For this week's post, I have chosen to focus on the challenges that the transgender and non-binary community faces when it comes accessing health care in Canada. Accessing primary and emergency care can be extremely difficult for the trans and non-binary community (Trans PULSE Canada Team, 2020). The Trans PULSE Canada Team recently released a report related to a survey for trans and non-binary people in Canada. According to this survey, in spite of being well-educated and having access to primary care services, individuals reportedly still experienced joblessness and unfulfilled health care requirements. (Trans PULSE Canada Team, 2020). The LGBTQ community faces a multitude of barriers to accessing health care including stigma, discrimination and lack of access to inclusive environments and competent care. (Action Canada for Sexual Health and Rights, 2017).
Barriers to Care
Stigma & Discrimination
One of the biggest hurdles that this group faces is discrimination. According to Action Canada for Sexual Health and Rights (2017), the discrimination that this community faces can have detrimental impacts on health and well-being. This organization mentions that service providers must use appropriate language and have access to the right resources and tools in order to meet the needs of this population and to help create an inclusive environment free of stigma and discrimination.(Action Canada for Sexual Health and Rights, 2017).
"The majority of trans and/or non-binary youth (70%) reported experiencing some form of discrimination in their lifetime. Youth were most likely to report they had experienced discrimination because of their sexual orientation (51%), their sex (53%), their physical appearance (45%), or their age (36%)" (Stigma and Resilience Among Vulnerable Youth Centre, 2019).
According to the findings of the Canadian Trans & Non-Binary Youth Health Survey published in 2019, many individuals do not feel comfortable discussing their needs with their health care providers. The infographic below provides recommendations for service providers based off of the survey findings, see below to learn more:
Lack of Access to Inclusive Environments
Increasing access to inclusive environments is especially important for the trans and non-binary community. I believe that the health care system today is extremely unprepared when it comes to providing trans and non-binary inclusive care in Canada. One of the most significant barriers to inclusivity is medical paperwork, which often lacks inclusive language. According to an article titled Barriers to quality health care for the transgender population, "Failure to be identified by a preferred name or pronoun can cause discomfort leading to a poor rapport with providers and impacting quality of care" (Roberts & Fantz, 2014). Another factor leading to increased discomfort, is only having access to washrooms that are restricted to use by a particular gender. Availability of private gender-inclusive washrooms can contribute to a more inclusive environment (Roberts & Fantz, 2014).
In 2017, the region I work for introduced a 3 hour instructor lead course related to LGBTQ inclusive environments. This course aims to assist staff to:
Identify & discuss common words to express sexual orientation, gender identity & gender expression in Canada;
Identify & discuss examples of homophobic & transphobic language & behaviour;
Demonstrate & share an empathetic understanding of the barriers faced by members of the LGBTQ communities; and
Propose ways to make the environment safe & inclusive for LGBTQ people
My hope is that one day this course becomes mandatory for all regional staff and that ongoing learning opportunities are introduced.
Catalysts for Change
The lack of safe and appropriate trans health services, such as hormone therapy, continues to be a significant hurdle (Safer et al., 2016). In Halton, we lack services specifically for trans and non-binary folks and many clients tend to travel to surrounding areas to access services. Health care providers should receive specific training and education related to trans and non-binary health care in order to provide the necessary care to all clients. All clients should be treated with compassion, dignity and respect. Please take a moment to watch the TED Talk by Jo Codde below to learn more about catalysts for change in transgender healthcare:
There are many online learning resources available for health care providers in Ontario today. On June 22nd, 2020, Rainbow Health Ontario released a new online learning platform called Health Connect. This online learning platform aims to provide evidenced based training to health and social service workers on topics related to LGBTQ health. Courses offered include the LGBT2SQ Foundations Course, Removing the Barriers: Making your Organization LGBT2SQ friendly, LGBT2SQ Emotional and Mental Health, Transition-related Hormone Therapy in Primary Health Care and many more. I am eager to dive into these resources myself!
Other resources for service providers include:
Trans Primary Care Guide - Rainbow Health Ontario
Creating Authentic Spaces - The 519
Voices of Value: LBGTQ+ Cultural Competency Toolkit - HIV/AIDS Resources and Community Health (ARCH)
It is clear that we all need to work together in order to ensure that clients are welcomed into an environment that they feel is safe and inclusive. As an ally, it is my responsibility to not only support the LGBTQ community, but also to listen, advocate, be willing to talk, and speak out against discrimination.
Compassion - Dignity - Respect
References
Action Canada for Sexual Health and Rights. (2017). A Handbook for Health Care Providers Working with Clients from Diverse Communities. Retrieved March 23, 2021 from https://www.actioncanadashr.org/sites/default/files/2019-04/ActionCanadaSHR-SRH2017-Handbook-EN.pdf
Roberts, T. K., & Fantz, C. R. (2014). Barriers to quality health care for the transgender population. Clinical Biochemistry, 47(10–11), 983–987. https://doi.org/10.1016/j.clinbiochem.2014.02.009
Safer, J. D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., & Sevelius, J. (2016). Barriers to healthcare for transgender individuals. Current Opinion in Endocrinology, Diabetes & Obesity, 23(2), 168–171. https://doi.org/10.1097/MED.0000000000000227
Stigma and Resilience Among Vulnerable Youth Centre. (2019). Canadian Trans & Non-Binary Youth Health Survey 2019: Ontario Fact Sheet. Retrieved March 22, 2021 from https://apsc-saravyc.sites.olt.ubc.ca/files/2020/03/Being-Safe-Being-Me-2019_Ontario.pdf
Stigma and Resilience Among Vulnerable Youth Centre. (2019). Being Safe, Being Me 2019. Retrieved Mar 22, 2021 from https://apsc-saravyc.sites.olt.ubc.ca/files/2020/12/Being-Safe-Being-Me-2019_SARAVYC_ENG_1.2.pdf
Trans PULSE Canada Team. (2020). Health and Health Care Access for Trans & Non-Binary People in Canada. Retrieved March 23, 2021 from https://transpulsecanada.ca/results/report-1/
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