‘Our systems are broken’: Panel discusses LGBTQIA+ health equity

Oftentimes, research fails to break down different gender and sexual identities in a helpful way to effectively portray an entire community. Dr. Tamal Carmel said he noticed problems with inadequate data collection on the LGBTQIA+ community while filling out the 2020 census.

“The census from the last administration left out several identities and would not let me accurately identify myself,” Carmel, the medical director of mental health services at Central Outreach Wellness Center, said. “I was forced to prioritize what parts of myself need more representation and would have broader implications for research, money and programming.”

Pitt Public Health’s Student Government Association hosted an LGBTQIA+ health equity panel Thursday evening, consisting of four healthcare professionals — Carmel, J. Coley Alston, Joanne Goodall and Victoria Grieve. Moderated by SGA President Michelle Nguyen and Danielle Nahas, SGA’s student engagement chair, the panelists were asked a series of questions and offered their insight and opinions on health equity for the LGBTQIA+ community.

Nguyen asked the panelists their thoughts on the barriers to health care faced by Pittsburghers, specifically LGBTQ+ individuals. Goodall, who works at the Center for Adolescent and Young Adult Health, said Pittsburgh offers “quite a bit of services,” but residents of the surrounding counties face the biggest struggles when it comes to accessing care.

“People come from three to four hours away to see us here in Pittsburgh, especially for gender care,” Goodall said. “I saw someone last week from Hershey and they told me it would be an eight-month wait to receive services in their area.”

Carmel said Pittsburgh has a “surprising” amount of services — such as alternatives for people without insurance, as well as health care for transgender people. But Carmel said the services are still “inadequate” when it comes to fully serving the LGBTQ+ community.

“LGBTQIA+ folks are disproportionately affected by social components of health and are left out of protections and assistance,” Carmel said. “The population is already traumatized within society and they have less access to care, which makes them less likely to seek out any care.”

When asked where the barriers exist within the community, Alston said the barriers result from a lack of data on the number of people in the LGBTQ+ community. They said the limited data skews the representation of the population and leads to a lack of understanding of the community as a whole.

“Information on gender, sexuality, family size, caregiving status, income are all really helpful,” Alston said. “It illustrates not only if you are doing the things you planned to do, but also shows who is reflective of the community.”

The panel discussed ways in which the COVID-19 pandemic specifically impacted health care for the LGBTQ+ community. Carmel said the pandemic significantly impaired access to doctors and other health care providers, as the “vast majority” of systems shut down. He said the pandemic also weakened the sense of community for LGBTQ+ people and hid their experiences from others, both good and bad.

“Domestic violence, intimate partner violence and violence in the home was all hidden behind closed doors,” Carmel said. “We couldn’t assess those situations even talking with the person because they are not in a safe environment.”

Grieve, an assistant professor of pharmacy and therapeutics at Pitt, said limited access to resources was seen at every level of social services.

“Even the basic things were shut down, like the social security office,” Grieve said. “I can’t get my social security card updated with my name, which means I can’t get my HR updated and my insurance updated. Little things like that start to fall apart.”

Alston said health care professionals during the pandemic had to prioritize the care and surgery they believed to be “essential.” They said oftentimes gender-affirming surgeries were deemed “non-essential,” which was “disheartening and difficult” for those people.

“It was devastating for people to be told their surgeries were cancelled and labeled as non-essential,” Alston said. “They had set up that window of time and they may never get it again. For them, this is their life-saving surgery.”

The moderators asked the panelists to give their input on the direction they thought the “new generation of health care professionals” should go. Goodall said discussion and awareness, rather than policy, are two of the most important aspects of the job for her.

“There are things I will never experience because of my privilege in this community and the country but I want to know about it and stand up for people,” Goodall said. “It’s not like you have to have this special talk about the issues, they should be included in everyday conversation.”

Carmel said the LGBTQ+ community lives in a “broken” society, with flawed systems and societal structures. He hopes to see the awareness of LGBTQ+ issues slowly absorb into mainstream consciousness, but does not expect for it to happen during his lifetime.

“All of our systems are broken, and it’s a society in which we have to navigate,” Carmel said. “I often have discussions about breaking down the existential philosophies in people’s values and figuring out how people can find their place of fulfilment in a dysfunctional society.”

Grieve said allies of the LGBTQ+ community are crucial to advancing opportunities for the community. She said being friends and supporters of these individuals is important, but it is not enough to bring about change.

“The true definition of an ally is someone who leverages their privilege for protection, advancement or support of a community,” Grieve said. “You are not an ally unless you are utilizing that privilege to speak up for people who can’t always do so for themselves.”

Carmel said establishing relationships and using one’s position to give back to others is critical in the fight for equity. He said those involved in the fight can face burnout and need to know when to ask for assistance.

“I personally didn’t have mentors that looked like me or had the same experiences as me,” Carmel said. “But now, there are more of us that can provide mentorship and there will continue to be more.”