Transgender Health Is Public Health

Thoughts on the Transgender Day of Remembrance.

Posted Nov 20, 2019

November 20 is Transgender Day of Remembrance, an annual commemoration of transgender persons whose lives were lost due to violence. In 2019, violence took the lives of at least 22 transgender or gender non-conforming people. In remembering them, we also remember the core truth that transgender health is public health, and we cannot be healthy, as a society, as long as marginalized groups face a disproportionate risk of illness and harm.

The discrimination and marginalization of the LGBTQ population are associated with a range of health conditions, including substance use, anxiety, and mood disorders. Additionally, LGBTQ populations may have less access to health care. On a larger scale, we know that discrimination, in general, is significantly associated with negative health outcomes as broad-ranging as depression, heart disease, obesityhypertension, and substance use, and we are in need of better data on the health effects of being transgender specifically. Globally, transgender women are nearly 50 times more likely to get HIV than the general population, and transgender individuals who are also members of an ethnic or racial minority are at even greater risk of discrimination and harassment.

With this in mind, recent years have been a time of both progress and challenge for transgender health. In 2016, there was indeed progress to celebrate, from the Obama administration’s decision to direct U.S. schools to let students use restroom facilities that correspond with each student’s gender identity, to, in Massachusetts, Boston Medical Center’s plan to launch a transgender medical center, and the state senate’s passage, by an overwhelming margin, of a transgender rights bill, which prohibits discrimination against transgender people in areas of public accommodation, including restrooms.

Since then, this progress has been challenged. The Trump administration has shown hostility to transgender populations in actions like its push to ban transgender military service members, and in the Department of Education’s announcement that it would dismiss complaints from transgender students barred from using the restroom that corresponds with their gender identity.

Yet the White House is not the only place where rollback of transgender rights has been considered. In Massachusetts, a ballot initiative calling for the repeal of the transgender rights law appeared before voters in 2018. Fortunately, this measure was resoundingly defeated, yet the fact that it was considered at all is concerning to those who care about transgender rights and health.

What, then, is the role of public health today, faced with efforts to marginalize a population, in this case, the transgender population, gaining traction in states across the country? 

Fundamentally, we must generate knowledge that can guide public discussions and thinking about this issue and many others. This means that we have to do the intellectual work that elevates human dignity and human rights as a core mission of public health, and work that emphasizes how marginalization and structural discrimination of any group adversely affect that group’s health and diminish us all. Importantly, social forces that diminish and marginalize groups are to be repudiated whether or not they have a direct impact on health.

At its core, an expansive definition of health suggests the centrality of issues of inclusion to the well-being of populations. Any efforts that systematically marginalize particular groups are inimical to the goals of public health. Data that illustrate how these efforts influence the health of populations directly add to the intellectual weight of our argument against such laws, and buttress the moral case against them.

We can and should continue to make this case. We as a country have reached a crucial moment in the fight for transgender equality; we should capitalize on the gains that have already been made and work to move this issue forward. I highlight today an issue that I think warrants our attention, as a challenge to us all, to inform our efforts to build a healthier world.

A version of this piece first appeared on the Boston University School of Public Health website