A key theme of the Trump era has been that of rollback, of seeing progress—often hard-won over the course of many years—suddenly threatened or reversed. From environmental protections, to reproductive rights, to voting and civil rights, recent years have shown how fragile societal advances can be. This is especially true in the area of transgender rights. In 2016, I wrote a note about public health’s responsibility to fight for transgender equality. At that time, there was indeed progress to celebrate, from the Obama administration’s decision to direct US schools to let students use restroom facilities that correspond with each student’s gender identity, to, here in Massachusetts, Boston Medical Center’s plan to launch a transgender medical center, and the state senate’s passage, by an overwhelming margin, of a transgender rights bill, which prohibits discrimination against transgender people in many areas of public accommodation, including restrooms.
Today, this progress is in danger. The Trump administration has shown hostility to transgender populations in actions like its push to ban transgender military service members, and in the Department of Education’s announcement that it would dismisscomplaints from transgender students barred from using the restroom that corresponds with their gender identity. Yet the White House is not the only place where rollback of transgender rights is being considered. Here in Massachusetts, a ballot initiative calling for the repeal of the transgender rights law will appear before voters this November, with each “no” vote counting towards repeal. As of recent polling, while a majority of voters are in favor of keeping the law, that majority is worryingly slim.
The future of this law matters not just for the dignity of transgender populations, but for their health. Indeed, both dignity and health are linked; the latter cannot exist without the former. Marginalized groups, such as the LGBTQ community, face distinct health challenges as a result of the discrimination they too often face. A precise estimate of the prevalence and health burden of transgender, gay, lesbian, bisexual, or queer individuals is difficult, given that the Census and many other official surveys do not explicitly askabout sexual orientation and gender identity. Further, estimates we do have may be biased due to underreporting; one study found that 71 percent of transgender people have hidden their gender in order to avoid discrimination. Transgender people are also sometimes “lumped in” with other populations—for example, HIV studies have characterized transgender women as “men who have sex with men.” An analysis by the Williams Institute in 2011 compiled different databases to estimate that about 8 million, or 3.5 percent, of Americans identify as gay, bisexual, or lesbian, with another 700,000 identifying as transgender.
As I discussed in a previous Dean’s Note, discrimination and marginalization of the LGBTQ population is associated with a range of health conditions, including substance use, anxiety, and mood disorders. Additionally, LGBTQ populations may have less access to health care. On a larger scale, we know that discrimination in general is significantly associated with negative health outcomes as broad-ranging as depression, heart disease, obesity, hypertension, and substance use, and we are in need of better data on the health effects of being transgender specifically. Globally, transgender women are nearly 50 times more likely to get HIV than the general population, and transgender individuals who are also members of an ethnic or racial minority are at even greater risk of discrimination and harassment.
What, then, is the role of public health today, as we are faced with efforts to further marginalize this already-vulnerable population? It seems to me that our responsibilities here map well onto the work that we do as a school of public health within a university.
First, we have a core responsibility to educate our students—to pave the way for the next generation of thinkers, teachers, and doers in population health. This responsibility includes exposing our entire community to the issues that dominate the public conversation and that are changing the social, economic, and cultural conditions that shape the health of the public, especially when the issues may not fall within our immediate range of experience. In this respect, our task is not just to fill minds, but to open them, and nowhere is this more important than in the area of transgender rights. This Dean’s Note is perhaps part of that attempt, as is the ongoing work of our Assistant Dean for Diversity and Inclusion Yvette Cozier, our Activist Lab, student groups like Queer Alliance, and our collective efforts to promote the use of pronouns that reflect the gender with which members of our community identify and to create more gender-affirming classrooms.
We also seek to educate through our events, like our September 12 Dean’s Seminar. This event will focus on what is at stake in the fight for transgender rights in Massachusetts. It will be moderated by Professor Sophie Godley, and will feature as speakers Mason Dunn, executive director of the Massachusetts Transgender Political Coalition and co-chair of the Freedom for All Massachusetts Campaign; Jennifer Siegel, medical director for the Center for Transgender Medicine and Surgery at Boston Medical Center; and Iris Olson, our Activist Lab fellow working with Freedom for All Massachusetts’ “Yes on 3” campaign. Freedom for All Massachusetts is a bipartisan coalition of communities, businesses, faith leaders, safety advocates, and other stakeholders who have come together to encourage state residents to vote yes on Question 3 of the November ballot, to stop the repeal of the transgender rights law and safeguard the dignity and health of this population.
Second, when confronted with an issue of consequence for health, such as transgender rights, we must be unafraid of taking sides collectively, as a school. I have written previously about the process of choosing when schools should speak with one voice on a given issue. In the note, I suggest two key criteria for deciding whether or not to take a position. First, a core value of the school must be at stake, and, second, we should only take a position when doing so could make a substantive difference. The fight to save this law from repeal qualifies on both counts. To strip the state’s transgender population of needed protections would violate our core values of empathy and inclusivity, to say nothing of the disastrous effect it would have on health. And it is clear we stand to make a substantive difference. As primaries and special elections have shown across the country, political outcomes are shaped by community mobilization, especially when the polling is as close as it is on Question 3 (prior thoughts on politics and public health). Indeed, this week’s seminar will help to show just how needed our continued efforts are in this fight. For these reasons, it strikes me as both necessary and natural for our school to endorse voting “yes” on Question 3 this November.
In this crucial moment in the fight for transgender equality, it is important to remember that the eyes of the country are on what we do here in Massachusetts. Just as this state took the lead on marriage equality 15 years ago, we have the chance to show the way forward on transgender rights. In 2016, we took a step in that direction. This November, we must make sure we do not backtrack.
I hope everyone has a terrific week. Until next week.
Acknowledgement: I am grateful to Laura Sampson, Michelle Samuels, Meaghan Agnew, Emily Barbo, Iris Olson, and Eric DelGizzo for their contributions to this Dean’s Note, and to Professor Ulrike Boehmer for a critical read.