Op-ed: Civil Rights Are Vital to Trans Health

Here in Philadelphia, this week marks the 10^th anniversary of the addition of gender identity and expression to our city's Fair Practices Ordinance, which prohibits discrimination in public accommodations, housing, and employment. At the time, there were only two states, eight counties, and 34 cities in the United States with laws prohibiting discrimination on the basis of gender identity or expression. That the bill was passed with so little resistance is a testament not only to the fair-mindedness of the city's leaders, but also to the dedication of the community activists who were involved in bringing about the change.

This week also happens to be the opening of the 11^th annual Philadelphia Trans-Health Conference, which began in 2002 as a one-day gathering of transgender activists, allies, and service providers and has grown in the decade since to become the largest transgender-specific conference in the world, offering three full days of workshops and activities, all free of charge. Last year, the conference drew a diverse group of more than 2,000 attendees from around the nation and the world to talk about all aspects of health and well-being, including safety, education, employment, housing, and social support.

From its inception, the Trans-Health Conference and its presenting organization, Mazzoni Center, have taken a holistic approach to the definition of health and well-being, recognizing that accessible and quality healthcare is an integral part of self-determination when it comes to presenting one's body and identity in the larger world. On the surface, it may not be obvious, but we firmly believe that a person's civil rights and legal standing have a great deal to do with their ability to achieve and maintain optimal health. Those of us who make up the lesbian, gay, and bisexual communities are well aware of the impact discrimination can have on our physical and mental health.

Think about it: if you cannot be assured of safe and stable housing, steady employment, or consistent insurance coverage, this creates a drain not only on your financial resources but also ultimately on your mental and physical state.

Health care professionals have long understood the effects of holistic wellness on the physical health of their patients. Nationwide, health organizations are paying more attention to the way that legal problems create real obstacles to their patients's well-being. Many are responding with the creation of medical/legal partnerships, which provide people with an additional tool to advocate for their health and well being.

We know that transgender individuals experience alarmingly high rates of violence and disproportionate levels of unemployment, in addition to institutional health-care and legal barriers. One in five respondents to theNational Transgender Discrimination Survey (2011) reported being refused medical care due to their gender or gender identity. Fifty percent of the sample reported having to teach their medical providers about transgender care. Nearly half (48%) of surveyed transgender Americans delayed medical care because they couldn't afford it.

It comes as no surprise, then, that they also report including much higher rates of HIV infection, smoking, drug and alcohol use and suicide attempts than the general population. These issues are all connected. Respondents to the 2011 Transgender Discrimination surveywere twice as likely to be unemployed compared to the population as a whole. Ninety percent reported encountering some form of harassment or mistreatment at work, and one in four were fired because of their gender identity or expression.

That's why the recent ruling in Macy v. Holder, Appeal No. 0120120821 (April 20, 2012) by the U.S. Equal Employment Opportunity Commission is so significant. For the first time, the EEOC has unanimously ruled that a transgender individual has standing to challenge an employment action based on her gender identity. Finding that an employer's decision to revoke an offer of employment to an applicant because she was transitioning amounted to gender discrimination, the EEOC has created new avenues of redress to ensure that workplaces are free from unlawful gender-based presumptions. Likening the process of transitioning from one gender to another to individuals who converts between religions, the EEOC found that Title VII, the federal law that prohibits discrimination "because of sex," naturally extended to employment decisions that were based on an employee's transition and gender stereotypes. Such advances in legal recognition of transgender rights will be yet another means by which transgender individuals can ensure that their health and wellness are protected in the workplace. It is why this year's conference offers a number of workshops and trainings for medical, mental health, legal, and social service providers.

Happily, in the U.S. in 2012, there are 16 states plus the District of Columbia, and a total of 143 cities and counties with laws prohibiting discrimination on the basis of gender identity or expression. Of course, a great deal of work remains to be done to combat prejudice and discrimination. We must continue to educate medical professionals, legal practitioners, and people in general about the transgender community and the diverse range of experiences represented within it. As with the gay and lesbian liberation movements of earlier years, progress will result as more of us get to know one another on a personal level and learn to recognize our shared dignity and humanity.

We at Mazzoni Center have always believed that people's civil and legal rights are an integral part of their health and well-being. We salute those whose determination and commitment to justice worked to make Philadelphia a better place for all its citizens a decade ago, and we are encouraged by those who continue that work throughout this week's Trans-Health Conference and into the future.

DAVID M. ROSENBLUM is legal director at Mazzoni Center, a nonprofit health and wellness organization based in Philadelphia. More information on the 2012 Philadelphia Trans-Health Conference is available at www.trans-health.org.