Last week’s historic election of the United States’ first black president was an uplifting event that speaks of possibilities, to being able to trounce racism and collectively help shape a better world. As Oprah Winfrey declared: “Hope won tonight!” And of course this was a vote that rejected the advocates of social conservatism. Well, it was and it wasn’t. Sarah Palin did have some reason to celebrate last week as Americans voted to repudiate equal rights in ballot initiatives across the country. Gay marriage bans were passed in California, Arizona and Florida; and Arkansas voted to ban gay couples from adopting or fostering children. This was about making equal rights illegal. Hope, it seems, also took a battering.

This is an overtly heterosexist development; yet heterosexism, as with other ‘isms’ – racism, sexism, ageism – is constantly at work, ensuring that what is “normal” is all around us, and that which is “other” is made invisible. Take another event this last week – the dramatic demise of the developing lesbian storyline in the medical drama Grey’s Anatomy with the sudden dismissal of Brooke Shields, who plays Erica, one of the two surgeons in the early throes of their first lesbian relationship. While the reasons for this are not entirely clear, it seems likely that a lethal mix of heterosexism, sexism and ageism prevailed – the unacceptable challenge of “two women of substance, physically and psychologically, falling in love and talking about it way too much” (www.afterellen.com).   

There are now no lesbian characters on US primetime broadcast TV. At the turn of the century, there were several lesbian series regulars on primetime broadcast TV – including Kerry in ER. In the 2004 season, there were four or five. By 2006, it was down to one. This season (2008), the number of lesbians among the 616 series regulars is approximately zero. It’s not much better on UK primetime TV – I believe there are lesbian characters on Holby City and Casualty, but basically, there is markedly meagre representation of lesbians (and yes, we have to pay our licence fee just like everyone else).   

Why is this an issue for us as health professionals? This week, I was shown excellent new material for a sexual health campaign for young people – excellent that is, except that all images were overtly heterosexual; there was no suggestion that adolescents are experiencing or have questions about same-sex relationships. Yet this month’s Observer sex poll found that, while only 6% of Britons define their sexual orientation as homosexual or bisexual, 16% of women have had sexual contact with another woman, and 10% of men have had sexual contact with another man.

So why is this a public health issue? If people or realities are made invisible to protect the heterosexual “norm” – if no lesbians are visible in mainstream media – this will insidiously influence how we design and deliver health interventions. Simply put, they will not be as effective as they should be, and the needs of the populations we serve will not be met.

My hope is that new developments such as renewed emphasis on patient-public involvement in the NHS and the requirement for equality impact assessments, if implemented with commitment to their principles and not simply as bureaucratic exercises, will help to ensure that we have to explicitly consider the needs of all those invisible people we serve, and will increase the bang we get for our buck.

Jeanelle de Gruchy is Deputy Director for Public Health, Nottingham City Primary Care Trust. She supports the recommendations made in this month’s Stonewall report: The Double-Glazed Glass Ceiling, including that employers should support and enable lesbian and bisexual senior members of staff to be out and involved in awareness raising initiatives.