CHAT WITH: Dr Rory McGill from Sefton Council
This week we chat with Dr Rory McGill about his work as a Public Health Consultant for Sefton Council, the health inequalities he has witnessed and experienced that have driven his career path and his ambitions to help improve health outcomes for LGBT+ people and those from more deprived areas of Sefton.
Hi there Rory, to start off, can you tell us a little bit about yourself and what a Consultant in Public Health does?
“Hello! My name is Dr Rory McGill, I use he/him pronouns and I am from Derry in the North of Ireland but have lived in Liverpool for the past 10 years. I work in Sefton Council as a Consultant in Public Health. A Consultant in Public Health is the same idea as a Consultant you would see in a Hospital but is based in the community. Public Health Consultants use scientific evidence to help people make healthier choices, understand and prevent the impacts of disease and work across partnerships to help make where we live a healthier place.
“I started my career at Queen’s University in Belfast by doing my undergraduate and PhD in Psychology. I then worked as a post-doctoral researcher, with my first job at the University of Liverpool on a 6 month contract. When this ended I was looking for more research jobs and a job came up in the Department of Public Health and Policy at the University of Liverpool. I hadn’t even heard of public health before then but the more I read about it I realised I had been doing it for years within my Psychology PhD! So I worked as a post-doctoral researcher in public health for a few years and worked across a wide range of issues including obesity, health inequalities and ageing well. I then applied for the formal training programme to become a Consultant in Public Health which I completed last year and started my first Consultants post at Sefton Council.”
And what does your role at Sefton Council involve?
“My role in Sefton Council involves quite a diverse portfolio (which is great!). I supervise the commissioning of local sexual health services and was responsible for amending the sexual health contract to include PrEP provision for those who want it. I also lead on mental health, including exploring ways to promote good mental health as well as preventing suicide where possible. Within my role I am also the lead public health representative from Sefton involved with the reformation of the local NHS and how the Local Authority, the NHS and our local Community and Voluntary sector all form a new partnership. I also supported the management of COVID outbreaks and am now working on COVID recovery and how the pandemic has impacted diverse groups differently.
“Finally on a regional footprint I am the chair and lead of the North West Behavioural Science and Public Health Network. I wanted to merge my backgrounds of Psychology and Public Health training and help professionals across the North West try to better serve our communities by doing things in a way that is informed by the scientific evidence around why we behave the way we do and what are the best ways to help people make healthier choices. Most of this is acknowledging the barriers people face around making healthier choices.”
Have you had personal experience of health inequality that has driven your professional work and ambitions?
“I have experienced health inequalities my whole life. I grew up on benefits in extreme deprivation, where we had very little money. This meant growing up in a different way to others that I didn’t realise wasn’t ‘the norm’ until I was an adult and through public health training I began to understand why. I was almost the ‘case study’ of health inequalities I so often hear about in public health now, which frustrates me because I feel people from more deprived backgrounds are all seen as the same, but as I show we are not all the same and should be considered individually. Where and how we grow up has lifelong implications on our physical and mental health and being able to ‘start well’ can really shape someone’s chances in life. I am one of the lucky ones.
“As a gay man I have also experienced health inequalities. I came out at 14 and went to an all-boys Irish grammar school so it wasn’t the easiest of times. A blood drive came to school and we were all asked to go and give blood. I went into the van and completed the questionnaire stating my sexual orientation, but also stating I had had zero sexual contact with another man. The doctor took me aside and said ‘we don’t want your blood here’. I explained again I had zero risks involved and he said: ‘I don’t think you understand, we don’t WANT YOUR blood here’. I left out the back crying. Other boys figured out what happened and some spat at me, others threw me into some lockers.
“As an adult I went for a full sexual health screen with my partner when we decided to be committed to each other. I was made to feel during the consultation like I wasn’t telling the truth as to why we were there. It was seen as “unbelievable” that gay men would be being proactive and preventative regarding their sexual health! One nurse even tried to imply my partner was coercing me into a sexual relationship. As I commission sexual health services now I realise how badly this was handled. I would like to say, though, that as members of the LGBTQI+ community we experience microaggressions, indirect and direct discrimination daily, and these things chip away at us. We don’t exist in a vacuum and there is no biological explanation for us to experience the health outcomes we do – it is determined by the society in which we live, where up until very recent history it was illegal for us to even exist!
I would like to add though, that – particularly as a white, cis gay man – I have an inherent level of privilege over others in our community. Trans healthcare in the UK is in crisis, with the system being unfit for purpose as it hasn’t evolved with society. People like me need to do more to support our trans brothers and sisters who are experiencing much harder times than us. We need to boost their voices and help them the way they have always supported us – Stonewall began with a black trans woman!”
What issues have you observed in terms of LGBT+ people experiencing health inequality, through research and work in Sefton?
“I completed a research project across Cheshire and Merseyside a few years ago which focused on the health experiences of older LGB+ people. The reason I did this research was I heard a horrible story of an older lesbian woman whose decades-long partner sadly passed away and she couldn’t care for herself, so she went into assisted living. She used to hide all photos and evidence of her partners when health professionals visited and it wasn’t until she died that they even knew she identified as lesbian. She was so scared to reveal the truth to those she was receiving care from. I didn’t include trans people in my research sample as there are very specific clinical considerations needed for the appropriate health and care of older trans people e.g. medical professionals knowing that trans men can have an overall higher risk of breast cancer or knowing to conduct a prostate exam on an older trans woman.
“Among the older LGB people I spoke to from Cheshire and Merseyside, I heard some quite shocking stories. Examples of older lesbian women going for emotional health and wellbeing support who had never had sexual contact with a man who were given pregnancy test. Older gay men who went in for a routine check-ups who again had no sexual contact with a man yet were given HIV tests. Being gay has become overmedicalised, partly due to it only being declassified as a mental illness in the 90s by the World Health Organisation (this didn’t happen for transgender people until 2019!) as well as the HIV crisis in the 1980s.
“It is a sad fact that because we don’t form the majority that we don’t always factor into national decision making. The HPV vaccine was a good example of this, something I campaigned for to be offered to boys as well as girls (which thankfully it now is). From 2008 it was only offered in schools to girls with the rationale of it protecting boys who they will go on to have sexual contact with. But what about the boys who will go on to have sexual contact with men? They weren’t protected, therefore widening the gap in health between gay men and their heterosexual counterparts concerning anal, penile and oral cancers. This was introduced for boys in 2019.
“It is also worth mentioning that we didn’t even factor into the national collection of data via the census until the most recent one in 2021. This means we don’t have an accurate picture of how many LGBTQI+ people there really are in our region. Therefore we were never part of the national picture in terms of planning. It is still so associated with stigma that professionals are still too afraid to ask if someone is LGBTQI+! This holds everyone back! It shows we still have a long way to go.”
It often feels like outcomes in this area are quite negative and the progress is show, how do you feel about this?
I think within my line of work it becomes easy to focus on the negatives and the worse health outcomes we experience in our community – and rightly it should be the focus of my work as these inequalities are avoidable and unjust. However we should also celebrate the excellence that exists within the LGBTQI+ community across the Liverpool City Region. There are so many amazing people doing really amazing things, with lots of positive examples of supporting each other through the most recent traumatic times of the pandemic and beyond. We need to get better at sharing these stories to help shape a more accepting culture. There was recently an increase in homophobic attacks in Liverpool so it shows that we are not there yet. But let’s not let those stories define who we are. Lets take up space and make our voices heard!
What are your aims and ambitions in your professional role and how do you intend to achieve this?
“I intend to be visible in my current role. I want to represent those from our more deprived parts of the borough as well as be a visible role model to all people who identify as LGBTQI+. As part of my role I am in conversations with colleagues across the health and care sector who describe ‘hard to reach’ groups when trying to do some consultation. We aren’t hard to reach, we just aren’t being given the platforms to speak. This puts the blame on disadvantaged groups and makes them responsible for their health when actually we know from extensive public health research that our health is determined by who we know, where we live and how much money we have
“Things have moved on a lot in quite a short amount of time for us but unfortunately we are not there yet. The evidence that LGBTQI+ people have disproportionately worse health outcomes and experiences of healthcare consistently remains. For almost every public health measure we look at, our communities fare worse than others. This will take time and requires more of a cultural shift, and hopefully with people like myself being visible in positions of authority will help move this along.
“I am currently an Equality and Diversity Champion for Health Education England supporting medical doctors who are training and experiencing discrimination because of either their gender expression or their sexual orientation. I hope through this I can help expose any discrimination these people face as well as help shape how medical training is happening across the North West of England to ensure we have a well informed medical workforce who can treat us all with the respect and dignity we deserve.”
What would you like to see for LGBT+ health care on a personal level?
“The ultimate goal I would say is for everyone who identifies as LGBTQI+ to feel safe, supported and cared for while accessing healthcare. For all members of our community to feel they are valued and loved members of society who should not shy away from seeking the help they need when they need it.
“I would like on a personal level to move away from a place where we have to keep educating our caregivers on our lived experiences. It has been said we never come out once, but constantly throughout our lives and this is very true within healthcare. We need a workforce who understand that not all people fit within the ‘standard’ heteronormative box of a nuclear family. We need a culture where sexual orientation or gender identity isn’t something to be afraid to ask about. Some people (myself included) have a family of choice – I would love to see these relationships as valued as biological and legally binding relationships when considering both formal and informal care and support.
“Finally I would love to see more people like me! More LGBTQI+ people influencing public health policy and the health agenda. More opportunities should be given to our younger generations to know there are viable careers in science, technology, engineering, and maths (STEM). LGBTQI+ people are underrepresented in STEM and if we aren’t in the room we can’t influence those who impact on our health.”
How can people in Sefton (and beyond) access support in this area?
“For those in Sefton, Embrace is a Sefton Council for Voluntary Service (CVS) network which is for all Lesbian, Gay or Bisexual (LGB) people who live, work or socialise in Sefton, Merseyside. The network is run by and for members of the local LGB communities and is open to everyone to join. Information on the network can be found here. Sefton Sexual Health Service is open for everyone and offers the online ordering of STI testing kits and online ordering for condoms and lube. There are also links to HIV risk checkers and details on accessing PEP and PREP in our emergencies section.
“For Sefton residents aged between 11-25 seeking mental wellbeing support, Kooth is available online and is accessible through mobile, tablet and desktop and is free at the point of use (www.kooth.com). The platform allows children and young people to access information, gain support from the Kooth community and chat anonymously about a wide range of potential issues using peer-to-peer forums, self-help articles and mood tracking tools to help set personal goals. Young people can message a counsellor or schedule in live text-based chat sessions and can discuss issues relating to being part of the LGBTQI+ community.
“Finally, for trans people, there is Trans Health Sefton. To access this service you have to be registered with a Sefton GP and be living in the South Sefton or Southport and Formby areas. Patients of all ages can be referred to Trans Health Sefton by other health care professionals such as their GP or they can self-refer by contacting the practice and filling out a short self-referral form either in person or over the phone. This service is for everyone, from those questioning their gender identity, to those already identifying as trans and those who have already had some form of medical or surgical treatment.”
In line with LCR Pride Foundation’s annual theme, “From Now On”, what do you pledge to change, from now on?
“From now on I will ensure that LGBTQI+ people are considered when exploring the best ways we recover from the pandemic. Our community has been disproportionately impacted by the pandemic for a variety of reasons including higher rates of smoking and homelessness to aversion to seeking help. I will take up more space in this conversation and help futureproof our local area to protect our community from this horrible scenario if we find ourselves in this position again in the future.”
