Making Healthcare Inclusive

Healthcare system- a mechanism which is sophisticatedly defined as a structure consisting of various participants to deliver services to meet the health needs of people, historically, could be viewed as being unfortunately biased. Biased: almost always on the basis of money, sometimes power, caste, and often on the basis of gender and sexuality. The LGBT community has been one of the victims of this gruesome discrimination in accessing healthcare over the years and centuries. The origin of the lack of access to proper healthcare to the LGBT community dates back to longer ago than the community’s recognition itself but the persistence of the stigma against the community has remained dreadfully unchanged.

The health care system for the community, especially in India, is neither caring nor healthy. Time changed, the community grew, it got recognized but not accepted. Then, rainbow capitalism happened which, driven by businessmen’s self-interest, marketizes the community’s culture; but fails to authentically take care of unmet needs such as healthcare of the community. For the community, accessing healthcare in India is nothing less than an ordeal. From condemnation, gruesome insults to abuse and not acknowledging the community’s medical needs at all- these have all become the norm and do not come to anyone’s surprise in Indian hospitals. (1) A multi-layered and multi-dimensional problem like this, one of many which the community faces, remains alarmingly unacknowledged by the ‘pink-capitalist firms’; and the community has been calling for help.

The Hurdles to Healthcare Acess

A primary reason for the hurdles faced by the LGBTQ+ community with respect to lack of access to healthcare is the acute lack of proper data and documentation to provide facilities to the beneficiaries in the first place. The count of gay people in India ranges from 2% to 13%, a statistical gap too large to be of any help. This gap exists because of the deep-rooted prejudices in society towards the community which leads to a lot of people to conceal their sexuality. The first-ever transgender census in India was carried out in 2011, which depicts the startling denial of the existence of these people and their needs by authorities. This leads to something we call the ‘vicious cycle of disappearance’, where prejudices and biases lead to concealing of identities, leading to no representation in statistics, which leads to even more prejudices and misinformation.

The effect of this vicious cycle is statistically visible yet is ignored. The national literacy rate for India is approximately 75%, while the literacy rate among the transgender community is 55%, around 20% less than the national literacy rate, and the correlation between education and health is no closeted secret. (2)

Due to the many challenges LGBTQ+ people face, a lot of them suffer from mental health illnesses that require attention and therapy. The prejudice existing in the Indian context with respect to sexual identities as well as mental health per se alienates the community from the system even more. Statistics paint a grim, impersonal picture of the damage. Suicide rates among the Indian population as a whole are 4%, while it is a staggering 41% of the population among the LGBTQ+ community.

There is a lack of representation of the LGBTQ+ community in all facets, and the discrimination faced in priority sectors like health is an embarrassment for us a community and a country. This is where the wariness about concepts like pink capitalism enters the picture. Pink capitalism, very simply put, ‘capitalizes’ on pride narratives to appeal to liberal, more accepting millennial consumers. While this does raise awareness about the challenges the community faces on a daily basis, it has hardly contributed in any way in increasing representation and access and decreasing the prejudice. Few pride-based advertisements cast people from the community, and fewer companies airing these adverts have made their workplaces inclusive or have made significant contributions to the people of the community. This is where the vicious cycle makes a re-entry. The forced alienation of the community and the consequences caused thereby make it even more difficult for the community to enter and contribute to the labor force.

Inefficiency in Data Collection

Relevant data is required to identify beneficiariesin a targeted welfare programme, and the lack of data on the LGBTQ+ community is a major hurdle in the way of any healthcare project that might be introduced in the future. According to a 2014 World Bank report (3), most countries’ surveys on economic welfare or health do not include questions on sexual identity. Moreover, “existing surveys of LGBTQ people are often administered to people who are not representative of the LGBT population”.

Documentation is a challenge but is not impossible. Uruguay, in 2011, included questions on same-sex relationships in their census. One method of sampling which can be used is called snowball sampling. Snowball sampling is used when it becomes difficult to find participants to participate in a survey. A couple of respondents are hired, who in turn hire other respondents. The snowball aspect of this comes into the fact that once the snowball starts rolling it picks up more “snow” on the way and becomes larger. Such methods of data collection can be used when it is difficult to find respondents, or rather, respondents do not want to be found due to the prejudices they may face. This data collection method has certain shortcomings; the sample may not be representative of the population. However, it enables studies to take place and helps in learning more about the difficulties faced by the participants of the survey.

Pink Healthcare and Health Programmes

One of the best ways to look at how important a community’s health needs to a nation are is to look at the nation’s healthcare system. When we referred to Google and Bing to know how various flagship healthcare scheme of India over the years, Ayushman Bharat Yojana and RSBY to name a couple of them, plan to deal with the particular problem of the community members being unable to avail the health services- we found nothing, absolutely nothing. As disturbing as the google search turned out for us, the study of two foreign healthcare programmes – the National Healthcare Service in the UK and the Affordable Care Act or nicknamed Obamacare in the United States – enable us to study possible remedial measures for the community’s unmet health needs under an ideal healthcare system.

Both foreign programmes are very LGBT-friendly. Where Obamacare enables a citizen to locate same-sex domestic partner coverage options (4), NHS UK has been successful in ensuring the representation of the community and its safety at the workplace. Both the programmes focus on easily accessible healthcare services to the community members and emphasize the target medical needs such as mental health and substance use. NHS goes a step ahead by creating different platforms for guiding the LGBT members regarding issues like parenthood, mental health; LGBT health often goes unnoticed and untalked about in India. (5) To be able to think of a step toward an ideal healthcare programme for the rainbow community, studying and learning from these two healthcare systems abroad could be very useful for India.

Suggestions For A More Inclusive Healthcare Sector

Here are some ways we suggest through which the healthcare sector can be made more inclusive and accepting of the LGBTQ community. The immediate answer is to sensitize medical fraternity. Indeed, it is ironic that while a lot of uninformed people perceive homosexuality as an ‘illness’, there are few who wish to cure people of the community facing real and serious illnesses. Another step that can be taken to empower the community in terms of access to healthcare is the setting up of recognized patient centers for people of the community to come together and appeal together for the resolvement of the problems they face, thus raising the ‘bargaining power’ of the community is demanding basic access to healthcare.

Nationwide healthcare yojanas could be made more inclusive. Under the Ayushman Bharat Yojana, a number of ‘Ayushman Mitra’ are hired. The job of the Ayushman Mitra is to disseminate information about the scheme to the beneficiaries. Higher representation of the LGBTQ+ community as Ayushman Mitras would play a major role in empowering people from the community to talk to officials linked to welfare plans without fearing stigma. Moreover, representation of the community in official posts in welfare programmes will help create a pseudo redressal route for those denied treatments due to their sexual identity.

Additionally, there is a stark need for major steps in the sphere of medical insurance and medical education to provide a remedy to the problem. The Indian healthcare insurance system could learn from Obamacare and enable citizens to identify same-sex partner coverage options. Furthermore, the need for medical training and proper incorporation of the same into the medical education syllabi could not be needed more. This will ensure eliminating one of the root problems because of which members of the community hesitate to go out and avail of healthcare services by securing the acceptance of members’ medical needs by doctors at an early stage.

Conclusion

Right to health is an internationally recognized human fundamental right. Yet the inability of the LGBT community to avail even the basic of healthcare services poses thousands of questions not only at the Indian healthcare system but our Indian societal behavior and the rainbow capitalists as well. Equality comes out of the closet in mysterious ways, and in the hearts of millions of people, it shall thrive in the face of adversity. We suggested solutions but bringing these recommendations on the legislative table and their subsequent implementation require a shift of societal perception, political willpower, more authentically altruist rainbow-capitalists- as dreamy as it might sound, this dream could be realized with more Indian literature and discussions on the table, willpower, the right medical insurance and education reforms, and at last, with what has kept this dream alive- hope.

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