Leaving no one behind: Sweden makes services safer for LGBTQ people

Sara Privelius

A core principle of the 2030 Agenda for Sustainable Development is to “ensure that no one is left behind” and to “reach the furthest behind first”. The WHO European health policy, Health 2020, also aims to reduce inequalities in health for all people living in the WHO European Region.

Despite these goals, many people across the Region and the rest of the world remain excluded from accessing high-quality health services. One of these groups is the lesbian, gay, bisexual, transgender and queer (LGBTQ) population. Studies across the Region have shown that LGBTQ people are less likely to seek health care because they do not feel that they can openly and safely disclose their sexual orientation or gender identity to health services or health professionals. When they do, they experience neglect, judgemental questions or simply have to deal with health professionals who lack the necessary professionalism and competencies to respond to LGBTQ needs. Such substandard services perpetuate societal exclusion and directly affect health outcomes for this population. LGBTQ people have poorer health outcomes and increased rates of mental health issues and disorders, including depression and substance abuse, higher rates of suicide and poorer survival rates.

Introducing training for LGBTQ-friendly health services

Ida Gulbrandsen, educator at the Swedish Federation for Lesbian, Gay, Bisexual, Transgender and Queer Rights (RFSL), knows this reality all too well.

Seeing that their members were missing opportunities to seek health care, the Stockholm branch of the RFSL decided to design a certification programme to accredit institutions that undergo special training on how to provide LGBTQ-friendly services. The programme was developed in 2007 in collaboration with the local Abrahamsbergs Vårdcentral primary health care clinic.

Since its inception, the initiative has been established as a national programme and has accredited 350 organizations across Sweden. The programme involves 4 days of education, workshops and meetings, with management focusing on increasing awareness among the health workforce about how to provide safe and respectful care to LGBTQ people, and promoting inclusion and equal rights for all its employees.

The main approach of the 4-day training is to engage personnel in self-reflective discussions about the norms and assumptions that exist in society and at the workplace and how they can improve services. These discussions are not easy. According to Ida, “This is often challenging work for me, for my colleagues, and for the participants in our training, who are asked to take in new knowledge, reconsider their societal norms and reflect on how they work”.

With the guidance of educators like Ida, however, organizations have made a series of improvements. Small but important changes include changing the choice of words (not assuming that people have wives or husbands but referring to them as partners), introducing patient-directed questions (“Who is part of your family?”), introducing gender-neutral toilets, displaying rainbow and trans symbols, and making sure that health information not only addresses and shows heterosexual couples but also depicts and addresses same-sex couples.

A role for managers and policy-makers

Of the people who have participated in the RFSL training, 95% would recommend it. When asked what has been important in this success, Ida explains that Sweden has adopted a Discrimination Act that protects individuals from discrimination based on age, disability, ethnicity, sex, sexual orientation, religion or other beliefs, or gender identities. In 2017, the Act was amended, requiring employers to assume responsibility for proactively preventing discrimination.

It has also been important that managers recognize that their services need such improvement and take the initiative to approach the RFSL. In Sweden, an important step was taken in 2014, when the government launched a national strategy on LGBTQ rights to make long-term efforts, including in education, to promote equal rights and opportunities regardless of sexual orientation, gender identity or gender expression. Health, care and social services were among the focus areas in this strategy.

Ida recognizes that these managers are really committed to creating inclusive and non-discriminatory health services in ways that do not merely involve verbal support but also include allocating resources and time for personnel to work with these questions and monitor progress in this area.

Finally, it is important that managers be given the mandate and budget to select the necessary continuous learning opportunities for their personnel to meet the needs of patients.

WHO and the Joint United Nations Statement on Ending Discrimination in Health Care Settings

In July 2017, WHO joined the heads of 12 United Nations agencies in endorsing the Joint United Nations Statement on Ending Discrimination in Health Care Settings. The statement reinforces that no group should face discrimination at the point of care based on their age, sex, race or ethnicity, health status, disability or vulnerability to ill health, sexual orientation or gender identity, nationality, asylum or migration status, or criminal record.

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The RFSL is a non-profit organization founded in 1950. RFSL works locally, nationally and internationally and is an ever-growing organization with about 7 000 members and 38 branches all over Sweden. The certification programme has also been adapted to youth centres, schools, family centres, libraries and municipalities, certified sports clubs and culture centres.

LGBTQ individuals encompass all races and ethnicities, religions and social classes.