Johnstone: Provinces must step up health services for trans people

Many provincial and territorial governments have a long and proud history of affirmative action on 2SLGBTQ + issues. But they have recently lost momentum.

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Transgender health care, otherwise known as transition-related or gender-confirming health care, is recognized as medically necessary by international medical experts, including the standards of care established by the Global Professional Association for Transgender Health (WPATH). However, with the exception of the Yukon, provincial and territorial health insurance plans do not cover these essential services, despite overwhelming evidence confirming their medical necessity.

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By failing to cover trans health care, provinces and territories are denying trans people access to medically necessary health services.

Although many provinces and territories cover certain procedures, such as hormone replacement therapy and a limited set of surgeries, they omit equally essential procedures such as facial feminization surgery, permanent hair removal, shaving. the trachea and breast augmentation.

These procedures may not seem important to non-trans people, but they are absolutely essential for many trans people. Many struggle with gender dysphoria, in which differences between the body and gender trigger intense psychological distress. These medical procedures are an integral part of the mental health of trans people who have access to them.

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A recent case in Manitoba demonstrated the importance of health care coverage for trans people when a trans woman successfully appealed the province’s policy of not covering facial feminization surgery. Following the decision, the Manitoba Health Appeal Board, which adjudicates complex health coverage cases, said the woman was suffering from “significant psychological distress affecting her mental and physical well-being by because of her gender dysphoria ”and that the procedure was“ the key to addressing her gender dysphoria ”. While provinces and territories do not take proactive or comprehensive action on trans health care, trans people are repeatedly forced to use the courts to demand medically necessary coverage.

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Trans people are much more likely to be poor than their non-trans counterparts, with 50% living at or below the low income cut-off. With the bulk of trans health care uncovered, they are denied access to medically necessary care that they cannot afford on their own. For trans people, coverage is more akin to the American model of health care than to the so-called “universal” system of which Canadians are proud. This inequity in health runs counter to the principles of universal health care.

The irony of it all? Improving coverage and access to health care for trans people would not be expensive. Trans people make up less than one percent of the population, and not all trans people need all of these procedures. Extending trans health coverage would cost only a fraction of a percentage point – a blow to the health care budget, but a blow that would dramatically improve the well-being of trans people.

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Many provinces have a long and proud history of affirmative action on 2SLGBTQ + issues. Years before the federal government was disturbed, many provinces and territories passed human rights legislation for trans and 2SLGBTQ + people and legalized marriage equality. While they were the early champions of many 2SLGBTQ + issues – including when many established limited coverage for trans health care in the 1990s and early 2000s – they have lost momentum in the years since. followed, assuming the fight for 2SGLBTQ + rights is now over.

While the federal government has expanded its work on 2SLGBTQ + issues, the provinces and territories have not, with one glaring and recent exception. Earlier this year, the Yukon updated its trans health coverage to align with WPATH standards, making this coverage the most comprehensive in Canada.

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The provinces and territories are the stewards of health care in Canada. Although linked to the principles of the Canada Health Act, the details of health care coverage and access are provincial responsibilities. In line with international standards of care and recognizing that transitional health care is medically necessary for trans people, it is time for provinces and territories to fully cover trans health and improve access to trans health care. It’s the right thing to do, it’s affordable, and it will make a big difference for trans people across Canada.

Fae johnstone, MSW, is the Executive Director of Wisdom2Action and a trans and LGBTQ2 + educator and activist in Ottawa.

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