Chapter 3: Health Disparities

INTRODUCTION

Increasing evidence suggests that transgender and gender diverse (TGD) people experience disproportionately high rates of several mental and physical health problems compared with cisgender people. Many researchers attribute these health disparities among TGD populations, including high rates of psychiatric and substance use disorders, to minority stress, a social and public health framework describing how the long-term effects of stigma, prejudice, and discrimination create a hostile environment that impacts a person’s health and well-being. An important corollary of this model is the concept of resilience—the coping strategies that enable minority populations to thrive amid adversity on both the individual and community levels. This chapter explores the health disparities experienced by TGD populations, and delineates the minority stress model and multilevel interventions that address individual, institutional, organizational, and societal/public policy issues.

DEFINING THE PROBLEM OF HEALTH INEQUITIES IN TGD COMMUNITIES

Health inequities experienced by TGD people gained increasing attention between 2010 and 2020. In 2011, the Institute of Medicine released a landmark report acknowledging extensive gaps in research on the health of LGBT populations.¹ In the same year, the US Department of Health and Human Services published its first annual report on LGBT health, outlining policy objectives for reducing discrimination against sexual and gender minorities (SGM) in health care and social services.² Both reports pointed to the lack of information on gender identity in nationally representative data as a critical barrier to studying the health of TGD populations. Additionally, in 2016, the National Institutes of Health formally designated SGM as a health disparity population to advance research in this area.³ More recently, increases in the volume of research on TGD populations, improvements in the quality of data inclusive of gender identity, and advancements in methodology for identifying TGD individuals in existing dataset have amplified evidence of significant inequities in health. New evidence suggests that TGD people experience higher rates of several mental and physical health conditions. Collective knowledge, however, about how these inequities vary across specific communities within the overall TGD population (e.g., by race, ethnicity, immigration status, socioeconomic position, geography, age, ability, or gender identity) remains limited.

DATA SOURCES FOR STUDYING HEALTH INEQUITIES AMONG TGD PEOPLE

Typically, researchers study rates of health conditions among subpopulations in the United States using survey and administrative data that are representative of a larger population (e.g., the population of the United States, the population of Nevada, or the population of individuals enrolled in Medicare). Representative data are generated using random or probability sampling techniques, through which researchers collect or have access to data on a subset of individuals who were randomly selected from the larger population. With these data sources, researchers can make broad inferences about the health of the entire subpopulation and assess how health varies within this subpopulation based on other important characteristics. Until recently, evidence of health inequities experienced by TGD communities came largely ...