Question Period Note: LGBTQ2 Access To Health

LGBTQ2 (Lesbian, Gay, Bisexual, Transgender, Queer, and Two-Spirited) populations in Canada experience inequalities across a range of social and economic conditions that support health. Many of these inequalities are the result of stigma and discrimination, which create barriers to accessing material and social resources (e.g. employment, housing, social support) as well as access to health and social services. LGBTQ2 populations have been disproportionately affected by COVID-19 as the crisis has compounded existing social, health, and mental health inequalities.

Key Messages
• The Government of Canada is committed to promoting equality, protecting rights, addressing discrimination, and reducing health inequalities for LGBTQ2 populations.
• We are working on the creation of the first federal LGBTQ2 Action Plan, for which health is a key stream, and which seeks to advance the social and economic conditions that affect health outcomes of LGBTQ2 communities in Canada.
• We are investing in research, health promotion, and disease prevention programs to address the unique and diverse needs of LGBTQ2 populations, including programs to address communicable diseases, mental health, and gender-based violence.
• We also recognize the additional challenges faced by LGBTQ2 communities during the pandemic, including increased risk of family and gender-based violence, physical and mental health issues, disproportionate economic impacts, and increased difficulties in accessing health services.

The Pan-Canadian Health Inequalities Reporting Initiative, led by the Public Health Agency of Canada (PHAC) (in collaboration with the Pan-Canadian Public Health Network, Statistics Canada, the Canadian Institute for Health Information, and the First Nations Information Governance Centre), measures and monitors health inequalities for over 100 indicators of health determinants and outcomes. Thirty (30) of these indicators can be reported by sexual orientation. The largest inequalities experienced by gay, lesbian and bisexual Canadians are in self-rated health, self-rated mental health, household food insecurity, smoking, heavy drinking, asthma, arthritis, and HIV infection.

Other research has established that suicidal thoughts, plans and attempts are disproportionately prevalent among LGBTQ2 youth compared to non-LGBTQ2 peers, and that LGBTQ2 Canadians face disproportionate risks of family violence and gender-based violence.

LGBTQ2 populations have been disproportionately affected by COVID-19 as the crisis has compounded existing social, health, and mental health disparities. Findings from Statistics Canada highlight a number of factors that leave LGBTQ2 populations vulnerable to the impact of the COVID-19 pandemic, including:
- The age and gender composition of LGBTQ2 populations means they face a higher risk of job loss during the pandemic
- Overall, LGBTQ2 Canadians have lower incomes than heterosexual/cisgender people, and therefore have fewer financial resources to buffer the impacts of job loss and unemployment. Surveys undertaken during the pandemic have found that over half (52%) of LGBTQI2S (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Two spirited) households have been affected by COVID-19 related lay-offs and reduced hours, compared to 42% of Canadian households overall
- LGBTQ2 Canadians may be at greater risk of losing access to safe and secure housing
- Increased exposure to homophobia, transphobia, and family violence in the context of social distancing, and a disconnection from social networks and chosen families present additional risks for LGBTQ2 populations
While PHAC does not have a stand-alone funding program dedicated to LGBTQ2 health, it has integrated components specifically designed to address the needs of LGBTQ2 populations within a number of its existing community-based grants and contribution programs. For example:
- The Mental Health Promotion Innovation Fund (MHP-IF) - PHAC is supporting projects focused on the mental health of LGBTQIA2 (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, Two spirited) youth through the MHP-IF. A total of $1 million is being invested over three fiscal years (2019/20 to 2021/22) in two projects that support the design and testing of interventions to support LGBTQ2S+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Two spirited plus) youth and their families.
- The Promoting Healthy Equity: Mental Health of Black Canadians Fund - PHAC is funding three additional projects focused on the unique needs of Black LGBTQIA+ Canadians
- The Pan-Canadian Suicide Prevention Service (CSPS) - PHAC is supporting the development of LGBTQ2-specific training standards and resources for CSPS crisis line responders.
- Kids Help Phone – an investment of $7.5 million to provide mental health support for children and youth during the COVID-19 pandemic. A portion of this investment will focus on reaching and supporting priority populations, including LGBTQ2 youth.
- Preventing Gender-Based Violence: The Health Perspective - PHAC is investing more than $3 million in five projects prioritizing LGBTQ2 populations that are implementing and testing programs to prevent dating violence, or equipping health and social service professionals to better recognize, prevent and respond safely to gender-based violence.
- The Healthy Canadians and Communities Fund (HCCF) supports interventions that prevent and mediate health inequalities in chronic disease risk factors and outcomes, such as addressing tobacco use among young LGBTQ2 adults.
- The HIV and Hepatitis C Community Action Fund - The Government of Canada Five-Year Action Plan on sexually transmitted and blood-borne infection (STBBI) (2019-2024) identifies stigma and discrimination as one of its key priority areas. To help reduce STBBI-related stigma, PHAC has developed tools for health professionals and is prioritizing investments for community-based interventions.
Work is also underway to improve data collection and strengthen evidence:
- The Enhanced Surveillance for Chronic Disease Program – in the past year, PHAC has invested $2 million in the Community Based Research Centre (BC) and the Lawson Health Research Institute (ON) to address persistent public health surveillance evidence gaps through exploration of new technologies, tools and approaches to collect, use and disseminate data for public health action. These funded projects focused on LGBTQ2 populations, including populations experiencing homelessness (where LGBTQ2 people are disproportionately represented).
In 2019, the Standing Committee on Health (HESA) tabled its report The Health of LGBTQIA2 Communities in Canada. PHAC led the Government Response to the HESA report, highlighting the Government’s progress in developing and implementing a number of policies or initiatives focused on promoting LGBTQ2 equality, protecting rights, and addressing discrimination.
Available research suggests that sexual orientation and gender identity status are linked to increased substance use in general. Health Canada is exploring opportunities to better engage LGBTQ2 communities and organizations in the development of cannabis public education messages, advertising campaigns, and outreach efforts.
Recently, Budget 2021 announced $45 million over three years (2021-2024) for Health Canada to fund community-based organizations that improve access to sexual and reproductive health care information and services for Canadians who face the greatest barriers and highest health risks, including members of LGBTQ2 communities.
Health Canada continues to support the work of blood operators to implement a behaviour-based model of donation that eliminates the deferral period for men who have sex with men (MSM) and others impacted by current policies and practices. Neither Health Canada nor the provinces and territories have the authority to mandate a policy change to donor screening requirements.
The Canadian Institutes of Health Research (CIHR), through its Institute of Gender and Health, has identified the health of LGBTQIA2S communities as a key priority in their current strategic plan (2018-2023) and endorses research that explores how sex and gender influence health. Advancing on this important priority, CIHR has invested over $30 million over the past four years to support research that focusses on the health of LGBTQIA2S communities.
Additionally, PHAC is partnering with CIHR and Egale Canada on a Health Research Training Platform pilot funding opportunity to support the development of inter-disciplinary and inter-sectoral research training opportunities for high-caliber trainees and early career researchers, with a focus on stigma reduction and life course mental wellness for LGBTQ2 populations. The maximum amount per grant is $400,000 per year for up to 6 years, for a total of $2.4 million per grant.

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