LGBTQ+ inclusion in local authority public health: a review of needs assessments in England

AIMS: A Joint Strategic Needs Assessment (JSNA) is the process through which health and wellbeing boards in England assess the needs of their local populations to identify inequalities in health and its wider determinants and inform both commissioning priorities and a Joint Local Health and Wellbeing Strategy. We sought to determine how and to what extent JSNAs address the needs of LGBTQ+ people in England. METHODS: The local authorities in receipt of a Public Health Grant in 2024 were identified and their websites searched for current (i.e. published in 2020 or later) JSNAs. Those which referenced LGBTQ+ health and wellbeing were assessed against pre-specified methodological and content criteria indicative of LGBTQ+-inclusive practice (e.g. LGBTQ+ community involvement in JSNA development). Counts and percentages described the frequency with which each criterion was met across the eligible JSNAs, and choropleth maps illustrated patterns of inclusion across England. RESULTS: Of 142 local authorities with an eligible JSNA, 108 referenced LGBTQ+ health and wellbeing at least once. However, few local authorities considered the diversity within LGBTQ+ communities or the impact of intersecting marginalised characteristics. Most disaggregated data for LGBTQ+ people concerned mental illness, sexually transmitted infections, HIV, and substance use. CONCLUSIONS: Currently, English JSNAs do not adequately characterise the needs of local LGBTQ+ communities and disproportionately focus on highly stigmatised behaviours and conditions.