Critically Examining the Invisible Healthcare Disparity for Gender-Diversity

Introduction

Unlike romanticized invisibility cloaks that one can simply put on or take off, the invisibility element of an ongoing disparity of health continues to remain prevalent for an underrepresented community. James et al. (2022) present how the gender-diverse community consistently experiences underrepresentation and health inequity. For this literature analysis and review, the terminology gender-diverse will encompass gender identities such as transgender, gender-nonconforming, and gender-queer, or individuals who do not identify as the gender assigned at birth (Ahmad et al., 2019). Gender-diversity will be used as a term to encompass individuals whose social identity is a minority within the normative gender binary.

Simmons-Duffin (2020) presents that 1 in 3 transgender patients delay their access to medical services as a result of experiencing discrimination and cultural insensitivity. In an effort to promote ethical practices for gender-diverse bodies or those experiencing gender dysphoria, governing organizations in health often turn to legislation and healthcare management for answers. However, the underpinning element that frequently is overseen is the lack of guidance that is informed by the clients who are gender-diverse identifying. This is a crucial missing component of patient-component service as it relates to the autonomy of gender-diverse communities with their own bodies (Warner et al., 2021).

In one study where healthcare professionals were surveyed about their experience with gender-diversity, 91% agreed that there was not enough teaching on transgender health (Vasudevan et al., 2022). This leads to issues like both intentional and unintentional cases of harassment and gender-based discrimination. In a study discussed by Eyssel et al. (2017), 28% of the gender-diverse respondents experienced verbal harassment, and 19% had their healthcare denied or refused. In addition to a lack of education, there is a lack of healthcare policy protecting equal treatment as it relates to the social identity of gender-diverse individuals (Martinez et al., 2017). The Movement Advancement Project (MAP) released research demonstrating the Banning of Medical Care and Legal Recognition for Transgender People, which is the fifth in MAP's report series titled: “Under Fire: The War on LGBTQ People in America.” There, it is presented how more than 1 in 3 transgender youth currently reside in a state where gender-affirming health care is banned for them, as well as restrictive for gender-diverse adults. This report also highlights how, in the United States, in 2023, over 725 anti-LGBTQ bills were proposed. When a lack of protection exists, incidents of discrimination against gender-diverse individuals or transphobia can be a result. Bradley (2020) presents in The Transphobic Hate Crime Report that 4 out of 5 individuals experienced some form of transphobic attack, while 72% of respondents stated that transphobia impacted their mental health through symptoms of anxiety, depression, and PTSD.

While emerging policies across the health management sector struggle to understand gender-diversity and healthcare, every day, those who are gender-diverse are experiencing inequitable treatment while existing in the healthcare system. Gupta et al. (2016) present how a majority of the gender-diverse population may avoid attending clinics and seeking care out of fear of discrimination. Merkel (2017) discusses how this is present in both general primary care and specialized care for the gender-diverse community. The invisible health disparity lies at the intersection of understanding how gender-diversity is experienced within health systems. The urgency to address this healthcare disparity is present in the studies that demonstrate the impact of poor health outcomes for this underserved community (Manzoor et al.,2022).