How covid-19 has exacerbated LGBTQ+ health inequalitiesBMJ 2021; 372 doi: https://doi.org/10.1136/bmj.m4828 (Published 16 March 2021) Cite this as: BMJ 2021;372:m4828
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I thoroughly welcome this article on the impact of Covid-19 and its impact on people from the LGB&T communities (Phillips 2021). This is an area that deserves much more attention.
In a recent systematic review in this area (submitted for publication), I and colleagues were distressed to find no fully published information on this from any of the large UK Covid-19 surveys, and no data at all on incidence, hospitalisations or deaths. For example, the UCL study into the psychological and social effects of Covid-19 in the UK (led by Prof Fancourt) omitted to collect data on sexual orientation and gender identity. The Office for National Statistics (ONS) validated a measure of sexual orientation over 10 years ago, which could easily have been used if they had just wanted to include that instead of both. I do not understand how a study on psychological and social impacts could miss out these key drivers.
Professor Sir Ian Diamond has agreed that incidence, hospitalisations and deaths in LGBT people is an important issue, and that the ONS fully supports discussions to attempt to understand these important questions. However, this topic seems to be so far down the SAGE list of priorities that we may not see data any time soon. Professor Sir Michael Marmot, the Health Inequalities expert, only mentions LGBT mental health issues in his Covid-19 review, and omits to mention the complete lack of data on incidence, hospitalisations and deaths in LGBT people.
The Women and Equalities Select Committee Report, as mentioned in the article by Phillips (2021), recommended that "In line with ethnicity monitoring, sexual orientation monitoring should be made mandatory across all NHS and state social care providers within the next 12 months" and that "Monitoring both sexual orientation and gender identity is far too important to be an aspiration rather than a concrete goal with clear timelines for delivery. The NHS needs to understand where the disparities are in order to formulate strategies to tackle them." . We know that there are some UK datasets which collect sexual orientation, for example the Health Survey for England, the Improving Access to Psychological Therapies (IAPT), Understanding Society, the UK Longitudinal Household Study, and there is sexual behaviour in Biobank. Surely one of these could be used to generate some sexual orientation data at least? Anything would be better than nothing, as I fear that no news is definitely not good news.
1. Marmot M, Allen J, Goldblatt P, Herd E, Morrison J. (2020). Build Back Fairer: The COVID-19 Marmot Review. The Pandemic, Socioeconomic and Health Inequalities in England. London: Institute of Health Equity
Competing interests: I am currently a member of the government LGBT Advisory Panel. This response is made in my academic capacity and not as part of the Panel.