What are some of the key factors that contribute to healthcare disparities within the LGBTQ+ community? Are certain sections of the LGBTQ+ community more susceptible to these disparities than others? originally appeared on Quora, the place to gain and share knowledge, empowering people to learn from others and better understand the world.

It’s likely not a surprise that LGBTQ+ people face disparities in both physical and mental health compared to their cisgender and heterosexual counterparts, and they’re getting worse. You can think of factors that drive these disparities as coming from three broad sources: (a) underlying socioeconomic factors, (b) structural problems, and (c) anti-LGBTQ stigma and discrimination.

Socioeconomics matters for health. LGBTQ+ individuals, especially trans individuals and bisexuals, face much higher rates of unemployment, lower household income, and higher poverty rates compared to the general population. These factors have enormous downstream consequences: lower income and employment mean that you can’t afford high-quality and nutritious foods, it means you have lower access to health insurance, it means you’re more housing-insecure.

There are also historical structural problems (or the remnants of them) within the American legal and health systems, as well as in cultural practices that give rise to health problems. For example, as late as 2003 thirteen states still explicitly banned consensual same-sex intercourse, let alone same-sex marriage. These bans shoved queer sexual relationships into the dark, disincentivizing safer sex, and giving rise to STI disparities that persist even today. Similarly, the decades-long fight for legal access to marriage denied the ability of many queer couples to share their health insurance benefits, giving rise to a makeshift network of domestic partner benefit offers, which completely fell apart following the Obergefell v. Hodges Supreme Court decision.

Finally, discrimination can create health disparities. Roughly 1 in 8 queer people live in a state where medical professionals can simply refuse to treat them at all on the basis of religious beliefs. Even in states where these “licenses to discriminate” don’t exist, queer people (especially transgender and nonbinary individuals) face significant discrimination in access to both physical and mental healthcare.

These factors, all taken together, imply that some of the principal drivers of LGBTQ+ health disparities come from the fact that LGBTQ+ Americans face largely different institutions of health than their cisgender and heterosexual counterparts.

This question originally appeared on Quora.

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