Health Equity and Collaborative Policy Development- Queering Care
The Canadian Health Care System continues to fail the Gender and Sexual Minority (GSM) population. Policy based in and created through a gender and sexually diverse lens is essential for the well-being of this marginalized community. Queer Ontario (2019), as one of thirteen recommendations calls for the government alongside GSM communities to collaboratively develop broad services, not only within queer communities but as services integrated into mainstream health care.
Heteronormativity continues as the dominant view woven throughout structures as an institutionalized system that normalizes heterosexuality silencing GSM groups (Mule, Ross, & Deeprose, 2009). Not only had data not been effectively collected, to truly be representative of this community, the pervasive belief that gender and sexuality is a binary must be dispelled. Adhering to a social constructed understanding invisibilizes, transgender, non-binary, bisexual and intersex individuals. The Trans PULSE Canada Team (2020), study reveals that while 81% of Trans and Non-Binary people have a primary care physician, 45% have unmet health care needs, as opposed to 4% in the general population. This report additionally highlights significant experiences of transphobic harassment and violence which impacts willingness to seek support for physical and mental health. Emergency care was avoided by 12% of trans and non-binary people report not attending ER when needed due to their gender identity (The Trans PULSE Canada Team 2020, p. 1).
While human rights recognize and protect gender and sexual diversity, the infrastructure to enforce and educate is sorely lacking. Most advocacy for patient rights are left to the patient themselves. The Human Rights tribunal system is complex and difficult to navigate, and most often requires more energy and resilience then minority individuals have.
Canadian non-binary musician brought light to this struggle in the early spring of 2020 when they were diagnosed with cervical cancer. In most literature cervical cancer is listed under the category of “women's cancers,” which alone makes a system more difficult to navigate. Spoon shared experiences of being welcomed with ‘Hello girls, and having pronouns mocked within earshot while waiting for a PET scan (Spoon 2020). Imagine what it would feel like if you arrived at an important and difficult medical appointment, or were vulnerable in reaching out for therapy and no one could get your name right, and they misgendered you, told you that your name was really difficult, asked if you really minded, if they just made up a new easier to remember name and use that instead. Now imagine this happening almost everyday.
In a quick google search of ‘cervical cancer’ Ontario’ this pamphlet (annotated to highlight problematic language) is what is returned by the Ontario Government site, one trusted as a source of quality resources. For many female-to-male (FTM) individuals undergoing procedures that highlight anatomy that they have dysphoria surrounding is terrifying, exhausting and triggering. Each time their identity isn’t affirmed it is an additional microaggression, which quickly accumulates and builds to insurmountable barriers. These experiences can mean the difference between someone seeking support and continuing to live with health concerns.
Spoon as a patient worked with the BC cancer Centre to change the language and categorize cervical cancer under a category of pelvic cancers (Spoon 2020). While Spoon has been a tireless advocate for the community and have themselves to be a powerful educator, they should be able to seek treatment and support and not have to take on additional weight of changing broken systems.
As health care supports and providers, as community members, it is essential to bring awareness to our language and our actions, to work to understand the gravity and impact that we have on others. Bringing awareness to our own privilege, and mindfulness to what complex systems of accessing support would look without the privileges that are socially created by the dominant groups. A diagnosis of cancer alone comes with stress and anxiety , for GsM people this is amplified by dysphasia and previous trauma and further problematic when gendered parts don’t align with social norms.
Action
I encourage organizations to mindfully review literature provided to ensure that it is inclusive of the targeted groups and community knowledge is utilized during the process of review and creation.
That institutions have internal human rights policies that ensure adequate training and inclusion of gender and sexual diversity.
I encourage individuals to stand up against homophobic and transphobic, and homophobic actions, and ideologies, when they are safe to do so.
Campaign archived here- not only do ads like ‘Guys Get Paps Too’ reflect the diverse gender identities of people who need regular cervical screening, but also normalized and educate.
Resources
Cancer Society trans men cervical cancer- the Canadian Cancer Society has some very thoughtfully worded resources for Cervical Cancer Screening.
Trans Cervical Health Primer - information for both patients and care providers.
Rae Spoon speaks out, article with audio interview included CBC
Language Matters Video -Short educational video that reminds of the importance of language. Video created by TRANSformative Talk and The PRIDE Project (my grassroots organization), created in collaboration with The Pucking Fuppet Co.
Video highlighting Trans Medical Experiences
References
Mulé, N.J., Ross, L.E., Deeprose, B., Jackson, B.E., Daley, A., Travers, A. Moore, D. (2009). Promoting LGBT health and wellbeing through inclusive policy development. International Journal for Equity in Health, 8 (1), 18.
Queer Ontario (2019). Queer Ontario Brief LGBTQ2 Health in Canada. Brief submitted to the House of Commons Standing Committee on Health. 42 Parliament 1 Session. Government of Canada.https://www.ourcommons.ca/Content/Committee/421/HESA/Brief/BR10437302/br-external/QueerOntario-e.pdf
Spoon (2020). Cancer, Human Rights and Community: How Things Go Right. https://medium.com/@raespoon/cancer-human-rights-and-community-how-things-go-right-7759b58d3cff
The Trans PULSE Canada Team (2020) Health and health care access for trans and non-binary people in Canada. 2020-03-10. Available from: https://transpulsecanada.ca/research-type/reports