November 20 is Transgender Day of Remembrance, an annual commemoration of transgender persons whose lives were lost due to violence. In 2019, violence took the lives of at least 22 transgender or gender non-conforming people. In remembering them, we also remember the core truth that transgender health is public health, and we cannot be healthy, as a society, as long as marginalized groups face a disproportionate risk of illness and harm. 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.
With this in mind, recent years have been a time of both progress and challenge for transgender health. In 2016, 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 areas of public accommodation, including restrooms.
Since then, this progress has been challenged. 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 dismiss complaints 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 has been considered. Here in Massachusetts, a ballot initiative calling for the repeal of the transgender rights law appeared before voters in 2018. Fortunately, this measure was resoundingly defeated—thanks in part to the efforts of members of our school community—yet the fact that it was considered at all is concerning to those who care about transgender rights and health.
What, then, is the role of public health today, faced with efforts to marginalize a population, in this case the transgender population, gaining traction in states across the country? 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 are charged with generating the knowledge that can guide public discussions and thinking about this issue, and many others. This means that we have to do the intellectual work that elevates human dignity and human rights as a core mission of public health, and work that emphasizes how marginalization and structural discrimination of any group adversely affect that group’s health and diminish us all. Importantly, social forces that diminish and marginalize groups are to be repudiated whether or not they have a direct impact on health. At core, an expansive definition of health suggests the centrality of issues of inclusion to the well-being of populations. Any efforts that systematically marginalize particular groups are inimical to the goals of public health. Data that illustrate how these efforts influence the health of populations directly add to the intellectual weight of our argument against such laws, and buttress the moral case against them.
Second, 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 teaching extends well beyond education about the canonical foundations of public health. It 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. 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.
Third, we must also do—knowing is not enough, we must do. And that informs our effort as a school to balance translation of knowledge with action, our Activist Lab, the work of our students and faculty, and our everyday awareness and practices. This involves our engagement with issues that represent a threat to population health, a readiness to partner with organizations and advocates who are positioned to tackle these issues, and, perhaps centrally, a willingness to embrace innovative approaches that might make a difference.
We can and should continue with these efforts. We as a country have reached a crucial moment in the fight for transgender equality; we should capitalize on the gains that have already been made, and work to move this issue forward. I highlight today an issue that I think warrants our attention, as a challenge to us all, to inform and fuel our thinking, teaching, and doing.
I hope everyone has a terrific week.
Warm regards,
Sandro
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.