January 6, 2020

What does health care look like in a post-binary world?

Dr. Aletha Maybank // WTF GENDER

Dr. Aletha Maybank joined the American Medical Association in 2019 as its first chief health equity officer.

Her mission, simply put, is to create a framework for the physician association to help improve health for all people. So, when Dr. Maybank asks What the Future, she’s asking how gender will matter as it interconnects with myriad social factors and institutions—in and out of the medical system—that affect people’s health.

WTF: Could you give us a brief explanation of what health equity means?

Dr. Aletha Maybank: I talk about it in terms of an outcome. It’s the conditions, resources, opportunities and power that allow one to achieve optimal health. You have to have all four. From the context of just human value, the human rights piece of it is demonstrating and saying that we all have a right to achieve optimal health and you have what it takes in order to do that. And we’re very clear that not everybody has all of those things. But it’s important to understand that it’s a process to get to that outcome.

WTF: What does this mean for practitioners and patients?

Maybank: A lot of folks talk about diversity and inclusion, of course. But then there are also things such as if you’re an institution, where do you give your money? Is that equitable? Are we supporting businesses owned by people of color or those that identify as women or LGBTQ? Are we collecting data in an equitable way? Are the systems set up so that they don’t cause harm and produce inequities? Are we asking questions that we need to ask? Do we have the right people on board to ask the questions?

WTF: Among the elements that create health inequity and inequality, how does gender factor in?

Maybank: We know oppression exists as a result of systems of racism, gender oppression, as well as classism. Gender identity also has an impact on health outcomes. Oftentimes, there are stereotypes toward people depending on how they identify based on their gender. Women’s experiences and symptoms don’t get recognized or acknowledged and paid attention to in the way that symptoms are for folks who identify otherwise.

Also, in this modern time, we no longer consider gender identity to be binary as male and female. There is a spectrum of gender identity which can intersect with identifying as lesbian, gay, transgender, queer, gender nonconforming and nonbinary. And evidence shows that folks who don’t identify as white and male–women who are black, as an example–have worse health outcomes as they relate to mortality. Black women are eight times more likely to die as a result of complications around childbirth in New York City, and about four times more likely in the country as a whole. If you are a black transgender woman, your death rate is one of the highest in this country right now.

WTF: Your big question was, “Will gender matter in the future?” Since gender is one of the bigger factors in equality, what did you mean by that?

Maybank: Gender equity will always matter. The source of inequities in this country is rooted in our history of colonization and the formation of structures and culture that were normalized through the guise of patriarchy, supremacy and heterosexism. This normalization is so deeply embedded in our mindsets and systems in this country. In addition, we are learning more and more that gender identity can be expressed in many ways beyond its binary form of man and woman. This expression across the spectrum of gender identity will not be static and will continue to evolve. And we as people, society and institutions will need to be responsive to the evolution and realities of people’s lives to ensure that we and our systems value all people to their fullest human capacity and desires, and that they are treated with dignity and respect.

WTF: Can you talk through specific changes you’d like to see to help create equity for patients in the future?

Maybank: If the [physician’s] gender is similar to the patient’s, we know that it can increase probabilities of survival for things such as heart attacks for women. This is why gender equity within the ranks of who’s a physician becomes important. Intake forms have to be set up so folks can identify across the spectrum of gender identity, which is inclusive of LGTBQ, nonbinary and nonconforming. And the same has to happen with race.

WTF: And what does that look like for practitioners?

Maybank: What it looks like in the [physician’s] office is also important. In society, we’ve become very normalized to not seeing informational posters that are representative of all colors, gender identity and language. But it’s amazing what it does when you start to see posters that look like you. You can identify better with what that messaging is on that poster. In addition, it’s important that we have gender-free restrooms. We use them every day in our homes, and it is unfair that people have to leave their office floors and sometimes the building to find a restroom that meets their needs.

Lastly, from the provider perspective, how do we better normalize conversations around power, privilege, oppression, patriarchy and heterosexism so people get more comfortable talking about these issues and the realities? We need to make sure that our biases are not impacting how we deliver care. For a patient to walk into an office where their providers have gone through structural competency, gender oppression, racial equity and cultural responsiveness trainings is very meaningful for the patient and provider, but also the entire folk that are within that system and that practice.

Dr. Aletha Maybank
Chief health equity officer, VP
American Medical Association
She, her, hers

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Gender might be fluidly expressed, but most still use binary pronouns.

How do you prefer to be referred to? That is, what are your preferred gender pronouns?

He/him/his/himself He/him/his/himself 45%

She/her/hers/herself She/her/hers/herself 46%

They/them/theirs/themself They/them/theirs/themself 1%

Ze/hir/hirs/hirself* Ze/hir/hirs/hirself 0%

Ze/zir/zirs/zirself* Ze/zir/zirs/zirself 0%

Other Other 1%

Don't know / Refused Don't know / Refused 7%

(Source: Study conducted between Oct. 4 and 7, 2019 on the nationally representative Ipsos KnowledgePanel, among 1,021 adults in the U.S. with an additional 285 adults gathered using demographic profiles and representative of the total LGBTQ population. *Percent was less than 0.5%.)

How gender and privacy factor in the patient experience.

The next few questions ask about your experience of going to see your primary healthcare provider (your general practitioner or main doctor) at their office. Please indicate the extent to which you agree or disagree with each of the following statements (Agree net):

When dealing with my healthcare provider, I am treated respectfully. When dealing with my healthcare provider, I am treated respectfully. 87%

When dealing with a healthcare provider, I often find that my questions or concerns are treated confidentially. When dealing with a healthcare provider, I often find that my questions or concerns are treated confidentially. 83%

When dealing with my healthcare provider, I feel safe being honest with them when giving feedback about my experience as a patient. When dealing with my healthcare provider, I feel safe being honest with them when giving feedback about my experience as a patient. 83%

When dealing with my healthcare provider, I am comfortable disclosing personal information. When dealing with my healthcare provider, I am comfortable disclosing personal information. 82%

When dealing with a healthcare provider, I often find that my questions or concerns are believed and taken seriously. When dealing with a healthcare provider, I often find that my questions or concerns are believed and taken seriously. 82%

When dealing with a healthcare provider, I often find that my questions or concerns are treated discreetly. When dealing with a healthcare provider, I often find that my questions or concerns are treated discreetly. 76%

When I check in at my doctor's office, I usually have the option of filling out forms in private. When I check in at my doctor's office, I usually have the option of filling out forms in private. 41%

My primary healthcare provider displays posters and educational information for health issues that are specific to [my gender]. My primary healthcare provider displays posters and educational information for health issues that are specific to [my gender]. 37%

I prefer to see a healthcare provider, who is the same gender as me, whenever there is a choice. I prefer to see a healthcare provider who is the same gender as me, whenever there is a choice. 34%

My primary healthcare provider offers gender-neutral bathrooms. My primary healthcare provider offers gender-neutral bathrooms. 28%

My primary healthcare provider usually uses gender-neutral language, for example saying "partner" as well as "husband" or "wife." My primary healthcare provider usually uses gender-neutral language, for example saying "partner" as well as "husband" or "wife." 27%

The forms I complete at my doctor's office offer options for male, female, and other gender identities (such as transgender, nonbinary, or other options). The forms I complete at my doctor's office offer options for male, female, and other gender identities (such as transgender, nonbinary, or other options). 25%

When dealing with my healthcare provider, I often find that my questions or concerns are stigmatized due to my gender/identity. When dealing with my healthcare provider, I often find that my questions or concerns are stigmatized due to my gender/identity. 10%

(Source: Study conducted between Oct. 4 and 7, 2019 on the nationally representative Ipsos KnowledgePanel, among 1,021 adults in the U.S. with an additional 285 adults gathered using demographic profiles and representative of the total LGBTQ population.)

White males feel the least stigmatized by their healthcare provider due to their gender identity.

When dealing with a healthcare provider, I often find that my questions or concerns are ... stigmatized due to my gender/identity.

Strongly agree Somewhat agree Neither agree nor disagree Somewhat disagree Strongly disagree Don't know / Refused
Don't know / Refused 10% Strongly disagree 56% Somewhat disagree 11% Neither agree nor disagree 16% Somewhat agree 2% Strongly agree 5%

Male, White, Non-Hispanic

Don't know / Refused 15% Strongly disagree 39% Somewhat disagree 7% Neither agree nor disagree 26% Somewhat agree 8% Strongly agree 5%

Male, Black, Non-Hispanic

Don't know / Refused 12% Strongly disagree 38% Somewhat disagree 8% Neither agree nor disagree 26% Somewhat agree 5% Strongly agree 11%

Male, Hispanic

Don't know / Refused 8% Strongly disagree 51% Somewhat disagree 10% Neither agree nor disagree 23% Somewhat agree 5% Strongly agree 3%

Female, White, Non-Hispanic

Don't know / Refused 7% Strongly disagree 38% Somewhat disagree 13% Neither agree nor disagree 28% Somewhat agree 8% Strongly agree 6%

Female, Black, Non-Hispanic

Don't know / Refused 11% Strongly disagree 34% Somewhat disagree 12% Neither agree nor disagree 27% Somewhat agree 9% Strongly agree 7%

Female, Hispanic

(Source: Study conducted between Oct. 4 and 7, 2019 on the nationally representative Ipsos KnowledgePanel, among 1,021 adults in the U.S. with an additional 285 adults gathered using demographic profiles and representative of the total LGBTQ population.)

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, Chief health equity officer, VP, American Medical Association



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