HealthBegins and all of you, our fearless upstream community, are committed to dismantling systemic oppression and restoring the health and equity that it strips away. But on our watch, systems of oppression for transgender people are being designed and codified into law. The examples are mounting almost weekly. 

In Tennessee, bills restricting public drag performances and banning gender-affirming treatment for youth are soon to be signed into law. In Florida, the Board of Medicine enacted a rule barring providers from prescribing minors puberty blockers or hormone therapy. The Alaska State Board of Education barred transgender female students from participating in sports. In Iowa, the legislature just passed a bill requiring that students use the bathroom for their sex assigned at birth. All told, an NPR analysis found that more than 300 bills were introduced targeting trans people in 2021 and 2022. 

We recognize that these restrictions cause harm to our transgender community members. This matters for all of us who are committed to advancing health and equity. This is not the first time our government has made laws about which public bathrooms Americans can use and which public spaces Americans can inhabit. It doesn’t seem coincidental that the same officials promoting such laws also wish to erase the history of racism from American classrooms. 

As our transgender friends face increasingly personal discrimination and violence, including public, politically-motivated vitriol, the effects on their health and wellbeing compound. These harms may look familiar to Upstreamists who have long worked to dismantle the systems and structures that put people in harm’s way and divide opportunities to thrive by race, immigration status, and other aspects of human identity. Their health-shaping effects are wide reaching and include:

• Housing and employment discrimination: According to the National Center for Transgender Equality, one in five transgender people has experienced discrimination while seeking a home, and one in five has experienced homelessness at some point in their lives. This study from New Orleans provides deeper insight into this discrimination. Employment discrimination is similarly common for transgender individuals. Twenty percent to 40 percent of trans youth report being homeless*.
• Violence: Transgender people are four times as likely to be the victim of violent crime compared to cisgender people.
• Criminalization: Transgender people face disproportionate rates of incarceration in America—with a particularly heavy risk falling on transgender youth of color, who are often pushed into tenuous circumstances by estrangement at home, abuse at school, and discrimination in other realms. 
• Depression, anxiety, and substance use disorders: Stigma and marginalization across multiple realms of life undermines transgender people’s mental health and puts them at elevated risk for substance use disorders. Forty one percent of transgender adults have attempted suicide (compared to 2 percent of all Americans). Transgender community members who are Black and Brown are especially hurting; one in four has attempted suicide in the past year.
• Sexual health risks: Transgender people face elevated risk for sexually transmitted infections, including HIV. These illnesses further compound the challenges they face across housing, employment, and other domains.

Sadly, when trans people need medical care, many experience discrimination, ignorance, or even hostility in the clinic. In a poll by the Washington Post and the Kaiser Family Foundation, nearly half of trans adults said their healthcare providers know “not too much” or “nothing at all” about how to care for trans people. More than one in three said it was “somewhat” or “very” difficult to find a provider who treats them with dignity and respect.

At HealthBegins, we commit to support our transgender friends through the following actions—and invite you to join us and do the same:

• Learn, or if needed unlearn: We commit to opening our hearts and minds to identify and assess our own biases and fears in order to become effective allies. If you aren’t sure what you think of the laws and policies described above, seek out more information about best practices and learn more. Helpful resources include the National LGBTQIA+ Health Education Center’s resources for healthcare organizations and the National Center for Transgender Equality’s “A Guide to Being a Good Ally,” which helped inspire this list.
• Use the right terminology: We will introduce ourselves with our pronouns. When a person tells us their pronouns, we will use them and only them. When in doubt, we will rely on first names! Here is a helpful guide to gender identity terms. 
• Improve organizational practices: We commit to updating our forms and documents so that they are inclusive and use sensitive terminology. We will provide inclusive health benefits for employees, develop a transgender-inclusive discrimination policy, and ensure that all single-use bathrooms in our facilities are gender neutral. We will identify opportunities for inclusivity and elevating the voice of transgender community members. We will continue to build our internal knowledge and skills by identifying training needs for staff. (For organizations seeking to improve their hiring practices, the TransLatin@ Coalition has a human resources training course on hiring trans and gender nonconforming people.)
• Help ensure that transgender patients know their rights. We will work to ensure that transgender people know they have the same rights to privacy and access to care and, in several states, have additional protections from discrimination. Support your transgender patients in advocating for themselves and their peers. 
• Support Organizations Supporting Transgender People. Some possibilities to consider include:
  • National Center for Transgender Equality — policy advocacy
  • Trans People of Color Coalition — advocacy through reporting and storytelling
  • Trans Women of Color Collective — advocacy, policy, and narrative
  • Transgender Legal Defense and Education Fund — legal services, litigation, and public policy
  • Transgender Law Center — legal action and advocacy for trans rights
  • Sylvia Rivera Law Project — legal help and prisoner advocacy
  • National LGBTQ Task Force — advocacy and political mobilization
  • Trans Latina Coalition — direct services in Los Angeles and multistate policy advocacy
  • Black Trans Advocacy Coalition — advocacy and direct support for health, housing, and employment
  • Transgender mental health hotlines, e.g., The Trevor Project and Trans Lifeline
• Advocate: We commit to using our voice to support transgender community members in every space we inhabit. We will work to proactively pass rules, policies, and laws that prohibit discrimination. In health care, we have a particular advocacy role to play around Medicaid, where transgender enrollees are uniquely vulnerable to inadequate access to gender-affirming care as their health benefits are influenced by politically selected leaders. Learn more about your state’s Medicaid gender-affirming care benefit and, if the benefit in your state is limited or non-existent, advocate to change that. 

We are all stronger when we rise together.

By: Kathryn Jantz (she/her), Kyron Pierce (he/him), Vince Pancucci (he/him), and Grace Rubenstein (she/her) on behalf of the HealthBegins team

HealthBegins appreciates Xiomara Cervantes-Gómez, PhD (she/ella/ela), and a.t. Furuya (they/them) for their generous feedback on this statement.

*Source: X. Cervantes-Gómez, Bottoms Up: Queer Latinx Exposure (NYU Press, forthcoming 2023.)