MedicalResearch.com Interview with:
Kellan E. Baker, MPH, MA
Centennial Scholar PhD Candidate
Health Policy Research Scholar
Department of Health Policy and Management
Johns Hopkins Bloomberg School of Public Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This study shows that transgender adults in the U.S. today have significantly worse health-related quality of life than cisgender (non-transgender) adults, as measured by self-reported health status and number of recent days of poor physical or mental health.
The study is important because it quantifies the gap in health-related quality of life between transgender and cisgender people, and it relies on a survey that allows us to believe that these findings are likely true not just for the people who answered the survey but for the U.S. as a whole.
Health-related quality of life is a very broad term that describes a person’s whole sense of well-being—we might think of it as the answer to the question, “how are you doing these days?” The answer has to do not just with your physical health but also your mental health, your outlook on your life and your community, your feelings of wholeness and happiness. Sources such as the National Academy of Medicine and the U.S. Transgender Survey have documented that transgender people face discrimination in areas of everyday life such as housing, health care, and public spaces. Encounters with discrimination don’t just keep transgender people from getting services they need: they hurt trans people both physically and mentally.
MedicalResearch.com: What should readers take away from your report?
Response: The U.S. has made a lot of progress over the last several years toward acceptance and celebration of natural human diversity in gender identity and expression. But between 2014 and 2017, which is the period when the study data were collected, discussions of transgender issues started to look less like forward progress and more like a seesaw: sometimes up, but often down. This study shows that being a transgender person in the U.S. today—being transgender in a society that you know doesn’t fully accept you—is hard. It affects your health in negative ways, and that’s why issues such as nondiscrimination protections for transgender people are public health issues.
The connection between nondiscrimination protections, public health, and quality of life is at the core of policy proposals such as the Equality Act, which is legislation that recently had a hearing in the U.S. House of Representatives. The legislation would update existing federal civil rights laws to ensure that they all cover sex, gender identity, sexual orientation, and other reasons why anyone in America might still be told, “we don’t want your kind here.” We know this is happening to transgender people—just look at the new ban on transgender soldiers or the nationwide proliferation of laws that allow businesses and health care providers to pick and choose who they consider worthy of being served and who they will turn away empty-handed. What’s more, just because someone is targeted for one aspect of their identity doesn’t mean they aren’t targeted for others as well: navigating life as a transgender person who is also a person of color, or a woman, or an immigrant, or living with a disability is often exponentially harder than for transgender people who have privilege in other areas of their lives.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Legislation like the Equality Act aims to make it easier for transgender people to take care of their health by, for example, buying insurance coverage or visiting the doctor for a check-up. But ultimately it’s not a question of any one person’s approach to their personal well-being: the gaps in health and health-related quality of life that affect transgender communities arise from the system-level failure of how we in the U.S. too often consider things like access to health care, an income adequate for basic needs like food and rent, and neighborhoods free from deprivation and violence to be privileges for a few rather than rights for all. In addition to the Equality Act, these systemic problems require systemic solutions such as universal health care, universal basic income, and real efforts to address climate change.
MedicalResearch.com: Is there anything else you would like to add?
Response: So while the findings of this study aren’t news for transgender people, they are a wake-up call for politicians, health care providers, insurance companies, and others who have the power to choose whether their policies and practices are going to harm or help transgender people and others who are often left behind or pushed aside. Everyone should be able to get the health care they need, when they need it. Everyone should be able to feel safe going to school and to be able to have a job where they are valued and respected and paid a living wage. Everyone should be able to imagine a safe and happy future for themselves. What this study highlights is that everyone—whether transgender or not—should have the right not just to survive, but to thrive.
Baker KE. Findings From the Behavioral Risk Factor Surveillance System on Health-Related Quality of Life Among US Transgender Adults, 2014-2017. JAMA Intern Med. Published online April 22, 2019. doi:10.1001/jamainternmed.2018.7931
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