The Story Goes the Canadians are lucky
we have a public single-payer Health
Care system which allows us to visit the
hospital or is your family doctor
without breaking the bank Healthcare is
just one of those things that our
government does one of those boring
public policy things that most of us
take for granted and since Healthcare is
less of a hot button political issue
here than it is in certain other
countries lawmakers spend less time
targeting things like abortion and
gender affirming care to rile up their
base in short it could be a lot worse
while this is true if you live in Canada
you know our system is not perfect
people call Canadian Healthcare
Universal but that kind of seems like
the wrong word because a lot of
important things aren't covered like
dental care and prescriptions things all
of us rely on at some point and for such
a rich country Canadians wait a long
time disease specialists in 2021 the
average wait time between referral and
treatment was six months with wait times
in Nova Scotia averaging over a year
this March the a Canadian Medical
Association released a statement titled
Canada's health system is on life
support they warned that Staffing
shortages massive backlogs and severe
overworking are pushing our system to a
Breaking Point these problems have
ramped up since covet hit but they've
been around for years it's not like
seeing a doctor was easy before coved
combined these factors make it tough for
anyone to get the care they need quickly
and affordably but especially
challenging for a certain group that's
been in the news lately I say that like
you haven't read the title of this video
it's it's trans youth young trans people
we're having a hard time
foreign
[Music]
this video was produced with support
from trans pulse Canada a 2019 Community
survey that asked almost 3 000 trans and
non-binary people about their lives and
needs including almost a thousand youth
between the ages of 14 and 24. the data
in this video is theirs but the hot
takes are all mine as of 2019 nearly
half of trans youth in Canada have an
unmet Health need anything from a
Mobility Aid they can't afford to a
surgery they need but haven't had yet
unmet Health needs were over six times
more common in trans youth than in the
general population and we're worse off
for it 30 percent of trans youth
describe their health as fair or poor
any staggering 68 describe their mental
health as fair or poor our health isn't
just worse than most young people it's
worse than most people over 55. despite
this trans youth have less access to
health care than CIS people and for that
matter less than trans adults we're more
likely to be on a waiting list to get
health care and less likely to have a
primary provider or like a family doctor
most of us want to medically transition
and these obstacles can draw out the
process substantially I find that kind
of worrying because medical transition
is a time sensitive thing especially for
young people whose bodies are still
changing the changes that happen from
puberty into the early 20s are common
sources of dysphoria and once they've
set in the candle will be reversed young
trans people find themselves in a window
of time or medical interventions like
hormones or puberty blockers can be
especially helpful having your
transition artificially delayed and
missing that window can be painful or
even dangerous in this episode of my
series on trans Youth and Healthcare
we're talking barriers and oh boy are
there barriers in this country with a
public health system and fairly
Progressive laws around trans people why
is it still so hard for many of us to
get the care we need and crucially how
can we make sure that changes
the pulse survey asked trans youth what
barriers prevent them from getting the
care they need and a lot of people about
36 percent said they couldn't afford all
the Care they wanted couldn't afford it
in this country with and I cannot say
this anymore sarcastically free health
care that's the problem of course not
all Health Care is free here the public
system is free but it's also chronically
overloaded and doesn't cover everything
for example people usually have to pay
out of pocket for things like breast
augmentations or revision surgeries to
fix complications they've had trans
Youth and low-income households who rely
on the public plan are likely to just
deal with it either powering through the
frustrations or foregoing Healthcare
altogether here in Quebec I know people
who've waited three or four years for a
free family doctor but youth who have a
decent income often seek out care in the
private sector where they have to pay
but don't wait as long the disparity
here is pretty Stark for Trans Youth and
low-income households only 62 percent at
a primary care practitioner like a
family doctor for youth who aren't low
income that number jumps to 82 percent
and without a PCP a lot of low-income
folks get their health care and walk-in
clinics walk-ins don't have the best
reputations around here I mean it's not
entirely their fault a doctor you've
never met before who sees a dozen new
patients every day isn't going to be
able to give you the same quality of
care as someone you've known for years
it's not their fault they just don't
know you walk-ins aren't super well
suited to trans Healthcare which really
benefits from ongoing relationships
things like referral letters for
surgeries or follow-ups to adjust
hormone dosages are easier to come by if
you see one doctor for a long time also
not everywhere even has walk-in clinics
so if trans Health relies on them too
much A lot of people are left out in the
cold that's not the only problem
low-income folks run into the survey
asks people if they had ever purposely
stopped taking hormones and why of the
handful of people who had by far the
most common reason is is that they
couldn't afford them anymore
prescriptions can be expensive not least
because a ton of us are uninsured but
Lily weren't you just talking about
public health insurance you probably
don't talk that way that was mean I'm
sorry but yeah it sounds like I'm
contradicting myself here but I'm not
unlike other countries with free health
care the Canadian system doesn't cover
prescriptions for whatever reason
instead that coverage is left for each
province to decide most of which only
offer it to a select few groups so
unless you live in a province that
covers pharmacare or you have your own
pharmaceutical Insurance you're out of
luck as of a 2019 report seven and a
half million Canadians don't have
insurance that covers any of their
prescriptions that's about one in five
of us and without that subsidy a lot of
low-income folks can't afford their meds
with most trans youth living in
low-income households it goes without
saying that a lot of us are included in
those numbers a couple years ago my
prescriptions were running me over
ninety dollars a month and I only made
14 an hour sometimes I'd wait weeks to
refill them and power through the
withdrawal because that's like two weeks
of groceries right there and for what
it's worth my profits does have
pharmacare it's just not great but
income inequality isn't the only
obstacle here the survey also found
disparities across ethnic lines only
about a third of racialized trans youth
had gotten gender-forming care compared
to about half of non-racialized Youth
part of this is that racialized youth
were less likely to want gender
affirming care but even those who did
were less likely to have gotten that one
factor here is differences in Family
Support racialized trans youth were less
likely to have families who supported
them a lot of young people rely on their
families for housing and financial
support and if transition would
jeopardize those things they often just
hold off the survey didn't have a huge
sample of racialized trans youth so it's
hard to draw really solid conclusions
from the data I don't want to take the
experience of like a hundred-ish people
and project it onto tens of thousands of
people but I will say the data at least
suggests that racialized trans people
are less likely to have a primary care
provider and that their providers are
generally less informed and less open to
talking about trans health issues the
Canadian medical system's racism and its
transphobia compound and make it
especially hard to access good care I
noticed especially striking and honestly
kind of infuriating disparities when
looking at indigenous youth in
particular more than a quarter of
indigenous youth said they've been
refused health care because of who they
are be it their trans identity ethnic
background or something else it was
almost twice as common for them compared
to youth who aren't indigenous
indigenous folks have spoken out for
years about the dismissiveness hostility
and outright violence they encounter in
the medical system and adding transness
on top of that this identity that's the
subject of so much Prejudice only
intensifies the problem a lot of people
are missing out on the care they need
for absolutely no good reason to say
it's an oversight would be too generous
medical racism is very much there on
purpose and it's plagued this country as
long as we've been a country tree
there's no viable path forward unless we
tackle this I'm not really the person to
talk on how we go about doing that but
I'll link to a few people doing the work
if you want to learn more
as we fight to make sure everyone can
see a doctor we run up against the
dreaded waiting list waiting lists are a
fixture of the Canadian medical system
as iconically Canadian as maple syrup
ice hockey
passive aggression if a Canadian with
public insurance needs to see a family
doctor a psychologist or God forbid a
specialist they expect to wait a while
the biggest culprit here is
understaffing there just aren't enough
doctors to go around in the public
system in my home province of Quebec
doctors are warning that working
conditions have pushed them out of the
public system and into private practice
where they have more agency and
flexibility although even with private
practice some treatments are only
offered in one or two places Nationwide
until recently any trans woman who
wanted a vaginoplasty had to travel to
the one clinic in Montreal in the case
of trans youth the waitlist problem is
made worse by something our own doctors
do needless referrals as of 2011 most
medical schools in the US and Canada
offer exactly zero training on
transition care which leaves a lot of
doctors unqualified to treat us of the
trans youth respondents with the PCP 22
percent said theirs didn't know enough
about transcare to provide it you'd hope
they would just I don't know learn this
stuff so they can like do their job but
apparently that's too much to ask
instead doctors end up referring us out
to Specialists like endocrinologists
that's where the wait times get really
wild and end up drawing out transitions
by months for most HRT patients a
referral is totally unnecessary
prescribing hormones isn't like this
uniquely complicated kind of care any
family doctor should be able to do it
when they send their patients elsewhere
it means we end up waiting longer for
the care we need and it clogs up the
public system even further
okay so now I've listed off a bunch of
problems I assume we're all pretty
bummed out by these findings but now
that we know what keeps people from
Healthcare we can get to thinking about
Solutions how can we break down the
barriers and make sure everyone gets the
care they need
Health Care policy is incredibly
complicated and if you'll believe it I'm
not an expert wild I know there's no one
decision that'll fix the Public Health
Care System but there are a couple
practical realistic things we can do to
help trans youth I've got the data to
back this up but keep in mind these are
ultimately my opinions and not the
official positions of transpulse Canada
first of all solid Universal pharmacare
on a federal level subsidizing
prescriptions would mean that more
people who want hormones can get them
and they can afford to stay on them even
if money troubles come up ideally
prescriptions will be free but I don't
know that any major players are getting
for that right now second more training
for doctors if pediatricians and family
doctors don't know how to care for us
they can learn thankfully we already
have a road map for this queer Health
groups in BC and Ontario have compiled a
bunch of resources to help doctors treat
their trans patients you can check those
out at the links in the description and
if you think your doctor could use more
info send it their way that goes for CIS
people too
if any watch my videos I'm not convinced
we might also want to push for the
expansion of the informed consent model
the informed consent model for transcare
is all about giving us the information
we need to make decisions and trusting
us on what's right for us if people
could reliably get gender affirming care
with a doctor they already see instead
of being referred elsewhere it would
mean shorter wait times and less strain
on our shockingly overwhelmed Health
Care System a lot of very smart people
have good ideas for improving the health
system in this country I don't have time
to talk about all of them those are just
a few we can start by learning about and
advocating for but there's always a but
even if we make sure everyone can see a
doctor it wouldn't be a complete fix in
the third and final episode of this
series we'll look at problems trans
youth encounter at the doctor ignorance
mistreatment power imbalances and the
rift all this has caused between
providers and the trans Community it's
like probably the best episode in the
series it's very fight the power you'll
love it follow the link on screen or in
the description if you want to check it
out this series was pretty produced in
partnership with transpulse Canada well
I took the lead on this project their
team analyzed the data shared resources
and offered their expert insight to
bring everything together I wrote the
videos with feedback from Greta Bauer
Aiden shime and Caleb valarozzo Jones
the data analysis was done by Jose
Navarro Joy Tran Min and looks Lee I
also got to thank the expert Freelancers
Sarah fieldgreen who shot the videos
magenta barabo who translated them into
French and Vic mongovi Who provided art
Direction and of course I wouldn't be
here in the first place without the
support of my loyal patrons whose
kindness has kept me going this year it
was a true team effort and I'm so
grateful to everyone involved if you
found the series interesting head to
transpulsecanada.ca and check out what
else the team is up to they put up
infographics and really easy to
understand reports about tons of
interesting things
barriers baby
walls borders moats
um what are some other barriers
um like a wall of fire oceans I guess or
barriers yeah oceans are barriers and
um reverse Rivers yeah yeah
um outer space
this will go somewhere