Last month, we encouraged people in positions of privilege to create space, stop monopolizing power, uplift voices, and share resources to enable Black Transgender and Gender Non-Conforming (TGNC) lives to coexist in our health care system. This is particularly important now, as Black TGNC people are disproportionately impacted by COVID-19, on top of the multiple oppressions they experience in everyday life. In this blog, we offer action steps to create an equitable and compassionate health care system for Black TGNC.
Now more than ever, non-Black and cisgender people must listen to and elevate the needs of Black TGNC people. Many of us who are not Black and/or TGNC are not knowledgeable about the lived experiences of Black TGNC people. This fact is important in order to meaningfully change our health care system. Emphasizing profit over caring for the most marginalized in our communities results in the system capitalizing on the health conditions of Black TGNC people, like access to HIV and gender-affirming care.
To move towards a more just health care system, entities with power need to prioritize Black TGNC people, rather than thinking of their health needs as an option. To do this, our health care system must have an action plan to understand the specific needs of Black TGNC people and to include their voices as they make decisions.
Yet the system should not wholly rely on Black TGNC people to advocate for their own basic needs. Those of us who are non-Black and/or cisgender people must become familiar with the barriers to care that Black TGNC people face so that we can also push for necessary and appropriate changes in our health care system.
Accomplishing meaningful change within our health care system requires change at all different levels. Black TGNC populations experience discrimination, violence, and inadequate health services at disproportionately higher rates because of systemic racism, patriarchy, and transphobia. These same oppressions make them more susceptible to contracting COVID-19, making these changes particularly urgent. High rates of conditions related to tobacco use, cancer, and HIV makes immunocompromised TGNC populations especially vulnerable to contracting COVID-19.
Social distancing mandates and shut downs have increased already present economic instability, delays to necessary care, and isolation from community and mental health supports for those sheltering in place with non-affirming family members. Below are specific ways our health care system can address the barriers to health care for Black TGNC people.
Adopt culturally sensitive language and inclusive space
Many providers have explicitly transphobic viewpoints. Health care systems often use binary and essentialist language like, providing only “male” and “female” as gender options on documents, misgendering TGNC patients, or incorrectly labeling TGNC individuals’ bodies by their sex assigned at birth (i.e. “female/male-bodied”). Common, yet incorrect, assumptions that transgender people are “born in the wrong body” and simply want to “pass” as cisgender also frames trans identity as a problem that must be fixed. Using gender-neutral language and avoiding assumptions about a person’s gender are important steps to ensure health care spaces are open to all.
Invest in continuous education about Black TGNC lives
Many providers are also unfamiliar with the specific health issues that Black TGNC individuals face. Providers often have racist biases and prejudices, which are deeply rooted in our nation’s history. When structural racism goes unchecked, it results in health disparities for Black people. TGNC patients also face significant gatekeeping when trying to access care. Even self-proclaimed LGBTQ clinics may fail to provide culturally sensitive care due to the conflation of gender identity and sexual orientation. TGNC patients frequently educate cisgender providers while defending their health care choices due to gatekeeping.
Integrating Black trans-led education and training throughout our health care system, from medical school, to providers’ offices, to health plans is important to become informed by those with lived experience. Education should be mandatory at all levels of our health care system, including upper level management to front line workers at provider locations and at health insurance companies. Policymakers, health insurance companies, and providers must compensate Black TGNC individuals for this education.
Implement accountability measures and policies
Requiring data collection and quality assurance checks is a useful way to make sure that providers and health plans are addressing racist and transphobic practices that harm Black TGNC individuals. Government agencies and community based organizations can implement rating systems on providers and health plans as well as require reports on goals, policies, and practices to ensure high quality access to care for Black TGNC individuals. Government agencies can also create “equity” funds that invest in Black TGNC-led organizations who already serve TGNC communities of color.. Investing funds into TGNC organizations and providers with lived experience ensures broader support and safety within the community.
Advocate for legal policies and regulations
Access to gender affirming care and trans-related services is hampered by legal obstacles. While federal and state laws prohibit most public and private health insurance plans and providers from discriminating against TGNC individuals, illegal discrimination is still common. Service denials occur due to illegal categorical exclusions or requiring excessive documentation.
Ways to remove legal obstacles can look like: protections that cover services otherwise covered for cisgender people and prohibit benefit designs with prescriptive requirements on gender identity; policies that require that providers and health plans use updated medical standards and research; requirements that medical examiners have relevant professional experience with specific authorization requests; and relaxing quantity limits on prescriptions. These are some specific ways our health care system can remove barriers to care for Black TGNC people.
Together, we must work at all levels to create a health care system that cares for everyone. This includes designing activities and community health events that connect attendees to resources not only to address the unique needs and health disparities of Black TGNC people, but also to integrate them into the dialogue.
This work is urgently needed, as Black TGNC people deal with the devastating effects of COVID-19 on top of the oppressions they have already faced for centuries. In order to address the systematic violence against Black TGNC people that pervades our society, it is important to address the biases and prejudice of people who are cisgender or White, even including those who identify as Lesbian, Gay, Bisexual, or Queer. We must also work at a systemic level to address the biases that are built into our health care system to disenfranchise Black TGNC people.
* The authors acknowledge Unique Woman’s Coalition (UWC) as a thought partner in helping to inform the content of this blog. UWC is the first formalized organization in Southern California to be founded, organized for and by Black Transgender women. Learn more about UWC on the organization’s website, and consider making a donation to sustain its life-changing work.