摘要：The World Health Organization's (WHO's) social determinants of health discussion underscores the need for health equity and social justice. Yet sexual orientation was not addressed within the WHO Commission on the Social Determinants of Health final report Closing the Gap in a Generation. This omission of sexual orientation as a social determinant of health stands in stark contrast with a body of evidence that demonstrates that sexual minorities are disproportionately affected by health problems associated with stigma and discrimination, such as mental health disorders. I propose strategies to integrate sexual orientation into the WHO’s social determinants of health dialogue. Recognizing sexual orientation as a social determinant of health is an important first step toward health equity for sexual minorities. Health equity and social justice are central to the World Health Organization’s (WHO’s) discussion of the social determinants of health. 1 The WHO’s Commission on the Social Determinants of Health (CSDH) 2008 final report, Closing the Gap in a Generation , defined social determinants of health as living conditions shaped by sociopolitical factors that contribute to the health of individuals and populations. 1 The social determinants of health were operationalized in nine themes: early childhood development, globalization, health systems, employment conditions, priority public health conditions, measurement and evidence, women and gender equality, urbanization, and social exclusion. The CSDH social determinants of health conceptual framework posits that factors associated with the distribution of health and well-being include social position, education, occupation, income, gender, and ethnicity/race. 1 Sexual orientation was not included within CSDH’s social determinants of health conceptual framework nor mentioned anywhere in this report. 1 Yet sexual minorities experience significant and pervasive health disparities. (I use the terms “sexual minority” and “lesbian, gay, bisexual” [LGB] interchangeably to convey nonheterosexual sexualities and identities claimed by persons across diverse cultures and contexts.) For example, systematic reviews and population-based studies report increased risks for depression, 2–7 suicidal ideation, 2,3,7–9 anxiety, 2,3,5–7 and substance dependence 2,4,6 among sexual minorities compared with heterosexuals. Open in a separate window A woman prays next to the coffin of Erick Alex Martinez, a journalist and gay rights campaigner, who was murdered in Honduras along with at least 20 other media workers over the last 3 years. Martinez's body was found by the roadside in the village of Guasculile, north of the capital, Tegucigalpa. He worked for an association defending lesbian, gay, bisexual, and transgender (LGBT) rights. Martinez had also been chosen last year as a candidate for a coalition of parties that emerged after the ousting of President Manuel Zelaya in 2009. Photograph by Orlando Sierra. Printed with permission of Getty Images. Omission of sexual orientation as a social determinant of health in Closing the Gap in a Generation stands in stark contrast with a large body of evidence that demonstrates that sexual minorities are disproportionately affected by health problems associated with stigma and discrimination. 2,5,10 Homosexuality is criminalized in 76 countries and punishable by death in five, 11 underscoring the impact of powerful sociopolitical factors on the lives of sexual minorities. Sexual minorities are a demographic that account for a significant proportion of the global disease burden, which is strongly impacted by sociopolitical factors; therefore, they should be included in health equity discussions. My objective is to demonstrate the importance of explicitly recognizing stigma and discrimination targeting sexual minorities as a social determinant of health to promote health equity.
