As one of a series of titles that provide an accessible introduction to various issues in health and social care policy and practice from a Scottish perspective, this book will appeal to readers who are interested in looking at how the categories of ‘“lesbian”, “gay”, “bisexual” and “trans” (LGBT) are used in everyday care-based encounters’ (p. xi). Its aim is to look beyond the assumed homogeneity of LGBT categories towards a nuanced consideration of the complexities and diversities of distinctive sexual and gender identities. Running through the book is the assertion that assumptions made about each of the groups in health and social care constrain, exclude and further marginalise many people who do not ‘fit neatly’ into any one. An emphasis is placed on understanding the way individuals construct their sexual and gender identity, and the practice of this complex task is exemplified by the contributors' brief synopses of how they define their own identities. This refreshing approach positions each author in relation to the issues that they discuss. The book uses empirical evidence, personal experiences and case studies, which will appeal to their primary readership of health and social care practitioners. Students, academics and policy makers may find their current perceptions, knowledge and strategies challenged and usefully reconstructed.
In the introduction, Jones and Ward discuss three approaches to sexual and gender identity: ‘person centred’, ‘rights based’, and ‘deconstructive’, all of which could contribute to the practitioner's toolkit. Particular emphasis is given to ‘queer theory’, which encourages readers to view sexual and gender identities as fluid, variable and socially constructed. The limitations of each approach are usefully explored and make the case for the need to combine both the awareness of the structural factors that affect LGBT communities with treating people as individuals. The first chapter by Eaglesham gives a comprehensive account of the legislation in both Scotland and the United Kingdom that has progressed the rights and status of LGBT people. This account is juxtaposed with evidence of poorer mental and physical health amongst people from LGBT communities. This disparity in policy and practice partly arises from the ways in which the needs of LGBT people are identified and responded to in an assumed and prescribed way, which results in many being excluded from certain health services. MacKian and Goldring explore this presumed homogeneity further by critically analysing the ‘one size fits all’ approach of many health promotion services for gay men. Empirical research is used to highlight that living through changing social and legal contexts creates generational differences in the ways that gay men define, experience and live their lives.
The sexual identity of older people is the focus of two further chapters. Archibald's research with older lesbians (aged 55+ years) highlights the issues faced when accessing health and social care services, and particularly challenges the assumption of heterosexuality. The impact of ageing on a ‘lesbian’ identity is also discussed, with the participants stating what they would like if, in the future, they needed residential care. One participant stated that an important part of any service was ‘to be treated as any other and recognise that I happen to love a woman … that is part of me being me’ (p. 41). Cronin and King focus on the experiences of older lesbian, gay and bisexual (LGB) people in giving and receiving care. As well as having to challenge the hetero-normative culture that permeates much of health and social care, older LGB people are also coping with the dominant myth that old age and sexuality are incompatible. Again it is important to recognise that people of different ages ‘do’ their sexuality in different ways. A useful case study of two older gay men, Alec and Peter, illustrates ‘the complexity, diversity and contextual nature of sexuality and care’ (p. 80). The task of interrogating ‘common understandings of sexuality and gender identity’ (p. xi) is progressed enormously by chapters focusing on bisexuality (Jones) and trans people (Alleyn and Jones).
These chapters should have come earlier in the book as they challenge entrenched views such as biologically-fixed sexual and gender identities and homogeneity within LGBT categories, whilst examining the ways people embrace and/or reject identity labels. The links to health and social care are clearly made, as are suggestions about developing good practice. Jones and Ward conclude that in order to have a progressive health and social care agenda which embraces difference and inclusivity, there is a need to understand the complexities of sexual and gender identities, challenge hetero-normativity, and highlight areas of inequality. This book goes some way to doing this by raising complex and important issues in a powerful yet encouraging way. It makes a much needed contribution to the debates within health and social care policy and provision about equality and access to services for all.
