| Sexual Orientation by District | |||||
|---|---|---|---|---|---|
| Area | Straight or Heterosexual | Gay or Lesbian | Bisexual | All other sexual orientations | Not answered |
| England | 89.4% | 1.5% | 1.3% | 0.3% | 7.5% |
| Derby | 88.1% | 1.3% | 1.5% | 0.4% | 8.7% |
| Derbyshire | 91.1% | 1.3% | 1.0% | 0.2% | 6.4% |
| Amber Valley | 90.8% | 1.3% | 0.9% | 0.2% | 6.8% |
| Bolsover | 91.0% | 1.5% | 0.9% | 0.2% | 6.4% |
| Chesterfield | 90.6% | 1.5% | 1.2% | 0.2% | 6.5% |
| Derbyshire Dales | 91.1% | 1.1% | 0.8% | 0.2% | 6.8% |
| Erewash | 90.9% | 1.4% | 1.2% | 0.2% | 6.4% |
| High Peak | 91.0% | 1.4% | 1.2% | 0.3% | 6.2% |
| North East Derbyshire | 92.0% | 1.1% | 0.8% | 0.1% | 5.9% |
| South Derbyshire | 91.8% | 1.3% | 0.9% | 0.2% | 5.9% |
| Source: Census 2021 | |||||
LGBTQ+
LGBTQ+
Health Inequalities
Population
Mental Health
Sexual Health
Alcohol
Physical Activity
HIV/AIDS
Suicide
Digital Divide
Work and Health
Gender Identity
Introduction
This summary provides an overview of the health and wellbeing of Lesbian, Gay, Bisexual, Trans, Queer, Questioning and others (LGBTQ+) communities. LGBTQ+ aims to be an inclusive term of a range of sexual orientations and gender identities. Terms and language change over time and this term is a useful summary. The + enables other sexual orientations or gender identities to be recognised and encompassed. In this summary LGBT or LGB and T made be used and this reflects the source of the information.
LGBTQ+ incorporates two aspects, sexual orientation, and gender identity. It is helpful to define these terms as they can be quite different, and people may have different sexual orientations and/or different gender identities. Sexual orientation is defined as: A person’s sexual attraction to other people, or lack thereof. Along with romantic orientation, this forms a person’s orientation identity.1
Gender identity is defined as: A person’s innate sense of their own gender, whether male, female or something else (e.g., non-binary), which may or may not correspond to the sex assigned at birth.2,3
ONS gender identity data is provided, these are statistics in development and guidance is provided for interpeting these statistics.4
The definition of gender identity in children is currently part of a consultation.
LGBTQ+ people live, work, visit and study in Derbyshire and may or not be visible with communities. Data shows that Derbyshire has a smaller LGBTQ+ population that other areas of England. Despite this smaller population there are several pride marches (Belper, Chesterfield) and cultural events, a network of organisations that support the resident and working population and visibility across workplaces and community events.
National evidence shows that LGBTQ+ can experience society, communities, and healthcare differently to non-LGBTQ+ people. This can be due to issues like stigma, discrimination and a lack of awareness or understanding of the experiences of being part of the LGBTQ+ population. There is a lack of evidence to identify how Derbyshire’s LGBTQ+ population live their lives and if these differences are felt. This leads to gaps in understanding of how to support these communities. This summary will provide an overview of what is known and highlight areas where more work is needed.
Taking a population health approach to LGBTQ+ health and wellbeing is needed to achieve fairness, reduce health disparities and inequalities, and promoting the overall well-being of everyone in our communities. LGBTQ+ health has a relatively recent history that has seen progress in holistic and person-centred approaches, collaborative action, addressing social determinants of health, improving access to healthcare services, and creating acceptance and inclusivity in all aspects of society.
Why is it important to Population Health?
LGBTQ+ people have unfair differences in health access and outcomes. These include higher rates of mental health issues like depression and anxiety, higher rates of substance use, increased risk of certain cancers, and higher rates of blood born viruses like HIV/AIDS.
Society and communities can treat LGBTQ+ people differently, this is known as the Social Determinants of Health. LGBTQ+ individuals often face stigma, discrimination, and marginalisation in various aspects of their lives. This can happen within families and communities, at healthcare settings, in employment, and accessing housing. These social determinants of health can have significant negative impacts on their physical and mental wellbeing.
LGBTQ+ individuals may encounter barriers to accessing healthcare services, including lack of culturally competent care and discrimination from healthcare providers.
LGBTQ+ individuals may experience minority stress, which refers to the chronic stress resulting from experiences of discrimination, prejudice, and stigma based on their sexual orientation or gender identity. Minority stress has been linked to negative health outcomes, including mental health disorders and physical health problems.
The Derbyshire Population Health Approach
The Derbyshire Population Health Approach focuses on prevention, population health, evidence-informed practices, causes, and collaboration. It emphasises proactive measures to prevent health issues, tailors interventions to specific populations, incorporates evidence-informed practices, addresses underlying causes, and promotes collaboration for effective action.
When considering the topic of LGBTQ+ within The Derbyshire Population Health Approach:
• Prevention
Inequalities and disparities are unfair and preventable. Action is needed across health and wellbeing services to achieve health equity and improving overall population health. Population health interventions can help mitigate the impact of minority stress on LGBTQ+ individuals’ health.
Improving access to healthcare for LGBTQ+ individuals is essential for preventing health issues or accessing treatment early. Services need to be accessible and culturally competent and free from stigma or discrimination. LGBTQ+ people can experience long waiting lists for gender identify clinics, breaks in confidentiality (where someone is involuntarily outed), being misgendered or experience unhelpful or distressing staff attitudes. Inclusive services, staff training, coproduction of services and or information and collecting data on sexual orientation and gender identity are all ways of preventing harm to LGBTQ+ when accessing services or achieving treatment aims.
There is a need to identify how services and activities in Derbyshire support prevention programmes or initiatives. Croydon Council in South London has created a summary of health and wellbeing needs of LGBTQ+ residents in their Director of Public Health report annual report.5 This is an example of best practice and provides a format and evidence base that could be used in areas like Derbyshire to create a deep dive of further information.
• Population
LGBTQ+ often experience stigma and discrimination and have poorer health outcomes than similar populations and are more likely to face difficulties accessing services. The experiences that LGBTQ+ people may have can make people less likely to access services or disclose their sexuality.
For the first time data relating to sexual orientation and gender identity of residents has been released as part of the 2021 Census. This means there is no comparison data from the 2011 Census. The data shows that there are around 16,600 members of the LGBTQ+ community and Derbyshire has a slightly smaller population than the national averages. The Derbyshire observatory provides a useful summary of the census data and can be found here.
The data section below shows how many people live in Derbyshire when categorised by gender identify and by sexual orientation. There is a note of caution around these numbers as there are several reasons why people from LGBTQ+ populations may not disclose their sexual orientation or gender identity. This can include being a child (as parents complete the census on behalf of their children) and not being ‘out’ to parents, fear of discrimination or being outed, cultural differences or a fear of authority.
National data and information from 2017 shows significant health inequalities for LGBTQ+ people.6 These impacts can be summarised as:
Safety and discrimination
- A fifth (one in five) of LGBT people reported that they had experienced a homophobic, biphobic or transphobic hate crime in the previous 12 months, with this rising to almost half for trans people. Since this data collection it is likely this hate crime rate has sadly increased.
- Around a quarter (one in four) LGBT people have witnessed anti-LGBT remarks by staff in healthcare settings.
Mental health and wellbeing
- A third (one in three) LGBTQ+ CYP people experience mental health issues, this is significantly worse compared to the non-LGBTQ+ population with one in eight CYP with mental health issues.
- Almost half (one in two) of Trans young people (ages 11-19) and a fifth (one in five) cis LGB young people have tried to take their own life. This is significantly higher than the general population.
Healthy behaviours
- Gay men, lesbian and bisexual women are more likely to be active than the corresponding straight populations. However, discrimination is a barrier for sports and sporting activity and LGB men and women are less likely to feel they have opportunities to be active.7
Risky behaviours
- A sixth (one on six) of LGBT people reported drinking alcohol almost every day in the last year, this compares to a tenth (one in 10) adults in the general population who report drinking alcohol on five or more days per week.
Access to services and housing
- A quarter (one in four) homeless people aged 16-24 are LGBT. The cause of most of these LGBT young people becoming homeless is parental rejection.
Rurality and ageing
- National research indicates that older LGBTQ+ people in rural communities are more likely to experience loneliness and isolation, a digital divide, transport and access to appropriate treatment.8
Sexual health
- A Derby and Derbyshire Health Needs Assessment (HNA) found that LGBT people are at higher risk of poor health outcomes. This includes higher rates of infections, barriers to access services, missed opportunities for invites (trans men who may have a cervix and be eligible for cervical screening are not invited for screening if they are registered as male) and a need for continuous awareness raising of risks, prevention and services.9
Work and health
- LGBTQ+ face discrimination and stigma at work. A 2018 report found that evidence through research studies suggesting that LGBT people have higher rates of bullying and harassment than heterosexual people. Almost a quarter (23%) had experienced a negative or mixed reaction from colleagues due to being LGBT, or being thought to be LGBT. 1 in 10 (11%) had experienced someone disclosing their sexual orientation or gender identity with their permission, 1 in 10 (11%) had experienced inappropriate comments or conduct and 1 in 10 (9%) had received verbal harassment, slurs of insults.10
In Derbyshire there is a lack of timley data, intelligence, and insight on the experiences of LGBTQ+ people.
There is some limited information on children and young people.
In Derbyshire there is an annual health and wellbeing survey called My Life My View.11
This survey shows stark inequalities for LGBT children and young people. LGBT pupils had significantly worse indicators than their non-LGBT peers. These indicators include happiness, bullying tobacco use, vaping and use of risk behaviour. The My Life My View survey contains further information and analysis of the experiences and indicators and is completed yearly. This rich source of information could be expanded in future deep dives.
There is a Healthwatch report from 2016 called LGBT+ experiences of using health services.12 25 people responded to a survey and a focus group. The report found several themes:
- Lack of LGBT+ magazines, information leaflets and rainbow signs in general practice
- Distrust over referral processes from general practice to gender identity clinics
- Professionals failing to use chosen name and referring to appropriate gender
- Frustration at tendency for professionals to attribute mental health problems to sexuality
- Issues at London Road Sexual Health Clinic, Derby, including access issues, long waiting times, delays in being seen, delays getting results and LGBT+ having to be seen by a doctor.
Health and wellbeing organisations can conduct research and collect data on LGBTQ+ health to better understand the specific health needs and disparities and inequalities within this population. This data and insight can inform the development of targeted interventions and policies. It can also show if LGBTQ+ are experiencing barriers or issues to access, treatment or have poorer outcomes
Public health and health and wellbeing organisations can develop:
- Advocacy and educational materials and campaigns to raise awareness about LGBTQ+ health, including the importance of regular screenings, preventive care, and safer sex practices. These materials should be co-produced with communities to ensure that they are culturally competent and inclusive of diverse gender identities and sexual orientations.
- Training for service providers on LGBTQ+ cultural competency. This can include understanding terminology, allyship, addressing bias and discrimination for LGBTQ+ patients, clients, or residents. This training can help improve healthcare access and quality for LGBTQ+ individuals.
- Policies that promote LGBTQ+ health and address health disparities like Equality, Diversity and Inclusion (EDI) polices. These polices highlight anti-discrimination laws, inclusive language and policies, and commitment or funding for LGBTQ+ health and wellbeing programs and services. These polices can also work to remove barriers to healthcare access and better treatment outcomes for LGBTQ+ individuals.
- Engage with LGBTQ+ communities through outreach events, support groups, and partnerships with community and charity and voluntary groups. This engagement can help build trust, provide support, and connect LGBTQ+ individuals with healthcare services and resources.
- Address the social determinants of health that impact LGBTQ+ individuals. Activities can include addressing biases, stigma and discrimination, accessible and culturally competent housing support, timely access to affirming healthcare and support services. Addressing social determinants will involve collaborating and partnership with other sectors, such as district and borough housing, education, and employment. This can create more inclusive and supportive environments for LGBTQ+ individuals.
- Research, policy and awareness address the intersecting identities and experiences of LGBTQ+ individuals, including gender, ethnicity, socioeconomic status, and disability. This intersectional approach can help ensure that interventions and policies are responsive to the diverse needs of LGBTQ+ communities.
Public health and health and wellbeing approaches that promote LGBTQ+ health require a multi-faceted approach that addresses both individual health behaviours and the wider social, economic, and political factors that influence health outcomes. These approaches and action can improve LGBTQ+ health equality and develop inclusive and affirming environments for all individuals.
• Causes
The social determinants of health are a direct and indirect cause of ill health and population health approaches can address these systemic inequalities to ensure that all individuals have equal opportunities for health and well-being. Issues and unmet needs like stigma can lead to mental health issues, unmet mental needs can lead to unhealthy behaviours, or risky behaviours like alcohol misuse.
The following aspects can be both causes and effects on LGBTQ+ people’s health and wellbeing:
- Safety and discrimination
- Mental health and wellbeing
- Healthy behaviours
- Risky behaviours
- Access to services and housing
- Rurality
- Ageing and digital divides
- Sexual health
- Work and workplaces.
Population health initiatives aimed at promoting LGBTQ+ health can have wider benefits for the entire population. HIV/AIDS prevention and treatment among LGBTQ+ individuals can contribute to reducing transmission rates in the general population. Promoting acceptance and inclusivity in healthcare settings can improve health outcomes for all individuals, regardless of sexual orientation or gender identity. Action on LGBTQ+ health links closely to the EDI agendas that support inclusive workplaces, services, places of education and health interventions.
The Derbyshire Network Alliance (DNA) has supported the development of this summary. The DNA aims to seek to build greater visibility, trust and a collective voice for the LGBT+ workforce within organisations based in Derbyshire. The DNA has representation from most employers in the county and voluntary and community sector. Further information can be found in the ‘local services’ section.
Latest Derbyshire Data
Sexual Orientation
Gender Identity
| Gender Identity by District | ||||||
|---|---|---|---|---|---|---|
| Area | Same as registered sex at birth | Different from sex registered at birth (not specified) | Trans woman | Trans man | All other gender identities | Not answered |
| England | 93.5% | 0.2% | 0.1% | 0.1% | 0.1% | 6.0% |
| Derby | 91.7% | 0.5% | 0.1% | 0.1% | 0.1% | 7.5% |
| Derbyshire | 94.7% | 0.1% | 0.1% | 0.1% | 0.1% | 5.1% |
| Amber Valley | 94.3% | 0.1% | 0.0% | 0.1% | 0.1% | 5.4% |
| Bolsover | 94.3% | 0.1% | 0.1% | 0.1% | 0.1% | 5.4% |
| Chesterfield | 94.4% | 0.1% | 0.1% | 0.1% | 0.1% | 5.3% |
| Derbyshire Dales | 94.7% | 0.1% | 0.0% | 0.0% | 0.0% | 5.1% |
| Erewash | 94.7% | 0.1% | 0.1% | 0.1% | 0.1% | 4.9% |
| High Peak | 95.0% | 0.1% | 0.1% | 0.1% | 0.1% | 4.7% |
| North East Derbyshire | 94.9% | 0.1% | 0.0% | 0.0% | 0.0% | 4.9% |
| South Derbyshire | 95.1% | 0.1% | 0.1% | 0.0% | 0.0% | 4.6% |
| Source: Census 2021 | ||||||
Trend Data
No trend data is available on sexual orientation or gender identity.
Prevalence Maps of Derbyshire
The maps below illustrate Lower Super Output Areas (LSOAs) and Middle Super Output Areas (MSOAs) for Derbyshire. LSOAs and MSOAs are geographical divisions used for statistical purposes, allowing for more detailed analysis of local data. In these maps, you can explore various health indicators and data for Derbyshire, providing valuable insights into the area’s health and wellbeing.
 |
In the top right of the map, you’ll find the ‘Layer Control’ icon. This is an easy way to customise what you see on the map visualisation. Click the ‘Layer Control’ to choose which information is displayed on the map. Pick the indicator that interests you the most, and the map will transform accordingly. |
Further Analysis & Assessments
Derbyshire Joint Strategic Needs Assessment (JSNA) involves a thorough examination of a specific health problem, exploring its causes, consequences, and underlying factors. It combines various data sources, collaboration with stakeholders, and rigorous analysis to generate insights for evidence-informed interventions and policy changes.
More Information & Resources
Here is a list of useful resources and information with regard to LGBTQ+. These materials are meant to provide individuals, healthcare professionals, and communities with the knowledge and tools they need as part of efforts to address LGBTQ+ as a population health topic.
Contributors
Thom Dunn, Assistant Director of Public Health, Adult Social Care and Health