGBTQ access has been emerging as relevant in a number of health and service sectors such as hospital, long-term care, and public health, there is an absence of LGBTQ-focused literature on the home care setting (Daley & MacDonnell, 2011). This article focuses on the first phase of a research study in Ontario, Canada, which aimed to understand issues relevant to home care service providers, LGBTQ service users, and other home care stakeholders with an ultimate goal of fostering LGBTQ-inclusive care in the home care sector.…”

“…Instead, this considers the complex and deeply embedded dynamics of power and privilege that are embedded in all social organizations (e.g., Daley & MacDonnell, 2011;McGibbon & Etowa, 2009;Wilkerson et al, 2011). Explicit attention to organizational and curriculum goals aligned with human rights demands a focus on the processes whereby change occurs, along with dimensions of responsive and supportive environments for diverse groups (Dobinson, MacDonnell, Hampson, Clipsham, & Chow, 2005;Gapka et al, 2004;Gay, Lesbian, Bisexual and Transgender Health Access Project, 2010;MacDonnell & Andrews, 2006;Moore, 2009).…”

“…They aim to foster inclusive higher education environments and a climate "free of discrimination" for faculty, staff, and students. According to OPHA (2011), a Canadian group that has advocated for LGBTQ-inclusivity across communities and sectors beyond the public health sector, past decade addressing cultural competence in professional curriculum and service organizations (e.g., Daley & MacDonnell, 2011;Jackson, Johnson, & Roberts, 2008;MacDonnell, 2009;Mulé et al, 2009;Wilkerson et al, 2011). For the most part, this focus on diversity has traditionally called for individual practitioners to celebrate or be sensitive to cultural differences in their patient/client populations.…”

“…For the most part, this focus on diversity has traditionally called for individual practitioners to celebrate or be sensitive to cultural differences in their patient/client populations. It has often implicitly or explicitly focused on visible differences related to race or language, supporting a multicultural and/or diversity discourse (Daley & MacDonnell, 2011). At the same time, there is an increasing, but still limited, literature that accounts for intersectionality in relation to LGBTQ people (e.g., Brotman, Ryan, Jalbert, & Rowe, 2002;Eliason et al, 2010;Ryan, Brotman, Baradaran, & Lee, 2008).…”

“…Over the past two decades, research has pointed to comprehensive approaches for creating inclusive social and health care (Daley & MacDonnell, 2011). A variety of LGBTQ-focused clinical guidelines and stand-alone service recommendations and policies and practices which contribute to affirming organizational spaces for gay men, lesbians, and trans people have evolved.…”