By Malaika Hill and Rebecca Cheff
Yesterday, Ontario announced it will be introducing gender-neutral health cards and driver`s licenses in 2017. According to the Toronto Star, “[t]he Liberal government says it is making these changes ‘to ensure the fair, ethical and equitable treatment of people with trans and non-binary gender identity.’” For health equity to be achieved, everyone should have access to safe and adequate health care, regardless of their gender identity. Research identifies specific health care barriers faced by the trans community. It tells us that those in the trans community often avoid seeking medical care because of transphobia, misinformation about trans bodies, experience with and fear of negative experiences including harassment, abuse, and refusal of care and erasure in the health care system in Canada. In order to remove these barriers there must be real institutional change at multiple levels in the health care system.
An estimated 0.5 percent of the Canadian population identify as transgender. Transgender is a term that describes people whose gender identity is different than the sex assigned to them at birth. Trans is an umbrella term, which includes transgender people, and refers to people whose gender expression and identify do not fit with society’s ideas of being a man or a woman. These definitions are based on the 519’s Glossary where you can learn more about inclusive language.
Despite limited research, we know that barriers for the transgender community are pervasive within the health care system. Many trans individuals are actively not seeking medically necessary health care because of these barriers. A Trans PULSE study found that more than half of trans Ontarians reported negative experiences at emergency departments from being refused care, to hurtful or insulting language, to being told that the health care provider doesn’t know enough to provide care. The study also found that one in five trans Ontarians avoided the emergency department when they needed it, due to discrimination they previously faced.
Discrimination, institutional violence and obstacles to adequate medical care have had significant impacts on the mental and physical health for many in the trans community. More than half of trans people in Ontario have high levels of depression, with 43 percent having a history of attempting suicide, which has been linked to experiences of transphobia and transphobic violence.
In May 2016, the government introduced federal legislation that would guarantee legal and human rights protection to transgender people across Canada (Bill C-16). This enactment would amend the Canadian Human Rights Act to add gender identity and gender expression to the list of prohibited grounds of discrimination. This change would hold health care institutions accountable for eliminating trans-specific discrimination in their organizations.
Toronto researcher and trans advocate Dr. Alex Abramovich has drawn attention to these barriers and called for change: “treating someone with dignity and respect is not a complex issue. That should be very simple.” Trans communities and allies have identified some best practices for trans inclusive health care: the Sherbourne Guidelines for Trans Care, the Winnipeg Trans Health Klinic and the Transgender Health Information Program. Rainbow Health Ontario recommends that organizations use training, education, mentorship, resources, and networking in order to be more inclusive.
Mount Sinai’s Are You An ALLY? Campaign reminds us that allies must work with trans communities to improve health care. Three starting steps we all can take as individuals to learn, reflect and practice allyship: 1) Be self aware 2) Identify your privilege and use it to create change and 3) Speak up and take action. Part of being an ally is challenging transphobia and fostering environments that are inclusive of gender identity and gender expression.
Creating barrier free access to health care is important to health equity in Canada. By collaborating with trans communities and community advocates, we can provide more inclusive health care. We must do better to dismantle health care barriers.
Malaika Hill is a Public Policy Intern and Rebecca Cheff is a Junior Fellow at the Wellesley Institute. Malaika and Rebecca are both cisgender and striving to be allies in the health system.