A few years ago, I remember reading that the estimated average life expectancy for a black transgender woman is 35 years old. Having already passed 35 myself, I was bewildered by this statistic, especially since most of my professional time is spent protecting the health of people. In public health, we primarily rely on data to spur us into action. However over the years, I have discovered that numbers are not always enough to move consciousness towards affirming the humanity of others. Stories do.
The story and life of Marsha P. Johnson did exactly that for me.
In a simple – and certainly not complete – description, Marsha was a black transgender woman, activist, and considered the mother of the transgender and queer liberation movement. In 1992, she was found dead in New York City’s Hudson River ― while ruled suicide, most who knew her suspect as a result of homicide. The incredible circumstances surrounding her short existence left me searching for more information about her. As I read more about her life, I became sensitized to the extreme invisibility experienced by transgender people while simultaneously experiencing the co-opting of their culture and work, as recently elevated by transgender activists upon the release of a documentary on her life.
Marsha Johnson and other activists fought hard to ensure that their communities were not forgotten, mistreated and abused. However, the priorities of transgender people were for decades left along the margins in mainstream gay rights movements and in political advocacy.
In the 25 years since Johnson’s death, the United States has made progress in the fight for transgender equity. Last month, eight openly transgender people were elected to city and state offices across the country. In 2012, the Equal Employment Opportunity Commission ruled that Title VII of the Civil Rights Act protected transgender employees – a ruling that would safeguard transgender employees from discrimination and unlawful firing.
But the current political climate in the United States has reawakened discriminatory policies and practices. The Trump Administration proposed a ban of transgender people serving in the United States military (which was fortunately blocked by a federal judge this past Monday), and they are seeking the reversal of the 2012 workplace protections. In Congress, legislators are discussing new bills that oppose gender-neutral bathrooms.
Today, we also still see incredible rates of discrimination and violence – institutional and interpersonal – against transgender people, especially trans women of color. 2017 already marks the highest number of annual transgender homicides on record ever. According to a 2015 study performed by the National Center for Transgender Equality, 51 percent of respondents who were black transgender women faced homelessness at some point in their life and 53 percent of them had been sexually assaulted. High rates of negative health outcomes are also reported for transgender people, including suicide. Reciprocally, challenges with health can be compounded by difficulty in accessing health care, employment, housing, and legal service opportunities.
This is an unacceptable reality. We in the medical and public health communities can help right these wrongs by acknowledging our own history of pathologizing and discriminating against trans people, learning from their experiences, being inclusive of the voices, ideas, and expertise of transgender people in every step of building policy and practice, and stepping aside so that transgender leaders can lead.
Only then can we really start to reshape the narrative and begin to dismantle systems of transphobia, homophobia, racism, and sexism that play an integral role in the oppression faced by transgender people, especially transgender women of color.
At the NYC Health Department over the past four years, we have changed our Health Code to allow gender maker changes, begun to train staff on racial and gender equity, published several health promotion materials specific to transgender health for health providers and NYers, enhanced our clinical service delivery to be culturally responsive to transgender people; and our Health Department leaders have used their voices to affirm the rights of transgender people in op-eds and press announcements. Even with this progress, we know we can do more.
Here is what we, the medical and public health community, can all do:
• Advocate for standardized sexual orientation and gender identity data collection. (The Williams Institute provides some useful guidance.)
• Allow all people to self-identify their gender identity on all identity documents, surveys, forms, and other materials.
• Train and educate staff on racial and gender equity as well as the importance of addressing transgender people according to their pronouns, name, and gender identity.
• Enhance programs and services to ensure that all people, especially transgender people of color, can walk into any health center, hospital, or other medical facility and receive quality care that affirms their identities.
• Partner with education, housing, employment, and law enforcement sectors to reduce discrimination and stigma and create inclusive policies that enhance the health and well-being of transgender and gender non-conforming people.
As a public health professional and a woman of color who does not identify as transgender, I feel the responsibility to fight for the rights and the wellbeing of transgender people. Their fight must become ours as well, because the liberation of a group of oppressed people is tied to the liberation of all oppressed people.
Follow Dr. Aletha Maybank on Twitter @DrAlethaMaybank