Mr. Chair and members of the standing committee, I am delighted to have this opportunity to speak to you in this first meeting of your historic study on LGBTQ2 health.
My name is Lori Ross, and I'm an associate professor in the Dalla Lana School of Public Health at the University of Toronto. I've been conducting research on LGBTQ2 health in Canada for the last 15 years, and in the time I have with you today, I'd like to draw your attention to two key issues for consideration in this study.
The first is that there is vast diversity, and in turn there are particular vulnerabilities within subgroups of the larger LGBTQ2 community, which we must attend to in order to meaningfully impact the community's health. The second issue is that enhancements to our current data collection mechanisms are required in order to more fully characterize and ultimately monitor improvements in LGBTQ2 health in Canada.
In making my first point, I'll particularly be drawing your attention to what we know about mental health outcomes within the LGBTQ2 community, given that this is an area where we see especially marked disparities, but please note that the within community vulnerabilities I am describing also pertain to many of the other health outcomes that Devon has drawn your attention to in his presentation.
Our first opportunity to examine LGBTQ2 mental health in Canada using population-based data started in 2003 when a question about sexual identity was first added to the Canadian community health survey, or CCHS. Analysis of these early data revealed that those who identified as lesbian, gay or bisexual were significantly more likely than heterosexuals to report a lifetime mood or anxiety disorder as well as lifetime suicidal ideation.
Subsequent analyses of more recent cycles of the CCHS continue to replicate these findings, showing no substantial decrease in the magnitude of the disparities, which are striking. In the 2003 data, lesbians and gay men were approximately three and a half to four times more likely than heterosexuals to report lifetime suicidal ideation, while bisexual women and men were approximately six times more likely.
This brings me to the first subgroup within the LGBTQ2S community that I would like to draw your attention to: bisexual people. Many are surprised to learn that bisexual people make up the largest sexual minority group, outnumbering gay men and lesbians. Often people are also surprised to learn that bisexual people report the poorest health outcomes of any sexual orientation group. That is, across a wide range of health outcomes, bisexual people fare more poorly than not only heterosexual people but also lesbian and gay people. Research suggests that these poor outcomes are likely attributable to the specific forms of discrimination faced by bisexual people as well as the pervasive invisibility of bisexuality, which in turn leads to a lack of social support. My team's work suggests that bisexual youth may be particularly at risk for poor mental health outcomes, with a recent survey of more than 400 bisexual people in Ontario finding that nearly 30% of bisexual youth reported past year suicidal ideation.
You may have noted that I have so far spoken only to sexual orientation. This is because until very recently—so recently, in fact, that the data are not yet available—we have not had access to any population-based data regarding the health of transgender people in Canada given the lack of a question on gender identity in our population-based surveys.
To understand the health of transpeople in Canada, we need to turn instead to the rigorous community-based research that's been conducted on this topic, particularly the Trans PULSE study, which was conducted in Ontario between 2009 and 2010 and currently is in development for a nationwide version to be launched in the coming months. Trans PULSE data estimated the prevalence of depression among transpeople in Ontario to be more than 60%. Thirty-six per cent of transpeople reported suicidal thoughts in the past year, and 10% reported a past year suicide attempt. Consistent with what Devon has told you about the impact of discrimination, those people reporting high levels of transphobia and low levels of social support were most at risk for these outcomes. These findings are echoed in a recent survey of more than 900 Canadian transgender youth, in which a shocking 65% reported past year suicidality.
The good news is that we have opportunities to change these statistics. Analysis of Trans PULSE data suggests that, by increasing levels of parental support and reducing levels of societal transphobia, it would be possible to dramatically decrease rates of suicidal ideation and attempt. Given this, attention not only to transpeople's health outcomes and health care experiences, which indeed is sorely needed, but also to the social conditions that produce these health outcomes, is critical.
I would next like to turn your attention to mental health among two-spirit and other indigenous LGBTQ2 people in Canada. Unfortunately, this is another area where data are lacking, again due to gaps in our collection of data related to sexual orientation and gender identity in surveys of indigenous health. Here, too, what we know comes largely from community-based research conducted in partnership with two-spirit people to assess health concerns and outcomes. This reveals high rates of depression, anxiety, drug use and suicidality. Qualitative research has highlighted the historical and ongoing impacts of colonization on two-spirit health, noting the critically important roles of intergenerational trauma and loss of language and culture. As for other indigenous people, interventions to redress these and other impacts of colonization must be at the forefront in order to meaningfully address two-spirit health in Canada.
In a similar vein, we so far know very little about the health of LGBTQ2 people who are members of other racialized groups in Canada, given that the sample sizes of population-based surveys have been too small to permit these types of intersectional analyses. Data are also lacking regarding the health of LGBTQ2 francophones and linguistic minorities, but through the lens of the minority stress framework, we would anticipate that discrimination and associated barriers to accessing health care may produce important disparities for these communities as well.
Finally, before turning to a brief discussion of data gaps and possibilities, I would like to highlight the importance of considering socio-economic issues as they impact the health of LGBTQ2 people. The available Canadian data indicate that there are important income disparities associated with sexual orientation and gender identity and that these disparities contribute to the health problems that we observe in our communities.
For example, in our research with bisexual people in Ontario, we found that over 25% in our sample were living below the low-income cut-off, and those living below the cut-off reported significantly higher levels of depression and post-traumatic stress disorder than those living above it. Given the elevated rates of homelessness and evidence of employment discrimination associated with sexual orientation and gender identity in Canada, policy interventions to address these and other social determinants of health for LGBTQ2 people will be an important mechanism for addressing the health disparities we are discussing today.
I would like to close with a brief discussion of the limitations and possibilities regarding data about sexual orientation and gender identity in Canada.
For many years, researchers and community advocates have been struggling with the lack of adequate data necessary to properly characterize health disparities for the LGBTQ2 community. Although the sexual identity question on the CCHS has been essential, the lack of data on gender identity as well as other important dimensions of sexual orientation such as sexual behaviour and sexual attraction has greatly hindered our work. The fact that the sexual identity question has been asked only of respondents aged 18 to 59 also limits our knowledge of youth and older adults, both groups with particular vulnerabilities.
As a result of these limitations, we have largely needed to turn to U.S. population-based datasets or seek funding to develop community-based research projects to address the necessary data gaps.
Statistics Canada's newly established Centre for Gender, Diversity and Inclusion Statistics offers the opportunity for Canada to become an international leader in this area through enhancements and additions to the questions currently asked on StatsCan surveys; the addition of relevant questions to surveys where they are not currently included, such as in the Canadian income survey; support to other levels of government in collecting appropriate sexual orientation and gender identity data; and development of innovations to ensure that the resulting data sets are sufficient to allow for robust analysis of important subgroups within the LGBTQ2 community.
This current study on LGBTQ2 health perhaps offers a natural opportunity to bring together the expertise of the new centre with Canada's ample academic and community expertise in LGBTQ2 health to maximize our opportunities for excellence in this domain.
At the same time, it's important to foster funding mechanisms to support community-driven research in LGBTQ2 health, which will inevitably continue to be essential in identifying emerging areas of concern. Historically, much of the research conducted in the area of LGBTQ2 health has been funded through HIV-related mechanisms. While HIV is certainly a health issue of concern to the LGBTQ2 community, as you are hearing today, our health needs extend well beyond this, and the HIV focus has been limiting.
Further, at present there is no explicit home for LGBTQ2 health research within the Canadian Institutes of Health Research; that is, there is no institute that explicitly includes LGBTQ2 health within its mandate. While the Institute of Gender and Health does include the health of gender-diverse people in its mandate and has funded important research on LGBTQ2 health, not having sexual orientation named in the institute's mandate means that we rely on supportive review committees to consider this type of work is within the institute's purview. Recognizing sexual orientation and gender identity within the mandate of the Institute of Gender and Health or within a variety of relevant institutes, together with priority funding announcements to address specific knowledge gaps, would serve to build a robust evidence base upon which to ground policy and practice interventions to address health disparities for LGBTQ2 Canadians.
In summary, despite major human rights advances and associated improvements in social conditions for many LGBTQ2 Canadians, significant health disparities persist. However, this first federal study on LGBTQ2 health and the new Statistics Canada Centre for Gender, Diversity and Inclusion Statistics make this a historic moment for understanding and ultimately addressing LGBTQ2 health in Canada. I greatly appreciate the opportunity to be a part of the conversation.
Thank you.