Trans and non-binary people still face health-care barriers in Canada: study

TORONTO — According to data from a new national study on trans health published this week, trans and non-binary Canadians still face under-employment, issues having their health-care needs met, and fear of harassment that leads many to avoid certain public spaces.

The report by Trans PULSE looked at survey data from more than 2,800 trans and non-binary people 14 years and older from across Canada.

It’s the largest national study on health care for trans people in Canada to cover such a broad age range, according to researchers, and provides some of the very first quantitative data on the topic for some provinces.

One jarring statistic from the report is that although more than 80 per cent of trans and non-binary respondents reported having a primary care provider, 45 per cent also said they’d experienced having one or more unmet health care need within the past year.

In a comparison, only four per cent of the general population reported having an unmet medical need within the past year.

“These results highlight what health services researchers already know, that general availability of health care is only the first step in accessibility,” said Greta Bauer, a Professor at Western University and the lead investigator on the study, in a statement.

Bauer told CTVNews.ca over email that “delays in accessing gender-affirming medical care such as hormones or surgeries,” also contribute to the issue.

HOW HARASSMENT AFFECTS TRANS HEALTH

The report showed that trans people still face a significant amount of transphobic harassment and violence in Canada, which can affect their access to health care, as well as their mental health.

Twelve per cent of the report’s trans and non-binary respondents said they avoided going to the emergency room in the past year when they needed care, simply because they were trans.

“In the past five years, most had experienced verbal harassment related to being trans or non-binary, and 16 per cent and 26 per cent had experienced physical and sexual assault, respectively,” the report said.

The fear of harassment affects how trans people operate in the public sphere as well, according to the report.

“When presented with a list of 14 types of public spaces, 64 per cent reported avoiding 3 or more of those spaces for fear of being harassed or outed. Only 16 per cent did not avoid any of the public spaces.”

In terms of disability and mental illness, 43 per cent of respondents reported that they were a “psychiatric survivor,” or had some form of mental illness. Over half of the respondents said their mental health was “fair” or “poor.”

A third of the respondents said they had considered suicide in the past year.

The respondents skewed younger, with more than 70 per cent of those surveyed being 34 or under. Just under half of the respondents said the gender label that fit them best was non-binary. Around a quarter of respondents said they identified as men/boys, and another quarter as women/girls. Two per cent of respondents specified a cultural gender identity, such as Two-Spirit.

In terms of sexuality, the trans and non-binary people surveyed overwhelmingly identified somewhere on the LGBTQ spectrum, with only eight per cent describing themselves as heterosexual.

FACING BARRIERS TO HIGHER INCOME DESPITE EDUCATION

The majority of respondents were highly educated, with half reporting that they had a college or university degree, and 19 per cent reporting a graduate or professional degree. Forty-three per cent were employed full-time. Despite this, more than half of the respondents aged 25 or older had a personal income of less than $30,000 a year.

According to information from Statistics Canada, the median after-tax income for Canadian households was $59,800 in 2017, but the amount a person needs to make a year to live comfortably ranges drastically across Canada. In Toronto, one of the most expensive cities in the country, a person who is renting and taking public transit would still need to be making around $55,000 a year to make ends meet in 2020, according to analysis by Lowestrates.ca based on average rent prices in the city.

The respondents on the Trans PULSE survey overwhelmingly reported living in urban or suburban areas — only six per cent lived in an area that could be classified as rural, or a small town.

Only one in 10 of the respondents reported earning more than $80,000 a year.

THE PACE OF PROGRESS

Although many advances have been made in health care, awareness and rights for the LGBTQ community in Canada, some changes have been slow to come.

The federal government introduced a new bill on Monday aimed at criminalizing those who force queer individuals into “conversion therapy,” a much-criticized form of religious counselling that seeks to eradicate LGBTQ individuals by teaching them through “therapy” to despise themselves and suppress their own understanding of their sexuality or gender.

The practice has existed for decades, despite being widely condemned by health and human rights groups.

According to a statistic posted by Trans PULSE in January, ahead of their main report, one in 10 respondents (out of the 2,033 who answered a question regarding conversion therapy) had undergone conversion therapy at some point that attempted to make them cisgender.

For respondents over the age of 50, the percentage who had undergone conversion therapy soared to 25 per cent.

Bauer said that studies that focus on trans and non-binary voices “can highlight inequities that could never be picked up in a general population-based sample,” because they “are designed by and for the communities that they serve.

“Community ownership helps to ensure that we’re asking the right questions, and that the results that we produce will be reported in a way that is accessible to the community, and useful when advocating for improved policy and practice,” she said.

The data isn’t a perfect representation of Canada’s trans community, the study acknowledges. Some people may not have heard of the survey during the window it was active, or may have obstacles that prevent them from accessing a survey conducted online.

Some provinces also responded in much higher numbers than others. After Ontario, which had 1,012 respondents, British Columbia and Alberta were the provinces represented most highly in the survey, with more than 500 respondents respectively.

The report said the distribution of respondents largely reflected the overall population in different provinces and territories across Canada.

The inclusion of non-binary voices in this survey was a big step forward in comparison to previous studies on trans health, according to co-principal investigator Ayden Scheim, an Assistant professor at Drexel University.

A previous, Ontario-based study conducted by Trans PULSE “was conducted before the public emergence of non-binary identities, and we see in this new Canada-wide report that almost half of the participants identified as non-binary,” Scheim said in a press release.

The report was funded by the Canadian Institutes of Health Research, and is the first report in a planned series of 10.

Further reports are hoping to break down data specific to “priority populations”, including “older people, youth, sex workers, those with non-binary identities, immigrants, those living with disabilities, Indigenous gender-diverse people, racialized people, and those in rural or remote areas,” Bauer said.

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