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Category: Diversity, Inclusion, & Accessibility

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Picture of the Martin Luther King, Jr. Memorial in Washington, D.C.
Photo by Mark Stebnicki

As we reflect on the life, work, and impact that Dr. Martin Luther King, Jr. has had on our nation and the world, we are reminded that Dr. King was passionate about activism on racial discrimination, poverty, and health disparities. A great way to honor Dr. King’s legacy and continue his important work is to learn more about anti-racism, inequities, and disparities in healthcare and use this knowledge to help build a more inclusive healthcare system. Himmelfarb Library has some great resources that can help you learn more about these topics so you can put your knowledge into action!

Himmelfarb Resources: 

Himmelfarb’s Anriracism in Healthcare Guide provides information and resources related to antiracism in healthcare including links to professional healthcare organizations centered around diversity and health justice issues, training resources, and links to GW-specific organizations. Browse the Journal Special Collections tab to find journal issues and health news on antiracism-related issues. Antiracism books and ebooks available at Himmelfarb are also included in this guide including: 

The Antiracism in Healthcare Guide also has links to podcasts, tutorials, and videos including:

In addition to the Antiracism in Healthcare Guide, Himmelfarb has a Diversity and Disparities in Health Care collection of books and e-books with nearly 200 books addressing issues of disparity and representation of minority communities in healthcare. 

Advancing the Dream Event:

On Tuesday, January 16, 2024, at Noon, SMHS and the Anti-Racism Coalition will hold the 8th Annual SMHS Dr. Martin Luther King, Jr. Lecture Series - Advancing the Dream: From Dream to Reality - The Journey Continues. This year’s speaker is Dr. Italo M. Brown, MD, MPH. Dr. Brown is an Assistant Professor of Emergency Medicine and Health Equity and Social Justice Curriculum Thread Lead at Stanford University School of Medicine. Please join us in room 117 of Ross Hall (virtual attendance via Zoom is available) for this great event!

Flyer for the 8th Annual GW SMHS Dr. Martin Luther King, Jr. Lecture Series. Information in image is included in blog post.

Student and Professional Organizations:

If you are interested in becoming more involved, consider reaching out to local student or professional organizations such as White Coats for Black Lives or the Antiracism Nursing Student Alliance. Involvement with these and similar organizations can help you put your knowledge into action and offer opportunities for collaboration in furthering the cause of finding solutions to healthcare disparities and opportunities to educate others on issues of health injustices.

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December is Universal Human Rights Month and this past Sunday (December 10th) was the 75th commemoration of the adoption of the Universal Declaration of Human Rights by the UN. The declaration was formed three years after the ratification of the United Nations charter. In the wake of the horrors of World War II there was a strong impetus to establish both a peacekeeping body and an agreed set of fundamental human rights to be universally protected.

Among the rights in the declaration are:

  • All human beings are born free and equal in dignity and rights.
  • Everyone has the right to life, liberty and security of person.
  • No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.
  • All are equal before the law and are entitled without any discrimination to equal protection of the law. 

There are over 30 articles in the declaration, ensuring freedom of movement, right to asylum, right to education, freedom of peaceful assembly, freedom of opinion and expression, freedom of religion, and right to privacy among others. It recognizes the right to marry and equal rights and dignity in employment. Article 25 specifically addresses the right to medical care:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. (United Nations, 1948)”

The United States is a signatory to the Declaration. Despite this, our government does not always live up to the ideals of the document. The structure of the health care system in the US does not support the standard of universal care guaranteed in Article 25 and the US has failed to ratify most of the international treaties that include a right to health (Willen, 2019). FDR advocated a Second Bill of Rights to include the right to “adequate medical care and the opportunity to achieve and enjoy good health” in his 1944 State of the Union. President Truman was also an advocate of a national health insurance program tied to Social Security. But in the 1940’s private health insurance became more common in the US, covering about half of the population, and the insurance industry created a barrier to further proposals for a national health program at the federal level (Berkowitz, 2005). 

The Johnson administration established Medicare and Medicaid in 1965 after a many years long fight and negotiation with the insurance industry. It was largely successful because it covered vulnerable populations who typically were too high risk to be privately insured. For decades many Americans fell through the gaps between the coverage of those programs and private insurance. 

While the Affordable Care Act of 2010 brought affordable health care to millions more, the country still fails to provide care to everyone and the current complex system of public and private funding increases inefficiencies and costs. A post pandemic study documented how our “fragmented and inefficient health care system” cost over 200,000 more lives and billions more in expenses during the Covid pandemic than a single payer system would have (Galvani, et al. 2022).  A 2022 survey published by KFF (formerly Kaiser Family Foundation) estimates that 41% of adults currently have some debt as a result of medical or dental treatment and one in 10 has significant medical debt. A quarter say they have debt that is past due or that they are unable to pay. One in four black adults, lower-income adults, and uninsured don't think they will ever pay off their health care debt. 

A January 2023 Gallup poll found that 57% of Americans say the government should guarantee health coverage for everyone, but a 53% majority want to preserve the current private insurance system. The AMA endorses expanding ACA and Medicare while preserving the current system of private insurance while Physicians for a National Health Insurance Program advocates for a non-profit single payer system. The American Academy of Family Physicians takes the middle ground  of laying out multiple options to get to universal care including a single payer model, a public option, and Medicare/Medicaid buy in.

However it is achieved, further progress in health care reform is necessary to provide the universal coverage all Americans deserve and reduce the costs and inefficiencies that are negatively impacting the delivery of healthcare in the US.

Sources

Berkowitz E. (2005). Medicare and Medicaid: the past as prologue. Health care financing review, 27(2), 11–23.

Galvani, A. P., Parpia, A. S., Pandey, A., Sah, P., Colón, K., Friedman, G., Campbell, T., Kahn, J. G., Singer, B. H., & Fitzpatrick, M. C. (2022). Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic. Proceedings of the National Academy of Sciences of the United States of America, 119(25), e2200536119. https://doi.org/10.1073/pnas.2200536119

United Nations (1948). Universal Declaration of Human Rights. https://www.un.org/en/about-us/universal-declaration-of-human-rights

Willen S. S. (2019). Invoking Health and Human Rights in the United States: Museums, Classrooms, and Community-Based Participatory Research. Health and Human Rights, 21(1), 157–162.

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International Transgender Day of Remembrance takes place on November 20th every year. It is a solemn day that honors the transgender and gender diverse people who died due to acts of transphobic violence. The day began in 1999 when trans rights advocate, Gwendolyn Ann Smith, held a memorial to honor Rita Hester, a transgender woman who was killed in 1998. From that first memorial in the late 90s, Transgender Day of Remembrance was soon recognized both within the United States and around the world. As Gwendolyn Ann Smith said “Transgender Day of Remembrance seeks to highlight the losses we face due to anti-transgender bigotry and violence…With so many seeking to erase transgender people–sometimes in the most brutal ways possible–it is vitally important that those we lose are remembered, and that we continue to fight for justice.” (GLAAD, 2023)

Accurate statistics on the violent deaths of transgender people are difficult to find for many reasons. “Many hate crimes and murders go unreported or, crucially, misreported in the media–meaning the actual number of deaths could be far higher.”(Wareham, 2023)  Transgender Europe is a collective of different organizations that advocates for equal rights and protection for transgender and gender diverse people. Each year at the start of Transgender Awareness Week, the group releases their Trans Murder Monitoring Global Update. This report tracks news articles of murdered transgender people. Since 2008, the organization has released a global report on the deaths of transgender people as well as observations on data trends. In their 2023 update, they reported that between October 1, 2022 and September 20, 2023, “320 trans and gender diverse people were reported murdered…This total is very close to the 327 cases reported in the previous year, showing that deadly violence against trans people remains at a consistently high level.”  (Transgender Europe, 2023) Alongside their global update report, Transgender Europe also released an updated map that shows 2023’s data as well as the total data collected since 2008. This map tracks the global violence transgender and gender diverse people face.

The National Center for Transgender Equality, an organization based in the United States, recently released their Trans Remembrance 2023 report with their virtual Trans Remembrance memorial. “We crafted this digital space for both grieving and celebrating those we’ve lost. Countless precious trans lives have been extinguished, and to grieve is an arduous journey. However, in our period of grief, we persist. We pay tribute to and exalt the existence of those who have departed, and our brilliance remains unaltered.” (National Center for Transgender Equality, 2023) The memorial highlights the stories of transgender and gender diverse people who lost their lives due to bullying or overt transphobic violence. Visitors are encouraged to read the stories of the people memorialized on the website in an attempt to combat transphobia. 

Transphobic violence may be underreported or misreported, but there are news sources that accurately report these instances. Organizations such as Transgender Europe, the National Center for Transgender Equality and GLAAD are valuable sources. LGBTQ focused news organizations and reporters such as LGBTQNation, Autostraddle, Erin Reed and Washington Blade also provide comprehensive coverage of transphobic legislation and bigotry. 

International Transgender Day of Remembrance is a day to mourn the lives lost and work towards equality and safety for transgender and gender diverse people. “Any measure of society must include the value it finds in protecting its most vulnerable from harm and healing the wounds they have already suffered….Transgender Day of Remembrances has never been so important.” (National Center for Transgender Equality, 2023)

Citations:

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Photo of vets with US flags at a fundraising event.

6 million US veterans receive care at a Veterans Health Administration (VHA) facility at least once a year. There are 1,298 sites of care within the VA system including medical centers, outpatient clinics, and nursing homes. Access to VA care is available to veterans who have proven service-related disabilities. They are “poorer, older, and sicker than private sector patients” (Veterans Healthcare Policy Institute and the National VA Council of the American Federation of Government Employees, 2023).

These facilities have been chronically understaffed for decades, resulting in long wait times for service for many veterans. In 2014, Congress passed the Veterans Access Choice and Accountability Act which allowed veterans to seek care at approved community clinics. A 2022 JAMA study found that between January 2018 and June 2021, veterans waited an average of 29 days for a primary care appointment and that time varied substantially depending on where the care facility was located. The study reported wait times extended to 38.9 days for those using community-based clinics. Allowing veterans to use these resources did not result in reduced wait times. A VA Department Inspector General’s audit in 2022 found that the wait times the VA system reported misrepresented the time a patient had to wait for care, using the date of appointment creation instead of the day the service was requested. For example, a cardiology appointment was logged as a 43-day wait when it was actually 66 from the date referred (US Dept of Veterans Affairs, 2022).

A survey of Veterans Affairs personnel conducted in Spring 2022 included the following findings:

  • 96% of VHA respondents indicated their facility needs more frontline clinical staff. 75% percent said their facility needs more administrative staff. 77% said that there are vacant positions for which no recruitment is taking place. 
  • 77% of those who responded to the survey reported that their VHA facilities have closed beds, units, and/or programs due to staffing and budget shortfalls. 
  • 55% of VHA respondents said they have less time to deliver direct patient care and support services than they did four years ago.

(Veterans Healthcare Policy Institute and the National VA Council of the American Federation of Government Employees, 2023)

This study recommended a number of measures to improve staffing, burnout, and inadequate facilities to serve the needs of the 9/11 generation of veterans who are “among the most disabled in the nation’s history.” These measures include increasing funding to support hiring and retention, infrastructure improvements at existing facilities, and construction of new and expanded facilities. HR dysfunction resulting from a Trump-era human resource management project that sought to centralize HR activities has resulted in delays in hiring. “Almost 50 percent of respondents said that the HR modernization project had increased the time it takes to hire a new employee… 93 percent said they had lost candidates to competing offers because of delays in the HR hiring process.” The report recommends that HR activities come back to the local level to allow personnel managers to respond to local conditions and needs.

Last year VA employee unions lobbied Congress to pass the “VA Employee Fairness Act” which will allow clinical staff collective bargaining rights. This should result in higher salaries and improved benefits and working conditions.

The VA also recently launched an AI Tech Sprint to develop tools that will ease the paperwork burdens on clinicians. Up to $1 million will be awarded to winning teams of developers. It is part of a Reduce Employee Burnout and Optimize Organizational Thriving (REBOOT) Task Force aimed at achieving hiring and retention goals. 30 chief well-being officers at VA healthcare facilities are meeting with frontline employees to gather and communicate their feedback on desired change. One of those is more flexible scheduling, for example, allowing nurses to work a “72 for 80” schedule of three 12-hour shifts a week. The VA is optimistic that these changes will help the agency meet ambitious FY 2023 hiring and retention goals.

Sources

Feyman Y, Asfaw DA, Griffith KN. Geographic Variation in Appointment Wait Times for US Military Veterans. JAMA Network Open. 2022;5(8):e2228783. doi:10.1001/jamanetworkopen.2022.28783

Heckman, J. (2023). VA launches AI Tech Sprint to reduce burnout among health care employees. Federal News Network. https://federalnewsnetwork.com/artificial-intelligence/2023/10/va-launches-ai-tech-sprint-to-accelerate-work-reducing-burnout-in-health-care-workforce/

US Department of Veterans Affairs/Office of Inspector General. (2022). Concerns with Consistency and Transparency in the Calculation and Disclosure of Patient Wait Time Data. https://www.va.gov/oig/pubs/VAOIG-21-02761-125.pdf

Veterans Healthcare Policy Institute and the National VA Council of the American Federation of Government Employees. (2023). Disadvantaging the VA: How VA Staff View Agency Privatization and Other Detrimental Policies. https://www.afge.org/globalassets/documents/generalreports/2023/03/vhpireport_v2.pdf

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Native American Heritage Month occurs in November every year. The month “is a time to celebrate the traditions, languages and stories of Native American, Alaska Native, Native Hawaiian, and affiliated Island communities and ensure their rich histories and contributions continue to thrive with each passing generation.” (U.S. Department of the Interior, n.d.) Many governmental agencies and health organizations share resources that discuss the history of Indigenous groups within the United States. 

Native Voices: Native Peoples’ Concepts of Health and Illness is a virtual exhibition that “explores the interconnectedness of wellness, illness, and cultural life for Native Americans, Alaska Natives, and Native Hawaiians.” (National Library of Medicine, n.d.) The exhibit is split into five sections:

Along with the five sections, a collection of interviews touches on themes such as community, healing, nature and more. 

The virtual exhibit has educational resources that are useful in a classroom setting or for personal use. Their suggested readings bibliography features works by Native Americans or works that focus exclusively on Native Americans. 

The Office of Minority Health (OMH) provides current information about the health of indigenous communities. Their Population Health Data has census reports, links to additional health websites and statistics about indigenous communities. The health data is separated across multiple categories such as asthma, cancer, immunizations and other health concerns. Finally, the OMH’s American Indian & Alaska Native Health in the United States pathfinder guides users to appropriate resources such as journals, government websites and research articles. 

This month is an excellent time to explore the concerns and needs of American indigenous communities. The readings and resources listed above provide a glimpse of the long history and unique culture of American indigenous nations. 

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Many people are aware that June is LGBTQ Pride Month in the United States. But the community’s history is also recognized in October during LGBTQ History Month. This month began in 1994 when Rodney Wilson, a high school history teacher in Missouri, noticed a lack of LGBTQ representation in the curriculum. To address this gap, Wilson drafted a proposal and shared it with national organizations such as the Human Rights Campaign. Wilson worked with other historians and community organizers to ensure that LGBTQ History Month was nationally recognized. 

Wilson envisioned LGBTQ History Month becoming part of a school’s curriculum. This meant that he needed to consider the standard academic schedule when selecting when to honor LGBTQ History Month. October was selected because it did not overlap with other cultural or historical awareness months such as Hispanic Heritage Month (September) or Black History Month (February). October also had historical significance to the LGBTQ community in the United States. “The first March on Washington for Lesbian and Gay Rights in 1979 was in October. The second March on Washington in 1987 was also in October, specifically October 11–a date that would make the inaugural National Coming out Day the following year.” (Agassi, 2023)

For these reasons, October became LGBTQ History Month in the United States.

The 1979 & 1987 March on Washington for Lesbian and Gay Rights:

Similar to the Stonewall riots and protests in 1969, the 1979 and 1987 March on Washington for Lesbian and Gay Rights were two events that drew attention to the discrimination  the LGBTQ community faced. During both marches, community advocates listed their demands that would protect people regardless of their sexual orientation or gender. 

The 1979 march was inspired by the 1963 March on Washington where Dr. Martin Luther King, Jr gave his ‘I Have A Dream’ speech. Openly gay San Francisco Supervisor Harvey Milk pushed for a similar march for LGBTQ people. Unfortunately Milk was assassinated before his idea could become reality. Two New York based activists, Steve Ault and Joyce Hunter, moved forward with Milk’s vision. (Chibbaro Jr., 2017). The 1979 march drew national attention as thousands of people came to DC to protest and share their demands for an equitable society. 

“A five-point platform for the march called for passage by Congress of a “comprehensive” lesbian and gay civil rights bill; a presidential executive order banning discrimination based on sexual orientation in the federal workplace, the military, federally contracted private employers; repeal of all ant-gay/lesbian laws; an end to discrimination in child custody disputes for gay and lesbian parents; and protections for gay and lesbian youth against discrimination at home or in schools.” (Chibbaro Jr., 2017)Several years later, the 1987 march took place in October and the group of marchers had similar demands as the one made in 1979. This march also focused on the impact of AIDS on the LGBTQ community and discriminatory laws. “Items added to the platform beyond those included for the 1979 march included a call for legal recognition of lesbian and gay relationships; repeal of sodomy laws applying to consenting adults; an end to discrimination against people with HIV/AIDS; reproductive freedom for women; and an end to racism in the U.S. and an end to apartheid in South Africa.” (Chibbaro Jr., 2017) The AIDS Memorial Quilt was displayed for the first time on the National Mall during the march. This NBC News report provides a historical view of the 1987 march and press coverage. Additionally, there is an original recording of the 1979 March and other resources available to the public.

While Pride Month celebrates the accomplishments of the LGBTQ civil rights movement, LGBTQ History Month serves as a time to reflect on the history of the community and remind people of the hard work from activists and other historical figures. Rodney Wilson if believes it is vital to look to history and that history has a way to make people feel less lonely or uncertain about their lives. “For Wilson, history at its core is mystical, particularly “about this continuing conversation with the dead, and with the events that they worked on and completed in their lifetimes–some of which are still with us, and some aren’t. There’s a real mystical communion between the past, the present and the future in studying our history.”” (Agassi, 2023)

References:

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Spanish-English dictionary page showing translation for Latino
Spanish dictionary, by Abigail Luke on Flickr, shared under Creative Commons Attribution 2.0 license

In honor of National Hispanic Heritage Month, let’s spend some time focusing on SALUD!

SALUD is a student-run organization at GW which was founded about five years ago, and is dedicated to teaching and learning Medical Spanish. During the academic year, SALUD runs regular Spanish classes for medical students at three different levels: Beginner, Intermediate, and Advanced. The content of these sessions, which occur during the lunch hour, is keyed to vocabulary related to body systems students are covering in the Practice of Medicine course.

In class one day in early Fall, MS2 student instructors Emily and Giuliana ask the eight students attending the Advanced level class where they have learned their Spanish. Some speak it at home, while others have studied the language. There is a review of the vocabulary for the musculoskeletal system, after which the students partner up to practice patient interview skills. “¿Que le molesta?” (“Can you tell me what hurts?”) is one opening, whereas others might start with, “¿Necesita un intérprete?” (“Do you need an interpreter?”) Some students form groups of three, with one student acting as the interpreter. A student is curious about interpreting opportunities. While certification is required to be a medical interpreter, GW students are able to volunteer and use their language skills as patient navigators at the GW Healing Clinic, where about 80% of the clientele are Spanish-speaking.

Screenshot of slide on translating a 1-10 pain scale into Spanish
Screenshot of Advanced level Medical Spanish lesson on how to translate a 1-10 pain scale

Over in the Intermediate level classroom, students are reviewing musculoskeletal vocabulary, translating it from Spanish to English. The lesson follows the structure of a history of present illness, teaching students to seek information from patients on the location, quality, and severity of their pain, along with its duration, timing and context. The instructor points out synonyms, such as débil and tenue for weak, as well as words that have more than one meaning, like sordo, which can mean deaf, but also dull, which might describe a patient’s pain. In the Beginner classroom, a dozen students begin their exploration of the same vocabulary at a slower pace.

In addition to teaching Medical Spanish, classes aim to teach students the correct use of interpreters. SALUD also serves the Latinx community in DC through Bridge to Care, an initiative of the GW Healing Clinic. Because up to 80% of patients seeking care at the Healing Clinic are Spanish-speaking, the support of students with Spanish-speaking skills from across the MD Program, PA Program, and MPH candidates from the Milken Institute of Public Health is essential.

A few days after the first lesson of the year, I met with two of SALUD’s board members, Tammy Moscovich (MS2) and Alisha Pershad (MS2). While Tammy was raised in a Spanish-speaking family, Alisha’s interest in learning Spanish developed through school. Alisha sought to put her Spanish skills to use, and pursued official interpreter training to earn a certification. Through her SALUD teaching, Alisha hopes “to empower others” to combine their Spanish-speaking skills with patient care.

The curriculum used by SALUD comes from a Medical Spanish course from Boston University, which was adapted with permission by medical student Cecilia Velarde De La Via (MS3). The curriculum correlates to the system blocks students learn about in the Practice of Medicine course, and includes both vocabulary, sample patient interviews, and flash card decks. The Intermediate level class is “more conversational than technical,” according to Tammy, whereas the Advanced class focuses more on review.

Screenshot of phrases in Spanish and English suggested for patient interactions
Screenshot of a suggested script for interacting with Spanish-speaking patients

Are there SALUD success stories? Tammy and Alisha shared one: a current MS3 student who began Medical Spanish last year eager to practice her skills gained confidence through the classes. Now, in rotations, she feels more confident with her Spanish skills in working with patients. For Tammy, her time serving at Bridge to Care serves as a good refresher for vocabulary lessons. Then there are the finer points to learn when working with patients coming from different parts of the Spanish-speaking world, like the difference in terminology from one country to another, or learning the informal terms used by patients in a medical context, versus the clinical terms. Tammy commented that, “This is the word I use” is a valuable contribution to the Spanish lessons, helping to communicate the variations across borders. Alisha agrees, adding that classes are enriched by people bringing their individual experiences and sharing it.

The increased arrival of migrants to the DC area is something the GW Healing Clinic is experiencing via some of the patients coming through its doors. Alisha reported that there have been more patients arriving with acute conditions, adding that “it’s gratifying to facilitate the encounter, and help them recover.”

From the classroom to the exam room, SALUD is helping students increase their confidence in both bilingual encounters and collaborating with interpreters, while helping patients in the community access medical care that speaks their language.

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Addressing consumer health questions from a racial or ethnic minority group requires cultural sensitivity and understanding. Healthcare organizations such as the Centers for Disease Control and Prevention, the National Institutes of Health, the Department of Health and Human Services and the Office of Minority Health provide consumer health resources that are available in multiple languages. The organizations also share resources on how to connect with minority groups in a healthcare environment. These resources allow providers to communicate health information with their patients and also establish a rapport between patients and providers no matter their background. To commemorate this year’s National Hispanic Heritage Month, we are highlighting several consumer and healthcare provider resources that specifically address the needs of the Hispanic community. 

The Office of Minority Health aims to “improve the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities.” (Office of Minority Health, 2019, para. 1) The office recently released their “Better Health Through Better Understanding for Hispanics/Latinos” reading list. The list is divided into three sections and contains information for both health consumers and providers. The resources are free to access and download. Some of the resources are available in English and Spanish so they may be shared with patients who may not be fluent in English. Lastly, there are links to journal articles that discuss the treatment and health outcomes of the Hispanic/Latino population. 

The Office of Minority Health also provides resources based on the five social determinants of health. The listed information contains federal and non-federal options so the information is applicable to many individuals. Similar to their Hispanic Heritage Month reading list, the resources on this page are intended for both healthcare patients and providers. Some resources that may be of interest include:

If you’re looking for mental health resources, Palo Alto University’s curated list of Latinx Community Resources features books, videos, podcasts and more. There is also an extensive list of mental health organizations that serve the needs of the Hispanic community. 

Himmelfarb Library is home to a diverse collection of health information. The Antiracism in Health research guide is an excellent starting point for available resources. Links to student and national healthcare organizations are listed on the guide, directly connecting you to groups actively working to meet healthcare needs and dismantle barriers to access. Himmelfarb Library’s Diversity and Disparities in Health Care connects you to physical and electronic books, academic journals and other library materials. Please be aware that some resources will prompt users to login with their GW UserID and password to access.  If there are journal articles, books, podcasts or other materials that you believe should be featured on the antiracism research guide, please submit your suggestion through this Google form.

Finding additional resources to address the questions of a specific community may feel daunting. If you are interested in finding information similar to the sources listed in this article, Himmelfarb Library is here to help. There are several ways to contact a staff member including by email, phone, or instant message. Contact us with any questions you may have. 

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Gender-affirming care has been a topic within mainstream media for the past several years. While some people think of surgical interventions during these discussions, health care providers and organizations classify a range of treatments as part of a gender-affirming care routine. Research shows that transgender and nonbinary individuals who receive gender-affirming care experience greater health outcomes such as decreased levels of depression, anxiety and suicidality. Dr. Arjee Javellana Restar’s paper Gender-affirming care is preventative care, examines the relationship between mental health and access to gender-affirming care. “While there are established treatments available outside of GAC, preventing negative mental health outcomes before they occur requires widening the tools of prevention, and calling in medical, insurer, and policy communities to value GAC in improving mental health for trans people.” (Restar, 2023, pg. 2) In order to address the mental health outcomes of trans and nonbinary individuals, it is important that barriers to gender-affirming treatment options are eliminated and the patient’s autonomy is prioritized. 

Gender-affirming care are treatment options that aim to affirm a person’s gender identity. Treatments may include speech therapy, hormone therapy, or surgical interventions. Gender-affirming care options are frequently discussed and created by patients, healthcare providers and if the patient is a minor, parental or legal guardians are also present. The Association of American Medical Colleges states that “For children in particular, the time of the interventions is based on several factors, including cognitive and physical development as well as parental consent. Surgery…is rarely provided to people under 18.” (Boyle, 2022) 

Research shows that transgender and nonbinary people who receive gender-affirming care often experience improved mental health outcomes than those who do not receive treatment. Dr. Restar writes “Addressing mental health problems among trans people necessitates explicit programmatic and investment goals that allow the equitable provision of not just treatment, but instead, an array of both preventative and treatment tools…” (Restar, 2023, pg. 1) Both Dr. Restar and the Association of American Medical Colleges note that people who receive gender-affirming care experience lower rates of negative mental health outcomes. (Restar, 2023; Boyle, 2022) “GAC is linked to improved quality of life and mental health among trans people…To date, no studies have reported findings that suggest GAC increases negative mental health outcomes.” (Restar, 2023, pg. 1)

There are social and structural barriers that prevent people from accessing the full range of gender-affirming care treatment options. Dr. Restar suggests that the healthcare profession should make changes to the existing structures to allow for more equitable access to care.  “Over the years, the benefits of GAC has become apparent, yet beneficiaries remain exclusive, leaving many trans people to wait until eligible for treatment at the cost of worsened outcomes…To address the high prevalence of mental health problems, GAC must be synergized as part of combined preventative mental health care options and strategies.” (Restar, 2023, pg. 2) 

Building a gender diverse and gender-affirming environment is important because it “allows for frank discussions about the patient’s gender identity and related stress, sexual activity, and potential transition toward a different gender identity.” (Boyle, 2022) Himmelfarb Library’s Diversity and Disparities in Health Care special collection contains materials to help you learn more about transgender and gender diverse healthcare needs. Additionally, Dr. Restar’s article provides suggestions that may lead to healthcare structural changes and improve healthcare access for transgender and nonbinary individuals. 

References: 

Restar, A. J. (2023). Gender-affirming care is preventative care. Lancet Regional Health - Americas (Online), 24. https://doi.org/10.1016/j.lana.2023.100544

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Would you like to learn more about healthcare related disability and accessibility issues? Would you like to hear perspectives from disabled individuals as they discuss how their disability impacts their lives? The Disability Visibility podcast, hosted by Alice Wong,  has one hundred episodes that center disabled individuals and activists who work to create a more accessible world. 

If you are interested in listening to the podcast, Himmelfarb Library’s DEI Committee suggests starting with episodes 95 and 98. In episode 95, Alice Wong speaks with Dr. Justin Bullock, an African-American medical resident who wrote the New England Journal of Medicine article Suicide–Rewriting My Story. The episode’s conversation focuses on Dr. Bullock’s experiences with Bipolar Disorder, suicidality and his medical school and residency journey. Episode 98 is another conversation with UC Berkeley undergraduate student, Alena Morales. Morales shares her experiences with creating the Disability Cultural Center on Berkeley’s campus and what that process taught her about creating communities for disabled people. 

Other episodes that may be of interest include episode 77: Mental Health Advocacy, episode 54: Disabled Scientists, episode 24: Disability Justice and Community Organizing, and episode 17: Invisible Disabilities. Additionally, Disability Visibility: First-Person Stories from the Twenty-First Century features work from over 30 authors and is an alternative way to learn from disabled individuals.

If you listen to the suggested episodes and would like to hold a community discussion, the DEI Committee created a starting list of questions that may guide the conversation:

  • Did this podcast change your perspective on disability? What surprised you?
  • If you or someone you know has disabilities, what challenges have you/they faced?
  • How does disability intersect with other identities such as race or sexual orientation?
  • Are you aware of ways that GW accommodates students with disabilities? What else could be done?
  • Dr. Bullock discusses his experience with bipolar disorder. Had you considered mental health issues as disabilities? In what ways are these disabilities similar to and different from a physical disability? 

The Disability Visibility podcast is one part of the ongoing Disability Visibility project. To learn more about the podcast or the larger multimedia project, visit the project’s website at disabilityvisibilityproject.com. If there is a DEIA resource that you would like to share with the committee, please contact the current chair, Rachel Brill at rgbrill@gwu.edu.

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