Hello, everyone.
I thank you for the opportunity to address you this afternoon, and I applaud your decision to examine more closely the health issues related to gender and sexual minorities.
Permit me to begin by saying that one of the most concrete and practical actions that could be taken would be to ensure that the bill before the Senate forbids conversion therapy as a legitimate reaction to youth and adults coming out. This is still offered to youth. It's condemned by all professional medical and psychological associations, and it has to stop.
The slow movement towards equality is lived asymmetrically depending on what initial in the acronym LGBTQ2I one identifies with. It surely has been noted to you already in your hearings that intersex Canadians have no protection.
After finishing my studies and moving to Montreal, my teaching and research careers focused on gender and sexual minority health. My first research in the late 1980s and everything I've done since then has kept that focus. It’s not uninteresting to note that I'm also a psychotherapist with a large practice composed mostly of gender and sexual minority youth and adults and their parents, who have learned that one of their children is coming out.
I base my presentation to you this afternoon on my experiences as a teacher, a researcher, a therapist and an activist.
The good news in the last 30 years is that much has changed in terms of law and social policy. The bad news is that, in spite of these landmark changes, the psychological distress experienced—especially but not exclusively in adolescence—is still being felt in ways that are as intense and devastating as they were 30 years ago.
Depending on where you live, who you have been taught by and what kind of work you do, things may have changed enormously or seem to have not changed at all. Until the health indicators, both mental and physical, of this minority are more closely aligned with those of the general population, we have a lot of work to do.
There are two examples I'd just like to invoke as a way to move into a broader discussion. The first is a letter I received from a young person not that long ago. I'll quote from his letter.
It says, “Hi Mr Ryan. I am 16 and I go to high school in Trois-Rivières. I saw you on TV recently and called for your address. I am gay, but have never officially told anyone. Everyone gives me a hard time at school, so much so that I am afraid to go to the cafeteria. Some guys say that they are going to do all kinds of things to me. Nobody, teachers or anyone in the school does anything to stop them…I can’t concentrate anymore. Everything seems hopeless. Please come to my school and talk to them. There is no one here to help me. Please do something before I feel I have no choice but to kill myself. My parents don’t know anything about any of this. I am afraid to talk to them. If they hated me because I was gay I don’t know what I would do.”
Here is another. It says, “ I ran a program for PHAC for several years that developed services for sexual minority youth across Canada, the Safe Spaces Project. Before going to conduct research with the youth who participated I was asked to visit parents whose 16 year old son had just jumped off a bridge and killed himself. He left a note at home, found after the fact, in which he wrote: 'Mom, Dad, I’m gay. I think you’d rather that I be dead, so when you read this, I will be.' I met with the parents. They would have accepted their child. But he, somehow, didn’t know it.”
With those two examples, I'd like to talk to you for a moment about population health. I was a little worried that two faculty members and social workers would talk about the same thing, and I'm glad that we're going to be complementary.
I was asked several years ago by the Public Health Agency of Canada to address the issue of population health as it might apply to gay, bisexual, trans and two-spirit Canadians. I examined the determinants of health as they might relate to sexual minorities. Allow me to review some of the most important factors that my team and I discovered through literature reviews, focus groups and individual interviews.
I'm going to go very quickly, because I'm used to speaking for three hours at a time. Ten minutes is not a lot.
On social support networks, within a population health framework, social support networks are conventionally seen as support from families, friends and communities. Such support assists people in dealing effectively with trying situations and in keeping a sense of control over one's life and life situations. The support of family and friends as well as social participation seem to act as a buffer against health difficulties. Increased emotional support and increased social participation are both tied to increased health. Close intimate relationships are a factor for health and well-being. Lack of social supports or isolation is conversely considered a disease determinant.
Population health interventions cited to strengthen social support networks include programs to maintain strong families, community development that increases social interaction and initiatives that reduce discrimination and promote social tolerance. More generally, social support networks are integral to a person's social environment.
LGBTQI2 adults, and youth especially, often experience significant diminishment and exclusion within conventional social support networks due to homophobia, transphobia and heterosexism. In the face of such degradation and exclusion, they have historically and creatively organized, informally and formally, their own social support relationships and networks. Simultaneously, they often challenge conventional social support networks to be more responsive to their well-being.
Isolation is the most recurring feature in the lives of most sexual minority youth. It includes not just social or physical isolation but also cognitive isolation, which is a lack of knowledge about themselves, and emotional isolation, which is a lack of emotional support as a member of a marginalized group and a lack of social support that is not obvious to them in high school or youth environments.
I'll move now to education and say a few things that have already been said, just to underline their importance. Education equips people with life skills, allows them to participate in their own community and increases opportunities for employment. Historically, schools have been hostile environments for sexual minority youth. Discussion of sexual minorities has been slow to enter the curricula of Canadian schools. When it does, such discussion often faces opposition. Such hostility—due to homophobia, transphobia and heterosexism—ranges from verbal abuse to physical violence. The effects of homophobia, transphobia and heterosexism in school environments contribute to many lesbian, gay and bisexual adolescents dropping out, many becoming street-involved and homeless, high rates of suicide and attempted suicide, and internalized shame and low self-esteem.
Notwithstanding the courageous risks taken by queer youth particularly—and by their allies, as we've seen recently in Alberta with the response to the controversy around gay-straight alliances—they meet tremendous obstacles. Teachers hesitate to come out or be stronger allies because of fears related to public perception and career advancement, depriving youth of role models and support.
I've included a section here on employment and working conditions. You'll be able to see that in the brief I have provided, but I want to move on now to healthy child and adolescent development.
Regarding the general population, positive prenatal and early childhood experiences have a significant positive effect on eventual health, well-being and coping skills. The quality of such early experiences is influenced by socio-economic determinants. Poverty in particular has a wide negative effect. Adolescence for LGBTQI2 youth is a crucial time for their health and well-being. It's during this time of development that they will most likely be dealing intensely with sexual orientation and gender identity issues in their lives, including resisting and surviving homophobia, transphobia and heterosexism.
Access to health and health services is another really important issue. That's been mentioned already. I'll let you consult my brief if you want a little bit more, but I want to talk about the training aspect. Homophobia, transphobia and heterosexism significantly affect the quality of care provided by health care providers within health services. Health practitioners appear insufficiently prepared for interacting effectively with sexual minority clients and patients. Sexual minorities experience both systemic discrimination in health care and individual prejudice by health professionals. Trans folk and those of minority cultural, ethnic or racialized groups may experience compounded systemic discrimination and prejudice. As well, sexual minorities are often rendered invisible within health care systems. These systems are often perceived as unsafe.
The lack of adequate and relevant training of health care providers is a major barrier to the health of LGBTQI2 people. For example, they do not seem to be trained to collect the information necessary to be of assistance. They apparently often confound sexual behaviour with sexual orientation, and generally appear to be ill-equipped to deal with queer patients. Health care providers who are members of sexual minorities often appear to have a better understanding of the issues. That knowledge is usually self-acquired.
I'll make a special mention here related to trans health care. Trans individuals are turned away from services that are in no way connected to their trans identity or their hormone or surgical status. For example, someone was told they could not see a physician for their sore foot because “we don't treat transpeople who take hormones”. Another issue is the arbitrary order to cease hormone therapy when the medical issue is in no way related. In this case, the health professional doesn't assess the impact of such an order on a transgender individual's well-being.
Professional schools across Canada need to recognize that the lack of training on issues related to sexual minority health has further marginalized them and has led to their being in situations of greater health risk.
I want to invoke an example from Quebec. For the last 20 years in Quebec, the Ministry of Health and Social Services has funded a training program on gender and sexual diversity. That training program, which I co-authored and am one of the trainers in, has trained 40,000 people. That program has had a huge impact on those who have followed it in terms of the services provided and the comfort level dealing with clients and patients from gender and sexual minorities.
I will stop there. I thank you for the opportunity to address you.