Estimating the size of the lesbian, gay and bisexual population
Why do we need an estimate of the LGB population?
Sexual orientation is a protected characteristic under the Equality Act 2010, meaning that public sector organisations have a duty to consider the specific needs of LGB people in the design and delivery of services.
There is a strong evidence base to show that lesbian, gay and bisexual (LGB) people are disproportionately affected by a range of health inequalities, including poor mental health, higher risk of self-harm and suicide, and increased vulnerability in old age. However, sexual orientation is not comprehensively monitored in research studies or in public services, leading to a lack of accurate data on the size of the LGB population. Public Health England has published a new estimate of the size of the LGB population, which was informed by an expert advisory panel including LGBT Foundation.
This estimate provides a robust estimate of the size of the LGB population and will support health and social care organisations to:
· Address the current major gaps in existing data and analysis relating to health outcomes and patient experience for LGB populations.
· Understand inequalities in health and care outcomes for different populations in England. This would support targeted preventative and early intervention work to address health inequalities
· Demonstrate the provision of equitable access for LGB individuals
Public Health England (PHE) population estimate
Public Health England’s study, Producing modelled estimates of the size of the lesbian, gay and bisexual (LGB) population of England (2017) systematically reviewed existing sources of data on the LGB population and synthesized this data into a new robust estimate. The study is based on 15 surveys that represent the general adult population of England, and only includes data on self-reported sexual identity.
The study estimates that 2.5% of England’s population identifies as LGB or ‘other’. If people who responded ‘prefer not to say’, ‘don’t know’ or gave no answer in the surveys are assumed to all be LGB, then the upper limit becomes 5.9%.
However, PHE notes that this estimate should be used cautiously. The 2.5% figure is likely to be an underestimate as it is derived from general social surveys that did not have the specific aim of counting the LGB population. The upper limit of 5.9% is also likely to be an overestimate as it is unlikely that all non-responders are LGB.
As the study only included data on self-reported sexual identity, the estimate won’t include men who have sex with men who don’t identify as gay or bisexual but may still be at risk of HIV and other STIs.
The report also found that the proportion of self-identified LGB people is highest in men, younger age groups and mixed/multiple or other (non-White/Black/Asian) ethnic groups.
Regionally, the highest prevalence was found in London, North West and North East regions with each having an overall LGB prevalence of 4.3%, 2.5% and 2.3% respectively. There are higher proportions in large city regions like Greater London (5.1%), Greater Manchester (3.6%) and Brighton and Hove (9.9%).
How can we use this population estimate?
A robust estimate of the LGB population is welcome, as using this information will enable policy makers, service commissioners and providers to better identify LGB communities’ needs at a population level, for example, understanding health risks or inequalities. This can support targeted preventative and early intervention work to address inequalities, which is shown to reduce expenditure linked to treatment costs.
It is important to note that this estimate does not represent the definitive number of LGB people in England. Rather, it shows an estimated proportion of people who have disclosed their sexual orientation across a number of surveys. Sexual orientation is not routinely asked in surveys, or monitored by public services, in the same way as other characteristics such as age or gender. Until monitoring sexual orientation becomes normalised, some LGB people will not be comfortable disclosing their sexual orientation even when asked.
PHE’s study indicates that the proportion of self-identified LGB people is highest in men, younger age groups, and mixed/multiple or other ethnic groups suggesting that these groups are more likely to disclose. There is still a way to go until all LGB people are confident to disclose their sexual orientation in surveys and when accessing services. Policy-makers, service commissioners and providers using this estimate should also consider locally available data on the LGB population in their area, as well as the estimated regional variations included in PHE’s study.
Monitoring sexual orientation in health and social care services
Public Health England and NHS England are working with LGBT Foundation and the National LGB&T Partnership to make sure that healthcare services collect information on patient sexual orientation and use this to improve services. We’re creating an information standard for sexual orientation monitoring, which will enable health and social care organisations to monitor sexual orientation in a way that is consistent across all other parts of the healthcare system. Our patient consultation indicates that 90-95% of people would be comfortable disclosing their sexual orientation as part of demographic monitoring if they understood why it was being collected. For more information about the standard, please visit www.lgbt.foundation/monitoring-standard.