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Canada has an international reputation for tolerance and free universal health care. However, these provisions don't hold up as well for its trans citizens, whose access to health care is often impinged by systemic transphobia and provincial differences in surgery options.
In part one, access to gender confirmation surgery was shown to vary by province, making the availability of certain procedures a regional lottery. rabble asks, why does provincial health care vary so widely and what is the federal government's role in ensuring equitable access for all trans Canadians?
Although all Canadian provinces now cover some gender confirmation surgeries, access to specific procedures depends on where you live. Ontario has recently made efforts to improve its health-care provisions for trans Ontarians, however there is still widely reported disparity in terms of access to primary health-care providers. Experts cite systemic transphobia for this disparity in health-care access.
NDP MPP Cheri DiNovo, who has long been an advocate for LGBTQ rights, suggests that Canada is only just beginning to realize its responsibility towards its trans citizens.
"We're just beginning to come to grips with the reality of being trans in Canada. When you look at the stats, they are the most marginalized of the marginal in Canada as we speak," DiNovo told rabble.
This national trepidation can be seen in the convoluted referral procedures, disparity between provinces, and lengthy travel and wait times for trans Canadians hoping to access surgery.
Jordan Zaitzow, the Trans Health Connection Coordinator at Rainbow Health Ontario also cites transphobia as the "largest barrier" to primary health care for trans people. Zaitzow emphasizes that trans health care is not "medically complex, but physicians and other health-care providers are sometimes still resistant to doing it."
Zaitzow credits this reluctance to a hesitancy to deal with trans clients. He explains the process of training health-care providers to deal with trans clients: "It really is just about demystifying trans bodies and demystifying trans health care. People don't know. Trans care is just beginning to be incorporated into medical and other health-care curriculum."
The hesitancy to address the fallout of transphobia in Canada is also reflected in the Canadian Human Rights Act, which still doesn't include a provision to protect trans Canadians as a minority. Bill C-16, a new bill currently in its second reading, hopes to change this by adding "gender identity or expression" to the act.
However, some provincial human rights codes are further ahead, with more than half the provinces protecting gender identity.
New Brunswick, the last of Canada's provinces to offer coverage of gender-confirming surgeries under its health-care program, still doesn't protect gender identity or expression under its current Human Rights Act.
However, in contrast to its lack of coverage for gender confirmation surgeries, the Northwest Territories was one of the first jurisdictions in Canada to protect "gender identity" under its human rights code.
Such nationwide inconsistency begs the question, what is the role of the federal government in influencing provincial policy?
DiNovo compares the trans health care situation in Canada to North Carolina's infamous "bathroom bill," which prohibits trans people from using the bathroom of their lived gender. She raises the question of federal responsibility for protecting the rights of trans Canadians across the country.
"You can see, south of the border, how states can be completely rogue, how Obama can come and say one thing and the life of a trans person in most of the states is still horrendous."
DiNovo is also keen to point out that the current movement to pass Bill C-16 would not protect trans persons in situations of employment, medical or housing discrimination.
"In many provinces in Canada, an employer can say I'm not going to hire you because you're trans, or I'm not going to see you because you're trans if you're a doctor, or I'm not going to rent to you because you're trans if you're a property owner. That's…the situation in most of Canada still."
Rebecca Gilman, a spokesperson for Health Canada, issued the following statement in response to questions about federal responsibility: "While provincial and territorial governments have primary jurisdiction in the administration and delivery of health-care services, including sex reassignment surgery services, Health Canada believes that all Canadians deserve equitable access to needed medical services."
Prime Minister Justin Trudeau raised the rainbow flag on Parliament Hill at the beginning of June in support of LGBTQ Pride Month. He will also be marching in Toronto's Pride Parade on July 3, led by Black Lives Matter Toronto, and Vancouver's Pride Parade on July 31, the first Canadian prime minister to do so.
However, in spite of this gesture towards LGBTQ rights, the federal government still isn't fulfilling its duty to trans Canadians. Although all provinces now fund some gender confirmation surgeries, the Northwest Territories and Nunavut still don't cover any of these vital procedures.
Furthermore, the effects of discrimination are known to cause health problems for LGBT people, making it vital that the federal government actively work to reduce transphobia.
Although it is widely hoped Bill C-16 will pass the senate, the bill still doesn't ensure workplace, medical or housing equity for trans Canadians.
It's time the federal government put its money where its mouth is and pressured all Canadian jurisdictions to grant equal rights and health-care access across the board to their trans residents.
Laura Brightwell likes to think of herself as a writer. She is currently a PhD candidate at York University and can be found online at lipstickterrorist.wordpress.com and rabble and @mslauralipstick on Twitter
Photo: flickr/Dennis S. Hurd
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