Street roots., May 20, 2016, Page 10, Image 10

: Make health a part of all policy
ff
AMANDA WALDROUPE
SI Al ’ W R I 11 R
epending on where a person lives, or if he or
she is white, black or another race or ethnicity,
or if they are impoverished - their health
reflects who they are.
People who spend an hour commuting to work may
not have time to eat healthy food or may suffer ln>m
sties». People who live near faetones nuiy bieath
toxins or particulates. People
who have fewer opportunities
have fewer connections to
preventative health care.
Eliminating disparities in
health care is a major focus
of policy makers, advocates
and health care providers
who seek to ensure that all
people - regardless of race,
ethnicity, gender, socio­
economic status, etc. - have
Dr. David Satcher access to quality health care.
The only way disparities in
health care can be eliminated, Dr. David Satcher said,
in foi tin- country's health cate sy-lern to become
committed to the health of every citizen, regardless of
their race, ethnicity and socioeconomic status.
Satcher, who will be giving the keynote address at
the National Healthcare for the Homeless Council’s
annual conference later this month, served as the
country’s ltith Surgeon General during the Clinton
and George W. Bush admini-ltations. He ha> al.-o
served in high-level positions at the Centers for
Disease Control and Prevention, the Kaiser Family
■
TRANSGENDER, from page 10
their gender identity,” Reike said.
Medical forms and electronic health
records also do not have places to enter
information such as a person’s preferred
pronoun or a chosen name different from
their birth name.
Receptionists at a clinic or hospital’s
front desk may even yell out the incorrect
name, which can cause emotional pain. It
can also lead to feeling physically unsafe
and to more harassment, violence and
prejudice because a person has “been
called out as being transgendered,” Reike
said.
Reike and others acknowledge that
using incorrect pronouns and names can
result from a simple mistake or oversight
“I still misgender someone,” Reike said.
“I say something that’s not accurate.”
Patients may go to a doctor for routine
care and may be given an unnecessary
pelvic exam or asked questions about their
genitalia or hormones.
“I thought I had strep throat once and
the doctor was asking about surgeries and
hormones and how it all works,” McGinnis
said. “That had nothing to do with strep
throat.”
McGinnis said some interactions
Page 11
News
Street Roots • May 20-26, 2016
Foundation and the Morehouse School of Medicine.
In 2006, he founded the Satcher Health Leadership
Institute at the Morehouse School of Medicine. The
Institute’s mission is to promote policy and practices
that will eliminate disparities in health.
Satcher said the major factors are what are known
as the social determinants of health: a person’s access
to transportation, then education, wutk and income,
where they live, etc. The thing that people within
health care can most easily change, he said, is the
health care system.
Amanda Waldroupe: How is changing the health
system easy?
David Satcher: We spend more money than any
other country on health care. And we don't have a
system that’s universal. We invest enough money in it
that we can provide access to quality care to
everybody, if we did it the right way. That means we’re
going to be focusing on preventive care, like preventing
obesity and diabetes That means w ere going to invest
in our schools, and physical education, and good
nutrition. It nitans we’ic going to provide the kind of
environments where every child can be physically
active. It’s what we as a country' must do to eliminate
disparities in health.
A.W.: What do you think that comes down to? Is it the
lack ot political m il at the federal level? The power of
i hsurancc rómpame s?
D.S.: It’s a combination of things. Surely, when it
comes to the politics, it has not, unfortunately, been
supportive enough of everybody being able to access
between a transgender person and their
health care provider are tainted by “the
ick factor.”
“Transgender people are seen as a
curiosity, an oddity,” he said. Health care
providers effectively send a message to
transgender patients that “we don’t want
to see you. We don’t know how to treat
you. And you’re kinda weird. I don’t really
know about you, and it kind of makes me
uncomfortable. Can you go somewhere
else?”
Training health care workers
The solution to changing the way health
care is provided to transgender people
starts with language - training providers
to ask about people’s preferred pronouns
and chosen name.
“You don’t want to mess it up,” Rieke
said. “It undergirds everything.”
Adding a place for preferred pronouns
in electronic health record systems is one
of many examples where the health care
system can be more sensitive to
transgender people, Rieke said.
“We had to find a place to fit it in,”
Rieke said. “It’s one small piece, and it’s
so complicated to change. But it’s so
im portant”
The Old Town Clinic allows people to
use bathrooms that match a person’s
health care. The Affordable Care Act was passed by
one party and not a single Republican voted for it. I
often .-¡i\ that we need to declare health arid health
care a political no-fly zone. The way we deal with
health care is too political,
A.W.: Then ate. more tforts to use Medicaid funding
flexible like paying for a pahent's shnrl-torm rent
assistance if getting them into stable housing could affect
then hfalth, or pay for an air conditioner for a person
mlh congestive heart failure. Do you think that is a part
of the solution?
D.S.; That’s one way to look at i t The other way is
to make sure that everyone has adequate income and
adequate housing. You could argue that health care
dollars should be spent for health care. The health
care budget is not the only way ro get money for those
things. Should we invest other monies in seeing
everybody has good working conditions and safe
housing? The answer is yes. Should there be no
children in this country who are exposed to lead in the
water? Is that the responsibility of health care? Or the
social determinant responsibilities of government? The
whole point of the social determinants of health is
what we used to call “health in all policy."
I think that when you develop budgets for housing,
for example, one thing you’ve got to consider is how it
will impact the health of the person.
So. the answer is not just in the health cate budget.
You've got to look at health as a component of all
policy. Whenever you are making policy, you ought to
ask yourself: How will this impact health?
gender identity. The clinic has also trained
front-desk staff, pharmacy staff and other
people who may not provide care to
transgender people but still interact with
them in the clinic on how to appropriately
communicate.
The clinic posts transgender-related
trainings, workshops and other events “to
normalize the existence of those things”
for the clinic and Central City Concern’s
staff, Rieke said. It also shows transgender
people that the clinic is accepting and
trans-inclusive.
Rieke also said it’s important that if
clinics and health care providers are
unable to provide services, they are able
to provide specific information and
referrals to other clinicians that do.
Last year, Outside In closed its Trans
Clinic and integrated all its services into
Outside In’s primary care clinic.
Over the course of a year, McGinnis and
other staff at the Trans Clinic provide
trainings and workshops. Outside In sent
its clinic’s providers to other trainings and
brought in providers from the community
to act as consultants.
Ultimately, providing trans-inclusive
primary care is easy, McGinnis said.
Hormone replacement therapy is just a
prescription medication and occasional
blood tests.
“It’s not complicated,” he said. “The
biggest thing in terms of training is
building the confidence of providers.”
Dr. Suzanne Scopes, a naturopath and
former volunteer doctor with Outside In’s
Trans Clinic, agreed.
“It doesn’t take that much,” she said. “I
teach doctors all the time. It takes a few
hours, a few nights reading some basic
information.”
As hospitals like Oregon Health &
Science University begin training all their
medical staff on providing trans-inclusive
care and being more sensitive to
communicating with transgender people,
McGinnis said, trans-inclusive care is more
than a doctor being able to provide
comprehensive medical care to patients.
“We have patients come in and they’re
suffering from extreme depression and
suicidality, who are struggling with
anxiety,” he said. After starting hormone
replacement therapy, “they come back and
these folks are no longer suicidal and have
their depression lifted because they can
finally be able to live in an identity and in
their body.
“It’s medically necessary care that stops
people from killing themselves, straight
up.”