According to the World Health Organization, everyone is entitled to healthcare access when and where it is needed, without financial hardship. Alas, this is easier said than done — the healthcare needs of minorities, the less financially privileged, and the marginalized are often overlooked. Law is an unarguably essential component for establishing inclusive healthcare, reflected by the incorporation of “right to health” in domestic and constitutional law. However, administrative efforts and healthcare system restructuring in certain localities should not be overlooked. In the United States, safety-net clinic services aim at providing these individuals with accessible and affordable healthcare, along with transport and legal services. Personally, what do clinic users think about these services? To answer this question, Howard et al from the University of Washington Tacoma carried out an open-ended single-question survey. Their findings have been published in the September issue of the Journal of Young Investigators.
In this study, patients from Community and Human Services Centers in Washington, D.C. and a community health center in Washington State were recruited as study subjects. Researchers set the key question as “in what way do you think the healthcare system can help you make the best decisions about your healthcare?”. Subjects, self-reported as either “transgender” or “non-transgender”, were encouraged to voice out their opinions freely. Subsequently, subject demographics were analyzed statistically, and the free responses to the single item question were processed manually by the content analysis model. Researchers isolated and clustered codewords or short phrases from the responses to achieve a more focused discussion. Finally, researchers compared and contrasted the opinions between transgender and non-transgender subjects.
It is long known that minorities face socioeconomic barriers, such as fear of discrimination and financial stress; these barriers also exist in healthcare access. According to a study by Chisolm-Straker et al, some safety-net clinic staff refused to address transgender individuals with their preferred pronouns, mocked them, and purposely outed them. However, structural and organizational barriers are equally frustrating to clinic users, according to survey results. Subjects from both the transgender and non-transgender groups mentioned two aspects of structure, “healthcare accessibility and affordability” and “provider knowledge”, as possible areas of improvement with non-transgender individuals reporting greater expectation-reality discrepancy in both areas. “Healthcare accessibility and affordability” refer to the number of providers and appointments available for booking, while “provider knowledge” involves provider-patient communication and dissemination of educational resources. Transgender subjects in Washington, D.C. reflected physician inadequacy, especially in testosterone replacement therapy, gender-affirming surgery, and mental health support. The latter is especially a burning issue for transgender individuals, considering their higher likelihood of gender dysphoria, suicide attempt, and completion rates. Remarkably, subjects opened up that physician uncertainty shakes patient confidence, highlighting the urgency for physicians to acquire transgender medicine knowledge, perhaps by lectures or training sessions. It is also necessary for healthcare curriculum facilitators to recruit workers from diverse backgrounds and stress the importance of inclusivity in professional ethics.
This survey serves to suggest ways for further enhancement of gender-affirming care offered by safety-net health systems. To gain more comprehensive and representative findings, researchers suggested the inclusion of gender-sensitive options of pronouns, providing an open environment for respondents to comment based on their gender identity. Moreover, online systems and health applications may increase appointment availability and facilitate time-flexible staff-patient communication, while physician training in transgender medicine will improve prescription confidence and rapport with patients. Physicians may even consider personalizing treatment plans to fit patients’ physical and mental health needs.
References:
World Health Organization. (n.d.). ‘Health Equity’. Available: https://www.who.int/health-topics/health-equity#tab=tab_1 [Accessed 7 Aug 2022].
Satcher, D. (2003) ‘Overlooked and Underserved: Improving the Health of Men of Color’. American Journal of Public Health 93(5), 707-709, doi: 10.2105/ajph.93.5.707
Bridges, Klara M. (n.d.). ‘Implicit Bias and Racial Disparities in Healthcare’. Human Rights Magazine. Available: https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/racial-disparities-in-health-care/ [Accessed 7 Aug 2022].
World Health Organization. (2017). ‘Advancing the right to health: The vital role of law’. Available: http://apps.who.int/iris/bitstream/handle/10665/252815/9789241511384-eng.pdf?sequence=1 [Accessed 12 Aug 2022].
World Health Organization. (2017). ‘Human rights and health’. Available: https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health [Accessed 12 Aug 2022].
Safety Net Center. (n.d.). ‘Quality of Care in Free and Charitable Clinics’. Available: https://www.safetynetcenter.org/ [Accessed 7 Aug 2022].
Oregon Health Authority. (n.d.) ‘Safety net clinics’. Available: https://www.oregon.gov/oha/HPA/HP-PCO/Pages/Safety-Net-Clinics.aspx [Accessed 12 Aug 2022].
Chisolm-Straker, M., Jardine, L., Bennouna, C., Morency-Brassard, N., Coy, L., Egemba, M. O. and Shearer, P. L. (2017) ‘Transgender and Gender Nonconforming in Emergency Departments: A Qualitative Report of Patient Experiences’, Transgender Health, 2(1), 8–16, available: https://doi.org/10.1089/trgh.2016.0026