Wisdom2Action develops targeted resources to facilitate transgender inclusion in health services

October 11, 2022

This Equity in Action story is distilled from an interview with Fae Johnstone, Executive Director of Wisdom2Action. The interview took place in July 2022, and its details should be considered within the context of that time period.

Deadnaming, misgendering and other forms of discrimination and stigma in the health care system foster fear in the transgender community. Due to this fear, the measures and mandates put in place during the COVID-19 pandemic had an inequitable impact on the transgender community. Wisdom2Action, through funding from the Canadian Public Health Association, developed trans-inclusive resources to guide health practitioners in creating more inclusive spaces. Their goal was that the trans community would feel more comfortable engaging with COVID-19 mitigating services such as testing and vaccinations, and with more general health services beyond the pandemic.

Canada’s transgender communities face significant barriers to achieving health and well-being due to systemic transphobia. In the context of COVID-19, new barriers developed, and existing barriers were reinforced.

Near the beginning of the pandemic, media was often referencing equity-seeking or -deserving communities, but there wasn’t a lot of information on trans folks’ experience of the pandemic. That changed when Trans PULSE Canada delivered preliminary data showing that trans people may be facing discrimination, stigma and other barriers while engaging with COVID-19 testing and related services. We now had data demonstrating a disproportionate need, we had a community that was already particularly vulnerable and then, in a context where they should be accessing essential health services to address a global pandemic, they were encountering additional barriers.

This data prompted the Canadian Public Health Association (CPHA) to recognize the critical need for targeted responses for the queer and trans communities to ensure that stigma and discrimination did not remain entrenched within the COVID-19 response. CPHA reached out to my consulting firm, Wisdom2Action (W2A), to respond to this situation.

Rooting our work in the unique context of COVID-19

There is a growing body of research around inclusive practices and concepts as well as an increased availability of tools and frameworks for equity, diversity and inclusion. W2A quickly realized that the existing guides just weren’t enough in the context of COVID-19. There needed to be a recognition that the situation was a lot for service providers, and they were being pulled in so many directions with the rapidly changing guidelines. Folks were exhausted. It was a difficult context within which we were trying to get more practitioners comfortable with providing trans health care. There was a fine balance between pushing our own priorities for inclusive health care while also recognizing that these folks were juggling too many priorities already, and when you have a million different priorities, you really have none.

Through this work, we wanted to equip clinics and other COVID-19-related health spaces with the tools and knowledge they needed to improve the experience for the trans community members who walked through their doors. Rooting our work in the context of COVID-19, we wanted to make sure that any resources we provided were easy to implement and would not be overwhelming, even during this health emergency.

W2A was trying to successfully respond to a lack of concrete and operational trans-inclusive resources in a way that would resonate with front-line workers and speak more to their world, rather than creating something that they felt lectured through like a “101 Workshop.” We wanted to develop resources that would lead to action and that would guide the creation of more inclusive spaces, rather than just add to the information that was already out there.

Designing trans-inclusive resources with folks who have lived expertise

To create the new trans-inclusive resources, we brought together a committee of trans community members and folks who were working on the front lines in health and social services. Centretown Community Health Centre in Ottawa was a huge help in forming this committee. We even recruited a service provider who was part of the trans community themselves.

The process of confirming from a service provider perspective — What are the essential things your colleagues need to know? — and then from a community member side — What are the essential things that you think a provider needs to know? — made the resources that much stronger through and through. The finished products reflect and address both the service providers’ and trans folks’ needs.

The biggest “aha” moment for me throughout the project was when we were developing our video to introduce the resources. In that video, one of the folks on the committee spoke to her own experience going through a COVID-19 testing clinic as a trans woman and experiencing deadnaming, misgendering and the feelings of fear and stigma that came along with that. It really highlighted the need for community engagement in this type of work because, while I can give you a rant and a ramble to make a case for this work, community members speak from the heart in a different kind of way. People’s personal stories better illustrate the impacts of inclusive practices and the trauma that folks may experience when those practices are not in place.

This engagement was true to W2A’s identity: we bring together folks with lived and living expertise, practitioners and researchers to see what magic can happen there.

Building a strong foundation through partnership with public health

When CPHA brought us on board, they said: “We will fund it, we will pay for it, and we want you to do what you have to do to mitigate these inequities.” Their generous support gave us wide open parameters. This allowed us the flexibility we required to respond to the needs we identified through community engagement without any pre-existing expectations of what the product would be. That is what enabled all the pieces to fall together just right.

It could have been very easy for trans folks to fall off the list of priorities during this global health crisis. The partnership with CPHA was critical to get this issue to the forefront and act on the inequities that the trans community faced. A huge facilitator in this was that we had a pre-existing relationship with CPHA, through workshops we had provided in the past.

Often there is limited capacity and resources within our Canadian queer and trans organizations to act on the inequities that we are advocating to address. It is important for us to recognize that public health institutions have structures and resources that we can leverage and learn from. Engaging with those institutions doesn't compromise our values, it just enables us to have a better reach. Relationships that are reciprocal and mutually beneficial to both public health and the smaller community organizations make magic possible. Relationships are the best foundation for this type of work.

Envisioning pandemic recovery and beyond — moving from resources to impact

Our suite of resources, including tip sheets, social media content and visual aids, has gotten traction since its release. We had organizations across the country hyping them up and supporting the work. Our resources have been and can continue to be used as a model for what targeted resource creation can look like.

However, we don’t see these resources as anywhere close to the be-all and end-all. The resources were an effort to get folks the practical information they needed, but we hoped they would also spark questions of what else needs to be done. The trans community is not a massive portion of the population, most clinics will only see a few trans folks come through their doors, but I argue that if inclusive practices create a friendlier environment for trans folks, it’s going to be friendlier for everybody. So why not? When it comes to measuring impact, there is more to the story than counting numbers of clients.

Through this work we have hopefully shifted the dial, even just a little bit, to where public health institutions see partnering with community organizations will foster and guide resource development and action. We need to get folks in the same room to really get a clear vision of what is needed from all perspectives. This is a powerful way to create resources and tools that will be used by health professionals and that will make a difference.

Lessons learned:

	Existing relationships allow for timely action when opportunities arise. Fostering relationships with community organizations on an ongoing basis is a must for public health, before needing to respond to a crisis.
	Partnerships between public health and community organizations are mutually beneficial: partners learn from one another, leverage one another’s resources, expand their reach and deliver higher quality products or services.

Background:

Wisdom2Action is a national social enterprise and consulting firm supporting civil society organizations and governments to facilitate change and strengthen communities across Canada.

Trans PULSE Canada is a national community-based survey of the health and well-being of trans and non-binary people in Canada.

Centretown Community Health Centre offers a full and diverse range of quality health and social services to families and individuals who live or work in the communities in Ottawa, Ontario.

Resources:

Wisdom2Action: Trans Inclusion in Practice Resources

Interviewee Fae Johnstone’s plenary presentation at the Alliance for Healthier Communities’ Primary Health Care Conference: Beyond Inclusion and Towards Health Equity - Advancing Health, Safety, and Wellbeing for 2SLGBTQIA+ Communities

To learn more about the initiative described in this story, contact the National Collaborating Centre for Determinants of Health, at [email protected].

Do you have an idea for an Equity in Action story? If you have heard of other health equity-promoting COVID-19 pandemic response initiatives in Canada that we should share, please let us know.

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