A presentation in June 2018 at the Opening Doors Conference. The presentation covers some of the issues and challenges for older LGBT people and some of the opportunities looking to the future.

1. Dr Justin Varney
Public Health England
Justin.varney@phe.gov.uk
Looking back,
Looking forward

2. How many lesbian, gay, bisexual and trans
people are there in England?
It is estimated that between 2.5 to 5.89% of the
population in England self-identifying as lesbian,
gay, bisexual or other. (PHE 2016)
The GP Patient Survey demonstrated that higher
proportions of self-identified LGB people live in
cities. The prevalence in this survey for Greater
London, Greater Manchester and Brighton and
Hove was 5.1%, 3.6% and 9.9% respectively.
There is no national agreed estimate of the
proportion of the population who identify as trans
because there are no routine questions on gender
identity currently included in national surveys. A
survey in 2012 estimated that 1 in 100 people
experience a significant degree of gender non-
conformity. (Glen et al 2012)
2

3. Current context
• Limited evidence base, especially on older LGB&T
people, and where there is evidence the L,G,B&T are
often combined.
• Evidence consistently highlights inequalities:
• Mental health, including suicide/self harm
• HIV & sexual health issues
• Substance misuse
• Smoking
• Intimate partner violence
• Inequalities are greater for bisexual, BME, disabled
people
• Little modelling or longitudinal studies to understand the
impact of these inequalities across the life course.
• Deficit based narratives drive investment but also
perpetuate stereotypes, creating a social narrative of
deficit rather than asset based identity.
3

4. Pattern of risks affecting LGBT health & wellbeing
C
A
B
Physiological risks:
Mental Health
MSK
Specific cancers
Sexual health
HIV
Behavioural risks:
Smoking
Alcohol
Substance abuse
Psycho-social risks:
Isolation
Lack of social support
Limited social networks
Risk conditions:
Discrimination
Violence
Systemic invisibility
Steep power hierarchy
Gaps/weaknesses in
services and support
LGBT
Wellbeing
and health
Causes of
the
causes
Causes
Attributable risks

5. ‘…LGB&T people experience
significant health inequalities
compared to the wider population
from high rates of physical and
emotional bullying, and risk of
parental rejection and running
away in childhood, through
significantly higher rates of
suicide and self-harm, drug and
alcohol use and smoking in
adulthood, and social isolation
and extreme vulnerability in old
age.’
Duncan Selbie, Chief Executive,
Public Health England (2013)
5 Image source: http://www.algbtical.org

6. Spaceships, Zumba and
Rewilding strategists

7. Looking ahead
7
Life expectancy continues to expand
but so does the proportion of life lived
with disease and disability.
Fertility rates remain relatively constant
and although migration patterns may
change the overall picture is of
population growth.
Increasing shift to city based living
aligned with mobilisation of sustainable
tech harmonised living.
More people are remaining in work into
later life for economic and personal
reasons.
Shrinking/static public sector resources
Estimated and projected total population, UK, year
ending mid-1971 to year ending mid-2089 (ONS 2015)
Percentage change in the size of the usual resident
population in urban and rural areas 2001 to 2011 (ONS)

8. Emerging contextual shifts
• 1 in 3 girls and 1 in 5 boys aged 5yrs today will
reach their 100th birthday which will influence
work patterns and types of work across the life
course.
• Climate change and ecological stability will
have an influence on the patterns of work.
• Evolution of types of industry and impact of
technology especially on ‘low skilled work’
opportunities.
• Globalised multi-nationals working with ‘crowd
sourced’ businesses and growth of ‘gig’
economy.
• Potential for increasing inequalities and social
division
8

9. Investing in prevention is key at an
individual level to being able to enjoy
life, remain economically active and
independent into later life.
For the business sector, ensuring
individuals are active across the life
course and investing in their own health
is essential to the economic viability of
local communities and the sustainability
of businesses.
At a national level, reducing inequalities
in access and uptake of safe and good
work is imperative to improving the
health, and wealth, of the nation.
9

10. Opportunities and Challenges
10

11. Short/Medium Term
• Sexual orientation monitoring
information standard
• NHS Charter
• Personalised care budgets
• Patient-centred care
• Integration of health and social
care commissioning
Longer Term
• Patient controlled care
• Community led services
11 Understanding LGBT Inequalities Image source: http://www.algbtical.org

12. Opportunities to influence the narrative
Healthcare pathway &
healthcare professional
advice & support
Patient narratives about
health conditions
Enablement support to
individuals to adapt/adjust
Suitable employment
opportunities &
opportunities for active
lives
12
Enablement
Empowerment
Opportunity

13. 13
Community-centred approaches
for health & wellbeing
Strengthening
communities
Community
development
Asset based
approaches
Social network
approaches
Volunteer and peer
roles
Bridging
Peer interventions
Peer support
Peer education
Peer mentoring
Volunteer health roles
Collaborations &
partnerships
Community-Based
Participatory
Research
Area–based Initiatives
Community
engagement in
planning
Co-production projects
Access to
community
resources
Pathways to
participation
Community hubs
Community-based
commissioning
https://www.gov.uk/government/publications/health-and-wellbeing-a-guide-to-community-centred-approaches

14. Reflections for the future
14

15. Some reflections
• Addressing LGBT issues needs a whole system approach which
thinks about mental and physical health in synergy with wider
determinants of health
• Co-production has been key to longevity and engagement for
implementation and keeping political focus on delivery
• Lack of mainstream data collection is a significant challenge so we
must embrace the information standard
• Challenges in international transferability because of different cultural
context of sexual orientation, gender and ethnicity
• Lack of consideration of compound identity issues and role in
inequalities
• Important to develop approaches that are woven across different
policy areas to make them less vulnerable to political shifts.
15

16. Thinking for the Future
• The nature of society has changed,
and with it the profile of the LGBT
elder community is also changing.
• There is more capacity now to
capture data and demonstrate what
works to improve health and
wellbeing for LGBT elders and share
the learning.
• The LGB&T community has huge
inherent assets, there is potential to
mobilise and gain strength in
numbers especially using new
technologies.
16 An overview of PHE’s matrix programme on work, worklessness and health

17. 17 Public Health Futurology