Health without walls: building trans-inclusive healthcare

Access to health and social care is a universal right, or at least, it should be. Yet for many trans people, navigating health systems can often be a daunting and challenging experience. Discrimination, lack of understanding, and inadequate resources frequently stand as barriers to accessing essential, basic health and social needs. The question is: are our current health systems healing or harming our trans communities? 

Comments from influential figures can exacerbate the polarisation of views. This can, in turn, widen inequalities and create deep divides within society, impacting health and social settings. Responsibility lies across all spectrums, from community leaders, educators, and healthcare professionals to policymakers, who must strive to bridge these divides and serve the communities they represent.

In this article, Max Sasha T., explores how we can break these barriers to not only foster equitable health systems but also how we, as a society, can advocate for solidarity with diverse communities to create a more inclusive Europe for all. 

When Alex walked into a medical centre seeking answers for a common health concern, what unfolded wasn't the routine check-up they anticipated. Instead of focusing on Alex's medical issue, the healthcare professional fixated on their trans identity. Intrusive questions about their transgender experience, from hormone therapy to surgeries to transition processes, left Alex feeling as if their privacy was violated.

Alex’s experience is not unique. It's a story that exemplifies the barriers and discrimination trans people often face when accessing healthcare. This is a struggle that shouldn't exist, and it extends far beyond the walls of hospitals and GP offices. It's systemic and highlights the need to understand and overcome the broader challenges trans people face from within and beyond our current health systems.

Inclusive access to healthcare for trans people

"Trans people are asking to be treated with basic respect, not be questioned about their identities beyond the issues they have come for, and not be dismissed like their concerns don’t matter,” says Deekshitha, Senior Policy Officer at Transgender Europe (TGEU).

But this isn't a question of whether trans people deserve access to healthcare that is respectful and inclusive; it is rather a question of why this isn't already a given. Basic actions such as using the correct name and pronouns, can make a big difference and significantly impact an individual’s sense of respect and dignity.

"Inequalities in health are very prominent and consistent in that if you look closely at LGBTQI+ communities, they fare worse across a range of health and social indicators compared to others. This is completely unacceptable and nor is this situation inevitable. Inequalities in health are socially determined, and this means that they are the consequences of a complex interaction of social, cultural, and political factors. Inclusive gender affirming healthcare for trans people saves and improves lives - it is that simple," explains Nigel Sherriff, Director of the Centre for Transforming Sexuality & Gender (CTSG) at the University of Brighton.

Trans people are asking to be treated with basic respect, not be questioned about their identities beyond the issues they have come for, and not be dismissed like their concerns don’t matter.

Challenges, initiatives, and paths forward

Many health professionals want to help and support their trans patients but don't always know how to do so. Lack of resources and underfunding have left it difficult for health professionals to meet the needs of the community. Our current health systems have gaps in addressing these needs. Medical school curricula often lack sufficient coverage of trans health, and resources for ongoing education may be limited. This creates a situation where many healthcare providers struggle to offer comprehensive support.

Yet, all is not lost. The EU-level pilot initiative, Health4LGBTI, aimed to bridge this gap. The programme provided specialised training to medical professionals, equipping them with the skills to deliver better care for the wider LGBTI community by increasing knowledge about their health needs, improving LGBTI-inclusive attitudes, and increasing LGBTI-inclusive provision of healthcare for LGBTI people.

Given that health and wellbeing extend beyond just medical treatment, healthcare providers can also consider adopting social prescribing for trans people who face isolation or lack the access to inclusive social environments. This can include, for instance, referring them to a trans-inclusive support group or community.

Despite this, trans people often encounter barriers. Health providers may lack knowledge on the health inequalities faced by the community and how to overcome them, leaving trans people with a lack of access to support and care.

Currently, around 33% of trans people do not go to primary care clinics when they have health issues because they feel uncomfortable, with a further 48% of trans people left feeling discriminated or given questionable behaviours from the healthcare professional at some point during a visit.

What's lacking is accessible and affordable healthcare that actively involves the community. A trans-friendly healthcare system works with, not against, trans people, [a system] in which trans people are directly consulted and heard in decision-making processes that concern them.

Promoting health and wellbeing

Access to inclusive health and social care is a fundamental right for all, regardless of their gender identity. Yet, despite this, many trans, non-binary, and gender diverse people face barriers to accessing appropriate and timely healthcare. Non-discrimantory access to health is not only a basic principle of health law and medical ethics but also a human right as outlined in the Universal Declaration of Human Rights. But what affect does this have on mental health and wellbeing?

"Inclusive gender-affirming healthcare is essential for the wellbeing of trans individuals, as research consistently shows that holistic and inclusive health services lead to improved mental and physical health outcomes. This includes reduced rates of depression, anxiety, and suicidal ideation, as well as better physical health outcomes such as a decrease in cancers and infections. Inclusive healthcare enables trans individuals to align their physical attributes with their self-identified gender, promoting overall health and wellbeing", states Nigel Sherriff.

Bridging gaps in trans-healthcare

So what happens when the system tasked with helping you lacks the resources to do so? For many trans people, the answer lies within their own community.

Facing a lack of institutional support, trans people often turn to one another for trusted recommendations to trans-friendly health and social practitioners, resources, and crucial support networks. Grassroots initiatives such as the trans-led and trans-involving charity, Gendered Intelligence, play a pivotal role in bridging this gap. "Grassroot local initiatives make up for the lack of support at institutional, national, or EU levels to meet [trans people’s] healthcare needs,” explains Sabah, a Senior Youth Worker at Gendered Intelligence.

While community support is undeniably invaluable, it shouldn't replace the responsibility of policymakers and decision-makers. Governments have a duty to ensure health and social professionals receive the right training, and that investments are directed towards creating and improving trans-inclusive care across sectors and spheres.

Highlighting this need is the FiveforFive initiative, created by a trans woman in the UK. This monthly effort aims to raise funds and directly support transfeminine people facing hardships. It operates by allocating 60% of the funds to transfeminine crowdfunding campaigns within the UK. People can nominate their own campaigns or nominate others for this pot of money, with recipients chosen randomly each month. The remaining 40% is split between two trans/LGBT organisations or groups that specifically support trans girls, women, and transfeminine people.

The very existence of initiatives like FiveforFive underscores a critical point: basic support services need adequate resources and funding to help everyone, particularly those from underrepresented communities.

Ensuring access to trans-specific healthcare

Trans-specific care encompasses a diverse spectrum of resources, such as hormone therapy, surgeries, and puberty blockers, tailored to each person's unique needs and identity.

However, long waiting times and shortages worsen challenges, and in many countries, accessing these treatments is difficult due to staff shortages, confidence amongst staff in administering these treatments or even legal restrictions prohibiting it.

But recent progress has taken some positive steps forward. A huge positive step was the change to the World Health Organization's (WHO) global manual of diagnoses, known as the International Classification of Diseases (ICD-11). In 2019, it was announced that transgender health issues would no longer be classified as mental or behavioural disorders.

“[Although] the WHO’s ICD stopped categorising trans experience as a mental disorder, not all countries have caught up yet. Many countries still impose the requirement of a psychiatric diagnosis to access trans-specific healthcare which perpetuates the stigmatisation of trans people,” explains Deekshitha.

While this is a crucial step in the right direction, there is still a long way to go. Not all countries have caught up on the implementation and there are still many countries where trans people have difficulty in accessing basic health and social care. Integrating trans-specific healthcare into general medical practice is crucial for delivering inclusive and culturally competent care.

Beyond words: connecting with the community

Trans people should actively be involved in decision-making, practice development, and methodology construction when decisions made by governments affect their lives.

"What's lacking is accessible and affordable healthcare that actively involves the community. A trans-friendly healthcare system works with, not against, trans people, [a system] in which trans people are directly consulted and heard in decision-making processes that concern them", explains Sabah.

Deekshitha adds, “Advocating for trans rights also means mainstreaming trans perspectives and ensuring trans inclusion in other policy areas, such as gender-based violence and sexual and reproductive rights, all of which may also be a concern or impact trans people in specific ways.”

Importantly, this inclusion doesn't diminish the significance of women's rights and experiences; instead, it fosters a more inclusive approach. By keeping an open mind and empathetically considering others' lived experiences, policies can genuinely reflect and support the diverse needs of our communities.

Advocating for trans rights also means mainstreaming trans perspectives and ensuring trans inclusion in other policy areas, such as gender-based violence and sexual and reproductive rights, all of which may also be a concern or impact trans people in specific ways.

Universal responsibility

Addressing discrimination as a determinant of health is crucial beyond healthcare. Trans people experience high levels of minority stress not only in healthcare settings but also in schools or at work; this significantly impacts their mental and physical wellbeing.

If we want trans people to be healthy and happy, we need to create more welcoming environments everywhere. Considering inclusive guidelines, such as Sabah's guide on how to make your practice inclusive of trans people of colour, is a good practice to adopt.

Continuously asking ourselves, as individuals, how we can be inclusive of diverse experiences is key. What are we missing? What are we not doing? Without this approach, we risk narrowing our perspectives, which are dominated by a single narrative.

Many people are eager to help but lack knowledge. Acknowledging this gap and fostering transparency about our limitations is a normal, ongoing process that contributes towards building inclusive societies.

Recognising our roles and responsibilities, whether as practitioners, policymakers, decision-makers, teachers, or as individuals, is essential for providing truly inclusive care.

So, what's next?

As Alex’s story illustrates, misconceptions and sensationalised narratives often hinder progress in ensuring that health and social care practices meet the basic needs of trans people. Ultimately, ensuring access to healthcare and wellbeing is a fundamental human right that calls for concerted efforts from health systems, policymakers, educators, and society as a whole.

"Government and policymakers play a crucial role in promoting health equity. It's vital to involve underserved communities in developing, implementing, and evaluating services. Centralised services in Europe, especially for trans individuals, pose access barriers like travel distance and wait times. Governments should decentralise trans healthcare, offering diverse service types like clinical, community, and private provision", states Nigel Sherriff.

Of course, it's important to understand that across Europe, Member States are very diverse, with different legal and social contexts. However, despite this, training such as that from Health4LGBTI has adapted and made the training accessible for all nations.

While significant progress has been made in promoting equality, such as the change to WHO's ICD-11,  trans and LGBTQ+ people still face discrimination in areas such as health and social care, employment and housing across Europe and beyond. This can have a serious impact on their wellbeing. It's therefore essential that policymakers, educators, and healthcare providers actively engage with the trans community, listening to their needs and working together to create a more inclusive society.

"It's inspiring to witness the success of healthcare models that prioritise inclusivity, self-determination, and informed consent. Malta, in my opinion, stands out with its progressive healthcare system, providing respectful, dignified, and inclusive care for trans individuals within the National Health System, free for citizens. Other European nations could learn from Malta's example to turn rhetoric into reality regarding trans-inclusive healthcare", states Nigel.

By taking collaborative action, we can build a future where everyone can receive the quality care and support they deserve.

Disclaimer

Please note that translated pages on the EuroHealthNet Magazine website are automated. Translations, therefore, may not fully capture the nuances and sensitivities essential for accurately representing trans and LGBTQI communities. We apologise in advance for this, but we are working on it. The original article employs gender-sensitive language, including gender-neutral pronouns 'they/them', and adopts inclusive language to respect the community and its contributors to the best of our ability. We apologise for any instances of misgendering or mistranslation. Despite these inaccuracies, we have chosen to make this translation available to promote its content, including to educate on various initiatives and projects aimed at fostering better trans inclusion across different sectors.

Further information

If you've been affected by anything in this story, please know that there is support out there.

Max Sasha T.

Max holds a multidisciplinary BSc in Anthropology from University College London (UCL) and a Master’s degree in Urban Governance/Public Affairs from the Urban School of Sciences Po in Paris (specialising in Governing Ecological Transitions).

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