Op-ed: Social Justice Can Cure What Ails Us

Our push for equality is having an unexpected benefit: better health for LGBT people.

As our movement continues to advance, we are learning that equality is not the end game in and of itself. It is becoming increasingly clear that legislative and public policy changes that reduce inequality can have a positive impact on health.

A report released this month by The Fenway Institute at Fenway Health and the Massachusetts Transgender Political Coalition found that transgender people who reported experiencing discrimination in public settings in the previous 12 months experienced striking negative physical and mental health effects. Those reporting discrimination were 84 percent more likely to report physical symptoms such as headaches, stomach upset, muscle tension, or increased heart rate in the past 30 days. They were also twice as likely to report emotional symptoms such as feeling upset, sad, or frustrated during this timeframe.

The study raises the intriguing possibility that passage of a law in Massachusetts banning discrimination against transgender people in public areas might not just lessen the likelihood of violent and discriminatory acts taking place against transgender people. Such a law might also improve the overall physical and mental health of the state's transgender residents.

"Discrimination and Health in Massachusetts: A Statewide Survey of Transgender and Gender Nonconforming Adults" was designed to measure the extent to which transgender people in Massachusetts experience discrimination in public settings such as restaurants and retail establishments; parks and public transit; and health care centers and hospitals. To no one's surprise, we found widespread discrimination among adults who self-identified as transgender or gender nonconforming (in which their gender identity or expression is different than their sex assigned at birth).

The survey of nearly 500 adults conducted in August 2013-December 2013 found that 65 percent reported at least one incident of discrimination in a public setting in the previous 12 months. Discrimination, which ranged from physical assault to verbal harassment, occurred most commonly in areas of public transportation, such as trains, busses, subways, and airports (36 percent). That was followed by retail establishments (28 percent), dining (26 percent), public gathering locations (25 percent), and health care settings (24 percent).

Nineteen percent of respondents said that they postponed or did not seek medical care when they were sick or injured in the past year due to experiences of disrespect or mistreatment by health care providers; 24 percent did not seek preventive care or get a check-up in the past year for the same reason. This supports a clear link between experiences of discrimination in health care settings and not accessing health care.

This study raises interesting questions that should be examined further. Do experiences of discrimination lead to ill health among LGBT people? And can advances in social justice improve health and reduce health disparities? A 2009 study by researchers at Emory University found that states that had enacted bans against the marriages of same-sex couples subsequently saw HIV diagnoses increase by 4 per 100,000 people. Meanwhile, a 2012 study by our colleagues at The Fenway Institute found that legal recognition of the marriages of same-sex couples corresponded with a marked increase in health among gay and bisexual men in Massachusetts.

One of the most alarming findings from our Massachusetts study is that among transgender people who have a health care provider, 23 percent reported that they had delayed preventative care such as check-ups, and 20 percent postponed care when they were sick or injured due to fear of discrimination. One in four also reported that they had experienced discriminatory treatment in a health care setting and nearly six percent reported that providers had refused to treat them based solely on their gender identity or expression.

A 2009 survey of LGBT people by the Massachusetts Department of Public Health found significant health disparities between transgender people and the general population. The study concluded that transgender respondents reported "the highest level of health disparities. Support of non-discrimination protection for transgender persons could help reduce stigma and by extension, improve health."

Just such a bill is pending in the Massachusetts legislature. The Equal Access Bill would outlaw discrimination against transgender people in public accommodations, such as health centers, restaurants, and subways. If passed, it could be much more than a measure to reduce discrimination and promote equality. It would also be a remedy for the poor health affecting too many of our transgender brothers and sisters--promoting health equity.


SEAN CAHILL, Ph.D. is director of Health Policy Research at The Fenway Institute.

SARI REISNER, Sc.D. is a research scientist at The Fenway Institute and a Postdoctoral Research Fellow in the Department at Epidemiology at Harvard School of Public Health.