Study reveals health care gaps for trans, non-binary people

Nearly half of transgender and non-binary Canadians who responded to a national survey say they faced one or more unmet health care needs in the past year—with about 1-in-10 saying they avoided an emergency room visit completely, according to a Western-led project exploring this community across Canada for the first time.

Released today, the first report from the Trans PULSE Canada survey shows that while 81 percent of transgender and non-binary respondents report having a primary health-care provider, 45 percent say they have had one or more unmet health-care needs in the past year, and 12 percent avoided going to the emergency room in the last year despite needing care.

The lead researchers say these numbers are concerning and point to barriers to care like fear of discrimination that need further study.

"These results highlight what health services researchers already know—that general availability of health care is only the first step in accessibility," said Greta Bauer, a Schulich School of Medicine & Dentistry professor and principal investigator on the study. "Some of our future research will focus on the roles different factors play in accessing health care, for example physician knowledge or anticipated discrimination."

The Trans PULSE Canada project includes academic and community researchers across the country. The team conducted a Canada-wide survey of almost 3,000 transgender and non-binary people. This is the first national all-ages data on the health and well-being of this group of individuals.

The survey also found that despite high levels of education—roughly half having obtained a university or college degree, and 19 percent having a graduate or professional degree—40 percent of respondents reported living in low-income households. And while 73 percent reported having good, very good or excellent physical health, more than half rated their mental health as fair or poor.

Bauer, who led a similar survey specific to Ontario in 2009 called Trans PULSE Ontario, says this national data is important to identify variation in health and health care access, because most health care in Canada is organized through provincial systems and policies. For some provinces, like Saskatchewan, this is the first all-ages quantitative data on trans and non-binary health that is specific to that province.

"Provinces or territories other than Ontario have not had any all-ages survey data on the broader health of trans or non-binary people. For some regions, these are the very first findings on key health and health care indicators," Bauer said.

Co-principal investigator Ayden Scheim of Drexel University says the inclusion of non-binary people in the Canada-wide survey was an important addition.

"Trans PULSE Ontario was conducted before the public emergence of non-binary identities, and we see in this new Canadawide report that almost half of the participants identified as non-binary. In future analyses, we will be able to examine how health and health care access may differ for non-binary people," said Scheim.

This is the first of an anticipated 10 initial first-year reports as a result of the survey data. Trans PULSE Canada is funded through a grant from the Canadian Institutes of Health Research.