Introduction to a Reprint of Emilia Lombardi’s “Enhancing Transgender Health Care”

In June 2001, the American Journal of Public Health (AJPH) published its first issue devoted to lesbian, gay, bisexual, or transgender (LGBT) health issues. In that issue, Emilia Lombardi presented a powerful case for greater understanding, greatly increased research, and appropriate services for the transgender population. Lombardi began by disentangling the meaning of “transgender” and how its elusive, and sometimes confusing, meaning has evolved. She then identified a range and variety of transgender health issues and raised important questions about access to care, as well as the cultural relevancy of transgender research, policies, and materials, culminating with seven proposals for improving the health of transgender people. These far-reaching proposals include acknowledging “the authenticity of transgender individuals’ identities,” promoting “increased and better access to health care resources,” and advocating for “more and better promotion of transgender related research and for more innovation within transgender health practices.”

In his editorial introduction to that first LGBT health issue, “Why Lesbian, Gay, Bisexual, and Transgender Public Health?,” Ilan Meyer wrote that “Transgender individuals are stigmatized, discriminated against, and ridiculed in encounters with even those entrusted with their care.”^1(p856) But, he added,

These perils are not inescapable. . . . [T]he promise of focusing on LGBT health is clear: It can bring much-needed resources, improved research methodologies, and knowledge to bear on the search for innovative approaches to health promotion and disease prevention and treatment.^1(p858)

Meyer was well aware of the dearth of research into LGBT and specifically transgender health issues, a glaring lack of attention scrupulously documented a year later by Ulrike Boehmer in the July 2002 issue of AJPH.² Both Meyer and Lombardi drew inspiration from the American Public Health Association’s Policy Statement 9933, passed by the Association in 1999, which

urges researchers, health care workers, the National Institutes of Health, and the Centers for Disease Control and Prevention to be aware of the distinct health care needs of transgendered individuals; and urges . . . funding for research that will enable a better understanding of the health risks of transgendered individuals, especially the barriers they experience within health care settings.^3(p482)

The American Public Health Association’s 1999 policy statement and Lombardi’s appeal had an effect. According to our online search, over the next 15 years, AJPH published 27 articles focused on transgender health issues. These articles addressed a variety of health concerns and were not simply preoccupied, as some earlier studies were, with HIV/AIDS and other sexually transmitted diseases. A sampling of these studies is as follows: “Stigma, Mental Health, and Resilience in an Online Sample of the US Transgender Population”⁴; “Access to Care for Transgender Veterans in the Veterans Health Administration: 2006-2013”⁵; “The State of Transgender Health Care: Policy, Law, and Medical Frameworks”⁶; “Demographic and Psychosocial Factors Associated With Psychological Distress and Resilience Among Transgender Individuals”⁷; “Non-Prescribed Hormone Use and Self-Performed Surgeries: ‘Do-It-Yourself’ Transitions in Transgender Communities in Ontario, Canada”⁸; “On Cultural Competence and Scientific Rigor in Transgender Treatment”⁹; and “Improving Transgender Health Education for Future Doctors.”¹⁰

Much has changed since Emilia Lombardi first published her clarion call. This February 2017 issue of AJPH is another major step forward.