science of us May 23, 2018
Why Do Queer Women Have More Health Problems Than Straight Women?
Photo: martin barraud/Getty Images/Hoxton
Earlier this month, Heather L. Corliss, a professor at San Diego State University's Graduate School of Public Health, published a study on lesbian and bisexual (LB) women's elevated risk for developing type 2 diabetes over a 24 year study period. Corliss found that lesbian and bi women were 27 percent more likely to develop the disease during that time period than their heterosexual counterparts, and that LB women were also more likely to develop the disease at a younger age — perhaps, in part, due to their experience of minority stress, or stress incurred as a result of their marginalized identity.
Getting this study funded wasn't easy, Corliss tells me — in no small part because health issues faced by queer and other marginalized populations remain vastly underfunded and under-researched.
I talked to Corliss about her work, and about the challenges she faces as a researcher of LGBTQ women's health issues. Here are just some of the reasons she suspects queer women's health remains largely unstudied.
If you exclude studies on HIV/AIDS, only about 0.1 percent of National Institutes of Health–funded studies concern LGBTQ health. Though LGBTQ identified people are a minority (4.1 percent according to a 2016 Gallup poll, though that number is thought to be low), the health research targeting them is still well below a representative proportion. In 2014, a team of researchers led by Robert W.S. Coulter searched every NIH-funded study published between 1989 and 2011, and found only 628 studies published on LGBTQ health concerns out of 127,798 total. Of those, most (79.1 percent) were dedicated to HIV/AIDS, and an even higher majority focused on sexual minority men (86.1 percent). Only 13.5 percent of that already tiny fraction concerned the health of sexual minority women (and only 6.8 percent studied trans populations).
What these funding patterns suggest is that LGBTQ populations are largely uninteresting to many government agencies, barring the development of a genuine health crisis. "So lesbian and bisexual women are invisible in our society," she says. "And women are invisible in our society unless it's in the context of motherhood." That queer men have been studied at all is owed almost entirely to the HIV/AIDS epidemic. At a certain point, says Corliss, "HIV/AIDS couldn't be ignored. So there was a lot of effort put into trying to figure out ways to address that crisis. And, therefore, if you're studying HIV in men who have sex with men, there's ample opportunity for funding." Beyond that, though, it's an uphill battle.
Minority stress likely plays a role in the health risks marginalized people face. Corliss suspects a number of factors might explain why queer women are more at-risk for type 2 diabetes — higher rates of obesity, tobacco smoking, and heavy alcohol use than straight women among them — but some of those factors may also be influenced by queer women's exposure to "minority stress," the name given by researchers to the stress incurred because of one's marginalized status.
The minority stress experienced by different marginalized groups varies, but for LGBTQ people, says Corliss, there are thought to be three main stressors: internalized stigma, expectations of rejection (the belief that people will reject you when they learn of your LGBTQ identity), and concealment (i.e. being partly or fully closeted). Queer women face the additional stressor of sexism, just as queer women of color also experience racism. The potential effect of these stressors on chronic health issues is enormous, says Corliss. "Distress and negative affect might feed into physiological stress responses, which then feed into individual mental health, which might feed into these groups' health behaviors," she says.
It's still hard to get good data on sexual orientation. "The public health model really starts with surveillance," says Corliss. "The first thing we need to do is have good surveillance to understand the health patterns in populations." The U.S. Department of Health and Human Services only began collecting data on LGBTQ identities via the National Health Interview Survey in 2011, after years of advocacy by researchers, says Corliss.
Progress has not, however, been linear — earlier this month there were reports that the CDC planned to drop the question on sexual orientation (until now an optional module) from their Behavioral Risk Factor Surveillance System, though the CDC denied these claims. "With the political climate the way it is, in some ways we're going backwards with this research," says Corliss. "There's just not much work done to try to reduce health disparities in sexual and gender minority populations."
Corliss says she's been discouraged from pursuing LGBTQ health-related research throughout her career. "When I was a graduate student, I had a number of faculty tell me that it would be the death of my career if I studied LGBT health issues," she says. "Some people think it's not real research. Some people think it's not important research." Despite numerous roadblocks and discriminatory experiences in the public health community, Corliss has only grown more resolved to study this demographic. In order to address some of the health disparities faced by queer women, more research is essential.
"We need a body of research to draw accurate scientific inference," she says. "We don't have that body right now. We have a fingernail."
Why Do We Know So Little About Queer Women's Health?