Tag: Gender

WASHINGTON, DC - OCT. 8, 2019: Rally for LGBTQ rights outside Supreme Court as Justices hear oral arguments in three cases dealing with discrimination in the workplace because of sexual orientation.

The Many Harms of State Bills Blocking Youth Access to Gender-Affirming Care

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By Chloe Reichel

State legislation blocking trans youth from accessing gender-affirming care puts kids at risk, thwarts physician autonomy, and potentially violates a number of federal laws, write Jack L. Turban, Katherine L. Kraschel, and I. Glenn Cohen in a viewpoint published today in JAMA.

So far this year, 15 states have proposed bills that would limit access to gender-affirming care. One of these bills, Arkansas’ HB1570/SB347, already has become law.

This legislative trend should be troubling to all, explained Cohen, Faculty Director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. In an email interview, he highlighted “how exceptionally restrictive these proposed laws are,” adding that they are “out of step with usual medical, ethical, and legal rules regarding discretion of the medical profession and space for parental decision-making.”

Turban, child and adolescent psychiatry fellow at Stanford University School of Medicine also offered further insight as to the medical and legal concerns these bills raise over email.

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WASHINGTON, DC - OCT. 8, 2019: Rally for LGBTQ rights outside Supreme Court as Justices hear oral arguments in three cases dealing with discrimination in the workplace because of sexual orientation.

Now Is the Time for a Sex-Based Civil Rights Movement in Health Care

The Petrie-Flom Center Staff Leave a comment

By Valarie K. Blake

The Biden administration and all three branches of government are poised to finally deliver a sex-based civil rights movement in health care that generations have waited for.

Sex discrimination is prevalent in health care, but especially so for LGBTQ people. Combine this with other forms of discrimination that LGBTQ people experience, and the result is a population that suffers from serious health disparities, including heightened risks of mental health conditions, substance use disorders, and suicide.

A much needed ban on sex discrimination in health care finally passed in 2010, as part of the Affordable Care Act (ACA). Section 1557 of the ACA prohibits health care entities that receive federal money from discriminating on the basis of sex, along with race, age, and disability. Specifically, Section 1557 bans sex discrimination in health care by way of extending Title IX, which previously applied to educational entities only. Section 1557 reaches most hospitals, providers, and insurers. Sex equality in health was a long time coming. Similar bans on discrimination by recipients of federal money had passed decades earlier: race discrimination in 1964, disability discrimination in 1973, and age discrimination in 1975.

Despite its historic nature, Section 1557 has yet to deliver on its promise, owing to delays and volatility in rulemaking and near-constant litigation. The statute was barebones, requiring interpretation, but the Obama administration only promulgated a rule and began full enforcement six years after the passage of the ACA. The Obama rule broadly banned gender identity and sexual orientation discrimination, but the part of the rule banning gender identity discrimination was judicially stayed only months later in Franciscan Alliance v. Burwell.

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DUQUE DE CAXIAS,(BRAZIL),MAY,20,2020: doctors take care of patients with covid-19.

The Future of Medicine Post-COVID: Not a Healthy Outlook for Women

The Petrie-Flom Center Staff Leave a comment

By Laura Dean, Valerie Dobiesz, and Peter Chai

During the COVID-19 pandemic, women health care providers have not only put their health at risk, but also suffered disproportionate professional consequences.

Women comprise 70% of the global and 76% of the US health care workforce, and data from the U.S. Centers for Disease Control (CDC) suggest that nearly three-quarters of the COVID-19 cases among health care workers are women. Additionally, pregnant health care workers suffer greater morbidity and mortality from COVID-19, face uncertain risk from medications and vaccines due to exclusion from clinical trials, and experience significant psychological and medical risk managing pregnancy amidst an uncertain pandemic. Returning to work in an era where limited and ill-fitting personal protective equipment (PPE) is available and risk of infection is uncertain is especially challenging to new and lactating mothers seeking to advance their careers in academic medicine.

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NEW YORK, NEW YORK - JUNE 06, 2020: A health care professional kneels in protest in New York City as part of the movement, 'White Coats for Black Lives,' during the COVID-19 pandemic.

Scope Creep: Serving Many Roles, Health Care Providers Need a Supporting Cast

The Petrie-Flom Center Staff Leave a comment

By Christian Rose

During the COVID-19 pandemic, physicians and nurses have found themselves on the frontlines of more than just medical care, advocating for their patients, their families, and themselves. Facing overwhelm and burnout at a scale hitherto unimagined, they continue to fulfill their ethical obligations to their communities and their patients. If they don’t, who will?

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Centers for Disease Control and Prevention. Georgia, Atlanta USA March 6, 2020.

The Politics of CDC Public Health Guidance During COVID-19

The Petrie-Flom Center Staff Leave a comment

A version of this post first ran in Ms. Magazine on October 28, 2020. It has been adapted slightly for Bill of Health. 

By Aziza Ahmed

In recent months, public health guidance from the U.S. Centers for Disease Control and Prevention (CDC) has become a site of political reckoning.

The agency has taken an enormous amount of heat from a range of institutions, including the executive and the public, during the COVID-19 pandemic. The former has sought to intervene in public health guidance to ensure that the CDC presents the President and administration’s response to COVID-19 in a positive light. The latter consists of opposed factions that demand more rigorous guidance, or, its opposite, less stringent advice.

Importantly, these tensions have revealed how communities experience the pandemic differently. CDC guidance has produced divergent consequences, largely depending on demographics. These differences have been particularly pronounced along racial lines.

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Grocery store.

COVID-19 Highlights the Vital Connection Between Food and Health

The Petrie-Flom Center Staff Leave a comment

By Browne C. Lewis

Together, food insecurity and COVID-19 have proven to be a deadly combination for Black and Brown people.

Data published by the Centers for Disease Control and Prevention indicates that COVID-19 hospitalization rates among Black and Latino populations have been approximately 4.7 times the rate of their white peers. The CDC suggests that a key driver of these disparities are inequities in the social determinants of health.

Healthy People 2020 defines social determinants of health as “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” The lack of access to good quality food is one of the main social determinants of health. People who eat unhealthy food are more likely to have diet-related medical conditions, like hypertension and diabetes, that make them more susceptible to developing severe or fatal COVID-19.

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Janitor mopping floor in hallway office building or walkway after school and classroom silhouette work job with sun light background.

Overworked, Overlooked, and Unprotected: Domestic Workers and COVID-19

The Petrie-Flom Center Staff Leave a comment

By Mariah A. Lindsay*

The COVID-19 pandemic has disproportionately affected communities already facing multiple oppressions, including women, people of color, people living with low incomes, and immigrants.

This post focuses on the impacts of the pandemic on a group that encompasses many of these identities: domestic workers, such as home health care workers, house cleaners, and child care workers.

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Abortion rights protest following the Supreme Court decision for Whole Women's Health in 2016

Book Review: Mary Ziegler’s ‘Abortion and the Law in America’

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By James Toomey

If you want to understand America, you must understand our politics of abortion. And if you want to understand our politics of abortion, you must read Mary Ziegler’s recent legal history, “Abortion and the Law in America: Roe v. Wade to the Present” (2020).

In comprehensive detail and in a singularly fair and thoughtful way, Ziegler tells the story of American regulation of abortion from the Supreme Court’s historic Roe v. Wade decision to the present, and looks ahead to an uncertain future. Through vignettes of activists who have dedicated their lives to one side of the debate or the other, Ziegler shows that, notwithstanding the superficial constancy of the abortion debate — one side proclaiming the constitutional, essential rights of the fetus, the other the similarly irreducible right of bodily autonomy — the character of the debate, and the kinds of arguments made, have shifted over the course of the last fifty years.

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COVID-19 Immunity as Passport to Work Will Increase Economic Inequality

The Petrie-Flom Center Staff Leave a comment

By Ifeoma Ajunwa

As scientists develop increasingly accurate tests for COVID-19 immunity, we must be on guard as to potential inequities arising from their use, particularly with respect to their potential application as a prerequisite for returning to the workplace.

A focus on immunity as a yardstick for return to work will only serve to widen the gulf of economic inequality, especially in countries like the U.S., which has severe racial health care disparities and uneven access to effective healthcare. This focus could also serve to diminish societal support for further understanding and curtailing the disease.

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Society or population, social diversity. Flat cartoon vector illustration.

Unequal Representation: Race, Sex, and Trust in Medicine — COVID-19 and Beyond

The Petrie-Flom Center Staff Leave a comment

By Allison M. Whelan*

The COVID-19 pandemic has given renewed importance and urgency to the need for racial and gender diversity in clinical trials.

The underrepresentation of women in clinical research throughout history is a well-recognized problem, particularly for pregnant women. This stems, in part, from paternalism, a lack of respect for women’s autonomy, and concerns about women’s “vulnerability.” It harms women’s health as well as their dignity.

Over the years, FDA rules and guidance have helped narrow these gaps, and recent data suggest that women’s enrollment in clinical trials that were used to support new drug approvals was equal to or greater than men’s enrollment. Nevertheless, there is still progress to be made, especially for pregnant women. In the context of COVID-19 research, one review of 371 interventional trials found that 75.8% of drug trials declared pregnancy as an exclusion criteria, a concerning statistic given that recent data suggest that contracting COVID-19 during pregnancy may increase the risk of preterm birth.

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