LGBTQ+ Americans face greater health care barriers in rural areas, study finds – The Hill

History at a glance


  • LGBTQ+ Americans living in rural communities face greater barriers to accessing health care than LGBTQ+ people in urban areas, new research has found.

  • Many physicians in rural communities may be unfamiliar with LGBTQ+ issues and identities and may not be equipped to address unique LGBTQ+ health care issues. LGBTQ+ patients in rural areas are also more likely to face discrimination based on their sexual orientation or gender identity.

  • Access to adequate health care in rural America is not a problem unique to the LGBTQ+ community, and people living in rural communities are at greater risk of poor health outcomes, the CDC said.

LGBTQ+ Americans in rural areas face greater barriers to accessing adequate health care, new research finds.

In a study published earlier this year in the Journal of Gay and Lesbian Social Services, researchers and doctors practicing in the Appalachian regions of Pennsylvania, Virginia and West Virginia said LGBTQ+ patients outside urban centers were more likely to make it difficult to find medical professionals who are familiar with LGBTQ+ issues or identities, a potential harm to the health of sexual and gender minorities.

Patients in rural areas are also more likely to face stigma around their sexual orientation or gender identity, according to the study, and many practitioners in rural communities are likely to have a worldview rooted in “heteronormativity,” or the belief that heterosexuality is the normal or preferred sexual orientation.

Physicians in rural America are also largely unprepared to address unique health challenges faced by members of the LGBTQ+ community, such as disproportionate rates of depression and anxiety.


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“Sexual and gender minority research is growing rapidly, but primarily in large urban centers,” said the study’s lead author, West Virginia University’s Zachary Ramsey, in a press release.

“There are a lot of differences between urban and rural populations for the general population, so it makes sense that there would be a lot of differences between urban and rural LGBTQ individuals,” Ramsey said. “Without more research specifically on LGBTQ rural individuals, these differences will not be known, and LGBTQ center policies and programming in rural areas can only use urban populations for guidance.”

Ramsey’s findings are consistent with those of similar studies. A study published earlier this month in the journal JAMA Surgery found that most transgender adults seeking gender-affirming surgery leave their home state to get it — even if it means paying additional medical expenses out of pocket.

Researchers in that study said one driving force may be the lack of health care professionals in places like the South and Midwest — two largely rural regions that are becoming increasingly hostile places for gender-affirming doctors to practice.

A 2020 study found that only 20 states had at least one surgeon capable of providing gender-affirming genital surgery to transgender adults, and most practices were located in the Northeast or West.

According to the Census Bureau, more than 46 million Americans, or roughly 15 percent of the U.S. population, live in rural communities. Individuals living in rural areas are at greater risk of poor health outcomes, the Centers for Disease Control and Prevention said, in part because they often have to travel long distances to receive specialty or emergency care.

Overall, only 11 percent of physicians practice in rural communities, according to the Association of American Medical Colleges. Of the more than 7,200 federally designated health care worker shortage areas, approximately 60 percent are rural.

“Attracting more providers to rural areas would be a big benefit,” Ramsey said, “not only for people who have to drive several hours to see an endocrinologist for hormones, but also for the general population, who can sometimes have a hard time getting find suitable services.”

Posted on July 25, 2022

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