Back To the Main SiteBeyond Boxes: Specific Health Issues
Peter Hyndal presented at a Men’s Health Conference in Newcastle, last week. A “National Health Gathering” presented by the Australasian Men’s Health Forum. For the conference he wrote a paper named Beyond boxes: Sex and gender diversity and health service provision
We’ll be posting the contents of his presentation over the next few weeks, in tasty bite sized morsels, and the full presentation (with all its references intact) will be available to download at the end of the series.
The story so far:
2 What does sex and gender diversity have to do with Men’s Health?
3 Medical Professionals involvement in Making Men
4 Issues with Primary Health Care
Todays post, is beyond the jump:
Understanding Health Risks
Another ongoing issue in health care is the high prevalence of (mis)understanding of risk factors that is based around a concept of sex and/or gender:
We all know for example that “men are at greater risk of heart disease” but does this mean a trans man is at greater risk than he was when he was a woman? Or that the trans woman continues to be at greater risk even after identifying and living as a woman? What about someone who is chromosomally neither male or female?
This issue also filters down to more general health and wellbeing issues that are part of targeted community health education programs. For example, how many standard drinks should a trans or intersex person have to fit within the recommended range? What safe sex information is most relevant for a lesbian trans woman who has not undertaken any surgical procedures? Whose responsibility is it to make this information available? Or to assess the effectiveness of its dissemination?
Too often it seems that health statistics and education campaigns are framed around the use of male and female as comparators simply because that is what we have come to expect. We must acknowledge that there is no inherent value in these comparators. Used inappropriately, they can serve to erase other perhaps more significant comparators (eg indigenous/non indigenous). We also need to acknowledge that using sex as a standard default comparitor is problematic for sex and gender diverse people to the degree that sex and gender diverse people are invisible within this framework – invisible to health services as individuals, invisible from health policy as a community, and provided with health information that is completely unintelligible to their reality.
Mental Health, Depression and Suicide
Very little research has investigated any health issues and outcomes relating to sex and gender identity, which poses serious problems for the development of robust and inclusive health policy. Here I will examine some of what we know about mental health issues specifically with relation to depression and suicide.
The rate of depression identified in the Tranznation report was particularly significant with 53.4% of the sample reporting one of the criteria for a current major depressive episode. Over 1/3rd of the respondents met the criteria for a current major depressive episode compared to 6.8% of the general population.
There is a long established and universally recognised association between depression and suicide. The Australian depression incidence indicated by the Tranznation report is in line with US and UK based research and that research shows around 1 in 3 trans people have attempted suicide at least once compared to approximately 1:380 for the general population.
Despite the rate of attempted suicide being approximately 125 times greater amongst sex and gender diverse individuals than the population as a whole, sex and gender diversity is not identified as a risk factor for suicide by any mainstream suicide prevention organizations in Australia.
For example, one national Australian organisation whose mission is to prevent depression states in a downloadable fact sheet that 50-60% of transgender people report having depression. Yet a search for “transgender” on the same website brings up only two other references – a brief fact sheet primarily focused on gay and lesbian issues, and a scoping study which contains no trans or intersex content at all.
The predominate focus of suicide prevention resources are currently targeted at men – on the basis of a suicide rate four times higher than the suicide rate amongst women. Personally I think that any men’s services receiving this funding has a moral and ethical duty to target at least some of these resources towards effective prevention strategies at the sex and gender diverse community who have suicide rates 125 times higher than the general population.
Broader Health and Wellbeing Issues
Most population level research in Australia has not included questions on the sex/gender diversity of respondents. Even where respondents have specifically indicated there status as gender diverse, most research ‘erases’ their response by randomly allocating their responses to either male or female categories. So while gender diverse people will have participated in this research, there is no way of analysing their responses compared to other population groups.
The 2006/2007 the Tranznation study found that on the SF36 scale, a standard measure of health, participants had poorer health ratings than the general population in Australia.
Tranznation also identified that although trans people were significantly higher educated than the general population, the largest proportion of participants earnt less than $20,000 pa. Unemployment rates, at 9.1% were more than double the national average of 4.4%. The Sydney Gender Centre quotes unemployment rates as high as 60% within the trans community.
Perhaps most importantly, Tranznation identified a clear relationship between the experience of discrimination and depression.
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