Heterosexism in Health and Social Care
The Journal of Health Organisation and Management aims, as part of its remit, to bring to a wider readership ideas that generally circulate among a minority of academics and managers and which deserve wider airing. We will, where possible, include authors’ summaries of books which contribute to that aim. Here is the first summary of a book that can open debate and discussion, while informing and educating.
Heterosexism in Health and Social CareJulie FishPalgraveBasingstoke2006230 pp.ISBN: 1-4039-4123-8Hardback £50.00
The early twenty-first century has witnessed a transformation in the political landscape for lesbian, gay, bisexual and transgender (LGBT) people. Increasingly liberal attitudes, alongside the repeal of repressive legislation,have created a climate that has never been so accepting. These changes require new understandings of the social conditions of LGBT people and the book proposes heterosexism as a term to conceptualise LGBT oppression.
The book is divided into two parts: understanding heterosexism in health and social care, and exemplars of heterosexism from research. In the first chapter,the author develops a theory of heterosexism and draws parallels with racism and sexism. Heterosexism is defined as a belief system that values heterosexuality as superior to homosexuality and it is based on the assumption that everyone is,or should be, heterosexual. Taken for granted assumptions suggest that heterosexism is more benign and unthinking than homophobia, with the implication that it is less important. This book challenges these assumptions by deconstructing the processes which sustain heterosexism and by providing examples from everyday health and social care environments.
The second chapter argues that despite the signs of progress, LGB health and social care needs are poorly understood. It develops an agenda for LGB people which includes: community safety; homophobic bullying in schools; domestic abuse in same-sex relationships; eating disorders; mental health, (especially suicide among young gay men, self harm among lesbians and the use of mental health services); substance misuse; HIV/AIDS; lesbians and sexual health; housing and parenting; and it addresses the social exclusion of LGB people from health and social care policy and delivery.
Chapter three is concerned with intersecting identities; it challenges pervasive stereotypes about lesbian, gay, bisexual and transgender people and recognises the heterogeneity of LGBT communities. It considers how different communities of LGBT people are positioned in terms of oppression, their identity formation and coming out issues; it explores their specific health and social care needs, their access to services and policy development. Intersecting identities include the needs of younger; older; Black; disabled; bisexual;transgender; working class LGBT people and those living in rural communities. This chapter provides one of the first analyses of intersecting identities in a British text.
Some of the methodological challenges facing health and social care researchers among LGB communities are explored in chapter four. The chapter engages with the conceptual definitions used in LGB research and provides a critique of issues concerned with recruiting LGB people to studies. These include the implications of refusals to participate, non-disclosure, the size of the sample, the costs of research and the composition of the sample. The chapter concludes with an examination of developments in research among LGB communities.
One of the biggest challenges to those concerned about policy development and service delivery is the historic invisibility of LGB communities. Little is known about the demographic characteristics of LGB people; they are overlooked by most government surveys. In 2001, the UK Census asked about couples living in same-sex relationships; because it was not well publicised and it did not address concerns about confidentiality, only a small proportion of people responded. However, it does provide important first information about the UK LGB population. It debunks the myth of a community completely concentrated in urban environments. Contrary to popular misconceptions, there are no vast swathes of“middle England” uninhabited by lesbians, gay men and bisexuals. The UK comedy programme Little Britain satirised this in the sketch “the only gay in the village”, but the Census shows that even in the remote corner of North West Scotland, people on the Shetland Islands identified themselves as living in same-sex couples. LGB people live in almost all of the 438 Local Authority areas in the UK (in only two places in Northern Ireland did same-sex couples not identify themselves in the Census). The chapter goes on to consider the income, education, occupation, employment status, family structure,home ownership and “race” and ethnicity of LGB communities.
Part two of the book draws on a UK national lesbians and health care survey of 1,066 lesbian respondents living throughout the UK and a series of seven focus groups in which lesbians talked about their health and health care experiences. Chapter six explores an issue common in both lesbians’ and gay men’s experiences of health care: whether and how to come out to a health care provider. Rather than conceptualising disclosure as a discreet, one-off event or as a trait of individuals (such as those with extensive social networks), the chapter develops a framework, first proposed by Hitchcock and Wilson (1992), to provide an analysis of disclosure as a process. It offers new understandings of disclosure and non-disclosure. The chapter concludes with a discussion of the heterosexual presumption in health care environments and LGB people’s use of the concept of relevance in their receipt of health care.
Lesbians’ risk of cervical cancer is a (relatively) well-researched topic in lesbian health. Chapter seven provides complementary findings about their experiences of cervical screening; in particular, their relationships with health professionals. In the survey data, the attitudes and behaviour of health professionals were most commonly reported as a reason for a positive experience;pain was cited as an adverse experience. The chapter provides explanations for,and examples of, these experiences. Some of them appear to differ from the experiences of heterosexual women reported in other studies.
Lesbians’ increased risk for breast cancer has been controversial since the early 1990s when a study conducted by a US epidemiologist suggested that lesbians were at greater risk than heterosexual women. This chapter provides data for the first time about lesbians’ perceptions of breast cancer risk. It considers quantitative data about lesbians’ perceptions of risk factors(for all women) and explores qualitative findings about their own perceptions of risk. Although lesbians’ breast cancer risk may not differ greatly from that of heterosexual women, their perceptions provide useful data about lay-people’s knowledge of risk.
The final chapter explores the opportunities and threats presented by new directions in equality agendas. It considers the legacy of 1980s political activism and 1990s political lobbying. It argues that the establishment of the new single equality body – the Commission for Equality and Human Rights(CEHR) – will be pivotal in promoting a common culture of shared values that underpin citizenship and in embedding an ethos of human rights in public services in the UK. The CEHR will be responsible, not only for the three existing equality strands (i.e. “race”, gender and disability), but also three strands not previously protected by statutory framework: sexual orientation, age, religion and belief. A single Equality Act is not being legislated for and this may mean different protections for each of the equality strands; moreover, the infrastructure for LGBT equality work is not well developed. The chapter concludes with an examination of the barriers to producing a sexual orientation mainstreaming strategy by using the framework adopted by the Women and Equality Unit.
The book will be useful for students and academics in health management,health policy, the sociology of health and for practitioners who are concerned about the health and social care needs of LGBT people.
