December 13, 2022

A new article from researchers at the UNC Gillings School of Global Public Health is shedding light on the potential health and human rights impacts of anti-trans legislation in the United States and abroad.

To ensure the health of gender-diverse people, the researchers – which include Gillings School alumni, students and faculty – say that human rights protections must move beyond a gender binary. Published in the Journal of Law, Medicine & Ethics, the article outlines how legal recognition of gender identity and expression has evolved under international law and analyzes how gender-inclusive human rights laws could strengthen health-related rights for trans people and other marginalized communities.

Aoife O'Connor

Aoife O’Connor

Max Seunik

Max Seunik

Co-authors Aoife O’Connor, MPH, and Maximilian Seunik talked more with us about the piece and shared their insights on the importance of health policy in human rights for trans people.

Q: What led to the development of this publication?

O’Connor: When we first began drafting this piece, a dramatic rise in anti-gender ideology had already begun permeating across both the United States and abroad. Propelled by a well-funded transnational movement that objects to the notion of gender as a socio-cultural construct (rather than a binary biological classification), this backlash has been emboldened in recent years, dominating public debate and garnering support from high-profile political and social figures.

This movement has caused an onslaught of anti-trans legislation that has extremely detrimental effects on the health of trans and gender-diverse communities, as well as the broader LGBTQI+ community, and the rights of cisgender women and girls.

Q: How can the enforcement of a rigid gender binary through policy impact health?

O’Connor: When the law fails to use a rights-based framework that addresses individuals’ intersecting identities and fails to incorporate a more expansive interpretation of gender, this can leave trans communities at risk of widespread violence, health neglect and discrimination.

Within the trans community, in particular, disparities include high rates of domestic and sexual violence, poor mental health outcomes, shortened life expectancy, as well as abuse and neglect experienced across the health system.

As public health professionals and human rights advocates, our team set out in this piece to name these egregious health disparities faced by the trans community as policy decisions — active choices that can and should be remedied by incorporating a more gender-expansive framework under international human rights law and through a rights-based approach to trans health on the local, national and international levels.

Violence and inequities based on gender identity and expression do not only impact the trans community. We all live in gendered societies, which means that we all have gender identities, and we all make decisions (either by force or through the freedom of expression) about how we are going to relate to gender expectations and roles in society. These decisions deeply impact how we’re viewed, what we have access to, and, as a result, our health and other protective factors. By working to promote and uphold protections for trans populations, we are making the world safer and healthier for us all.

Q: How did you bring a global lens to the research?

Seunik: This piece brings together both academics – like Dr. Benjamin Mason Meier from UNC-Chapel Hill – and practitioners – like Liberty Matthyse from Gender Dynamix in South Africa – while blending authorship perspectives from the Global North and South. For a topic as rooted in pernicious global forces as anti-trans discrimination, this team was well-equipped to study an issue that stretches far beyond the U.S. and has resonance throughout the world.

Q: What are your goals for those who read this publication, especially those in the field of public health?

O’Connor: The most important takeaway is that we want people to understand the immense power that law has to enable or constrain action around the health and human rights of trans and gender-diverse communities.

While our paper focuses on the importance of using gender-expansive approaches in law and policy at the international level, we hope that this publication can inspire our public health colleagues to think about how to incorporate gender-expansive approaches across their own work, whether at the local, regional, national or international level.

Seunik: The most important takeaway from our piece is, quite simply, that trans rights are human rights — and that includes the human right to health. The human right to health provides a range of tools and a framework from which practitioners, communities and advocates can draw to advance the health of trans folks. The core principles of this human right include equality, non-discrimination and accountability, providing a rights-based foundation for health policy.

My hope is that readers can begin to imagine — and put into practice — the powerful changes envisaged by a rights-based approach to trans health. This work is absolutely urgent, and human rights offer a universal legal foundation for us to move forward.

Q: Are there some actionable takeaways or resources for those who want to learn more about trans human rights?

O’Connor: Absolutely! If you’re interested in getting involved in work about trans rights, I always recommend starting locally and seeing where you can plug into this work in your own community. This can look like canvassing and voting to support LGBTQI+ rights; advocating for more trans-inclusive work, school and health care spaces; ensuring that all-gender bathrooms are available; donating trans-inclusive books to your local public school or library; supporting the rights of trans youth to participate in school sports; or talking to your friends and family about trans rights. Great resources can be found from the Human Rights CampaignGLAAD or the National Center for Transgender Equality.

Seunik: Readers should interrogate how the gender binary shows up in their own work and turn their minds to how this may disadvantage or harm the health and human rights of trans communities. Our piece ultimately endorses an expansive view of gender that goes beyond the narrow limits of the binary, or one’s sex assigned at birth, and reconceptualizes human rights under international law.

The article co-authors are Aoife O’Connor, MPH, a Master of Public Health alumna from the Gillings School and program officer at Johns Hopkins Center for Communication Programs; Maximillian Seunik, a Bachelor of Science in Public Health alumnus from the Gillings School and chief of staff at Zenysis Technologies; Blas Radi, doctoral student at the University of Buenos Aires; Liberty Matthyse, executive director at Gender Dynamix; Lance Gable, JD, MPH, professor of law at the Wayne State University School of Law; Hanna Huffstetler, doctoral student in health behavior at the Gillings School; and Benjamin Mason Meier, JD, LLM, PhD, professor of public policy and health policy and management at the Gillings School.

Read the full article online.

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