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McCadney 1 and Brooke A. Levandowski2,3  \nAbstract  \nThe variety of ways that cultural competency has been used to improve health care for historically marginalized groups, including the lesbian, gay, bisexual, transgender, and queer community, has been documented in the literature. As clinicians seek to deliver competent care, we encourage consideration of how the intersectionality of patient lives, including institutional racism, impacts clinical care, and assert the need for the immediate application of an antiracist framework to center and achieve the goal of restorative and holistic clinical care.  \nKeywords  \ncultural competency, LGBTQ, health care delivery, antiracism, health equity Received: 1 April 2025; accepted: 8 December 2025  \nSignificance for public health  \nIn 2016, led by Dr. Camara Jones, the American Public Health Association led the conversation on why racismnot race has been a public health crisis underlying health inequities. To clarify, racism is the way a person is treated based on the color of their skin while race is a U. S. Census question which asks about identity within defined groups. This distinction is critical, as it shifts the focus from race as a static identity category to racism as an active force shaping access to care, health outcomes, and overall wellbeing. A decade later, we continue this broad and deepreaching conversation and apply lessons learned in antiracism spaces to improve healthcare for LGBTQ+ communities, especially LGBTQ+ Communities of Color. We recognize racism as a public health crisis and acknowledge the interconnected nature of discrimination, where ableism, transphobia, classism, homophobia, and xenophobia intersect to deepen health disparities for LGBTQ+ individuals of color. Medical distrust, prejudiced procedures and policies, and the lack of culturally responsive care create structural barriers that limit equitable access to healthcare and worsen these disparities. We ground our work in the principles of antiracist public health discourse and go beyond acknowledgment by actively dismantling  \nthese barriers, ensuring that the voices and experiences of those most affected drive transformative change. In doing so, we not only affirm the dignity and humanity of LGBTQ+ Communities of Color but also drive meaningful progress toward a more just and equitable healthcare system.  \nLimitations of cultural competency in LGBTQ+ care  \nCultural competency in healthcare and social services is a well-established framework defined as improving the quality of care by enhancing providers’ ability to  \n1 Harrisburg Area Community College, Pennsylvania Community College, PA, USA  \n2Department of Obstetrics and Gynecology, University of Rochester, NY, USA  \n3Department of Public Health Sciences, University of Rochester, NY, USA  \nCorresponding author:  \nBrooke A. Levandowski, Department of Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave, Box 668, Rochester, NY 14642, USA.  \nEmail: [Brooke_levandowski@urmc.rochester.edu](Brooke_levandowski@urmc.rochester.edu)  \nCreative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution  \nNonCommercial 4.0 License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ([https://us.sagepub.com/en-us/nam/open-access-at-sage](https://us.sagepub.com/en-us/nam/open-access-at-sage)).  \nunderstand, respect, and work with diverse populations.1 In recent years, healthcare and social","cbCaioHQbkQPNOw0","https://ap.wps.com/l/cbCaioHQbkQPNOw0","pdf",462102,"English","# Significance for public health\n## Limitations of cultural competency in LGBTQ+ care","[{\"question\":\"What is the main argument for moving beyond cultural competency in LGBTQ+ care?\",\"answer\":\"The article argues that cultural competency often overlooks how structural racism and other intersecting forms of discrimination marginalize LGBTQ+ people. It calls for adopting an antiracism framework to address systemic barriers rather than surface-level behaviors.\"},{\"question\":\"Why does the paper distinguish racism from race?\",\"answer\":\"It explains that racism is the way people are treated based on skin color, while race is an identity category used in the U.S. Census. This distinction shifts attention from static identity to an active force shaping access to care and health outcomes.\"},{\"question\":\"How do intersecting discrimination factors affect health equity for LGBTQ+ communities?\",\"answer\":\"The text notes that discrimination can involve ableism, transphobia, classism, homophobia, and xenophobia, which deepen health disparities. It also highlights medical distrust and prejudiced procedures and policies as structural barriers limiting equitable access.\"}]","Beyond cultural competency: Applying an antiracism lens to LGBTQ+ care and health | PDF",1790653400,13]