LGBTQIA+ inclusion in the global health policy agenda: A critical discourse analysis of the Lancet Commission report archive Journal Article
| Authors: | Rosa, W. E.; Goitiandia, S. W.; Braybrook, D.; Metheny, N.; Roberts, K. E.; McDarby, M.; Behrens, M.; Berkman, C.; Stein, G. L.; Adedimeji, A.; Wakefield, D.; Harding, R.; Spence, D.; Bristowe, K. |
| Article Title: | LGBTQIA+ inclusion in the global health policy agenda: A critical discourse analysis of the Lancet Commission report archive |
| Abstract: | Context LGBTQIA+ people worldwide experience discrimination, violence, and stigma that lead to poor health outcomes. Policy plays a crucial role in ensuring health equity and safety for LGBTQIA+ communities. Given Lancet Commissions' substantial impact on health policy across domains, we aimed to determine how LGBTQIA+ communities and their care needs are incorporated throughout Lancet Commission reports and recommendations. Methods Using critical discourse analysis, we analyzed 102 Commissions for inclusion of and reference to LGBTQIA+ communities using 36 key terms. Three levels of analysis were conducted: 1) micro-level (overview of terminology use); 2) meso-level (visibility and placement of LGBTQIA+ references); and 3) macro-level (outlining characterizations and framing of references with consideration of broader social discourses). Findings 36 of 102 (35%) Commissions referenced LGBTQIA+ communities with 801 mentions in total. There were minimal (9/36) references made in the "Executive Summary,""Recommendations,"and/or "Key Messages"sections of reports. LGBTQIA+ communities were most frequently discussed in reports related to HIV/AIDS and sexual and reproductive health. Few Commissions related to public health, or chronic conditions (9/60) referenced LGBTQIA+ communities. Some reports made non-specific or unexplained references; many discussed the LGBTQIA+ population without specific reference to sub-groups. LGBTQIA+ communities were often listed alongside other marginalized groups without rationale or a description of shared needs or experiences. We identified framings (legal, vulnerability, risk) and characterizations (as victims, as blameworthy, as a problem) of LGBTQIA+ communities that contribute to problematizing discourse. Conclusions LGBTQIA+ people were rarely included in the Commissions, resulting in an inadvertent marginalization of their health needs. Policy initiatives must consider LGBTQIA+ groups from a strengths-based rather than problematizing perspective, integrating evidence-based approaches alongside community-based stakeholder engagement to mitigate inequities and promote inclusive care and policymaking. © 2024 Rosa et al. |
| Keywords: | human immunodeficiency virus infection; breast cancer; prevalence; health care policy; health policy; rigor; sexuality; epidemiology; management; hiv infections; health disparity; disease transmission; prevention and control; medical student; reproductive health; global health; sexual health; victim; antiretroviral therapy; men who have sex with men; sexual violence; homophobia; integrity; data extraction; vulnerability; social stigma; discourse analysis; humans; human; article; health equity; sexual and gender minorities; sexual and gender minority; lgbtqia+ people; sociologist |
| Journal Title: | PLoS ONE |
| Volume: | 19 |
| Issue: | 10 |
| ISSN: | 1932-6203 |
| Publisher: | Public Library of Science |
| Date Published: | 2024-10-04 |
| Start Page: | e0311506 |
| Language: | English |
| DOI: | 10.1371/journal.pone.0311506 |
| PUBMED: | 39365801 |
| PROVIDER: | scopus |
| PMCID: | PMC11452035 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author William E. Rosa -- Source: Scopus |
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