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.

This piece was originally published on Thriveglobal.com.

The burden of poor mental health is all around us. In the U.S., one in five adults experienced mental illness in 2018 — nearly 48 million people. About 18 million people experienced a major depressive episode. In 2017, over 47,000 Americans died by suicide. Clearly, mental illness is not just a challenge for individuals, but for populations. Yet we tend to think of mental health as a personal matter, something to be faced alone or with a therapist, rather than as a matter of public health. This needs to change. Public health seeks to improve health by improving the conditions in our society that shape it. This World Mental Health Day, it is time we apply a public health approach to mental health.

Our health is a product of the context in which we live. Whether or not we can be healthy depends on the air we breathe, the water we drink, the quality of our neighborhoods, our education and family income, the prejudice we face or do not face, and countless other factors that have little to do with doctors and medicines. Income and race, for example, are linked to asthma risk; income and geography are tied to life expectancy. The influence of these conditions is not limited to our physical well-being — it also shapes our mental health. For example, income inequality has been linked with higher risk of depression, and laws that allow discrimination based on LGBT status can cause mental distress among sexual minority adults.

The burden of poor mental health is all around us. In the U.S., one in five adults experienced mental illness in 2018 — nearly 48 million people. About 18 million people experienced a major depressive episode. In 2017, over 47,000 Americans died by suicide. Clearly, mental illness is not just a challenge for individuals, but for populations. Yet we tend to think of mental health as a personal matter, something to be faced alone or with a therapist, rather than as a matter of public health. This needs to change. Public health seeks to improve health by improving the conditions in our society that shape it. This World Mental Health Day, it is time we apply a public health approach to mental health.

Our health is a product of the context in which we live. Whether or not we can be healthy depends on the air we breathe, the water we drink, the quality of our neighborhoods, our education and family income, the prejudice we face or do not face, and countless other factors that have little to do with doctors and medicines. Income and race, for example, are linked to asthma risk; income and geography are tied to life expectancy. The influence of these conditions is not limited to our physical well-being — it also shapes our mental health. For example, income inequality has been linked with higher risk of depression, and laws that allow discrimination based on LGBT status can cause mental distress among sexual minority adults.

Health in America has improved significantly in the last century, with progress seen in a number of areas, such as life expectancy. In 1900, the average American could expect to live to about age 47. That number has since risen to nearly 79. This progress reflects generations of public health improvements, better living standards, nutrition, and sanitation. But this progress is not the whole story. Health gaps remain, notably between racial groups. The percentage of US adults 18 or older with diabetes, for example, is 15.1 percent for American Indian/Alaska Natives, 12.7 percent for Hispanics, 12.1 percent for black non-Hispanics, 8 percent for Asians, and 7.4 percent for white non-Hispanics (Figure 1). Black mothers are over three times likelier to die in childbirth than white mothers (Figure 2). And young African Americans are likelier than whites to die from a range of conditions that are typically more common at older ages, such as high blood pressure and stroke (Figure 3). While there has been progress towards closing some racial health gaps, they remain a persistent challenge for public health.

I WAS working as a young doctor for Médecins sans Frontières in Somalia in the late 1990s when I realised for the first time how helpless I was in improving the health of my patients.

I was the only doctor for about 350 000 people. Every day, they’d come through the door, most of them with malaria or another preventable injury or disease, their lives literally in my hands.

The end of summer can be a melancholy time, but in academia it is an occasion for joy. Welcoming first-year students and faculty, along with returning members of our community, makes for a kind of second spring, as our school renews itself. It is a time to look to the future, but also to mark where we have been. SPH has undergone many changes over the last few years, building on the work our community has done over four decades to deliver a world-class public health education to our students. I would like to use this Dean’s Note to reflect on our evolution as a school, while anticipating, with excitement, the future. This is a time when the work of public health is more important than ever. It strikes me as fitting that, at the start of the academic year, we reaffirm why we do what we do, touching on the core values that animate our school, as we come together once more to build a healthier world.

Like many Americans, I have found it hard to stop thinking about the heartbreaking photo of the bodies of Óscar Alberto Martínez Ramírez and his daughter, Angie Valeria, migrants from El Salvador who drowned while attempting to cross the Rio Grande to seek asylum in the US. I think about the hopes and fears that might have caused them to make such a dangerous journey—hopes for a better life in America, fears of having to return to face gang violence and economic hardship in El Salvador. I have especially been thinking about Óscar and Valeria this Fourth of July week, a time to celebrate the country’s founding, and the ideals of freedom and opportunity that characterize this nation at its best. These ideals are important to all Americans, but, I would argue, they are particularly important to immigrants. Indeed, they are the reason many immigrants come to this country, often in the face of difficult circumstances.