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The Importance of Affirming Health Care Policies and Practices for Transgender People

By Ryan Combs, Ph.D., M.A., University of Louisville School of Public Health & Information Sciences

Transgender people face substantial barriers to accessing health care. The 2015 U.S. Transgender Survey - a study of over 27,000 participants - found that one-third of respondents who had been to the doctor in the past year had at least one negative experience related to their gender. These experiences include incidents ranging from verbal harassment to refusal of treatment. A quarter of those surveyed did not seek the health care they needed due to fear of mistreatment. Moreover, negative interactions with health care providers are widespread in our state according to a study my research team conducted on lesbian, gay, bisexual, and transgender Kentuckians’ health equity and access. Transgender participants shared their most frequent and negative experiences. The transgender community responds to these challenges by sharing information about affirming providers, traveling long distances to receive competent care, not disclosing their identity to providers, or simply avoiding health care altogether.

As a result of these and other barriers to health, there are significant differences in health outcomes between transgender people and our population as a whole. They report more days of poor physical and mental health. They are also at an increased risk for social isolation and multiple types of violence. For those who experience additional oppression, such as transgender people of color and transgender people with disabilities, the health risks are compounded. Much of the debate over transgender health focuses on treatments related to gender transition, but they are also subject to the same illnesses as everyone else - from arthritis to Zika.

Federal legislation enacted in recent years had begun to make health care services more accessible to this population. The promise of nondiscrimination protection allowed patients to more safely come out to their providers. However, policymakers have recently shifted away from explicitly protecting the rights of transgender people in health care settings, leaving patients more vulnerable to discrimination by health care professionals. This may erode their trust in the health care system and is likely to directly contribute to a retrenchment of any gains recently realized in addressing health disparity gaps.

Every major association of health professionals in the United States has recognized the importance of accessible and inclusive health care for transgender people. As health professionals, we are in a position to work towards increased access for this and other marginalized populations. We must continue to collect more and better data on how to address the social determinants of health at the societal level and develop best practices on delivering high quality care to each individual. Anything less would run contrary to the core values and ethics of health professions.

Ryan Combs has recently co-authored a chapter on transgender health care policy in The Remarkable Rise of Transgender Rights by Jami K. Taylor, Daniel C. Lewis, and Donald P. Haider-Markel, published by University of Michigan Press.


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