Critical Race Approaches to Understanding Health Inequities Impacting Trans People of Color in the United States

Abstract

This dissertation critically examines structural drivers of health inequities impacting trans people of color in the United States. To do so, I use theories that concern how the structural power dynamics that drive these inequities are produced and maintained: Critical Race Theory, the structural trauma framework, and the structural vulnerability framework. This research is an attempt to respond to community-identified priorities and support community-led initiatives to promote trans people of color’s health and wellbeing by identifying, understanding, and working towards dismantling the systems that produce hardship and adverse health outcomes in trans communities of color.

In the first study, I used Behavioral Risk Factor Surveillance System data to examine differences in the prevalence of Adverse Childhood Experiences (ACEs) and their relationship with self-rated mental and physical health between trans people of color and multiple comparison groups using an intercategorical approach to intersectionality. Findings revealed that trans people of color had higher probabilities of six ACEs in comparison to at least one other group and that the relationship between five ACEs and poor mental health was more pronounced than for at least one other group. Interpreted through the structural trauma framework, these findings underscore the need to restructure the interconnected systems that contribute to ACEs and mediate their health impacts in trans children of color.

In the second study, I use data from a large convenience sample of trans women to examine differences in the relationship between trans-related state policies (e.g., nondiscrimination laws, gender marker change laws) and self-rated health between trans women of color and White trans women. I drew from Critical Race Theory’s critique of liberalism to conceptualize this study, and the analysis used both intracategorical and intercategorical approaches to intersectionality. Findings indicated that multiple policies were associated with better self-rated health for White trans women and worse self-rated health for trans women of color. These results suggest that trans-related state policies may widen health inequities impacting trans women of color by increasing access to resources necessary for wellbeing more effectively for White trans women than trans women of color, highlighting a need for greater attention to race and racism in research and organizing efforts to promote health equity for trans people of color via policy change.

The third study uses qualitative methods and an intracategorical approach to intersectionality to explore how Black trans leaders of organizations serving Black trans communities cultivate Black trans joy and liberation. In partnership with the Black Trans Fund, I interviewed ten such leaders and used reflexive thematic analysis and Critical Race Theory’s counternarrative methodology to develop three themes: envisioning joyful, liberated futures; laying groundwork through liberatory praxis; and prioritizing safety and healing. These themes emphasize the proactive, strategic, and values-driven nature of these leaders’ work and offer insight into how efforts to achieve health and social equity within and beyond public health research can better align with Black trans communities’ priorities and approaches.

Ultimately, findings from this dissertation demonstrate the utility of integrating multiple critical theories to examine health inequities. Applying these theories implicates the structures that drive health inequities among trans people of color, suggesting the need for continued evaluation and transformative restructuring of the systems that that impact safety for trans children of color, develop state-level trans-related policies, and influence community-based organizations.