Policy in Motion: LGBTQ+ Health from the Fringes to Mainstream?

This manuscript-based dissertation examines the perceptions and experiences of selected community-based LGBTQ+ health organizations in the Greater Toronto and Hamilton Area of Ontario as they navigate the current neoliberal policy environment. It also examines how well these organizations understand and implement the social determinants of health (SDH) framework in their communities within that environment. As such, the SDHs structural approach to health equity, augmented by an emergent Queer Liberation Theory, forms the theoretical foundation of this analysis. For historical context, I conducted a content analysis of The Body Politics coverage of the HIV/AIDS crisis from 1981 to 1987 to examine the impact of HIV/AIDS on the movement. I also conducted semi-structured interviews with people who were active with the publication during that period for their reflections on how the movement has developed. To understand the place of LGBTQ+ health in the existing policy environment, I collaborated with colleagues to analyze how LGBTQ+ health is represented on the Ontario Ministry of Health and Long-term Cares and the Ontario Local Health Integration Networks websites. We conducted comparative snapshot content analyses in 2009 and 2017. To contextualize the comparative content analysis, we conducted semi-structured interviews with bureaucrats to see how well stated policies and commitments to health equity matched with real policy initiatives. With these insights, I conducted semi-structured interviews with staff of community-based LGBTQ+ health organizations to understand their perceptions and experiences of the policy environment and of the SDH approach more broadly. Findings indicate that LBGTQ+ health equity is a very small part of the policy discussion and remains very much on the fringes of health care policy and programming in any practical sense. LGBTQ+ organizations have a good understanding of equity issues and the SDH approach but must operate in survival mode. The theoretical contribution of this work is to point out the inadequacy of the SDH frameworks understanding of LGBTQ+ health equity and to articulate three pillars in the development of Queer Liberation Theory (anti-assimilationism, solidarity across movements, and political economy) in the hope of improving the SDH framework and moving forward equitable approaches to LGBTQ+ health in a challenging policy environment.