Pride, Prejudice & Determinants of Health

The GradientTerry Trussler EdD

Community Based Research CentreFor Gay Men’s Health

Health & Social Theory

• Social Determinants (SDOH) Marmot et al.

• Minority Stress Meyer et al.

• Intersectionality Hankivsky et al.

• Syndemic Production Stall et al.

See: US Institute of Medicine Report on LGBT Health (2011)

Minority StressMeyer et al. (2010)

Gay Health @ Work

• Workplace prejudice lore • Social context of “gender order”• Origins of Canada’s Health Policy • Whitehall Study

gradient social status health status

What do disparities reveal?

Whitehall Study Marmot et al. 2004

Distress & Disease0

0.5

1

1.5

2

2.5

3

High ControlIntermediateLow Control

Sex Now 2011

• September 2011- February 2012• Men seeking men online• n=8,607 participants• All provinces/territories• Average age 43, Range 13-84• Gay 65% Bisexual 32% Straight 2% • Married MSM 21%

National Sample

72% of all FSA postal codes

Within Group Analysis

The Gradient

Privacy @ work

Importance

Very Important 38%Important 16%Not that important 21%Not important 22%Indefinite 3%

Out @ Work

Who knows your sexuality @ work?

No one 39%Almost none 10%Some 21%Everyone 31%

Employment Discrimination

dismissed, rejected, restricted

Definitely yes 5%Probably yes 12%Probably no 26%Definitely no 57%

Between Group Analysis

The Gradient

Grouping for Analysis

by “social location”…• Gay• Bisexual• MSM (married/partnered with a woman)

85% bisexual10% gay5% straight

Privacy @ Work

Privacy Important0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Gay BisexualMSM

Out @ work

Some to almost everyone0

10

20

30

40

50

60

70

Gay BisexualMSM

Employment Discrimination

Dismissed, Rejected, Restricted

0

5

10

15

20

25

Gay BisexualMSM

Career Damage (status loss)

56% endured discrimination0

1

2

3

4

5

6

7

8

9

10

Gay BisexualMSM

Annual Income

More than $50,0000%

10%

20%

30%

40%

50%

60%

70%

80%

Gay BisexualMSM

Higher Education

College-University0

10

20

30

40

50

60

70

Gay BisexualMSM

Property

Unstable Housing 0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Gay BisexualMSM

Outcome Analysis

The Gradient

Health Effects of Prejudice

Outcomes COR (95%CI) AOR (95%CI)Career damage - status loss 8.272 (6.982-9.801) 7.382 (6.014-9.061)

Suicidality 2.460 (2.177-2.781) 1.672 (1.405-1.885)

Depression .934 ( .831-1.049) .913 ( .797-1.046)

Emotional care seeking 2.753 (2.420-3.132) 1.667 (1.431-1.943)

HIV sexual risk (UAIU) 1.535 (1.359-1.733) 1.249 (1.084-1.439)

STI (gonorrhea) 1.998 (1.517-2.633) 1.595 (1.158-2.197)

Age adjusted logistic regression: employment discrimination vs. no discrimination

Health Effects of Prejudice

Intersections: “axes of (dis)advantage”

• Age (<30: depression)• Class ($100K+: UAIU)• Race/Ethnicity (min: UAIU)• HIV status (HIV+: suicidality)• Orientation (bisexual: suicidality, UAIU)

More Gradients

The Gradient

ManCount

HIV+ Blood Sample 0

2

4

6

8

10

12

14

16

18

20

GayBisexual Straight

Sex Now n=8,494

Self-reported HIV+0

2

4

6

8

10

12

14

Gay Bisexual MSM

ManCount

Sexual risk UAIU0

5

10

15

20

25

Gay BisexualStraight

Sex Now n=8,494

Sexual Risk UAIU0

5

10

15

20

25

30

35

Gay Bisexual Married MSM

ManCount

Physician Disclosure0

10

20

30

40

50

60

70

80

90

GayBisexualStraight

Sex Now

Physician Disclosure0

10

20

30

40

50

60

70

80

90

100

Gay Bisexual MSM

Exposure to Violence

Series10

10

20

30

40

50

60

70

Gay BisexualMSM

Suicidality

Suicidality0

10

20

30

40

50

60

Gay BisexualMSM

Resilience

Healthy, Happy, Optimistic0

5

10

15

20

25

30

35

40

45

50

Gay BisexualMSM

Discussion

The Gradient

Global FundAdam, B. (2011)

US $ Millions0

5

10

15

20

25

30

35

Gay Sex WorkersIDU

Acknowledgements

Vancouver FoundationPublic Health Agency of Canada

Province of British Columbia

acknowledgements

CBRC Olivier Ferlatte, Travis Salway Hottes, Rick Marchand, Craig Phillips, David Ham & the CBRC Board

Investigaytors Alex Chen, Joshun Dulai, Daren Ho, Trevor Hodges, David Le, Daniel McGraw, Keith Reynolds, Jordan Sang, Jaedyn Starr

DialogueMoffat Clarke, Jeff Dodds, Mark Gilbert, Olena Hankivsky, Ilan Meyer, aaron poirier… and many more