Social Determinants of Transgender Health
Scout
Submitted in partial fulfillment of the
requirements for the degree
of Doctor of Philosophy
under the Executive Committee of the
2005
© 2005
Scout
All Rights Reserved
ABSTRACT
Social Determinants of Transgender Health
Scout
Transgender people are “compromised
survivors” who both experience and challenge gender-based oppression.=
The
term “transgender” describes a diverse population of people who=
se
identity does not conform to normative gender expectations. Transgender people experience adve=
rse
health outcomes unlikely to be biological in nature, and are best understoo=
d in
terms of social determinants of health. The social determinants fram=
ework
contextualizes transgender health outcomes, situating them within a larger
social context of discriminatory gender oppression. Life history interviews with 13
transgender people, focus groups with 16 transgender people and 9 in-depth
interviews with “key informants” suggest that stress, (lack of)
social support, and social exclusion are the primary social determinants of
transgender health.
Violence-related stress is most pronounced. Violence against transgender peopl=
e is
associated with level of gender variance; transgender people who regularly
“pass” as either gender reported lower frequency of violence.
LIST OF CHARTS, GRAPHS, AND
ILLUSTRATIONS
A NOTE ON PRIVELDGE AND OWNERS=
HIP
An Introduction to
“Transgender”
CHAPTER TWO: REVIEW OF THE
LITERATURE
Complicated relationship with =
the
medical community
Social determinant information=
CHAPTER THREE: RESEARCH METHOD=
S
The Research Plan: A Triangula=
tion
of Qualitative Methods
Conceptual and Empirical Chall=
enges
in Studying Transgender People
Data Sources: A Study in Finding Hard to Reach
Populations
Findings related to a secondary
research question
Data Transcription, Cleaning, =
and
Verification
Introduction: The Effect of
Discrimination
The Major Finding: Compromised
Survival
Research Question: How Do Social Determinants Affect
Transgender Health?
Finding 1: Transgender Health is Defined by
Extremely High Stress
The Stress of Pervasive Violen=
ce
Place and time 1: Amanda Milan=
on
the mind
Trauma and early development:
“A heart of stone”
Violence in perspective: explo=
ring
its role across narratives
The example of three white wom=
en:
visibility equals risk
FTMs: less exposure to violenc=
e but
still not safe
No warning, never safe: the
phenomena of “hair-trigger violence”
Place and time 2: Paola Matos =
on the
mind
The Stress of Internalized Gen=
der
Oppression
Introduction: seeing the ̶=
0;the
pattern of craziness”
Traditional gender oppression =
and
transphobia: the story of Anna
Non-traditional gender paradig=
ms
still oppress: the story of Carrington.
Internalizing gender oppressio=
n in
perspective: its role across narratives.
The stress of internalized gen=
der
oppression: in conclusion
Finding 2: Transgender Health =
is
Defined by Extreme Social Exclusion.
Extreme Social Exclusion: the =
Story
of Darlene’s Transition
Social Exclusion From Educatio=
n
Education as social support: o=
ne
unusual college in the south
Social Exclusion From Employme=
nt=
Social Exclusion from Health C=
are
Interaction Between Social Exc=
lusion
and Transitioning
Social Exclusion in Conclusion=
Finding 3: Transgender Health =
is
Constrained by Lack of Social Support.
Social Support and Family of O=
rigin
Widespread stories of early li=
fe
rejection and alienation
Later life support from family=
of
origin
Social Support & Personal
Relationships
The role of initial community
contact
CHAPTER FIVE: SUMMARY AND
CONCLUSIONS
Review and Discussion of Prima=
ry
Research Findings
Transgender health is characte=
rized
by compromised survival=
Review and Discussion of Secon=
dary
Research Findings
Social determinants is a valua=
ble
framework for studying highly stigmatized populations
Recommendations for future res=
earch
Additional research on social
determinants
Prioritize educational system
interventions
Prioritize early life safety n=
et
interventions
Pursue multi-level policy chan=
ges
Prioritize mental health and t=
rauma
recovery services across the lifespan.
Prioritize life-stabilizing
interventions and services
Prioritize interventions tuned=
to
population-specific challenges
APPENDIX: INSTITUTIONAL REVIEW=
BOARD
PROPOSAL
Social determinants of
health, p. 23
Profile of North Amer=
ican
transgender needs assessments, p. 36
Research plan, p. 65<= o:p>
Research outcome, p. =
65
Outreach plan overvie=
w, p.
82
Strategies to verify a
message, p. 89
Steps to distributing=
a
verified solicitation, p. 90
Steps to building inr=
each,
p. 91
Interview locations, =
p. 98
Life history particip=
ant
profile, p. 101
Major coding nodes, p=
. 103
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p; &=
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ACKNOWLEDGEMENTS
This research wou=
ld not
exist were it not for the assistance and support of a great many people.
Thank you also to=
my
family. Lynette Wood, I am so=
proud
to be your son and more like you than I will admit. Thank you for first introducing me=
to
the queer community so long ago, and for the friendship and guidance over y=
ears
that only a mother can provide.
Alice Deighan, your early connections to the transgender community w=
ere
invaluable. I am indebted to =
you
for the years of time and energy you invested in my education, thank you so
much for that. While I would =
not
otherwise counsel going through a divorce in the middle of a dissertation, =
for
me these life changes brought an unexpected benefit. My greatest thanks go to Susanna J=
ane
Rankin Bohme, my partner in life and now dissertation crime. Yours was an addition to the team =
that I
did not expect and cannot now imagine being without. I only wish everyone writing a
dissertation could have an able a supporter and strategist rolled into
one. All of the acknowledgeme=
nts
above carried me through the intense period of fieldwork, but you
single-handedly provided a foundation of support for the other world that is
writing. After years of langu=
ish,
you provided the crucial momentum that enabled me to finish. I cannot thank you enough for this
gift.
Finally, to my ch=
ildren,
Dwyer,
To Dr. Judith B.
Bradford, whose encouragement, vision, resources, patience, and friendship =
over
the last decade ensured that this would get done long before I even knew it=
was
coming into my life. I promis=
e to
pass on your gift to one from the next generation.
This research is =
focused
on communities for whom language has fallen short. Many of the words now in use are u=
nknown
to outsiders, and contentious to community members. I have chosen to use the word
transgender to broadly identify a set of communities linked by non-traditio=
nal
gender identities. But while =
this
is emerging as a useful tool in naming these groups to outsiders it is often
not adopted by people within the communities. Issues of language are addressed i=
n the
body of this document, and in fact they are perhaps minimized, because that=
is
not the focus of this research.
While it might be difficult to find appropriate pronouns for the peo=
ple
herein, that should not be an obstacle to understanding their life experien=
ces.
Through
the process of this dissertation, I was fortunate enough to have people
generously share their life stories.
Included in those three or so hour events was decades of time spent
surviving experiences I could not have possibly imagined. After those interviews, I used the
skills I had built through my advanced education to cut, package and commen=
t on
the information in a framework that would help move forward academic discou=
rse
on chosen topics. While conve=
ntion
dictates that this dissertation have my name on it, I wholly acknowledge th=
at
the import of this document was contributed by and is owned by the
participants. My addition, th=
rough
the privilege of my education, is only the secondary styling.
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