It’s not what we would class as the front of our priority’ : a qualitative, intersectional perspective on LGBTQ+ disadvantage within health and social care service pathways in North East England

Abstract

Background: While income and access to healthcare systems remain primary drivers of health inequalities, there is growing evidence of the health inequalities experienced by population groups who are marginalised due to factors such as ethnicity, level of physical ability, sexual orientation, or gender identity. Aims: Adopting an intersectional perspective, this study aimed to explore the health and social care pathways of LGBTQ+ people in North East England who had experienced disadvantage, to identify barriers and facilitators within these pathways, and use these findings to inform future service provision. Methods: A qualitative interview study, underpinned by an ethos of co-production, with 33 professionals and 39 LGBTQ+ people who had experienced disadvantage. Over 66 hours of interview data were imported into MAXQDA software to support data management and analysis. Descriptive phenomenological methods were used to identify the essence of the interviews, which served as an axis around which data were synthesised. Results: Three key themes were generated from analysis of the interviews. Collective directions and core groups: normativity within services led to majority groups holding positions of privilege. Policy vs. practice: workplace culture functioned in opposition to legislation and guidance. Oblique angles rendered invisible: LGBTQ+ disadvantage went unseen within current frameworks. Conclusions: Participants marginalised by factors such as ethnicity, physical ability, sexual orientation, and gender identity experienced inequalities within health and social care services. Discrimination led to disengagement from early interventions, and later use of crisis services. Many LGBTQ+ disadvantages remained unseen, rendered invisible by normative policy and practice. This study suggests that an understanding and application of health inequalities that is constrained within a framework of economic disadvantage will continue to sideline the social inequalities of health. It calls for greater consideration of social inequalities, and recommends a utilitarian position that considers ‘all of us’ rather than ‘us and them’.