I’ve written quite a bit about how people of different races in the U.S. experience significant disparities when it comes to health. But race is not the only category that is correlated with these disparities—there are other identity groups that also show worse health outcomes when compared to the general population. Fenway Health, an LGBT Health organization based in Massachusetts has named this week Transgender Awareness Week, and put out new infographics reiterating what we know about health disparities in the transgender community.
I addressed in a previous column the different ways that the causes of race-based health disparities get interpreted. There are some, often based on flawed genetic research, who want to claim that race-based health disparities are simply a result of genetic differences between racial groups. But what I and other researchers and academics believe is that these disparities are actually a result of systemic racism, inequality, and discrimination—and the impacts of those on one’s health.
When we look at the disparities facing the transgender community, this dynamic becomes even more clear, because the research shows widespread discrimination across all arenas of life. This discrimination happens in the home, with their families, in schools, in employment, in public services, in housing. The national transgender survey conducted by the National Gay and Lesbian Task Force and the National Center for Transgender Equality polled 6400 transgender people in the U.S. and compiled their findings into the appropriately named Injustice at Every Turn report.
To understand how discrimination can impact a person’s health, it’s useful to look at the transgender community simply because the experience of discrimination is so widespread. And while some might try to also pin these disparities to genetic differences, it’s a much more difficult argument to make considering that the transgender community is an extremely diverse group. I hazard to say that finding genetic similarities among transgender people would be an impossible task. So instead we must look at the lived experiences of transgender people, where we do find a lot of similarities, particularly in experiences of discrimination.
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While we still do not know as much as we would like about health disparities in the transgender community, mostly because there are few national health surveys that ask about gender identity in a manner that would recognize transgender people, we do know some bits and pieces of the picture. All transgender people are more likely to be uninsured than the general population. Black transgender people are twice as likely to be uninsured as the general population. Between 15 and 36 percent of transgender people report being denied health care. The percentage varies based on race and gender, with the highest, 35 percent among American Indian transgender people. When it comes to mental health, transgender people report high rates of depression and attempted suicide—62 percent and 41 percent respectively. When it comes to HIV, .6 percent of the general population is HIV positive, while 2.6 percent of the transgender community and 4.4 percent of the black transgender community is positive. All this data is referenced in the Fenway infographic, compiled from multiple sources.
The numbers are clear: transgender people face a whole host of health disparities not seen in the general population. The qualitative experiences of people in the community explain at least some of the disparity. Lack of access to health care, increased levels of poverty and homelessness all can be connected to discrimination based on gender identity and expression, as well as these negative health outcomes.
The good news, though, is that because the problem is so clear, the solutions are also more apparent. Part of the solution is educating the general public about transgender people to reduce stigma and decrease discrimination, something the Washington, DC government is trying to do with a new ad campaign. Another part of the solution is making sure transgender people can get health care coverage, and that that health also covers the specific health needs of the transgender population—something San Francisco is trying to do.
We must understand health disparities within the context of people’s lives because their lived experiences, both positive and negative, ultimately shape their health and wellbeing. A true justice-based health approach understands these intersections and finds solutions to health problems outside of the health care arena as well as within it.
Transgender Health Disparities infographic from Fenway Health