Trans Health Connection - a project of Rainbow Health Ontario and Sherbourne Health Centre - is increasing the capacity of Ontario's primary health care system to provide high-quality, comprehensive care to trans communities through training, education, mentorship, resources, and networking.
The Making of the Project
In 2008, when some gender-affirming surgeries were relisted under OHIP, the Ministry of Health and Long-Term Care approached Sherbourne Health Centre, Rainbow Health Ontario, and the Centre for Addiction and Mental Health (CAMH) to consult on access and equity issues in health care for trans people in Ontario.
While a number of gaps were identified, the Ministry decided to fund a program of in-depth training for primary health care teams as a first step. In April 2011, Trans Health Connection was launched to provide training and to offer ongoing clinical supports to build knowledge and skills among service providers.
In its first year, the project has focused primarily on building capacity in four geographic areas across the province: Thunder Bay, Ottawa, Windsor and St Catharines. Each of these areas has a Community Health Centre or Community Family Health Team which has stepped up to act as the hub for the development of local services for trans people.
What are the Issues that Affect the Health of Trans People in Ontario?
Trans people in Ontario are frequently denied health care, or are treated with disrespect within health care settings. Trans primary health care, such as hormone treatment, is not currently a part of the standard medical education curriculum, and many clinicians have never seen (or believe they have never seen) trans people in their practice. Because of the invisibility of trans lives and experiences, trans people are continually referred "elsewhere"- even when their health needs are routine. Accessing health care services is especially problematic for trans people who live outside Toronto. We believe that everyone has a right to basic health care close to home and Trans Health Connection is working to make this a reality.
The Trans PULSE Study, a large and representative study of trans people in Ontario, found that:
- Trans folks often do not see themselves reflected in health policy, studies, materials, and services. This absence contributes to the lack of evidence in regards to clinical protocols and practices in working with trans communities in health care settings.
- Approximately 70% of trans people in Ontario live outside of Toronto and have very limited access to appropriate primary care. One common misconception is that most trans people in the province live in Toronto, where competent trans primary health care is more accessible. The reality is that finding trans positive primary health care is a challenge for many Torontonians, and that most trans people in Ontario live outside of the GTA. Many trans people across the province are moving to bigger cities in search of care, community, and access to supports and resources. We want to envision that competent and respectful care can happen close to home.
- Trans people routinely experience discrimination in the workplace, at school, at home, and every day on the streets. Transphobia interacts with other systems of oppression (racism, classism, ableism, sexism, and others), and significantly contributes to poor health. Transphobia works with these other systems to maintain a dominant profile (white, cis, male, able, educated, employed, heterosexual, etc). Trans people may experience transphobia differently, based on various intersections of oppression.
- At a population level, trans people have exceptional degrees of formal education, and are simultaneously extremely underemployed. While formal education is certainly not necessarily a marker of knowledge, we do know that formal schooling often increases employability. However, many trans people are not finding meaningful employment, or employment at all, despite often having those credentials. To us, this signifies clear discrimination. Not surprising, many trans people in Ontario live in poverty (approximately 50% of trans people in Ontario make less than $15,000 a year).
- Trans people often experience a high degree of mental and emotional distress due to experiences of social marginalization and transphobia. Some trans people experience trans-related discrimination and violence every single day. The impact of these experiences is significant.