University of North Texas Health Science Center, School of Public Health, Department of Health Behavior and Health Systems, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA.
University of North Texas Health Science Center, School of Public Health, Department of Health Behavior and Health Systems, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA.
Health Place. 2023 Mar;80:102985. doi: 10.1016/j.healthplace.2023.102985. Epub 2023 Feb 16.
Transgender individuals globally face varying policy contexts that can influence their health. In the United States (US), a patchwork of exclusionary and inclusive policies exists, creating potentially different social and political contexts that shape transgender health depending on the state. In this article, we consider how recent legislation introduced in US states focused on transgender people may be a political determinant of health and affect health equity goals. To advance this aim, we employed the perspective of legal epidemiology to systematically search a US legal database (Westlaw) for policies focused on transgender individuals proposed between January of 2017 and September of 2021.698 policies were analyzed as affirming or exclusionary of transgender identities and categorized by content. We calculated a ratio of affirming versus exclusionary bills to create "exclusionary density" and "affirming density" measures. Those measures were used to calculate an inclusivity score and corresponding maps of inclusivity and exclusionary contexts by US state. Exclusionary and affirming density measures showed deeply polarized policy responses to transgender individuals depending on US state. Further, we observed differences in magnitude regarding the laws being proposed. Exclusionary laws largely focused on criminalization while inclusionary laws focused on representation in government agencies. These findings highlight that transgender individuals in the US can experience vastly different political contexts depending on where they live.
全球范围内的跨性别者面临着不同的政策环境，这些环境可能会影响他们的健康。在美国，存在着一系列排斥性和包容性政策，根据州的不同，形成了潜在的不同的社会和政治环境，从而影响跨性别者的健康。在本文中，我们考虑了美国各州最近出台的针对跨性别者的立法如何可能成为健康的政治决定因素，并影响健康公平目标。为了实现这一目标，我们采用法律流行病学的观点，系统地在美国法律数据库（Westlaw）中搜索了 2017 年 1 月至 2021 年 9 月期间提出的针对跨性别者的政策。分析了 698 项政策，以确定其对跨性别身份的肯定或排斥，并按内容进行分类。我们计算了肯定性与排斥性法案的比例，以创建“排斥密度”和“肯定密度”指标。这些指标用于计算包容性得分，并按美国各州绘制包容性和排斥性背景的地图。排斥性和肯定性密度指标表明，根据美国各州的不同，对跨性别者的政策反应存在严重的两极分化。此外，我们还观察到所提出的法律在规模上存在差异。排斥性法律主要侧重于刑事定罪，而包容性法律主要侧重于政府机构的代表性。这些发现强调，美国的跨性别者可以根据他们居住的地方，经历截然不同的政治环境。
