Today, 31 March is International Trans Day of Visibility (TDOV). The topic of trans, transgender and non-binary equality is sensitive and complex. There are differing opinions both within the medical profession and in wider society. My approach to topics like this is to get back to basic human rights, and as Head of Equality Inclusion and Culture at the BMA that’s what I advise on a policy level. Every person has a right to healthcare, no matter their gender (affirmed, identified, or defined) nor their physical attributes. Healthcare is not a place to debate the validity of a person’s identity – services must be able to meet the needs of all the communities and individuals they serve.
Access to healthcare for all people is a human right. Healthcare should be needs-based, which means having an inclusionary, not exclusionary, approach – where all elements of a person’s identity are incorporated into their care to ensure they have equitable healthcare outcomes.
Statistical evidence for disparities in health and everyday life for people under the trans umbrella is often absent from the evidence base; often it is not collected or (because the number of people sharing their data is low due to stigmatisation and fear of the consequences of disclosure) numbers are too small to be reported. This feeds into a narrative that because the numbers are small, the issues are insignificant; and when evidence does exist, it can be starkly shocking.
The 2016 Transgender Equality Report by the Women and Equalities Committee provided an overview of the key issues trans people face in the UK. Stating that ‘the NHS is letting down trans people, with too much evidence of an approach that can be said to be discriminatory and in breach of the Equality Act’. The report also stated that ‘discrimination is a part of daily life for trans people—a reality which many feel they have no alternative but to accept’[1].
In July 2018 the Government Equalities Office published the National LGBT Survey. Transgender people were around twice as likely to experience threats of physical or sexual harassment or violence compared with the LGBT community as a whole (11% v 5%) and 67% of trans and 76% non-binary respondents said they avoided being open about their gender identity for fear of a negative reaction from others[2].
Looking at these stats it seems that anyone in the medical profession seeking to provide care and prevent harm would acknowledge that more must be done for this community. Tackling these disparities must be a priority, without distracting discussions about toilets. There are meaningful discussions to be had about the lack of resources, funding and training for healthcare professionals to provide those services where they are needed.
It is by using a human rights approach to health that we can look, not at broad groupings based on collectively agreed (or disputed) identities, but at what each person needs, at that point, in that context. Viewed through this lens, trying to win a theoretical ‘debate’ about which right trumps which other rights in every time, place and context, becomes meaningless. We can likewise avoid becoming stuck in endless discussions about changing terminology by recognising that at the most fundamental level, we are talking about people.
When we look at how things operate practically on the ground often, we find that there may not really be a problem. The Equality Act 2010 protects transgender people from discrimination when accessing services. The same legislation also allows service providers to restrict access to single sex spaces on the basis of biological sex if there is a clear justification. Instead of rigid blanket policies, it allows for a reasoned, nuanced, context specific assessment of how to handle particular situations.
It is important to add some context to the trans ‘debate’ in the UK. Last year, a report[3] by the Council of Europe said the UK had ‘anti-trans rhetoric’ that is ‘contributing to growing human rights problems’ and an increase in transphobic crime since 2015.
I am not trans, I don’t have trans friends or family – I have no lived experience of trans life. My role at the BMA is to promote equality, inclusion and fair workplace cultures in the medical profession. Using an evidence-based human rights approach it is easy to see that we must all try harder to ensure that that the population of trans and non-binary people in the UK have access to health services, and that their experiences while accessing those services are fair and non-discriminatory.
Thanks to Lucy Brant, Senior Policy Advisor in the BMA’s Equality Inclusion and Culture team who helped me edit this blog.
The BMA have today launched new guidance on Inclusive care for trans and non-binary patients
[1] Transgender Equality: First Report of Session 2015-16; 2016; House of Commons Women and Equalities Committee
[2] National LGBT Survey; 2018; Government Equalities Office
[3] Combating rising hate against LGBTI people in Europe: 2021; Parliamentary Assembly; Council of Europe
