Three reasons we need to reform healthcare systems to protect the transgender community today
This article originally appeared on LinkedIn on November 20 2020.
Today, 20 November, marks the International Trans Day of Remembrance, to honor and remember those who have lost their lives to anti-transgender violence.
To commemorate this, Transrespect versus Transphobia Worldwide (TVT) has published a report showing that in the last year, 10 people have been murdered in Europe as a result of their trans status. Globally, this figure reaches over 350 people who have been violently murdered. These tragic losses highlight the desperate need to change attitudes towards anti-transgender bigotry and violence.[i]
Systemic problems in society contribute towards the negative attitudes against minority communities. The transgender population face significant barriers to healthcare, which help to further embed prejudice into our culture and attitudes towards these communities.
This year we have seen so much change, in ways that nobody ever expected and I believe that we need to use this momentum for change to make the healthcare system more inclusive to the transgendered community, and to help put an end to anti-transgender violence.
Healthcare systems are not set up to be inclusive towards the trans community
Transgender people face significant barriers to accessing healthcare. Many transgender patients report that "a lack of providers with expertise in transgender medicine represents the single largest component inhibiting access." This is because "transgender treatment is not taught in conventional medical curricula and as a result, too few physicians have the requisite knowledge and comfort level to manage a transgender patient."[ii]
Screening policies are another huge barrier for trans people accessing healthcare. In many countries across Europe, women are invited to attend preventive screening for cervical or breast cancer. Likewise, many men are invited to similar preventative screening appointments for prostate cancer. In various countries these invitations are based on legal gender, or the gender that you are registered with your healthcare practitioner as. This implies that trans people may not receive the invitation to the correct screening for them based on their physiology, putting them at higher risk of developing these cancers.
These examples show just some of the ways that transpeople are discriminated against by the healthcare system and illustrate the ways that change is needed.
Systemic issues legitimize societal behaviors
The year 2020 has been eye opening in so many ways for all of us as a society. A crisis often brings out the very best, but also the very worst of ourselves and we have seen this play out clearly in recent months. The global repercussions to the death of George Floyd and the re-invigoration of the Black Lives Matter movement – which actually began back in 2013 – have been moments that I think have made us all stand still and question our own behaviors. Uncertainty often brings to the forefront some of those really raw tensions that have been left simmering for so long and the topic of acceptance has without a doubt been central.
We know that groups who experience negative discrimination by the system are put at greater risk of violence. The rise of the BLM movement has put this sharply into focus for us all, showing the world how institutional racism has led to the marginalization of black people and people of color. This leads to mental health problems in these groups, as well as putting them at higher risk of suicide and murder.
The same is true of the transgender population, and especially for black trans people. The TVT report found that 89% of the trans people killed in the USA this year were people of color [i].
During the COVID-19 pandemic, many healthcare systems across Europe paused non-essential medical care, including transgender medical care. This language of referring to gender-affirming medical and mental health as ‘non-essential’ feeds the growing opinion that transgender medical care is not a priority.
The healthcare system has a duty of care to protect the transgender community from becoming marginalized. The system is not currently set up to do this which puts these minority groups at risk.
There is a disparity in trans healthcare across Europe
Despite the welcome increase in public knowledge and appreciation of trans and intersex lives, there is a disparity in access to healthcare across Europe. In its 2014 report, ‘Being trans in the EU’, the European Union Agency for Fundamental Rights (FRA) observed ‘serious and repetitive victimization in the EU’.[iii]
Across Europe, there are some countries who have no or insufficient medical specialists in the field causing long waiting lists, which has significant impact on the mental health and well-being of trans people.
There is also a disparity in financing treatment for transgender people, with some countries only financing part of the treatment. There are even some cases where gender confirming treatment is specifically excluded from public healthcare funding. No specific regulation exists in this area at all, despite the fact that a change of legal sex is possible and is subject to the requirement of physical adjustment.
But there are positives to tell also. Malta is breaking ground and working on significant improvements in its healthcare services beyond traditional gender stereotypes. Denmark and Malta are the only two countries in Europe and Central Asia that have now depathologized trans identities, and don’t require prior psychiatric diagnosis for trans-related medical care.
We need to see more countries in Europe following in the footsteps of Malta and Denmark to break down some of the barriers for the trans community.
Much progress has been made for trans rights in Europe over the last few years. Just last month, the Belgian government appointed a new Deputy Prime Minister – Petra De Sutter. She is the first out transgender minister in Europe. Politico ran a story on the news with the headline: ‘Belgian Milestone: A first trans minister and nobody cares’. The journalist went on to say that the lack of media frenzy around her gender identity is a powerful sign of progress. De Sutter has always been open about her trans identity and has never sought to hide that fact in her political career. "That the media coverage of her nomination as deputy prime minister focused on her work rather than on her trans identity is a reflection not just of her impressive political career, but also of the progressive nature of Belgian politics today." But as we’ve seen, this progress is not seen everywhere across Europe.
At Janssen, we believe that only when being open-minded, respectful, treating others equally and supporting everyone, can you be inclusive. I have spent the past three years trying to learn more about the personal and professional experiences of the LGBQT employees of Janssen. During this time many people have shared their experience and these haven’t always been positive. It’s been difficult to hear that people haven’t always felt welcome, accepted, able to talk freely about who they are and the life they wish to lead. As a leader you want your people to feel able to show up as their authentic self but we have to acknowledge that for some people this in itself seems an impossible task as they fear it could be detrimental to their career or may prevent them from seeking opportunities out of fear of rejection.
I am always looking to learn more and do my part as an ally and as an agent for change. I’m going to continue to do that – and I’m going to encourage others to challenge their thinking and actions as well. We all have a part to play to bring about real, meaningful change both within our own workplaces and society overall.
I would encourage you to take some today to reflect and remember the trans individuals whose lives have been tragically cut short because of the life choices they made. By taking steps to make the healthcare system more inclusive toward the trans community, we can start to end the systemic discrimination this community faces on a daily basis.
[i] TMM Update Trans Day of Remembrance 2020: https://transrespect.org/en/tmm-update-tdor-2020/
[ii] Safer JD, Coleman E, Feldman J, et al. Barriers to healthcare for transgender individuals. Curr Opin Endocrinol Diabetes Obes. 2016;23(2):168-171. doi:10.1097/MED.0000000000000227: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802845/
[iii] Being Trans in the EU - Comparative analysis of the EU LGBT survey data: https://fra.europa.eu/en/publication/2014/being-trans-eu-comparative-ana...