Bay Windows Feature: The needs and trending policies of transgender health



by Emilia Dunham
Program Associate, Network for LGBT Health Equity

Bay Windows Guest Article

Emilia was asked to write an article on transgender health for Bay Windows: New England’s Largest LGBT Newspaper. Here is her article cross-posted.

Wednesday Jun 29, 2011


When you think of transgender* health, what do you think of? Hormones, surgeries? Is women’s health just breast cancer walks and pro-choice debates? Clearly there’s more to it than that.

It’s common to have a narrow view of transgender health as there is such invisibility of trans health needs. As a transgender health advocate and with firsthand knowledge, however, I know that transgender health is much more involved. We have a number of health needs and experience a variety of health disparities.

We’re a community with a complicated relationship with health services. To transition or even access health services, trans people are forced to interact with a field that doesn’t want us there, doesn’t see us, and/or enforces restrictive gate keeping. Transgender people have a remarkable lack of autonomy in their care, but this is starting to change.

Health disparities

To look at health challenges facing our community, it’s clear that gender transitions don’t define our health, but being transgender might. A national survey by the National Center for Transgender Equality shows striking figures of health issues affecting trans people.

Transgender people smoke at a 30% prevalence rate, and use other substances to cope with the stress from discrimination. We’re more likely to suffer from depression and anxiety, and more likely to live with HIV.

Some statistics seem more like war casualty counts. 61 – 64% of transgender people have been physically or sexually assaulted. 41% of transgender people have attempted suicide. All these percentages skyrocket for transgender people of color and low-income folks.

On top of the health challenges, a startling 1 in 5 transgender people have experienced complete refusal of services from healthcare providers. So much for the Hippocratic Oath.

That last statistic just relates to providers. However, discrimination occurs not just in the patient room, but when scheduling the visit, checking in or filling prescriptions. How a transgender person is treated in the waiting room is just as important as the doctor’s sensitivity. If transgender people aren’t referred to with correct names or pronouns or are treated with coldness, they may avoid the office. Can you blame them?

The light at the end of the tunnel

While these health disparities are rather extreme, knowing them informs policymakers and providers.

Emilia's article:

And fortunately we’ve seen improved policies for trans health. I am proud to be working with a national program advocating for these policies: The Network for LGBT Health Equity. We work to reduce tobacco disparities within the LGBT community but also advocate for transgender inclusion within federal health policies. We’re housed at an organization that also happens to be one of the leaders and models in providing service for transgender clients, Fenway Health.

To name a few tremendous successes: The Institute of Medicine released strong recommendations for trans inclusion. The federal National Prevention Strategy now includes transgender people. The U.S. Office of Personnel Management and Veteran Health Administration established more inclusive health policies for trans people. Just last week, Secretary Kathleen Sebelius announced that the Department of Health and Human Services is committed to collect data on gender identity.

There’s great potential in health settings as well. As of July 1st, the Joint Commission which accredits most health centers across the country are requiring LGBT non-discrimination and welcoming policies. The Center for Excellence in Transgender Health has protocols for treating transgender patients, and Fenway Health has accessible modules for health facilities to train their staff. The Human Rights Campaign has models for how health settings can improve.

What are current needs, and what’s the future of transgender health?

Even with successes and potential for transgender health, there’s more to be done. We need more research on our communities as little research has been conducted on transgender people. We need national surveys to ask questions of transgender people. Providers and health staff need culturally competency training.

Most states, including Massachusetts, don’t protect transgender people from discrimination. Looking at employment, nearly half of all trans people have lost jobs on the basis of their gender identity or expression, which drastically affects health outcomes and access to health insurance.

These incredible gains will have an exponential impact over time. There are more policies protecting us and more resources we can use to advocate for ourselves. The public health field will be more knowledgeable and providers will be more respectful. That is my vision, but it’s a far off dream for many transgender people who are struggling right now. Even with the successes, more needs to be done and we can all chip in — whether it’s raising awareness, improving health settings, advocating for inclusive policies or helping a trans person access services. Now is the time to put these disparities behind us and to give trans people an equal chance to be healthy.

*By “transgender,” I am referring to people whose gender identities and/or expressions vary from their assigned sex at birth. This includes a broad range of people who transition from one gender to another and those who fall outside of traditional gender expectations. For more on transgender definitions, visit

Emilia Dunham is a Program Associate for the Network for LGBT Health Equity, a project of The Fenway Institute at Fenway Health. She also serves on the Steering Committee for the Massachusetts Transgender Political Coalition. She can be reached at

Published by Emilia Dunham, MPP, MBA

Emilia Dunham is currently a Project Manager at MassHealth/Department of Public Health, and formerly the Project Manager of the Life Skills project at The Fenway Institute, an HIV intervention study for young transgender women. Emilia worked at Fenway for 7 years, first as a Quality Control and Regulatory Assistant mainly involved with biomedical HIV prevention trials, before serving as the Program Associate for The Network for LGBT Health Equity, a network instrumental in many national LGBT health policy improvements. She is also involved with the Massachusetts Transgender Political Coalition, serving as a Steering Committee member and the Policy Committee Co-Chair, an organization largely responsible for the recent passage of the Trans Rights Bill. Additionally she serves as a member of the Massachusetts Commission on Gay, Lesbian, Bisexual and Transgender Youth, Co-Chair of the Recommendations Committee. Emilia received a Bachelor’s degree from Northeastern University. There she served as President of the LGBTQ student group where she planned programs such as Pride Week, Transgender Day of Remembrance, and AIDS Week. In addition, she advocated for LGBTQ inclusive policies and programming on campus such as a Gender Neutral Housing program, an LGBTQ Center and the expansion of Women’s Studies to Women, Gender and Sexuality Studies. Emilia recently earned a Master of Public Policy and Master of Business Administration in health policy and management from the Brandeis Heller School School for Social Policy and Management.

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